It Takes a Village: A Comprehensive Community-Level Maternal Nutrition Program based in Egypt

Alejandro Armenta, Angela Hong, Hannah Sauter, Jane Smith, Katherine Boss
University of Michigan School of Public Health - PH 511

Background Mission Statement, Goals, Objectives Solution

The United Nations International Children’s Emergency Fund (UNICEF) defines undernutrition as “the outcome COMMUNITY LEADER TRAINING
of insufficient food intake and repeated infectious diseases… [including] being underweight for one’s age, too Before interventions are addressed at any level, community leaders must be trained to ensure that their interactions with
short for one’s age (stunted), dangerously thin (wasted), and deficient in vitamins and minerals (micronutrient the community enforce proper nutritional care and that these individuals are prepared to support their community through
malnutrition). Maternal undernutrition has been linked with low birth weight and increased risk of chronic individual counseling, group sessions, and to work with public health groups working to induce larger scale changes
disease later over the child’s lifetime, such as hypertension, higher body mass index (BMI), and cognitive

MISSION
throughout this program. They will not be expected to do this on their own, and will be paired with an educated dietitian, a
impairment. In addition, low birth weight has been seen as a crucial contributor to infant mortality. Babies are social worker, and a physician specializing in maternal and child health.
considered to be underweight when they are less than 2500 grams at birth (5.512 lbs) and being a low weight or
preterm baby can have lifelong consequences to the development of the child and that is if they survive. In
Egypt, 17.14% of low birth weight infants were due to mothers who were malnourished. Two factors that have THREE STEP COMMUNITY LEADER TRAINING:
the highest influence in low birth weight are, poor maternal health nutrition before conception and poor nutrition 1. Introduction to nutritional education topics through modules
during pregnancy. In Egypt, vitamin and mineral deficiencies cost the national GDP over $814 million annually, 2. Shadowing professional staff supporting community members
with a large burden on the vulnerable population of pregnant and breastfeeding women and young children. 3. Supporting community members individually
By striving to improve nutrition for mother and child across the globe, we aim to better MATERNAL NUTRITION INTERVENTION ACTIONS:

Prevalence of Risk Factors for Negative Effects of Maternal health throughout the lifespan.
Undernutrition Undernutrition on the Child
Systems Level:
Condition Prevalence
● Training of providers in nutritional counseling
Iron deficiency in 23% ● Development of culturally informed counseling materials
mothers Impaired cognitive
● Provision of counseling materials to health facilities
development
Zinc deficiency in 9%
mothers

Vitamin A
deficiency in
22%
Increased risk of
GOALS ●
●
Community Level:
Training of trusted community members in nutritional counseling
Assist community counselors in creating support groups in towns
mothers
hypertension
with limited provider access
Underweight in 6%
children under 5 Increased risk
for high BMI Interpersonal Level:
Stunting in 29% 1. Educate, counsel, and provide support to expecting mothers to encourage more ● Family members (fathers and grandmothers) engaged in
children under 5
counseling sessions
Wasting in 8% . healthful nutritional choices for themselves and their child ● Support groups consisting of pregnant women to build support
children under 5 and information sharing

2. Encourage mothers to abide to prenatal recommendations for both the health of Individual Level:
While Egypt has made some efforts in fortifying their wheat with folic acid to reduce anemia levels in pregnant
● Teach proper food choices during & after pregnancy
and lactating women and young children, there is still much room for more involved interventions, namely
community educational and counseling efforts. Despite estimates that the return in investment for educational themselves and their developing child ● Cooking class teaching alternative meal possibilities

intervention and counseling is 1400%, Egypt is still lacking a comprehensive nutrition education program to ● Referrals to health resources
encourage mothers to make more healthful dietary choices during pregnancy.

Evaluation
Program OBJECTIVES At each of the three measurement periods below, a Food Frequency Questionnaire, maternal blood hemoglobin levels, and
child weight will be measured to determine progress towards better health for the mother and child.

THREE MEASUREMENT PERIODS

1. Before Nutritional counselling/Support Groups
2. At Birth
3. One Year Post Birth

In order to complete the evaluation, in depth participant and provider interviews will be conducted to better understand the
Expecting PROCESS: perceptions of the program, how key stakeholders engaged with the program, and what needs to be improved for future
iterations of the program. Furthermore, evaluating the counterfactual (regions that do not have the program implemented),
Objective 1: Enroll 100 women in our nutritional counselling and support groups in Egypt by
Families 2020
will allow us to see the effect the program had on maternal nutrition and child health outcomes.

Objective 2: Have 75 Egyptian women participate in at least one cooking class during Limitations
pregnancy by 2020.
It Takes While our research and solution are focused on increasing availability of care to individuals who may not have access, there
IMPACT: are other concerns that can affect their maternal health.
a Objective 3: Train at least 15 providers and 25 community counselors in Egypt in one region SOCIOECONOMIC FACTORS:
Village (5+ individual communities) on principles of nutrition counselling by 2020. One potential problem is with socioeconomic factors. While some women will be able to afford vitamins and regular trips to
Health Communities the doctor to closely monitor the pregnancy, women of lower socioeconomic levels may not be able to do one or both of those
preferred actions due to too great of a traveling distance to care, inability to afford high nutrient foods and vitamins, or not
OUTCOME:
Providers Objective 4: Decrease rates of maternal anemia by increasing hemoglobin iron levels through
living in an area that has access to high nutrient foods, such as a food dessert.

supplementation to be between 11.0 - 15.5 g/dL in at least 70% of enrolled women in Egypt by
2020
Objective 5: Decrease the proportion of babies born underweight to enrolled women by 50% by
the year 2020.
FOOD AVOIDANCES:
While it may be in her best interest to ingest certain high nutrient foods, it may cause severe distress, nausea, or discomfort
upon ingestion which would reduce the likelihood of that female continuing to eat that food thus potentially decreasing her
intake of that nutrient. While both of these are important to note in maternal health, it is difficult to determine common food
avoidances within a population to best prepare alternative for females as well as difficult to determine frequencies of foods
consumption in pregnant population.