What is missing in our understanding of urban slum environments and maternal, infant and young child nutrition from publicly available data in Asia and the Pacific?

Given the recent, rapid urbanisation in Asia and the Pacific region, coupled with increases in the triple burden of malnutrition, we need to better understand maternal, infant and young child nutrition (MIYCN) for populations living in urban slum environments. This research used existing large‐scale datasets to explore MIYCN indicators for those living in urban slum, compared with urban nonslum, areas. Data since 2015 from available Demographic and Health Surveys (DHS; Afghanistan, India, Indonesia, Myanmar, Pakistan and the Philippines) and Multiple Indicator Cluster Surveys (MICS; Bangladesh, Fiji, Kiribati, Mongolia, Nepal, Thailand and Tuvalu) were analysed. Most urban children in the 13 countries from the region were breastfed within 24 h of birth, with slightly higher rates for those living in slums. Conversely, almost all indicators of infant and young child malnutrition were worse for those in urban slums. For mothers living in slums, underweight prevalence and iron deficiency anaemia were higher while maternal overweight and obesity prevalence were lower. Analysis revealed disparities across countries in the wealth status of those living in slum versus nonslum areas. What is currently missing is representative sampling of households, adequate collection of data both within and across countries, and accurate representation of slum‐dwellers in large‐scale surveys. Given that limited data for the region show urban poor slum populations are vulnerable to poor nutrition indicators, more data are needed on the poorest urban slum populations to enable effective resource allocation to support optimal MIYCN.</p

Socio-economic characteristics across intervention and control area, endline survey, 2021.

Socio-economic characteristics across intervention and control area, endline survey, 2021.</p

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BackgroundUndernutrition–before, during and after pregnancy endangers the health and well-being of the mother and contributes to sub-optimal fetal development and growth. A non-randomized controlled evaluation was undertaken to assess the impact of engaging federations of women’s group on coverage of nutrition interventions and on nutrition status of women in the designated poverty pockets of three Indian states—Bihar, Chhattisgarh, and Odisha.MethodThe impact evaluation is based on two rounds of cross-sectional data from 5 resource poor blocks across 3 States, assigning 162 villages to the intervention arm and 151 villages to the control arm. The cross-sectional baseline (2016–17) and endline survey (2021–22) covered a total of 10491 adolescent girls (10–19 years), 4271 pregnant women (15–49 years) and 13521 mothers of children under age two years (15–49 years). Exposure was defined based on participation in the participatory learning and action meetings, and fixed monthly health camps (Adolescent Health Days (AHDs) and Village Health Sanitation and Nutrition Days (VHSNDs)). Logistic regression models were applied to establish the association between exposure to programme activities and improvement in coverage of nutrition interventions and outcomes.ResultsIn the intervention area at endline, 27–38% of women participated in the participatory learning and action meetings organized by women’s groups. Pregnant women participating in programme activities were two times more likely to receive an antenatal care visit in the first trimester of pregnancy (Odds ratio: 2.55 95% CI-1.68–3.88), while mothers of children under 2 were 60% more likely to receive 4 ANC visits (Odds ratio: 1.61, 95% CI- 1.30–2.02). Odds of consuming a diversified diet was higher among both pregnant women (Odds ratio: 2.05, 95% CI- 1.41–2.99) and mother of children under 2 years of age (Odds ratio: 1.38, 95% CI- 1.08–1.77) among those participating in programme activities in the intervention arm. Access to commodities for WASH including safe sanitation services (Odds ratio: 1.80, 95% CI- 1.38–2.36) and sanitary pads (Odds ratio: 1.64, 95% CI- 1.20–2.22) was higher among adolescent girls participating in programme activities.ConclusionWomen’s groups led participatory learning and action approaches coupled with strengthening of the supply side delivery mechanisms resulted in higher coverage of health and nutrition services. However, we found that frequency of participation was low and there was limited impact on the nutritional outcomes. Therefore, higher frequency of participation in programme activities is recommended to modify behaviour and achieve quick gains in nutritional outcomes.</div

Year-wise budget contributions for Swabhimaan programme—pilot implementation (2016–21) and scale-up (2018 onwards) (Bihar, Chhattisgarh and Odisha).

Year-wise budget contributions for Swabhimaan programme—pilot implementation (2016–21) and scale-up (2018 onwards) (Bihar, Chhattisgarh and Odisha).</p

Access to nutrition specific and nutrition sensitive intervention package among pregnant women, Swabhimaan program in intervention and control area by participation status in VHSND and PLA meeting across states.

Access to nutrition specific and nutrition sensitive intervention package among pregnant women, Swabhimaan program in intervention and control area by participation status in VHSND and PLA meeting across states.</p

Access to nutrition specific and nutrition sensitive intervention package among pregnant women in intervention area by participation status and frequency of participation in VHSND and PLA meeting.

Access to nutrition specific and nutrition sensitive intervention package among pregnant women in intervention area by participation status and frequency of participation in VHSND and PLA meeting.</p

Access to nutrition specific and nutrition sensitive intervention package among mothers with children under 2 years of age in intervention area by participation status and frequency of participation in VHSND and PLA meeting.

Access to nutrition specific and nutrition sensitive intervention package among mothers with children under 2 years of age in intervention area by participation status and frequency of participation in VHSND and PLA meeting.</p

Essential nutrition interventions of Swabhimaan programme 2016–2021.

Essential nutrition interventions of Swabhimaan programme 2016–2021.</p

Frequency of participation in Swabhimaan programme activities (PLA meeting, VHSND and AHD) across intervention and ontrol area, endline survey, 2021.

Frequency of participation in Swabhimaan programme activities (PLA meeting, VHSND and AHD) across intervention and ontrol area, endline survey, 2021.</p

Access to nutrition specific and nutrition sensitive intervention package among mothers with children under 2 years of age in intervention and control areas by participation status in VHSND and PLA meeting across states.

Access to nutrition specific and nutrition sensitive intervention package among mothers with children under 2 years of age in intervention and control areas by participation status in VHSND and PLA meeting across states.</p