METODOLOGÍA

The ONDP project aims to identify the correlation between maternal nutrition and child growth faltering, and to identify the impact of an intervention (supplementary food) on maternal and child nutrition status in Pirganj. By using the ecological model, the findings from this study are shown to inform the ONDP projects study interventions across multiple levels, including data collection tools, supplementary food design, education materials, training of facilitators and collaboration with local services/organisations, which incorporates every level of the ecological model – from the individual through the societal levels. Figure 6.1 below demonstrates how the findings from this research study were incorporated into individual, relationship, community and societal levels.

166 Figure 6.1 Application of the research findings to the Optimal Nutrition During

Pregnancy project using the ecological framework.

Individual: The major intervention in the ONDP project is the development of and intervention with a supplementary feeding product (named ‘Pushti Khadda’, Bangla for nutritious food), given to pregnant women who are identified as being malnourished.

Pushti Khadda was designed to include foods which the majority of women identified during the focus group discussions of this research study as their favourite food and also associated as being nutritious (e.g. lentils, milk and banana); while still conforming to the WHO guidelines of macro and micronutrient content required in supplementary products. The supplementary food is based on locally available foods which were identified during the harvest calendar, IDDQ, and market visit; therefore its production will be sustainable by the community and accessible to all women if they want to replicate it themselves.

Aspects of the women’s nutritional knowledge, health care and cultural practices which were found in this research study helped design Information, Education, Communication/Behaviour Change Communication tools, such as:

 a health care monitoring card (encouraging women to attend health care examinations and take supplements during pregnancy),

167  posters informing about micronutrient rich foods easily grown and available in the area (e.g. mango, potato, banana, eggplant, gourd and beans which were identified in the harvest calendar and IDDQ),

 a leaflet informing about good care practices during pregnancy (e.g. increase food intake by adding a meal each day or nutritious snacks (fruit, tamarind, biscuits),

 making savings to pay for doctor/hospital/transport if complications arise during pregnancy/delivery,

 increase rest and restrict physically demanding work,

 purchase iodised salt.

All of these are recommendations identified from the findings in the focus group discussion.) The tools will encourage women to consume sufficient amounts of nutritious foods and to diversify their diets by consuming more locally available and accessible foods (lentils, nuts, seasonal fruits, seasonal vegetables, eggs and milk). Current taboos and superstitions need to be approached with caution as they stem from traditional and cultural beliefs and therefore are not easily modified. Therefore, women will be provided with advice about alternative food choices which don’t cause conflict with beliefs and practices. All health care and nutrition information will be delivered in the women’s homes and during community workshops by ONDP staff.

Relationship: The findings from this research study show that family members (especially husbands) have a large influence over what food is available to the woman during her pregnancy (husband responsible for harvest and purchase of household food). They also influence the level of support the woman receives to increase the quality and quantity of food and care during pregnancy (family members advise women to consume nutritious food and increase rest, and family hierarchy of eating at meal times were both identified during focus groups). Therefore family members and especially husbands will be involved in community workshops focused on increasing their knowledge about the importance of the women’s nutrition during pregnancy. If family members have an increased understanding of the importance of nutrition during pregnancy and are aware of nutritious behaviours and practices readily

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available in to them, they are more likely to feel empowered and provide beneficial support.

Community: The ONDP project staff will consist of one project manager, two supervisors and eight village facilitators. The staff will be involved in collecting anthropometric data, recruiting women into the ONDP intervention, delivering Pushti Khadda and facilitating the community health and nutrition workshops. Therefore before the ONDP started, a week long training session was provided to all eleven staff members to ensure the quality of their technical nutrition and research knowledge. The training incorporated findings from this research study such as locally harvested crops (from harvest calendar), information on food groups lacking in the women’s diets (from IDDQ) and therefore what to advise as accessible alternatives (e.g. lentils, orange/yellow coloured fruits and vegetables, banana flower, milk) which did not cause conflict with food taboos, and how they can encourage beneficial health practices by the women during pregnancy (e.g. consume more and a wider variety of foods, increase rest, take supplements (especially, iron/folate and vitamin A) during pregnancy, attend health examinations).

A collaborative relationship has been built with local schools to teach health and nutrition as part of the curriculum. Schools provide the ideal opportunity to reach both male and female children and empower them with knowledge and behaviours which will change the malnutrition cycle even before pregnancy. A collaborative relationship has also been established with local health centres. World Vision will refer pregnant women who are malnourished or require an examination/medical attention to the local health centres. In return the health centres will support the ONDP project by providing health care and collecting additional study data (e.g. anthropometric, haemoglobin, disease record). Photographs of the consultation process with local schools and representatives from local health clinics are pictured in figure 6.2.

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Figure 6.2 Consultation process (for the ONDP project) with local schools (left) and a representative from a local health clinic (right) to establish collaborative

relationships.

Societal: This research has provided an understanding of cultural and religious practices and their influence has been considered at all underlying levels.

World Vision and the ONDP project will advocate for the increased social status of women within poor rural areas and the priority of increasing access to quality health care services for pregnant women in rural areas.