How Can We Improve the Consumption of a Nutritionally Balanced Maternal Diet in Rural Bangladesh? The Key Elements of the “Balanced Plate” Intervention
Abstract
:1. Introduction
Cluster Randomised Controlled Trial
2. Materials and Methods
2.1. Study Population and Sampling
2.2. Data Collection
2.3. Data Analysis
3. Results
3.1. Practical Demonstration of Portion Sizes Engaging the Users
This is a modern method; I have never seen something like this before. She (Shasthya Kormi) talked about different kinds of nutritious foods, why they are important, and how they will benefit our child. We all participated in the process of measuring foods and then put on a plate. I think this is something new.—Husband.
My daughter-in-law does not want to eat, and she doesn’t feel like (eating). Now she would realise how little she is eating. She has to eat that much as shown on the plate. Now she will listen to what I say (for eating more).—Mother-in-law.
Rozina Apa (fictitious name of Shasthya Kormi) showed me how to make my plate. She used a bowl from my kitchen and measured rice, curry, lentil and other foods and put together on a plate. First couple of days I also tried that way, but later I realised that I know how much rice makes two bowls, I don’t need to measure it now. I can do it with a spoon.—Pregnant woman.
Displaying visually made it easy for me to recall what components should be on the plate. For example, now I know in my plate there should be either meat or fish or egg. I should eat lentil regularly, which I was not habituated before.—Pregnant woman.
3.2. Addressing Local Food Perceptions
3.3. Demystifying Animal-Source Foods
Previously my husband used to buy big fish once in 1–2 months. I know it is expensive and not affordable for him; still, he used to buy, even in small quantity. Now we don’t aim for buying big fish; he buys tilapia, pangash (a variety of white catfish) and the like but more often. You don’t need much money to buy them these days.—Pregnant woman.
3.4. Engaging Husbands and Mothers-in-Law
Suppose my previous weekly budget (for food) was taka 1500. Now I need additional taka 200–300 per week. I work some extra hours to manage the extra money my family needs now. I have no problem with it.—Husband.
He (husband) bought more foods while I was pregnant. He didn’t wait for me to tell him what to buy.—Recently delivered woman.
My son is the person who had to work all day long to feed the whole family. Where would he get energy for work if he does not eat more? Can they do it if they don’t eat meat and fish?
This is my third child. I feel craving for food all the time. My mother-in-law watched me and didn’t allow me to eat stomach-full. She says the baby will get big. So, I asked Apa (Shasthya Kormi) to talk to her but without letting her know that I told her about it. She might get angry if she comes to know, you know. I found afterwards that my mother-in-law is not preventing me from eating some more.—Recently delivered woman
3.5. Involving Neighbours
The women around me didn’t receive any benefit (from this project), but (they) helped me so that I can make the plate. It’s natural that we didn’t always have everything (all food items) to make the plate as exactly Apa’s (Shasthya Kormi) has told us. There were some days when I had to exchange foods with my neighbours.—Pregnant woman.
3.6. Harnessing Community Health Workers’ Social Role
Jahanara Apa (a Shasthya Kormi) has been working in our village for years, and we know her very well. She is my relative too. She is seeing (ANC visit) pregnant women for a long time. So, I am happy to discuss with her, and I am sure she is the best person to help me here.—Pregnant woman.
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Meal | Food | Quantity (One Dish = 250 mL) |
---|---|---|
Breakfast | Rice | 1.5 dishes |
or | ||
Chapati (medium size) | 3 pieces | |
Vegetables | 1 dish | |
Egg | 1 | |
or | ||
Lentil (thick) | 1 dish | |
Mid-morning snack | Seasonal fruit(s) | 1 piece/dish |
Milk product(s) | 1 dish | |
Lunch | Rice | 3 dishes |
Lentil (thick) | 1 dish | |
Leafy/non-leafy vegetables | 1.5 dishes | |
Meat/fish/egg | 1 piece | |
Afternoon snack | Milk | 1 glass |
Seasonal fruit(s) | 1 piece/dish | |
Puffed rice with molasses | 1 dish | |
or | 1 dish | |
Biscuits | ||
Dinner | Rice | 2 dishes |
Lentil (thick) | 1 dish | |
Leafy/non-leafy vegetables | 1.5 dishes | |
Meat/fish/egg | 1 piece | |
Milk | 1 glass | |
or | ||
Curd | 0.5 dish |
Method | Type of Respondents | Number |
---|---|---|
In-depth interviews | Mothers of infants | 16 |
Focus group discussions | Pregnant women | 2 |
Mothers-in-law | 1 | |
Husbands | 1 | |
Key informant interviews | Shasthya Kormi | 4 |
Observation of Shasthya Kormis’ intervention home visits | 13 |
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Alam, A.; Chowdhury, M.; Dibley, M.J.; Raynes-Greenow, C. How Can We Improve the Consumption of a Nutritionally Balanced Maternal Diet in Rural Bangladesh? The Key Elements of the “Balanced Plate” Intervention. Int. J. Environ. Res. Public Health 2020, 17, 6289. https://doi.org/10.3390/ijerph17176289
Alam A, Chowdhury M, Dibley MJ, Raynes-Greenow C. How Can We Improve the Consumption of a Nutritionally Balanced Maternal Diet in Rural Bangladesh? The Key Elements of the “Balanced Plate” Intervention. International Journal of Environmental Research and Public Health. 2020; 17(17):6289. https://doi.org/10.3390/ijerph17176289
Chicago/Turabian StyleAlam, Ashraful, Morseda Chowdhury, Michael J. Dibley, and Camille Raynes-Greenow. 2020. "How Can We Improve the Consumption of a Nutritionally Balanced Maternal Diet in Rural Bangladesh? The Key Elements of the “Balanced Plate” Intervention" International Journal of Environmental Research and Public Health 17, no. 17: 6289. https://doi.org/10.3390/ijerph17176289
APA StyleAlam, A., Chowdhury, M., Dibley, M. J., & Raynes-Greenow, C. (2020). How Can We Improve the Consumption of a Nutritionally Balanced Maternal Diet in Rural Bangladesh? The Key Elements of the “Balanced Plate” Intervention. International Journal of Environmental Research and Public Health, 17(17), 6289. https://doi.org/10.3390/ijerph17176289