A positive deviance-based antenatal nutrition project improves birth-weight in Upper Egypt.

The positive deviance approach identifies and promotes existing uncommon healthy behaviours. A positive deviance-informed antenatal project was pilot-tested in Al-Minia Governorate, Upper Egypt, during 2003-2004, after a positive deviance study in 2000 found that successful pregnancies had increased consumption of meat and vegetables, daytime rest, and antenatal care; less second-hand smoke exposure; and symptoms of no urinary tract infection. Accordingly, health facilities were upgraded in target and comparison areas to provide quality antenatal care, including treatment of urinary tract infection. Additionally, in the target villages, women at-risk of delivering low-birth-weight infants were enrolled in weekly 'IMPRESS' (improved pregnancy through education and supplementation) sessions with counselling and supplemental food. In total, 519 women (344 target, 175 comparison) were enrolled in the third or fourth month of pregnancy and were followed through delivery. Birth-weights of the target mothers increased 2.2 times more than birth-weights of the comparison mothers over baseline (mean increase: 0.58 vs 0.26 g respectively, p<0.01). Similarly, the decrease in prevalence of low birth-weight from baseline was greater in the target villages than in the comparison mothers (% of decrease: 26.9 vs 11.9 respectively, p<0.01). The target at-risk women were far more likely than their counterparts to report eating more food (54.9% vs 10.6%), more meat (57.1% vs 4.2%), more vegetables (66.9% vs 5.3%), increasing daytime rest (64.1% vs 11.7%), and avoiding second-hand smoke (91.3% vs 51.6%) during pregnancy. The cost per 100 g of improvement in birth-weight was US$ 3.98. The Government of Egypt and partners are scaling up the elements of the project.

Effect of targeted food supplementation and services in the Bangladesh Integrated Nutrition Project on women and their pregnancy outcomes.

Monitoring data from the Bangladesh Integrated Nutrition Project and new data collected for this purpose were analyzed to assess the effects of targeted project services, including supplementation of food, on malnourished pregnant women (women with a body mass index [BMI] of < or = 18.5 in early pregnancy). Monitoring data on 456 women--195 receiving food supplement and 261 not receiving supplement--were collected from 17 upazilas (sub-districts) in four districts of Bangladesh. The assessment found that, despite lower economic status, the women with low BMI receiving supplementation of food and intensified services were more likely to have adequate pregnancy-related weight gain than the more economically-advantaged women with higher BMI. Primigravidae receiving supplementation were also more likely to have adequate pregnancy-related weight gain than the better-off non-supplemented primigravidae (85.7% vs 51.9%, p = 0.044). The mean birth-weights of infants of the supplemented women with low BMI were comparable to those of the better-off, non-supplemented women.