Screening and management options for severe thinness during pregnancy in India
Screening and management options for severe thinness during pregnancy in India
This paper answers research questions on screening and management of severe thinness in pregnancy, approaches that may potentially work in India, and what more is needed for implementing these approaches at scale. A desk review of studies in the last decade in South Asian countries was carried out collating evidence on six sets of strategies like balanced energy supplementation (BEP) alone and in combination with other interventions like nutrition education. Policies and guidelines from South Asian countries were reviewed to understand the approaches being used. A 10-point grid covering public health dimensions covered by World Health Organization and others was created for discussion with policymakers and implementers, and review of government documents sourced from Ministry of Health and Family Welfare. Eighteen studies were shortlisted covering Bangladesh, India, Nepal, and Pakistan. BEP for longer duration, preconception initiation of supplementation, and better pre-supplementation body mass index (BMI) positively influenced birthweight. Multiple micronutrient supplementation was more effective in improving gestational weight gain among women with better pre-supplementation BMI. Behavior change communication and nutrition education showed positive outcomes on dietary practices like higher dietary diversity. Among South Asian countries, Sri Lanka and Nepal are the only two countries to have management of maternal thinness in their country guidelines. India has at least nine variations of supplementary foods and three variations of full meals for pregnant women, which can be modified to meet additional nutritional needs of those severely thin. Under the National Nutrition Mission, almost all of the globally recommended maternal nutrition interventions are covered, but the challenge of reaching, identifying, and managing cases of maternal severe thinness persists. This paper provides four actions for addressing maternal severe thinness through available public health programs, infrastructure, and human resources.
India, management of maternal severe thinness, policy, pregnancy, screening for maternal severe thinness, severe thinness
357-379
Sethi, Vani
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Choedon, Tashi
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Chowdhury, Ranadip
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Bhatia, Neena
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Dinachandra, Konsam
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Murira, Zivai
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Bhanot, Arti
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Baswal, Dinesh
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de Wagt, Arjan
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Bhargava, Madhavi
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Meshram, Indrapal Ishwarji
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Babu, Giridhara R
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Kulkarni, Bharati
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Divakar, Hema
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Jacob, Chandni Maria
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Killeen, Sarah Louise
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McAuliffe, Fionnuala
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Vergehese, Mini
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Ghosh, Sebanti
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Hanson, Mark
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1 November 2021
Sethi, Vani
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Choedon, Tashi
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Chowdhury, Ranadip
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Bhatia, Neena
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Dinachandra, Konsam
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Murira, Zivai
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Bhanot, Arti
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Baswal, Dinesh
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de Wagt, Arjan
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Bhargava, Madhavi
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Meshram, Indrapal Ishwarji
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Babu, Giridhara R
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Kulkarni, Bharati
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Divakar, Hema
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Jacob, Chandni Maria
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Killeen, Sarah Louise
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McAuliffe, Fionnuala
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Vergehese, Mini
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Ghosh, Sebanti
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Hanson, Mark
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Sethi, Vani, Choedon, Tashi, Chowdhury, Ranadip, Bhatia, Neena, Dinachandra, Konsam, Murira, Zivai, Bhanot, Arti, Baswal, Dinesh, de Wagt, Arjan, Bhargava, Madhavi, Meshram, Indrapal Ishwarji, Babu, Giridhara R, Kulkarni, Bharati, Divakar, Hema, Jacob, Chandni Maria, Killeen, Sarah Louise, McAuliffe, Fionnuala, Vergehese, Mini, Ghosh, Sebanti and Hanson, Mark
(2021)
Screening and management options for severe thinness during pregnancy in India.
International Journal of Gynecology & Obstetrics, 155 (3), .
(doi:10.1002/ijgo.13939).
Abstract
This paper answers research questions on screening and management of severe thinness in pregnancy, approaches that may potentially work in India, and what more is needed for implementing these approaches at scale. A desk review of studies in the last decade in South Asian countries was carried out collating evidence on six sets of strategies like balanced energy supplementation (BEP) alone and in combination with other interventions like nutrition education. Policies and guidelines from South Asian countries were reviewed to understand the approaches being used. A 10-point grid covering public health dimensions covered by World Health Organization and others was created for discussion with policymakers and implementers, and review of government documents sourced from Ministry of Health and Family Welfare. Eighteen studies were shortlisted covering Bangladesh, India, Nepal, and Pakistan. BEP for longer duration, preconception initiation of supplementation, and better pre-supplementation body mass index (BMI) positively influenced birthweight. Multiple micronutrient supplementation was more effective in improving gestational weight gain among women with better pre-supplementation BMI. Behavior change communication and nutrition education showed positive outcomes on dietary practices like higher dietary diversity. Among South Asian countries, Sri Lanka and Nepal are the only two countries to have management of maternal thinness in their country guidelines. India has at least nine variations of supplementary foods and three variations of full meals for pregnant women, which can be modified to meet additional nutritional needs of those severely thin. Under the National Nutrition Mission, almost all of the globally recommended maternal nutrition interventions are covered, but the challenge of reaching, identifying, and managing cases of maternal severe thinness persists. This paper provides four actions for addressing maternal severe thinness through available public health programs, infrastructure, and human resources.
Text
Intl J Gynecology Obste - 2021 - Sethi - Screening and management options for severe thinness during pregnancy in India
- Version of Record
More information
Accepted/In Press date: 17 September 2021
Published date: 1 November 2021
Additional Information:
Funding Information:
The research reported in this publication was developed from the working paper submitted to the Ministry of Health and Family Welfare, Government of India, and funded by the United Nations Children’s Fund (UNICEF), New Delhi, India.
Funding Information:
CMJ is supported by the European Union's Horizon 2020 LifeCycle Project under grant agreement No. 733206. MH is supported by the British Heart Foundation and the National Institute for Health Research, UK, through the Southampton Biomedical Research Centre.
Funding Information:
CMJ is supported by the European Union's Horizon 2020 LifeCycle Project under grant agreement No. 733206. MH is supported by the British Heart Foundation and the National Institute for Health Research, UK, through the Southampton Biomedical Research Centre. The research reported in this publication was developed from the working paper submitted to the Ministry of Health and Family Welfare, Government of India, and funded by the United Nations Children?s Fund (UNICEF), New Delhi, India.
Publisher Copyright:
International Journal of Gynecology & Obstetrics© 2021 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
Keywords:
India, management of maternal severe thinness, policy, pregnancy, screening for maternal severe thinness, severe thinness
Identifiers
Local EPrints ID: 453549
URI: http://eprints.soton.ac.uk/id/eprint/453549
ISSN: 0020-7292
PURE UUID: ee10a2f1-8c10-4e32-965d-9326f5ddaaaa
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Date deposited: 19 Jan 2022 17:44
Last modified: 17 Mar 2024 03:44
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Contributors
Author:
Vani Sethi
Author:
Tashi Choedon
Author:
Ranadip Chowdhury
Author:
Neena Bhatia
Author:
Konsam Dinachandra
Author:
Zivai Murira
Author:
Arti Bhanot
Author:
Dinesh Baswal
Author:
Arjan de Wagt
Author:
Madhavi Bhargava
Author:
Indrapal Ishwarji Meshram
Author:
Giridhara R Babu
Author:
Bharati Kulkarni
Author:
Hema Divakar
Author:
Sarah Louise Killeen
Author:
Fionnuala McAuliffe
Author:
Mini Vergehese
Author:
Sebanti Ghosh
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