1 Introduction

1.1 Background
In May 2004 a panel of economists, including four Nobel laureates, was asked to rank; 40
potential interventions designed to tackle some of the worlds most ve!ing development
problems named the "openhagen "onsensus, and they suggested that the interventions; such as
those designed to address micronutrient deficiencies and other dimensions of hunger and
malnutrition were e!cellent investments#
$he often held belief, that all nutrition programs are welfare interventions that divert resources
that could be better used in other ways to raise national incomes, is incorrect; many investments
in nutrition are in fact very good economic investments# $he "openhagen "onsensus also
disclosed the value of e!panding the nascent interface between economics and nutrition#
More than 20 million infants worldwide, representing %&#& per cent of all births, are born with
low birth'weight, (&#) per cent of them in developing countries# $he level of low birth'weight in
developing countries *%)#& per cent+ is more than double the level in developed regions *, per
cent+# -alf of all low birth'weight babies are born in .outh'central /sia, where more than
0uarters *2, per cent+ of all infants weigh less than 2,&00 g at birth# 1revalence of low birth
weight in 2angladesh is 403 according to 45-. report in 62angladesh country health system
profile#
Maternal under'nutrition and malnutrition are ma7or problems in especially the poorest
developing countries and are generally considered to be of importance for the high prevalence of
low birth weight and fetal growth retardation# 8imited access to high 0uality foods is the ma7or
reason for under'nutrition, but traditional food habits, food taboos and limited knowledge may
also contribute to under'nutrition#
$he important role of low birth weight and prematurity for perinatal mortality and morbidity in
developing countries and its association with under'nutrition and malnutrition in the mothers,
has motivated various attempts to improve pregnancy outcome through food supplementation#
%
.ubstrate supply to the fetus is a ma7or regulator of prenatal growth# Maternal nutrition
influences the availability of nutrients for transfer to the fetus# observational and intervention
studies in humans provide limited support for a ma7or role of maternal nutrition in determining
birth si9e, e!cept where women are 0uite malnourished #
4uring pregnancy, the foetus is solely dependent on maternal intake and nutritional stores,
mostly fat, for its energy# 1oor maternal nutrition during pregnancy in turn implies a risk of poor
nutritional availability to the foetus# $he best methodological approach for assessing the effect of
this factor on birth'weight and more specifically on I:5; or prematurity is thus supplementation
aiming that an increase in food intake may increase birth'weight and thus the prevalence of 82<
and I:5;=premature infants may be decreased#
1rovision of food does not necessarily lead to its consumption# >ven if it is consumed, it may
replace some of the usual diet# .upplementation trials must take this into account in order to
evaluate the actual e!tra amount ingested# Many such trials have been carried out# :ntil recently
most of the evidence seemed to indicate that maternal caloric intake during pregnancy had no
effect on prematurity; however supplementation had a positive effect on birth'weight and I:5;#
$he effect was greater among the mothers, who were malnourished before their conception#
Nutritional supplementation during pregnancy was also shown to be associated with a reduction
in the incidence of 82< in developing and developed populations
%
#
?or at least )& years, nutritionists, physicians, and public'health policy'makers have studied the
impact of food supplementation to pregnant women who are under'nourished or otherwise at risk
for adverse pregnancy outcomes
2
# Most of these studies on feeding supplementation have
targeted an increase in the birth'weight of the offspring, based on the well'established
relationship between higher birth'weight *at least up to an optimal birth'weight rarely attained in
developing countries+ and increased survival, reduced morbidity, and more recently, even
perhaps a lower risk of long'term chronic diseases of adults, such as hypertension, type 2
diabetes, and coronary heart disease
@, 4
A2arkers hypothesisB#
5estational maturity is a far more important predictor of infant *and especially neonatal+
mortality and severe morbidity than is si9e for gestational age, and thus, the relationship between
birth'weight and these outcomes is primarily due to the close correlation between birth'weight
2
and gestational age
&
# .ince food supplementation during pregnancy has not been shown to
prolong gestation, most of the presumed benefit arises from an increase in the si9e of infants
born at term
)
# $he 5ambian supplementation trial, which succeeded in reducing both stillbirth
and neonatal death by providing a much higher net increase in energy intake than any other of
such trials
,
#
/lthough an increase in si9e of term infants may be beneficial, randomi9ed trials have not shown
a benefit of maternal food supplementation on long'term growth or functional outcomes in
children
)
# Moreover, recent data from Ca7nik et al. suggest that Indian newborns that are growth'
restricted compared to newborns in the :D have a relatively normal fat mass
E
# $hese data raise
the warning that increasing the si9e of .outh /sian infants might increase fat mass without
adding substantially to bone, muscle, or other lean body tissue, with potentially adverse long'
term conse0uences *insulin resistance and type II diabetes+ in later childhood and adulthood# /ll
this is to say that the goals of providing food supplementation, even if targeted to thin women in
countries like 2angladesh and India, must clearly consider medium' and long'term functional
outcomes in the offspring, not merely an increase in birth'weight
(
#
8ow birth weight is a ma7or contributor to neonatal and post neonatal

mortality# $wenty five
million babies a year are born below

2&00 g, the <orld -ealth Frgani9ations cut off point for
low

birth weight, and over (03 of these are born in developing countries

where perinatal and
infant mortality is already high
%0
#
Maternal weight gain does not differentiate between the weight of the mother, the foetus or the
various other components such as fat stores, breast and uterine tissue, plasma volume, and the
foetus# It provides only a general impression of foetal growth# ?oetal weight however increases
e!ponentially with high weight gains in the third trimester, while the overall rate of maternal
weight gain is fairly constant after the first trimester#
/n analysis of the components of weight gain during pregnancy revealed that (03 of the fat was
deposited as maternal stores in the first two trimesters of pregnancy# -ealthy women in urban
5uatemala who delivered term infants were followed during pregnancy# Maternal nutritional
status at the beginning of gestation and the rate of fat gain early in pregnancy were the two
indicators most strongly associated with birth'weight
%%
#
@
.uch results lend support to the theory that fat deposited early in pregnancy acts as a reserve for
the last trimesters caloric demands# /s most nutritional interventions were implemented in the
third trimester of pregnancy, this could e!plain the lack of a large effect on birth'weight and
I:5;, rather than the recently suggested lack of association
%2
# .upplementing in the last
trimester *after 20 weeks+ may indeed e!clude from the benefits of stunting# <asted infants, who
have been shown to have diminished subcutaneous fat reserves
%@
, would on the other hand
probably benefit from supplementation during the third trimester# 4ata on the prevalence of
stunted versus wasted I:5; infants would therefore be most beneficial#
?urther studies are needed to attempt to distinguish between the effects of energy e!penditure
and non work'related factors such as posture, fatigue, and stress# Indeed maternal work could
have an effect on pregnancy independently of its nutritional effect# 1hysical e!ertion or upright
posture might diminish uterine blood and thus hinder the supply of nutrients and o!ygen to the
foetus# In 5ambia for e!ample the supplement effect in the wet season, when women are hard at
work in the fields, was not mediated by a change in maternal nutritional status, i#e# there was no
increase in weight gain# $he timing and fre0uency of the supplementation, mediating an
increased placental blood flow, may have been responsible for the increased birth'weight in the
wet season
%4, %&
#
More than 20 million infants worldwide, representing %&#& per cent of all births, are born with
low birth weight, (&#) per cent of them in developing countries
%)
# $he level of low birth weight
in developing countries *%)#& per cent+ is more than double the level in developed regions *, per
cent+
%)
# 2irth weight is a strong indicator not only of a birth motherGs health and nutritional status
but also a newbornGs chances for survival, growth, long'term health and psychosocial
development
%,
# / low birth weight *less than 2,&00 grams+ raises grave health risks for children#
2abies who are undernourished in the womb face a greatly increased risk of dying during their
early months and year#
$his is based on epidemiological observations that infants weighing less than 2,&00g are
appro!imately 20 times more likely to die than heavier babies# More common in developing
countries, a birth weight below 2,&00 g contributes to a range of poor health outcomes# $hose
who survive have impaired immune function and increased risk of disease; they are likely to
4
remain undernourished, with reduced muscle strength, throughout their lives, and to suffer a
higher incidence of diabetes and heart disease
%,
# "hildren born underweight also tend to have
cognitive disabilities and a lower IH, affecting their performance in school and their 7ob
opportunities as adults#
1revious studies have also linked infant mortality with motherGs education, age at childbirth,
delivery status, health status, parity and marital union; fatherGs education and employment;
household income and consumer goods, household safe source of drinking water and sanitation;
and slum and rural residence
%E,%(,20
# 4emographic characteristics such as childGs se!, ethnicity,
preceding and succeeding birth interval, and birth order are also known to be associated with
infant mortality
2%
#
&
1.2 Justification of the study
In developing countries chronic maternal undernutrition is a prime contributor to the birth of
over 2& million low birthweight babies annually and to high rates of neonatal mortality# /n
absence of well designed field trials has created uncertainty about the potential efficacy of
maternal feeding programmes# $his small scale operational research was aimed to show that
dietary supplementation in pregnancy can be effective in reducing the proportion of low
birthweight babies# $his research also had the notion that supplementary feeding program can be
installed efficiently into a rural primary healthcare system, middle and late pregnancy is the
period most amenable to intervention
,
#
82< infants have less chance of survival; when they do survive, they are more prone to disease,
growth retardation and impaired mental development# / good start in life is important and
maternal nutritional status during pregnancy has repeatedly been demonstrated to be associated
with pregnancy outcomes for the infant
22
#
In developing countries intrauterine growth retardation *I:5;+ accounts for the ma7ority of low
birth weights whereas in developed countries most 82< babies are premature as opposed to
growth retarded
2@
#
$he most sensitive measure of acute nutritional stresses during pregnancy is indeed maternal
weight gain# $here is strong epidemiological evidence of an association between maternal weight
gain during pregnancy and 82<=I:5;, especially in undernourished women i#e# those who
begin pregnancy in a nutritionally disadvantaged state# <omen are at the greatest risk of having a
82< infant if low pre'pregnancy weight and low weight gain during pregnancy are combined#
Many efforts have been made in order to identify a potential ImodifiableJ factor for 82<#
Maternal nutrition is modifiable in the short term; if it is one of the ma7or environmental causes
of I:5; in the developing world, a substantial fraction of 82< could possibly be prevented# In
turn this might reduce the prevalence of mortality, morbidity, physical and mental development,
factors associated with 82<
22
# It must however be born in mind that no matter how convincing
the evidence that a given factor is causally related to 82< *I:5; or gestational duration+, there
is no guarantee that its elimination or reduction will lead to lower infant mortality or child
)
morbidity# Fther environmental factors may indeed directly affect these outcomes independently
of birth weight
22
#
$he magnitude of the immediate conse0uences as well as the generational and inter'generational
effects of foetal growth retardation are enormous in .outh /sia, and especially in 2angladesh,
where reportedly 4&3 of infants are born with a weight below 2,&00 g# -alf of the worlds
malnourished children live in three countries on the subcontinentK 2angladesh, India, and
1akistan# $his forms the background to launch ambitious nutrition programmes in the region,
where large investments have been made to break the cycle of malnutrition through food and
micronutrient supplementation *and related activities+ to pregnant women and infants
24
#
In 2angladesh, every second woman becoming pregnant has a body mass inde! consistent with
chronic energy deficiency# .paring supplementary calorie support of about )00 kcal consisting
about %E gm of vegetable protein; one of the ma7or determinant for the distribution of the effect
seems to be the mothers pre'pregnancy weight A2MIB# Fther important factors for the si9e of the
effect are her basic dietary intake during this period, the energy and nutrient composition of the
supplement, the timing and total duration of supplementation, the replacement level of the
supplement, her level of physical activity, and her general health, especially the presence of
infectious diseases# "hronic psychological stress may probably also contribute significantly to
the problem of pre'term delivery and low birth'weight or modify the effect of nutrition
interventions
2&
#
$here is a need to determine the nature of factors that contribute to poor growth and development
before birth, within, and between populations# $he possible adverse effects of interventions also
re0uire further e!ploration# $he researchers failed to provide concrete conclusion e!plaining the
/sian enigma of low birth weight reduction by nutritional intervention programs adopted by
different population# $hey even could not advice us to accept any of the philosophies regarding
these interventions through logically evaluated publication# $hus the basis of our knowledge
about supplementary food is so far weak, with seemingly contradictory results#
Many of the basic 0uestions still remain unanswered#
<ho will be benefitted *mother and=or foetus+, from what interventionL
1erformed whenL /nd when will what effect be shownL
,
1.3 Conceptual framework of low birth weight



E
Insufficient access
to food, 5ender
discrimination
Inade0uate care
for children and
woman
1oor water sanitation
and inade0uate health
service
Low pregnancy weight
gain
4isease ; chronic disease, -$N,
diabetes, renal disease, "F14,
vulvular heart disease
Inade0uate 4ietary Intake, life
style, normal dietary habit,
social=cultural beliefs,
religion
4rug abuse, other
habits, $obacco,
alcohol
Inade0uate ;est,
working status,
stress= an!iety
Low birth weight
/ge at conception
8iving condition , short
stature, unplanned
pregnancy
.e! of child ,
se0uence, multiple
pregnancy, M ?e, vit#"
folic acid, I , Nn,vit /

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$uantity and %uality of actual resource &
human' economic and organi(ational and
the way they are controlled
1.) *ypothesis
$argeted food supplementation of National Nutrition 1rogram has influence on pregnancy weight
gain and birth weight of the newborn#
1.+ #b,ecti!es
-eneral ob,ecti!e
$o find out the effect of targeted food supplementation of National Nutrition 1rogram on
pregnancy weight gain and birth weight of the newborn in the mothers among intervention area
and nonintervention area in the selected :pa9ilas#
.pecific ob,ecti!es
%# $o compare the pregnancy weight gain of the selected mothers among NN1 intervention
and nonintervention areas#
2# $o compare the birth weight of the newborn between two areas#
@# $o find out the socio'demographic status of the selected mothers#
(
1./ 0ariables in the study
.ocio1 demographic !ariables
%# /ge
2# /ge at marriage
@# ;eligion
4# >ducational status of the sample
&# Fccupation of the sample
)# /ge of the samples husband
,# >ducation of the samples husband
E# .tudy sample husbands occupation
(# .ocioeconomic status of the sample
%0# O54 card
0ariables related to pregnancy 2 deli!ery
%# $ime of pregnancy registration
2# 8ast menstrual period
@# >!pected date of delivery
4# 4ate of delivery
&# -eight of the respondent
)# 5ravid
,# /N" .tatus
E# <eight of the respondent at *booking+ first visit
(# <eight of the respondent at last visit
%0# Iron supplementation status
%%# $otal weight gain during pregnancy
%2# 1lace of delivery
%@# 2irth attendant
%4# 4elivery complication
3ood supplementation
%# ?ood supplementation status
2# 4uration of food supplementation
0ariables related to the new born
%# .e! of the new born
2# 2irth weight of the new born
@# $ime at measurement taken
%0
4# "olostrums giving to the new born
1.4 5ey !ariables and scales of measurement
.pecific ob,ecti!e 0ariables .cales of
measurement
%%
%#$o compare the
pregnancy weight gain of
the selected pregnant
mothers between NN1
intervention P non'
intervention areas#
%# 1regnancy duration in days
a. Last menstrual period
b. Date of delivery
2# $ime of pregnancy registration
a. Last menstrual period
b. Date of pregnancy registration
@# 1arity
4# No# of /N" taken
&# -eight in centimeters
)# <eight of the respondent at *booking+

,# $otal weight gain during pregnancy
a. Weight in kg in 1
st
visit
b. Weight in kg in last visit
E# Iron supplementation
(# ?ood supplementation
%0# 4uration of food supplementation in
days
%%# 1lace of delivery
%2# "omplications during delivery
%@# 2irth attendant
.cale
.cale
.cale
.cale
.cale
.cale
.cale
.cale
0 = no supplement
1= supplemented
0 = no supplement
1= supplemented
.cale
Home =0
Govt. hospitals =1
linics = !
%2
%4# .e! of the child
"o = 0
#es = 1
$ntrained %&' = 0
%rained %&' = 1
"urses and
paramedics = !
Doctors = (
)emale child = 0
*ale child =1
2# $o compare the birth
weight of the newborn
babies of the respondents
between two areas#
%&# 2irth weight of the new born in grams
%)# $ime at which birth weight is taken
%,# "olostrums giving to the new born
.cale
.cale
.cale
@# $o determine the socio'
demographic status of the
respondents
%E# /ge
%(# -ow long being married
20# ;eligion
2%# >ducation of the respondent
22# Fccupation of the mothers
.cale
.cale
+slam = 0
Hindu and others = 1
"o education = 0
,re-primary =1
.-/ class = !
00 and above = (
%@
2@# /ge of the sample husband
24# >ducation of the samples husband
2&# .amples husband occupation
2)# .ocioeconomic status
2,# O54 card
House1ife = 0
0ervice = 1
.cale
"o education = 0
,re-primary =1
.-/ class = !
00 and above = (
$nemployed =0
Heavy 1orker = 1
0killed 1orker = !
&usinessman = (
0erviceman = 2
Destitute = 0
,oor = 1
"o = 0
#es = 1
%4
1.6 #perational 7efinition
.ocio1 demographic !ariables
1. 8ge
/ge was taken as completed years, preferably from the Ooter I4 card#
2. 8ge at marriage
/ge at marriage was taken in completed years# It was computed by deducting the duration
of marriage from their current age#
3. 9eligion
$he religion of the mothers was classified as Islam, -indu, "hristian, 2uddhist# It was
further classified as Islam and Fthers for easy applicability of the statistical procedure#
). :ducation of the samples
>ducation was taken as a continuous variable during data collection then it was further
classified as, no education, pre primary Q non'formal education,&'( years of education and
above secondary education#
+. #ccupation of the mothers
Fccupation was categori9ed into housewife, service and others# $hose who involved
themselves in income generating professions were included into service category#
Fccasional 7ob holders or those who generate income inconsistently were distributed in the
others category#
/. 8ge of their husband
/ge in completed years
4. :ducation of the respondent;s husband
.ame as mothers education
6. 9espondent;s husband occupation
1rimarily it was categori9ed as farmer, fisherman, rickshaw and other manual three
wheelers puller, daily laborers, weaver, businessman including small business, teacher,
service holder and others but finally they were grouped as no employment, heavy workers,
.killed workers, businessman and service holder; permanent occupation of the participants#
<. .ocioeconomic status
%&
In this study all the samples were taken from the poor socioeconomic group designated by
the respective organi9ation#
1=. 0-7 card
$hose were given economic support through vulnerable group funding program#
0ariables related to pregnancy 2 deli!ery
11. >ime of pregnancy registration
4ate of first registration# $his time should not e!ceed %20 days from her last menstrual
period#
12. Last menstrual period
4ate of onset of her last regular menstrual bleeding#
13. :?pected date of deli!ery
It was counted by adding 2,0R%0 days with the 8M1
1). 7ate of deli!ery
/ babys low weight at birth is either the result of preterm birth *before @, weeks of
gestation+ or due to restricted foetal *intrauterine+ growth .o Mothers conceived for @,
completed weeks were taken into count, the date of delivery of the baby#
1+. *eight of the mothers
-eight in centimeters was taken as continuous variable#
1/. -ra!id
$he no of times she became pregnant includes M;, abortion, miscarriage, still birth, live
birth#
14. 8@C .tatus
$he fre0uency of antenatal care she was provided#
16. Aeight of the respondent at BbookingC first !isit
$he weight of the mother in kilograms during registration
1<. Aeight of the respondent at last !isit
<eight of the mother in kilograms during last follow up# It should be of preferably within
@0 days of delivery#
2=. Iron supplementation status
%)
Iron and folic acid supplementation in completed months
21. >otal weight gain during pregnancy
$his measurement was computed by subtracting last weight and first weight
22. "lace of deli!ery
1lace where she completely delivered her baby with the delivery of placenta# 1lace of
delivery were categori9ed as home delivery, delivery at 5overnment health facilities and at
clinics or at other similar services#
23. Birth attendant
Fne who assisted as well as completed the total delivery process and professionally
designated as any of the category mentioned in the 0uestionnaire#
2). 7eli!ery complication
/ny untoward event during birth process that might cause threat to mother or her baby that
re0uires special medical support#
2+. Body Dass Inde?
$he 2ody Mass Inde!*2MI+ formula was developed by 2elgium statistician /dolphe
Huetelet*%,()'%E,4+, and was known as the Huetelet Inde!#$he metric bmi formula
accepts weight measurements in kilograms = height measurements in either cmGs or meters
s0uare#
2/. Chronic :nergy 7eficiency
New criteria are proposed for classifying chronic energy deficiency *">4+ in adults# /
progressively more precise approach to identifying affected individuals involves measuring
body weight and height, then energy intake *or e!penditure+ and finally the basal metabolic
rate *2M;+# $hree cut'off points for body mass inde! *2MI+ were identifiedK %E#&, %,#0
and %)#0# / 2MI above %E#& is classified as normal and below %)#0 as grade III ">4# /
diagnosis of grades I and II ">4 depends on finding the combination of a 2MI of %)#0'
%)#( or %,#0'%E#4 with a ratio of energy turnover to predicted 2M; of less than %#4#
Measuring the individual 2M; avoids misclassification and confirms the diagnosis# *">4+
III *2MI M%)#0 kg=m2+, ">4 II *2MI+ S %)#0T%)#( kg=m2+ and ">4 I *2MI+ S %,#0T%E#&
kg=m2+# -ere researcher found it impossible to measure 2M; for the samples because this
%,
was not recorded in any of the organi9ational report so he took only 2MI level for
categori9ing "hronic >nergy 4eficiency status#
24. 3ood supplementation
?ood supplementation through NN1 *Intervention area+K
:pon disclosure by a woman of her pregnancy *usually during the third month+, weight and
height of the woman are recorded to assess her 2MI# $hereafter, regardless of 2MI, she is
weighed monthly until delivery when the birth'weight of child is recorded# / woman whos
2MI in early pregnancy is e0ual to or less than %E#& are enrolled in a daily on'site
supplementary feeding regimen which continues until delivery## $he food supplementation
contains an estimated 2,3 of a womans daily allowance for calories, using 2,2E0 kcal as
the daily re0uirement for pregnant women#
26. 7uration of food supplementation
$hree supplementation groups were constructed comprising low, intermediate and high
number of days of supplementation which e0uated to M%20 and U%)0 days in registration
month @# "onse0uently the supplementation groups were defined as M%20 *low+ days, %20'
%&( *intermediate+ days and U%)0 *high+ days of supplementation, respectively# In
registration month 4, low, intermediate and high supplementation groups were defined as
M%00 days, %00'%@( days and U%40 days, respectively#
0ariables related to the new born
2<. .e? of the new born
3=. Birth weight of the new born
8ow birth'weight has been defined by the <orld -ealth Frgani9ation *<-F+ as weight at
birth of less than 2,&00 grams *&#& pounds+# It is governed by two ma7or processesK a short
gestational period, i#e# the infant is born too soon and is 0ualified as premature *bwtM2&00g
and gestational age M@, weeks+, or retarded intrauterine growth, i#e# the infant is small for
gestational age *bwtM2&00g and gestation age V@, weeks+ # $his is based on
epidemiological observations that infants weighing less than 2,&00 g are appro!imately 20
%E
times more likely to die than heavier babies# ;esearcher took 2&00gm of birth weight as
cut'off value for low birth weight#
31. >ime at measurement taken
$he birth weight should be taken preferably within the first hour of life# In this study the
birth profiles of the newborn were taken from the relevant primary baseline records when
reported within ,2 hours of delivery#
32. Colostrums gi!en to the new born
33. @on1 Inter!ention area
$he area from where the respondents were selected to compare the effects of food
supplementation# $wo areas were chosen by the researcher keeping two priorities in mind#
$he respondents should bear almost similar socio'demographical characteristics and the
primary records of the respondents should be reliable# -ere the area chosen to compare the
NN1 area was 5D *5onosashthaya Dendra + territory 4hamrai .avar#
%(
1.< Limitations
It is necessary to discuss the limitations of this study# $he present study was performed in two
up9ilas of almost same demographic characteristics# 4ata were collected from the baseline
organi9ational reporting of two different organi9ations# <orkers of both organi9ations reported
this information were different in their perception, educational 0ualification and training#
%# 2ecause of the inherently'lengthy period necessary to collect information on baseline
pregnancy'related weight gain and birth'weight, the decision was made, intentionally, not
to collect it# $his study is the cross'sectional nature of the analysis and hence the
direction of causality could not be established#
2# .ervice'based *monitoring+ data have sometimes been suspected and cause measurement
bias# /s it is a record based study, another potential limitation is reliance on reported
anthropometric measurement, height of the mothers, weight of the mothers, birth weight#
$hough it would be far more correct to measure the pre'pregnancy nutritional status of
the mothers in terms of 2MI prior to conception, to measure the pregnancy weight gain
precisely, this was practically impossible# Neither of the organi9ation provided any pre
pregnancy anthropometry for such purpose# .o early pregnancy 2MI were taken as
baseline nutritional status#
@# Fther potential problems needed to be addressed regarding faulty records of birth weights
were
a+ the reluctance of some mothers to permit weighing of their newborns,
b+ the weighing of some infants with heavy but un'weighed coverings, and
20
c+ a tendency of some community nutrition promoters to record birth'weights at or above
2#& kg to avoid the additional responsibilities re0uired in low birth'weight cases#
4# 8astly as more than E0 3 of the delivery were conducted at home it was practically
impossible to take birth weight measurement within the first hour of birth# ;esearcher
allowed birth'weight records that were taken within ,2 hours of delivery# &# $ime for the
study was inade0uate and more over there were no fund support for conduction of such
research pro7ect#
&# In this study, as only one intervention site samples are taken into count to compare the
effect of supplementation, the result of the study may not reflect the e!act effectiveness of
supplementation in the large scale National Nutrition 1ro7ect A<orth (2 million WB#
2%
2 9e!iew of literature
Daternal malnutrition 2 low birth weight
Maternal under'nutrition and malnutrition are ma7or problems in especially the poorest
developing countries and are generally considered to be of importance for the high prevalence of
low birth weight and fetal growth retardation# 8imited access to high 0uality foods is the ma7or
reason for under'nutrition, but traditional food habits, food taboos and limited knowledge may
also contribute to under'nutrition#
$he important role of low birth weight and prematurity for peri'natal mortality and morbidity in
developing countries and its association with under'nutrition and malnutrition in the mothers, has
motivated various attempts to improve pregnancy outcome through food supplementation
2)
#
$he most recent trial included in the review was published in %((,# $his trial was conducted in
rural 5ambia and the beneficial effects of high energy with balanced protein content
supplementation would likely apply to similar settings where a substantial proportion of the
populations are undernourished#
Ideally, rising of the social and economic status of women in developing countries is the best
long'term solution for improving the nutritional status of undernourished pregnant women# <ith
regard to the specific interventions, the best way would be to supplement the diets of pregnant
women with energy'rich foods through community'based sustainable programmes
,
#
22
8ow birth weight is a ma7or contributor to neonatal and postneonatal

mortality# $wenty five
million babies a year are born below

2&00 g, the <orld -ealth Frgani9ations cut off point for
low

birth weight, and over (03 of these are born in developing countries

where perinatal and
infant mortality is already high
%0
#
3ood supplementation
?or at least )& years, nutritionists, physicians, and public'health policy'makers have studied the
impact of food supplementation to pregnant women who are under'nourished or otherwise at risk
for adverse pregnancy outcomes
2
# Most of these studies on feeding supplementation have
targeted an increase in the birth'weight of the offspring, based on the well'established
relationship between higher birth'weight *at least up to an optimal birth'weight rarely attained in
developing countries+ and increased survival, reduced morbidity, and more recently, even
perhaps a lower risk of long'term chronic diseases of adults, such as hypertension, type 2
diabetes, and coronary heart disease
@,4
#
5estational maturity is a far more important predictor of infant *and especially neonatal+
mortality and severe morbidity than is si9e for gestational age, and thus, the relationship between
birth'weight and these outcomes is primarily due to the close correlation between birth'weight
and gestational age
&
#
.ince food supplementation during pregnancy has not been shown to prolong gestation, most of
the presumed benefit arises from an increase in the si9e of infants born at term
)
#Fne study in
5uatemala showed that continued supplementation during two pregnancies and the lactation
period increased the average birth'weight @ times more *@00g in the high supplement group+ than
the usual increment observed *%00g+# $hus improving the womens nutritional status prior to and
during two consecutive pregnancies was more effective than improving nutritional status during
one pregnancy only
%
#
?rom various data sets it was also established that for undernourished women an additional %00
kcal ingested per day throughout pregnancy would increase the birth'weight by about %00g
*provided kcal taken at any time during pregnancy have the same effect+# In non malnourished
mothers the effect was three times less importantK on average @&g increase in birth'weight for
2@
each additional %00 kcal ingested daily# .imilarly a significant reduced risk of I:5; in women
who received the supplements was shown# "ollated data sets suggested that if %00 kcal per day
were supplemented throughout pregnancy, the risk of I:5; would be halved in mothers
undernourished prior to pregnancy, but only reduced by %=& in well'nourished mothers
22
#
In other conte!ts, birth weight is an IinputJ T i#e#, a pro!y for the initial endowment of an
infants Ihealth human capitalJ# "onsistent with this view, research has found that 82< infants
tend to have lower educational attainment, poorer self'reported health status, and reduced
employment and earnings as adults, relative to their normal weight counterparts
2,
#
3ood supplementation through @@" BInter!ention areaC
:pon disclosure by a woman of her pregnancy *usually during the third month+, weight and
height of the woman are recorded to assess her 2MI# $hereafter, regardless of 2MI, she is
weighed monthly until delivery when the birth'weight of child is recorded# / woman whos
2MI in early pregnancy is e0ual to or less than %E#& are enrolled in a daily on'site
supplementary feeding regimen which continues until delivery#
$he intent of the new National Nutrition 1rogram is also to enrolled in the supplementary
feeding regimen any pregnant woman failing to gain at least % kg of body'weight during any
month of her pregnancy# $he food supplement is produced at the "ommunity Nutrition "entre
by groups of low'income mothers for whom production of the supplement is an income'
generating activity# Oillage women employed by the program prepared the food supplements
using local products# $he prepared food was provided in plastic packets to be mi!ed with water#
$he daily supplement contained E0 g roasted rice powder, 40 g roasted pulse powder, 20 g
molasses, and %2 m8 *) g+ soybean oil, which provided )0E kcal and %,#( g vegetable protein
*%%#&3 of total energy+# $he supplements were usually eaten at the "N", but were often
brought to the participantsG homes# $he food supplementation contains an estimated 2,3 of a
womans daily allowance for calories, using 2,2E0 kcal as the daily re0uirement for pregnant
women#
.tudy findings in Bangladesh E:ffect of 3ood supplementationF
24
Monitoring data on 4&) womenX%(& receiving food supplement and 2)% not
receiving.upplements were collected from %, upa9ilas *sub'districts+ in four districts of
2angladesh# $he assessment found that, despite lower economic status, the women with low
2MI receiving supplementation of food and intensified services were more likely to have
ade0uate pregnancy'related weight gain than the more economically'advantaged women with
higher 2MI# 1rimigravidae receiving supplementation were also more likely to have ade0uate
pregnancy'related weight gain than the better'off non'supplemented primigravidae *E&#,3 vs
&%#(3, pS0#044+# $he mean birth'weights of infants of the supplemented women with low 2MI
were comparable to those of the better'off, non supplemented women
2E
#
1regnant women who had a 2MI of, %E#&kg=m2 on first presentation should have been selected
for supplementary feeding *2&%2 kY *)00 kcal+=d for si! days per week+ starting at month 4 *%)
weeks+ of pregnancy# -owever, of the &2) ">4 pregnant mothers only @@& received
supplementation; so the failure rate was @)#@3, among them only %(@ women *@)#,3 of &2)
women+ commenced supplementation at the correct time, of whom thirty'two *(#)3 of @@&
women+ received supplementation for the correct number of days *%003 days+# $here were no
significant differences in mean weight gain between 2MI, %E#& kg=m2 supplemented or non'
supplemented groups# 8ighter women gained relatively more weight during their pregnancy than
heavier women# $he mean birth weight in the supplemented and non'supplemented groups was
2#)@ kg and 2#,2 kg, respectively# Mothers with 2MI, %E#& kg=m2 who were or were not
supplemented had almost e0ual percentages of low'birth'weight babies *2%3 and 22 3,
respectively+# $he study raises doubt about the efficiency of the 2IN1 to correctly target food
supplementation to pregnant women# It also shows that food supplementation does not lead to
enhanced pregnancy weight gain nor does it provide any evidence of a reduction in prevalence of
low birth weight
2(
#
In early first trimester, @&0 women were followed for duration of pregnancy and data gathered on
maternal factors such as social, demographic, anthropometric, biochemical measures and
newbornGs birth weight within 4E hours of birth# /lmost a 0uarter of babies *243+ were born
with 82< and mean birth weight was 2()% g# 2ivariate analysis found associations between
82< and motherGs age, parity, weight and hemoglobin level at booking, weight gain and health
problems during pregnancy, tobacco consumption, and gestational age# 2ut no such association
2&
was seen for birth spacing, motherGs height, economic status, educational level, body mass inde!,
mid upper arm circumference and number of /N" visits
@0
#
Fver @)3 of mothers were malnourished *2MI M%E#&+ while %@#43 and 4E#&3 of their children
were wasted and stunted respectively# "hildren at risk of wasting and stunting were @%#&3 and
))#&3 respectively# Mothers from better'off households tended to be taller, heavier and have
higher 2MIs# $here were mainly low'to'moderate positive correlations between mothers 2MI
and childs N'scores# /fter taking into account variation in socio'economic variables, the
distribution of households on the combined basis of maternal 2MI and child nutritional status did
not suggest that low maternal 2MI was associated with increased levels of childhood wasting,
stunting or underweight
@%
#
In another study cohort of undernourished pregnant women *n S ,,,+

who received prenatal food
supplementation *)0E kcal=d+ was

followed# $he association between the uptake of food
supplements

and 2< was analy9ed after ad7ustment for potential confounders

*n S )%( with
complete information+# 4ifferential effects in

lower and higher maternal postpartum weight
groups were e!amined#

$he average 2< was 2&2% g# Fn average, the women received

daily
supplements for 4 months, which resulted in an increase in

2< of %%E g *%#0 g=d+# $he strongest
effect was found for births

occurring in Yanuary and ?ebruary# $here was a linear dose'response
relation between duration of supplementation and 2< for women

with higher postpartum
weights *42 kg, above the median+# In

women with lower weights *M42 kg, below median+, a
shorter

duration of supplementation *M4 mo+ had no such dose'response

relation with 2<, but
there was a linear dose'response relation

for longer durations of supplementation#

/nd they
concluded that the association between duration of prenatal food

supplementation and 2< varies
with maternal postpartum weight#

/ large effect was observed after the season with food
insecurity

*mid'/ugust to mid'November+
@2
#

-owever, has the 2angladesh Integrated Nutrition 1ro7ect *2IN1+ actually resulted in an
increase in birth'weight or a reduction in low birth'weightL /s Frtolano and her colleagues
obviously recogni9e in their article in this issue of Y-1N, a randomi9ed trial design would
provide the best answer to such a 0uestion
@@
# Fne could ask whether another such randomi9ed
trial is needed in a country like 2angladesh# $here is no reason to suspect that the previously'
2)
demonstrated effects of food supplementation would not also have a positive impact on foetal
growth among 2angladeshi pregnant women#
$he research design used in this study is highly unusual, however# $he intervention was not
randomi9ed, nor was the intervention group compared with a similar group of women neither
elsewhere in the country or region who did not receive the supplement, nor even with a
historical group of similar women who gave birth prior to the intervention# Instead, the authors
elected to feed all women who met their eligibility criterion *body mass inde! A2MIB M%E#&
kg=m
2
at the time of registration+ and compared weight gain and birth'weight *without respect
to gestational age, presumably because the latter was unavailable or felt to be inaccurate+ with
those outcomes in women with higher baseline 2MIs *and therefore not eligible for the
supplement+, who generally came from more socioeconomically favourable households# <hat
the authors have reported based on this unusual design is that the thinner, poorer women who
were supplemented had a higher average gestational weight gain *in kg per week+ and similar
birth'weight distribution compared with the better off'mothers who did not receive the
supplement#
/lthough the authors were surprised by this success, their result provides relatively weak
evidence that their supplement was as effective as they have inferred# ?irst, pre'pregnancy
2MI *or even early'pregnancy 2MI, used here as a pro!y+ is often inversely associated with
gestational weight gain# In other words, the thinner women are when they enter pregnancy, the
more weight they tend to gain during pregnancy, presumably as a physiologic compensatory
mechanism for pre'pregnancy under'nutrition# .econd, the authors provide no information on
the e!tent to which the 2IN1 supplement replaced, rather than added to, the womens normal
dietary intake# $hus, there is no assurance that energy intake and subse0uent weight gain were
higher in the supplemented group than they would have been in the absence of the supplement#
?inally, only 224 of the 4&) women included in the study had recorded birth'weights, creating a
strong potential for bias in reporting of birth'weight if women who received the supplement
and had a low'birth'weight infant did not have the birth'weight recorded, perhaps to avoid
conveying bad news to the providers of the supplement and to the investigators
@4,@&
#
2,
1rovision of food does not necessarily lead to its consumption# >ven if it is consumed, it may
replace some of the usual diet# .upplementation trials must take this into account in order to
evaluate the actual e!tra amount ingested# Many such trials have been carried out# :ntil recently
most of the evidence seemed to indicate that maternal caloric intake during pregnancy had no
effect on prematurity; however supplementation had a positive effect on birthweight and I:5;#
$he effect was greater the more malnourished the mother was before pregnancy# Nutritional
supplementation during pregnancy was also shown to be associated with a reduction in the
incidence of 82< in developing and developed populations#
.urprisingly, and regardless of methodological and practical differences, the effect of nutritional
supplementation during pregnancy on birthweight has generally been modest, with an average
increase of about %00g
%
#
International study finding E:ffect of supplementationF
Fne study showing a substantial effect was in the 5ambia where daily supplements of groundnut
based biscuits and vitamin fortified tea was distributed to pregnant women# $he mean net
increase of energy intake was 4@% kcal per day# $he resulting significant increase in birthweight
was on average %20g and the overall prevalence of 82< babies decreased significantly from 20
to )3# $here were however marked seasonal differences# .upplementation during the wet season
*IhungryJ season+ led to a significant increase in birthweight of about 200g and a decrease in the
proportion of 82< from 2@#,3 to ,#&3; in the dry season supplementation had no effect
*average increase of 2g only+
%@
#
/s stated by Oillar women without overt malnutrition or in positive energy balance *5ambia dry
season+ obtain a limited benefit from nutritional supplementation during one pregnancy#
"hronically malnourished mothers also supplemented during one pregnancy e!perience only a
modest impact on birthweight of about %00g# <hen women are however in negative energy
balance, food supplementation produces a significant increase in birthweight as in the 5ambia
*2@0g increase+# $he e!pectation of a dramatic recovery from generations of poverty and food
scarcity in a short time is an overly optimistic proposition# It may be that e!tra, yet prolonged,
intake during pregnancies and lactation, rather than large amounts of supplementation during
short periods of a given gestation, produce the foetal growth effect
%
#
2E
/ recent meta'analysis of controlled clinical trials on the effect of supplementation during
pregnancy on the outcome of pregnancy confirmed that Itrials of nutritional advice to increase
energy and protein intakes and of balanced energy and protein supplementation, have
demonstrated only a modest increase in maternal weight gain and fetal growth, even in
undernourished women, and no long term benefits to the child in terms of growth of neuro'
cognitive development
%4
# $hat is, the clinical e!perimental evidence reviewed showed that
modest increases in fetal growth in the absence of effects on gestational duration do not appear to
confer long lasting benefits on infant and child survival, health and performance#J
Fnly trials using controls or random or 0uasi random methods of treatment allocation were
included in the overview *the 5uatemalan and 5ambian trials were e!cluded+# $he author
concluded that Iunless future trials of energy and protein supplementation demonstrate clear
reductions in risk for preterm birth, stillbirth, or neonatal death, or improvements in maternal
health, clinicians and politicians should avoid high e!pectations from this type of nutritional
intervention and should perhaps shift their focus towards potentially more fruitful avenues for
improving maternal and child health
%4
#
$he contrasts between the findings of this overview and the results of observational studies
suggest that the latter may have overestimated the effects of supplementation on pregnancy
outcome# $he robust findings of a strong association between maternal weight gain and fetal
growth and of an even stronger association in undernourished women may partly reflect a non'
nutritional effect mediated by such factors as e!panded maternal plasma volume and increased
placental blood flow
%4
#
Most of the dietary intervention studies addressed only birthweight as the outcome variable# Fne
study in >ast Yava however showed that maternal nutrition during pregnancy influenced growth
of the offspring beyond the intrauterine period# .upplements were distributed during the last
trimester of pregnancy# <omen received either a high energy *4)& kcal+ or a low energy *&2
kcal+ supplement#
"hildren were subse0uently followed up from birth until & years# 2irthweight and length at one
week were not significantly different between the two groups of women although there was a
modest improvement in the children whose mothers had been in the high supplement group#
2(
$hese children were significantly heavier up to the age of 24 months and taller throughout the
first & years# .tunting was less prevalent among children whose mothers had received the high
energy supplement# Mothers may have had an improved breastmilk output and their better'
nourished children were less likely to become sick
@)
#
$he ability of supplementation to reverse the retardation of

fetal growth in the hungry season
when provided for an average

of only E2 days in the second half of pregnancy is consistent

with
findings from the 4utch Zhunger winterZ of %(44'&
@,
#
#ther contributors effecting pregnancy outcome
If indeed this improved pregnancy performance among the younger women is due to early and
ade0uate antenatal care then it follows that all adolescent girls should be encouraged to seek
early and appropriate antenatal care to decrease the morbidity and mortality associated with
pregnancy as previously reported# "hang et al have shown that there is a relationship between
inade0uate prenatal care and an increase rate of preterm birth
@E
# In this study, the high rate of
antenatal care e!perienced in each group suggests that the similar pregnancy performance
between the mature women and the adolescent girls may in fact be linked to ade0uate antenatal
care and this ade0uacy of care has a positive effect on pregnancy outcome in adolescent girls#
?indings by .choll et al and ?raser et al also support this as they have shown a strong association
between inade0uate prenatal care and adverse outcomes
@(, 40
# $his study therefore concurs with
studies which suggest that improved antenatal care may improve outcome in the adolescents#
$he :#. Institute of Medicine recommendations for weight gain during pregnancy are based on
pregnancy 2MI and uphold a slightly different range of weight gain for each 2MI category#
<eight gain within these guide lines is associated with optimal birth weight *between @000g and
4000g+ and best labour and delivery outcomes# <omen who gain more weight during pregnancy
than recommended have a significantly increased risk of having an infant weighing greater than
4000g
4%
#
>vidence from observational studies suggests that low pregnancy 2MI *2MI M20kg=m
2
+ is
associated with reduced infant birth weight, and increased incidence of pre term delivery
42
#
@0
$he highest prevalence of low iron stores, iron deficiency and iron deficiency anaemia is among
New Nealand Maori women, particularly aged from %&'24 years
4@
# Maternal anemia is associated
with infant mortality and premature delivery
44
#In addition to reducing neural tube defects, lack
of folate during pregnancy is associated with increased risk of pre term delivery, low birth weight
and poor fetal growth
4@
#
3 Daterials and methods
Dethodology
3.1 .tudy design
$his is an operational research aiming to evaluate the outcome of the targeted food
supplementation program by NN1 2angladesh#
3.2 .tudy period
$he total study lasted for a period of ) months commencing from Yanuary 200( to Yune
200(# $o complete the study in time, a work schedule was prepared including all the tasks in
a se0uence# $he first three months were spent for literature review, topic selection,
development and approval of the protocol# $he subse0uent three months were spent for
0uestionnaire development, pretesting, data collection, compilation and analysis, report
writing, printing and submission of the thesis# 8iterature review was simultaneously going
on till the final report was written#
3.3 "lace of the study
$his study was conducted in Dapasia :pa9ila * NN1 intervention area + of 5a9ipur district
P .avar 4hamrai * nonintervention area + 4haka disttrict # Dapasia
3.) .tudy population
$he samples were taken from two different population served by two different N5Fs
*O/;4 P 5D+# O/;4 is implementing the maternal and child nutritional supportive
programme following National Nutrition 1rogram guidelines in one study area *Dapasia+ P
@%
5D *5onosashthaya Dendra+ is delivering maternal P "hild health "are services through
primary health care in another area *.avar+#
/t first %%(@ sample information were collected, )&E from 5onosasthaya Dendra P &@& from
O/;4 NN1 area# 2ut only &)& of them e!clusively meet the selection criteria #/lthough
according to NN1 all pregnancies with 2MI MS%E#& are eligible to get daily on'site
supplementary feeding regimen until delivery but records reveal only 2@E out of &@& chronic
energy deficient mother were inconsistently supplemented # In this situation a good number
pregnant mothers who resides in the O/;4 NN1 area and are entitled to have food
supplementation become non'supplemented #$hus a third group evolves naturally that is
Dapasia non'supplemented group#
It was obvious that the researcher should conduct P compare the analysis between two
samples but instead he took the opportunity to compare the results of the study between three
groups to make it more e!haustive# .o the results presented in this section are based on three
category of respondents comprising &)& mothers#
5onoshasthaya Dendra .avarA4hamraiB * n S %2) +
Dapasia non supplemented * n S 22E+
Dapasia supplemented * n S 2%%+
/ll pregnant women with 2MI M %E#4( Dg=m
2
of the selected :p9ilas#
@2
.election criteriaG
Inclusion criteria
1regnant women have 2MI M%E#& P
;egistered at not more than 4th month of pregnancy
2etween age %@ to @& years
$he birth profiles of the newborn are only taken when reported within ,2 hours of delivery
:?clusion criteria
Multiple pregnancies
1regnancy with chronic diseases
1regnancy with metabolic diseases
.mokers
1re termed delivery P post'dated or prolonged pregnancy
3.+ .ample si(eG
$he sample si9e was determined by following formula
>stimating the difference between two population proportion with specified absolute
precision

n H (
2
11IJ2E"1 B11 "1C K "2B11"2CF J d
2
or n H (
2
11IJ2 !J d
2
where' E0 H "1 B11 "1C K "2 B11 "2CF
@@
1opulation proportion 1% and 12
1roportion of low birth weight in non'intervention area 1% S @E#E 3
1roportion of low birth weight in NN1 area 12 S 2& 3
"onfidence level (& 3 * 9 S %#() +
/bsolute precision d S & 3 *#0& +
Intermediate value O S 1% *%' 1%+ Q 12*%'12+



O S #@EE*#)%2+ Q #2&*#,&+ v S #424(
Now, n S 9
2
%'[=2 v= d
2
S %#()
2
#424( = #0&
2
S )&@#0044
S )&@
/ sample si9e of )&@ would be needed
*for "I S(&3, d S 0#0& P OS #424(+
3./ .ampling techni%ue
$he study was conducted by sample survey# .amples were taken from the pregnancy P birth
registers P cards of the corresponding organi9ation# $hen he selected the participants
according to the inclusion criteria# /ll samples of randomly selected unions were taken in the
study#
3.4 7ata collection method
/ format was made as data collection instrument to collect data from the past P present
records of NN1 intervention area *O/;4 conducted+ P non NN1 intervention area *5D
;5onoshasthaya Dendra working territory+# It was used to collect information from primary
@4
records regarding socio'demographic, reproductive, delivery, food supplementation and
pregnancy outcome profile#
$he draft format was trialed and modified for several times to make it synchroni9ed, easy and
informative# $he necessary modification was done after consultation with an epidemiologist
and a statistician# It was finali9ed in a way so that it could collect all the relevant information
to meet the ob7ectives of the study#
3.6 .tatistical analysis
7ata management
\ .orting the data
\ 1erforming 0uality control check
\ 4ata processing
] "ategori9ing
] "oding
] summari9ing
\ 7ata presentation
4ata will be presented by tables P graphs
\ 7ata analysis
4ata were cleaned, edited, coded and computed with the help of the computer by .1..
%)#0 for windows#
4ata collected were of 0ualitative P Huantitative type#
Huantitative data were analy9ed to find out the mean P standard deviation P were tested
by .tudents 6t test and one way analysis of variance# */ssuming (&3 confidence interval
P &3 precision+#
@&
Hualitative data were analy9ed to estimate the proportion and will be tested by
2
tests# $o
remove the effects of confounders, binary and multinomial logistic regression, 5eneral
8inear Model *;epeated measure+ and linear regression were performed#
3.< :thical consideration
1rior to commencement of the study, the research protocol was approved by the ethical
committee *local ethical committee+ of the NI1.FM, 4haka, 2angladesh# Frgani9ational
approval was taken and detailed information regarding the study was acknowledged#
) 9esults of the study
$his record'based study was carried out in Dapasia and .avar upa9ila to e!plore the effect of
targeted food supplementation by comparing the pregnancy weight gain and birth weight# 4ata
on %%(@ samples *)&E from .avar and &@& from Dapasia+ were collected# 2ut only &)& of them
met the selection criteria, therefore detailed analysis were done on those data only# $his chapter
presents those data through tables and graphs under following headings#
4#% .ocio'demographic characteristics
4#2 ;eproductive health
4#@ "hronic energy deficiency status
4#4 ?ood supplementation
4#& <eight gain during pregnancy
4#) 2irth weight
).1 .ocio1demographic characteristics
/ll of the samples were of poor socio'economic status including 2% 3 destitute and almost all of
which were from Dapasia upa9ila# /mong the selected mothers &3 of the respondents were
supported by O54 card# Fne'fourth of the samples in .avar area were -indus whereas only
&#)3 of the Dapasia were -indus#
@)
/mong the mothers selected from Dapasia upa9illa 2%% received food supplementation, rest did
not *22E+# In addition to 6.avar non'supplemented and 6Dapasia supplemented a new group
6Dapasia non'supplemented was formed# $he researcher e!plored the social P demographic
status of the mothers of different categories# $he aim of the analysis was to compare their
background characteristics including age, education, and occupation between these groups of
pregnant women#
).1.1 8ge of the mother
$he study included samples having their age at pregnancy between %4 and 44 years #$he mean
age at pregnancy were almost same among all three categories *? S 0#@4, pV0#0&+#$he
distribution of age categories showed that only )#@3 of the .avar group were under 20 years
which was double and triple in Dapasia non'supplemented and Dapasia supplemented group,
respectively# Fn the other hand 403 of the mothers in .avar area were in 2&'2( years category
which was %03 higher than that of both non'supplemented and supplemented mothers in
Dapasia area# 8ess than &3 of the study population had their age over @& years# $hese
differences were statistically significant * p S 0#00)+#Atable 4#%B
>able ).1 8ge distribution of the samples E@H+/+F
@,
8ge of mothers in years
.ample category
L
2
p 1!alue
.a!ar
B @ H 12/ C
kapasia non
supplemented
B n H 226 C
kapasia
supplemented
B n H 211C
N 3 N 3 N 3
31/ E )#@ 2( %2#, @E %E
#00)
!0-!2 &4 42#( (E 4@ E4 @(#E
!.-!/ &0 @(#, &E 2&#4 &% 24#2 2%#2E
(0-(2 %0 ,#( 24 %0#& 2) %2#@
4(. 4 @#2 %( E#@ %2 &#,
BDean M.7C 2@#(ER4#@, 24#%@R&#&& 2@#,&R&#@4 #@4 ^ ns
^? ratio for one way analysis of variance,
).1.2 Dothers; education
.ignificant differences were observed in the educational status between the mothers of the three
groups *
2
S 4@#4&, df S ) , p M0#00%+# Illiteracy was three times higher in .avar area mothers
*2% 3+ than those of Dapasia area *)#%3 among non'supplemented and ,#%3 in supplemented
mothers+# $he proportion of 1rimary education was least among mothers of .avar which is three
and four times higher in Dapsia non'supplemented and supplemented mothers, respectively#
;esearcher wanted to find out the relationship of education and supplementation status only
among Dapasia categories and it was found not significant, A$able 4#2B#
).1.3 3athers; education
Illiteracy among fathers of .avar group was higher *%(#E 3+ than that of Dapasia groups; it was
%23 in supplemented and %43 in non'supplemented and primary education was two times more
common in non'supplemented and three times among supplemented mothers in Dapsia, than $he
mothers of .avar# $he difference was tested by
2
test **
2
S 2&#0%+ and found significant *p
M0#00%+, A$able 4#2B#
).1.) Dothers; occupation
/lmost all the mothers were housewife e!cept %0 who were mainly N5F workers5A$able 4#2B#
).1.+ 3athers; occupation
/bout &(3 of the husbands of Dapasia supplementation group were heavy workers in
comparison to the .avar group where it was only @)#&3# .killed labour category was larger in
.avar group#
2
S @)#),, *p S M 0#00%+, A$able 4#2B#
@E
>able ).2 :ducation and occupational status of the study samples E@H+/+F
@(
:ducation and
occupational status
.ample category
L
2
p 1!alue
.a!ar
B @ H 12/ C
kapasia non
supplemented
B n H 226 C
kapasia
supplemented
B n H 211C
@ N @ N @ N
Dothers education
"o education 2, 2%#4 %4 )#% %& ,#%
M0#00%
6 ,rimary %0 ,#( 4E 2%#% )% 2E#( 4@#4&
.-/ years ,E )%#( %2( &)#) %0E &%#2
00 and above %% E#, @, %)#2 2, %2#E
3athers; education
"o education 2& %(#E 2, %%#E @0 %4#2
M0#00% 6 ,rimary %4 %%#% )( 2&#( ,2 @4#% 2&#0%
.-/ years )E &4 %0& 4)#% E0 @,#(
00 and above %( %&#% @, %)#2 2( %@#,
3athers; occupation
$nemployed @ 2#4 , @#% ( 4#@
M0#00%
Heavy 1orker 4) @)#& %0@ 4&#2 %24 &E#E
0killed labour @0 2@#E 2% (#2 %, E#% @)#),
&usinessman 2& %(#E )4 2E#% @( %E#&
0erviceman 22 %,#& @@ %4#& 22 %0#4
).2 9eproducti!e health characteristics
).2.1 8ge at marriage
$he age at marriage ranged from %@ years to 2& years# $he mean *R.4+ age was lowest %,#(,
*R%#&E+ years for .avar population and was highest %E#@) *R2#4)+ years for Dapasia non'
supplemented group# /ge class was formed as two subsets; 6 17 years and 417 years *pS #(@ +,
Atable 4#@B# More than one third of the participants were married at an earlier age# $he age of
marriage was not associated to either pregnancy weight gain category or birth weight category
when "hi s0uare test was run, A$able not shownB#
$he age at marriage of the husbands ranged from %& to ,2 years# / good number of them got
married at or below the age of 20 years# $he mean *R.4+ age of marriage of the husbands were
2@#(0 *R&#2@+ years for .avar group and 2&#)4 *R4#)+, 24#,&*R4#,(+ years for Dapasia non
supplemented and supplemented group, respectively# $he difference between the age at marriage
of husbands three groups is statistically significant #? value &#&2 with a p value of 0#004#
>able ).3 Darital and gra!id status of the samples E@H+/+F
40
8ge at marriage
.ample category
L
2
p 1!alue
.a!ar
B @ H 12/ C
kapasia non
supplemented
B n H 226 C
kapasia
supplemented
B n H 211C
@ N @ N @ N
6 17 years 4@ @4#% E% @&#& E% @E#4 ,%
0#,0,ns
417 years E@ )&#( %4, )4#& %@0 )%#)
BmeanM.7C
*other %,#(, Q %#&E %E#@) Q2#4) %E#%)Q%#&E %#@2^ ns
)ather 2@#(0 Q &#2@ 2&#)4 Q4#)0 24#,&Q4#,( &#&2^ #004
-ra!ida
6 ! (% ,2#2 %)E ,2#2 %&& ,@#& #0(
ns
4! @& 2,#E )0 2)#@ &) 2)#&
^? ratio for one way /NFO/
).2.2 -ra!id
$here were no significant differences in number of gravid among the mothers between the study
areas# $hree 0uarters of the sample mothers conceived at least twice in their reproductive life, *p
S #(&+, A$able 4#@B#
).2.3 8nte1natal care
/nti'natal care status was classified following <-F guideline i#e#, IM 4 visit and 6U 4 visit#
More than one third of the .avar respondents had less than 4 /N" visit during their gestational
period# 2ut in Dapasia (,3 of the sample mothers visited for antenatal services for more than 4
times# $he difference between three category of respondents getting /N" services were highly
significant obtaining
2
value of %0)#%% with p'value M0#00%, A$able 4#4B#
>able ).) 8ntenatal .er!ice status among the sample mothers E@H+/+F
4%
Characteristics
9espondent category
L
2
p 1!alue
.a!ar
B @ H 12/ C
kapasia non
supplemented
B n H 226 C
kapasia
supplemented
B n H 211C
@ N @ N @ N
8@C status
62 visit 42 @@#@ , @#% & 2#4 %0)#%% M0#00%
4 2 visit E4 ))#, 22% (,#) 20) ()#(
Iron supplementation
"o 2@ %E#@ %@% &,#& %%2 &@#% &4#(2 M0#00%
#es %0@ E%#, (, 42#& (( 4)#(
).2.) Iron and 3olic acid supplementation
More than E2 3 of the respondents from .avar got iron and folic acid supplementation for @
months or more and the percentage were 42#&3 and 4, 3 in Dapasia non'supplemented and
supplemented respectively# $he differences were statistically significant with a
2
value of &4#(2
*pM 0#00%+, A$able 4#4B#
).2.+ "lace of deli!ery
In .avar area E%#, 3 of the deliveries were conducted at home and in Dapasia those were E0#, 3
to E&#E 3 among non'supplemented and supplemented group, respectively# 5overnment
hospitals conducted only 2#&3 of the delivery in .avar and E#E 3 and ,3 delivery in Dapasia#
$he variation was noticeable and had a
2
value of %%#%, *pS0#0@+, A$able 4#&B#
).2./ Birth attendant
$raditional birth attendant conducted more than E03 of the delivery in all three groups of both
areas# 2ut in .avar area most of the delivery attended by the trained $2/ ,E#)3 and only @3 of
the birth events involved the untrained personnel# $he proportion of delivery conducted by the
untrained $2/ is relatively higher in Dapasia ranged %43 to %,3 in Dapasia non'supplemented
and supplemented category respectively# $he variation was tested statistically and found
significant,
2
value %4#)( *p S 0#02+# $he proportion of delivery conducted by doctors was
mostly of caesarian type, A$able 4#&B#
).2.4 Complication at deli!ery
"omplication during delivery was %2#,3 in .avar and the proportion was almost same for
Dapasia non supplemented group# $he proportion of complication was highest in the
supplemented Dapasia group *%)#)3+ although not statistically significant, A$able 4#&B#
42
>able ).+ 7eli!ery related !ariables among the study samples E@H+/+F
4@
7eli!ery characteristics
.ample category
_
2
p 1!alue
.a!ar
B @ H 12/ C
kapasia non
supplemented
B n H 226 C
kapasia
supplemented
B n H 211C
@ N @ N @ N
"lace
Home %0@ E%#, %E4 E0#, %E% E&#E
%%#%, #0@ Government Hospitals @ 2#4 20 E#E %& ,#%
linics 20 %&#( 24 %0#& %& ,#%
Birth attendant
$ntrained %&' 4 @#2 @2 %4 @) %,#%
%4#)( #02 %rained %&' (( ,E#) %&) )E#4 %@, )4#(
"urses 8 paramedics %2 (#& 22 (#) 20 (#&
Doctors %% E#, %E ,#( %E E#&
Complication
"o %%0 E,#@ 202 EE#) %,) E@#4 2#)2
ns
#es %) %2#, 2) %%#4 @& %)#)
).3 EChronic energy deficiencyF C:7
/ccording to National Nutrition 1rogram only pregnancies with 2ody Mass Inde! M%E#& were
eligible to get daily on'site supplementary feeding regimen# $o match with the supplemented
samples, mothers with 2MI M %E#&3 were selected from .avar area also#
).3.1 7istribution of BDI among the Chronically :nergy 7eficient mothers
7istribution of BDI among the participants
44

3igure11
5raph shows the mean *M.4C 2MI was %)#,, *M.(,( C below ">4 II level# 2MI ranged
from%@#4 to%E#4(# -ighest fre0uency of 2MI was at or around %,#
>able )./ 7istribution of C:7 among the supplement categories E@H+/+F
4&
C:7 categories
.upplement category
3 p &!alue
.a!ar
B @ H 12/ C
kapasia non
supplemented
B n H 226 C
kapasia
supplemented
B n H 211C
@ N @ N @ N
9D + ,E )%#( %40 )%#4 %4 )#)
9D ++ 2) 20#) ,2 @%#) %@2 )2#) %,@#%) M0#00%
9D +++ 22 %,#& %) , )& @0#E
*ean :0D %,#0@ R %#%( %,#%4 R#E2 %)#2% R#,, ))#@E^ M0#00%
^? ratio for one way analysis of variance
.upplemented mothers from Dapasia area had, on average, lower 2MI *%)#2%R0#,,+ than non
supplemented mothers in Dapasia *%,#%4R#E2+ and .avar %,#0@R%#%(+ area# Fneway /NFO/
showed the difference significant and by performing posthoc -ochbergs 5$2 test it was further
noticed that the mean 2MI level of the supplemented group differed highly significantly from
other two groups, *? value ))#@E, p M0#00%+, A$able 4#)B#
$able 4#) shows that more than )0 3 of the non'supplemented mothers both from Dapasia and
.avar were with ">4 I while only )#)3 supplemented mothers were in this category# More than
(03 of Dapasia supplemented category were at or below ">4 II level of malnutrition # $he
variation was highly significant *_
2
S %,@#%), pM0#00%+#
).) 3ood supplementation
7uration of supplementation among the sample categories
4)
3igure12

$hree supplementation groups were constructed comprising low, intermediate and high number
of days of supplementation and were defined as no or 0 days, M%20 *low+ days, %20'%&(
*intermediate+ days and U%)0 *high+ days of supplementation, respectively# In registration month
4; no, low, intermediate and high supplementation groups were defined as 0 days, M%00 days,
%00'%@( days and U%40 days, respectively# ;esearcher try to segregate the classification only for
Dapasia respondents as .avar population are normally destitute of supplementation# .o the
classification for Dapasia was no supplementation, poor supplementation, moderate
supplementation, 6good=ade0uate supplementation

4,

3igure13
?igure @ shows only about E3 of the Dapasia participants got full supplementation# More than
&03 were not supplemented at all though all of them were eligible for on'site food support#
4E
).).1 Chronic energy deficiency status in !arious supplementation Categories
$he non'supplemented group of Dapasia were mostly of ">4 I category respondents#Fn the
other hand those who got either poor, moderate or ade0uate supplementation in Dapasia are
mostly of ">4II P ">4 III category# $he results show NN1 targeted food supplementation tried
to ensure supplementation for most vulnerable ones though the enthusiasm was very much
inconsistent, A$able 4#,B#
>able ).4 Chronic :nergy 7eficiency status among different supplement
categories Ebased on duration of supplementationF @H+/+
2ut after starting supplementation at early pregnancy they were incapable to manage the on site
food support consistently to all upto delivery# >ven among E% of the severely malnourished
mothers only %& were managed to complete the full supplementation# $hus only @4 out of 2%%
supplemented mothers got supplementary food support upto the term#
$he relationship between the supplement category and ">4 status were found highly significant
in
2
test# *
2
%,(#2, p S M0#00%+# $he mean *R.4+ 2MI of the good supplementation group were
lowest %)#0) *R#,(+ and for Dapasia non supplement group it was highest %,#%4*R#E2+# /fter
performing univariate analysis 1osthoc 5ames -owell test was done assuming the variances
were not e0ual * as levene statistic was significant )#%@ df%S 4, df2 S&)0 sig#0#000+# /nalysis
showed .avar and Dapasia non supplement categories possessed almost similar 2MI level
although there were significant differences of the mean 2MI between these categories and other
groups# ? ratio @&#4@, dfS4, pSM0#00%, A$able 4#,B#
4(
C:7
.upplement category

2
p1!alue
.a!ar 5apasia
@o
supplement
@H12/
@o
supplement
@H226
"oor
supplement
@H112
Doderate
supplement
@H/+
8de%uate
supplement
@H3)
n N n N n N n N n N
9D+ ,E )%#( %40 )%#4 ( E#0 @ 4#) 2 &#(
M0#00% 9D++ 2) 20#) ,2 @%#) ,@ )&#2 42 )4#) %, &0 %,(#2
9D +++ 22 %,#& %) ,#0 @0 2)#E 20 @0#E %& 44#%
BDI
mean:0D; %,#0&R%#%2 %,#%4R#E2 %)#2ER#,) %)#%)R#,, %)#0)R#,( @&#4@ 0#00%
^? ratio for one way analysis of variance
<hen the analysis were done only for Dapasia it showed significant difference between the non
supplement and rest of the various supplement group #$his finding is important because the non
supplement category possessed better early pregnancy 2MI than the supplemented ones#
).+ Aeight gain during pregnancy
).+.1 7istribution of pregnancy weight gain

&0
7istribution of pregnancy weight gain among the samples
3igure1)

?igure 4 shows the average pregnancy weight gain and the distribution of weight gain in study
population# $he weight gain ranged from 2#2 kg to %2#@ kg# with a meanR.4 of ,#&, R2#% kg#
&%
>able ).6 "regnancy weight gain in supplement categories E@H+/+F
).+.2 Aeight gain among supplement category
$able shows there was significant relationship between food supplementation and pregnancy
weight gain in one way /NFO/ *p S M0#00%+# 2ut post hoc 5ames -owell test was done to
specify the variant categories and it was found that .avar group with a meanR.4 )#&0R%#&@
deferred significantly from other groups# $he 6no supplementation and poor supplementation
group gained almost same average weight during pregnancy# 2ut those who were ade0uately
supplemented gained better weight than all other groups as they gained E#&0 *R%#&(+ kg at their
prenatal period, A$able 4#EB#
$hen analysis was repeated e!cluding the .avar group *as Dapasia had de novo non'supplement
group for better and logical comparison+ from the analysis to find out more specific relationship
between food supplementation and weight gain# /fter performing one way analysis of variance
no association was found *? S %#0@ df S@, pS0#@E ns+, A$able not shownB#
&2
.upplementation category "regnancy weight gain 3 p1!alue
@ DeanM.7 Din Da?
"o supplement 22E ,#E2R2#2E 2#20 %2#@0
,oor supplement %%2 ,#E%R2#%@ 2#)0 %%#)0
*oderate supplement )& ,#E)R%#EE 4#00 %2#00 %2#%( M0#00%
Good supplement @4 E#&R%#) @#E0 %%#%0
0avar no supplementation %2) )#&0R%#&@ @#00 %%#00
^ ? ratio for one way analysis of variance
3igure 1+.1
;epeated measure analysis shows significant variation in weight gain between .avar and all
other Dapasia categories# ? S%2#%( *p M0#00%+
&@
"regnancy weight gain pattern in different supplement categories
3igure1+.2
<hen .avar category is e!cluded from the analysis there showed no significant variation in
pregnancy weight gain among the categories# ? S %#0@#ns
;epeated measure analysis was done to predict the weight gain pattern of different supplement
category#A ?igure &#% and ?igure &#2B# <eight gained by .avar category significantly differs from
other categories# Dapasia good supplement category crosses the Dapasia poor and moderate
&4
"regnancy weight gain pattern in different supplement category e?cluding
.a!ar samples
supplement line A2ut we found earlier that all supplemented category had almost similar early
pregnancy 2MIB# $his might suggest that supplementation might have effect on pregnancy
weight gain in severe malnourished woman but the effects of other factors related to pregnancy
weight should be ruled out#
).+.3 Aeight gain at different le!el of C:7
>able ).< "regnancy weight gain according to C:7 le!el of the samples
$he weight gain ranged from 2#20 kg to %2#@0 kg# $able shows .everely malnourished mothers
gained better weight than those of mild P moderately malnourished category# Fne way analysis
of variance reveals significant variation in gaining weight between the categories# 1ost -oc
analysis was done assuming e0uality of variances * 8evene statistic not significant+ among the
groups and the method showed average weight gain in ">4 III category mothers significantly
differs from other two ">4 categories, * ? S (#,& and p SM 0#00%+, A$able 4#(B#
&&
C:7 "regnancy weight gain 3 p1!alue
@ DeanMsd Din Da?
9D + 2@2 ,#%@R2#00 2#20 %%#)0
9D ++ 2@0 ,#,)R2#0( 2#)0 %2#20 (#,&^ M0#00%
9D +++ %0@ E#%@R2#%E @#00 %2#@0
^? ratio for one way analysis of variance
&)
3igure1/.1
&,
"regnancy weight gain pattern in sample categories considering C:7
?igure shows no variation in weight gain among different supplement group considering the
effect of ">4 status of the mothers# ?S#(@ ns#
&E

3igure1/.2
>!luding savar category from the analysis 5raph shows no variation in weight gain among
different supplement group considering the ">4 status of the mothers# ?S #@4 ns#
&(
"regnancy weight gain pattern in sample categories considering C:7
E:?luding .a!ar samplesF
)0
>able ).1= :ffect of food supplementation on pregnancy weight gain ad,usting
C:7 status of the sample mothers E@H+/+F
Supplementation Beta t " <+N CI forB
Lower bound pper bound
onstant< &2#2@ #000 ,#@2 ,#(0
,oor supplement '#0), '%#42 #%&, '#E4E #%@,
*oderate supplement '#0&2 '%#%@& #2&, '#(@@ #2&0
Good supplement #02, #)%& #&@( '#&2@ %#00%
0avar no supplement '#2,% ')#%4) 0#000 '%#E0) '#(@
BMI class[according to CED] #%) @#&4 #000 #20E #,2E
^"onstantA Dapasia no supplementationB
2eta S standardi9ed co'efficient
t S t statistic
"I S confidence interval for un'standardi9ed regression co'efficient
In primary analysis it was noted that .avar group contribute to the significant variation in mean
difference A ?S%2#%(, p M0#00% B from other comparative groups and after selecting only Dapasia
samples no such variation were signified statistically,A$able 4#EB#
8inear regression was performed to find out the association of levels of food supplementation on
pregnancy weight gain# ? ratio for the model was %0#4( with M 0#00% significance level# /d7usted ;
s0uare for this model was #0(2 can e!plain the proportion of variation in pregnancy weight gain by
supplementation# /ssuming Dapasia non'supplement group as reference, only .avar group shows
noticeable variation in mean difference# None of the other Dapasia group varied significantly with
the reference group# ?or .avar category tS ')#%&, p M0#00% and "I SA'%#E0) to '#(@B#


)%
<hen .avar group was e!cluded from the analysis there revealed no significant association
between any level of food supplementation and pregnancy weight gain# *? S %#)(, pS#%)(, ns+ and
ad7usted ; s0uare was #0@2,A $able 4#%0#%B
>able ).1=.1 9egression analysis e?cluding .a!ar category E@H )3<F
Supplementation Beta t " <+N CI for B
Lower bound pper bound
constant < 4,#0,) #000 ,#20, ,#E@&
,oor supplement '#%02 '%#E@ 0#0)E '%#0@, #0@,
*oderate supplement '#0E@ '%#&@4 #%2) '%#%4@ #%4%
Good supplement #00, #%@@ #E(& '#,), #E,E
CED class #222 @#(2 #000 #@@2 %#000

^"onstant ADapasia no supplementationB
)2
>able ).11 :ffect of Chronic :nergy 7eficiency on pregnancy weight gain
ad,usting food supplementation status E@H+/+F

Chronic Energy
Deficiency
Beta t " <+N CI for B
Lower bound pper bound
9D +< &0#)@ 0#000 ,#2E ,#E,
9D ++ #0E% %#E 0#0,@ '#0@2 0#,22
9D +++ #%&& @#&4 0#000 0#@,) %#@%@
)ood supplementation #2&4 ')#%@ 0#000 0#0%, 0#00(
^"onstant S ">4 I A 2MI SV %, B
2eta S standardi9ed co'efficient
t S t statistic
"I S confidence interval for un'standardi9ed regression co'efficient
/s previously it was noted that the average E#%@ kg pregnancy weight gain in ">4 III category
significantly differ from ,#%@ kg of ">4 I mothers with a ? ratio (#,&, researcher tried to analy9e
the situation more specifically, A$able 4#(B#
.o 8inear regression analysis was performed to find out the association of level ">4 on pregnancy
weight gain removing other effects that might contribute to the significance observed in earlier
analysis# ? ratio for this model was )#@4 at 0#002 significance level# $he /d7usted ; s0uare for this
model was #0E( can e!plain the proportion of variation in pregnancy weight gain by ">4#
/ssuming ">4 I as reference; only ">4 III group shows noticeable variation in mean difference##
?or ">4 III category tS @#&4, p M0#00% and "I S A#@,) to %#@%@B, A$able 4#%%B#
<hen .avar group was e!cluded from the analysis there was little change in the significance level
).+.) "regnancy weight gain category
/s National Nutrition 1rogram targeted the ">4 mothers to supplement them and monitor
regularly ensuring pregnancy weight gain more than % kg per month for ) months, the researcher
took the opportunity to categori9e the respondents based on their total pregnancy weight gain#
$he categories were 6`&#(( Dg and 6U) Dg# Fn the other hand one of the core ob7ective of NN1
program is weight gain during pregnancy increased U ( kg in &0 3 women# .o this classification
was also used in the upcoming analysis# ;esearcher was not able to find out relevant literature
regarding classification of weight gain# In one way it was very much realistic to categori9e
weight gain taking (kg cut'off value *as it is the program ob7ective+, on the other hand as all the
samples were mild to severely malnourished and they were studied from @
rd
to 4
th
month of their
conception it was practically reasonable to take )kg as a cut off value *one kg per month+#
>able ).12 .upplementation status among pregnancy weight gain categories
Cut1off le!el / kg E@H+/+F
$able shows significant relationship between weight gain categories and food supplementation
status when all the categories were included in the analysis#
2
H %0#4, dfS4, p S M0#0@4, A$able
4#%2B#
/lmost all the Dapasia good supplemented group gained U ) Dg e!cept two# $he table shows as
the duration of supplementation increased the proportion of 6ade0uate weight gain 6status
increased steadily along'with but this variation is statistically significant at #0& level as savar
)@
"regnancy weight gain
.upplementation status O / kg P / kg

2
" !alue
@H11/ @H ))<
n N n N
"o supplement 4E 4%#4 %E0 40#%
,oor supplement 22 %( (0 20
*oderate supplement ( ,#E &) %2#& %0#4 0#0@4
Good supplement 2 %#, @2 ,#%
0avar no supplementation @& @0#2 (% 20#@
category were taken into count in the analysis# 2eing not supplemented %E0 out of 22E
respondents gained weight ade0uately in Dapasia region# $he proportion of poor pregnancy
weight gain was more or less similar in all groups e!cept in case of savar where more than one
third of the mothers gained weight M ) kg, A$able 4#%2B# .electing kapasia mothers only, the
researcher further wished to find out the association between supplementation and weight gain
status and no significant relation was noted# In the good supplementation category the proportion
of e!pected weight gain was almost (& 3# $his variation is very important though not
statistically significant# Fne of the regions for getting insignificant statistics was that respondents
of ade0uate supplementation group were only @4# *
2
value &#)2, dfS@, pS0#%@ns+, A$able not
shownB#
>able ).13 .upplementation status in pregnancy weight gain categories
Cut1off le!el' < kg E@H+/+F
$able shows significant association of supplementation and weight gain categories# B
2
value
4E#E, pSM0#00%+, A$able 4#%@B# 2ut if we e!clude savar group in which almost all of the mother
were gained below ( kg weight e!cept ) smples# $here found no such association *
2
S @#%0,
pS#@E ns+, A$able not shownB#
).+.+ C:7 status in pregnancy weight gain categories
)4
.upplementation status
"regnancy weight gain

2 " !alue
O < kg P < kg
@H)=3 @H1/2
n N n N
"o supplement %4, @)#& E% &0
,oor supplement ,2 %,#( 40 24#,
*oderate supplement 4) %%#4 %( %%#, @#%0 0#@E,ns
Good supplement %E 4#& %) (#(
0avar no supplementation %20 2(#E ) @#,
>able ).1) C:7 among pregnancy weight gain categoriesQ Cut off / kg
E@H+/+F
$able shows no significant association between ">4 status and pregnancy weight gain
categories, *pS 0#2)+, A$able 4#%4B#
>able ).1+ C:7 among pregnancy weight gain categoriesQ Cut off 1< kg
E@H+/+F
$able shows a little more than one fifth of the samples managed themselves to gain weight U(kg#
$he less malnourished group =9D + ; gained lesser weight and the severe malnourished group
gained better weight proportionally #*
2
S22#0,, pS M0#00%+, A$able 4#%&B#
)&
"regnancy weight gain category
C:7 M( kg *NS40@+ U(kg *NS%)2+

2
" !alue
n N n N
9D + %(0 4,#% 42 2&#(
O=.==1
9D ++ %&0 @,#2 E0 4(#4 22#0,
9D +++ )@ %&#) 40 24#,
"regnancy weight gain category
C:7 M ) kg *NS%%)+ U )kg *NS44(+

2
" !alue
n N n N
9D + && 4,#4 %,, @(#4
0#2)'ns
9D ++ 44 @,#( %E) 4%#4 2#,@
9D +++ %, %4#, E) %(#2
))
>able ).1/ :ffect of food supplementation on pregnancy weight gain
category ad,usting C:7 le!el among the sample mothers E@H+/+F

3ood supplementation

2
p1!alue #9 <+N CI for :R"BBC
8ower :pper
CED I* %E#%&Adf,2B 0#000
CED II %2#%, 0#000 2#& %#4(@ 4#%,2
CED III %)#)0 0#000 @#,, %#(( ,#%&,
"o supplement < @&#,&Adf,4B M0#00%
,oor supplement @#(% 0#04E #&,, #@@& #((
*oderate supplement )#(% 0#00( #40( #2% #E0
Good supplement #%&E #)(% #E&2 #@( %#EE
0avar no supplement @2#00 M0#00% #0,E #0@2 #%EE
^^ 1regnancy weight gain category were formed assuming (kg as cut'off value
^ ;eference group,
F; S odds ratio,
"I S "onfidence interval for standardi9ed regression co'efficient

4uring earlier 0ualitative analysis after e!clusion of .avar category there were no significant
relationship between food supplementation and pregnancy weight gain for the rest of the
categories# 2ivariate logistic regression was done to find out the association of pregnancy
weight gain and food supplementation ad7usting the ">4 status of the mothers# $he model
correctly classify ()#E3 less weight gained mothers and only %%#% 3 better weight gained
mothers, the overall classification were ,2 3 correct# -osmer 8emeshow goodness'of'fit test
were applied which was not significant A
2
@#&(, dfS,, nsB and "I for standardi9ed regression co'
efficient was taken# A1oor supplementation F;S#&E, moderate supplementation F;S#4%, .avar
no .upplementation F;S#0EB, A$able 4#%)B#
/s researcher analy9ed only Dapasia data for the same test, he observed Apoor supplementation
group F;S#&& and for moderate supplementation group F;S#@(B, poor and moderate supplement
group were 2 to 2#& times less likely to gain ade0uate weight during pregnancy#A$able not
shownB

),
>able ).14 :ffect of C:7 on pregnancy weight gain category ad,usting food
supplementation status E@H+/+' assuming <kg as cut1off !alueF
C:7

2
p1!alue #9 <+N CI for :R"BBC
8ower :pper
9D +< %E#%& M0#00%
9D ++ %2#%, M0#00% 2#& %#4( 4#%,
9D +++ %)#)0 M0#00% @#,E %#(( ,#%)

^ ;eference group, F; S odds ratio,
"I S "onfidence interval for standardi9ed regression co'efficient
2ivariate logistic regression was done to find out the association between ">4 status and pregnancy
weight gain ad7usting the food supplementation status of the mothers# $he model correctly classify
()#E3 less weight gained mothers and only %%#% 3 better weight gained mothers ,the overall
classification were ,2 3 correct # -osmer 8emeshow goodness'of'fit test were applied which was not
significant A
2
@#&(, dfS,,ns B and "I for standardi9ed regression co'efficient were noted#
/fter removing the effect of food supplementation status and assuming ">4 I as reference group; the
variables in the e0uation showed pregnancy weight gain had significant relationship with ">4 II A
2
H
%2#%,,M0#00%B and ">4 III categories#A
2
H%)#)0,M0#00%B# A?or ">4 II, F;S2#& and ">4 III,
F;S@#EB# ">4 II and ">4 III mothers were 2 to 4 times more likely to gain ade0uate pregnancy
weight considering effect of food supplementation# A$able 4#%,B
;esearcher was interested to find out the effect of ">4 within Dapasia samples and the data were
analy9ed accordingly# $he results showed even after e!clusion of .avar group, the level of significance
remained same with a slight increment,A$able shown belowB #

>able ).14.1 9e!iew analysis e?cluding .a!ar samples E@H)3<F
C:7

2
p1!alue #9 <+N CI for :R"BBC
Lower pper
Food supplementation E#EEAdf,@B 0#0@%
9D +< %E#)(Adf,2B 0#000
9D ++ %2#@2 0#000 2#)% %#&@ 4#4,
9D +++ %,#4% 0#000 4#2& 2#%& E#@(
onstant @0#,( 0#000 #@&&
"regnancy weight gain in different chronic energy defficient categories
C:7 I EP14 BDIF
3igure 4.1
5raph shows the effect of supplementation on pregnancy weight gain in ">4I category# $he
variation in weight gain pattern is not significant regarding supplementation pattern#
)E
"regnancy weight gain in different chronic energy defficient categories
C:7 II E1/11/.<< BDIF
3igure14.2
5raph shows the effect of supplementation on pregnancy weight gain in ">4II category# $he
variation in weight gain pattern is not significant regarding supplementation pattern#

)(
"regnancy weight gain in different chronic energy defficient categories
C:7 III ES 1+.<< BDIF
3igure14.3
5raph shows the effect of supplementation on pregnancy weight gain in ">4III category# $he
weight gain is highest in this category though not significant in comparison to other
supplementation pattern#
.eparate plot were constructed to measure the effect of supplementation on weight gain at
different level of ">4# A58M# repeated measureB# 5ood supplementation enhanced ma!imum
weight gain in ">4 III mothers with respect to other supplementation status, A?igure',#@B#
,0
)./ Birth weight
4./.1 7istribution of birth weight among the newborn
3igure16
$he histogram with normal curve shows birth weight varies from %&00 grams to 4000 grams#
$he ma!imum fre0uency is observed around 2&00 gm and also a lesser pick in fre0uency is
noticeable at @000 gram, A?igure EB#
,%
>able ).16 7istribution of birth weight among supplement categories
$able shows the average birth weight of .avar group is significantly different from all the other
groups of Dapasia# $he mean birth weight of .avar category Mean *R.4+ 24,0R@))#0@ were
lower than the cut'off value of 8ow birth weight# *? %0#)4, p S0#00%+, A$able 4#%EB#
$he researcher e!cluded .avar category from the analysis and found no significant difference in
birth weight among the Dapasia categories# $he mean *R.4+ birthweight for Dapasia non'
supplemented group 2,20#%E*R@)E#)@+ grams and in Dapasia good supplemented group it was
2,&2#(4 *R@44#E)+ grams# *? S2#0, pS0#%%, ns+, A$able 4#%EB, Atable not shownB#
>able ).1< 7istribution of birth weight among supplement categories in
5apasia E@H+/+F
/ little less than half of the poor supplemented group delivered low birth weight baby whereas
almost all of the good supplemented mothers delivered normal weight babies e!cept five# $he
researcher noticed birth weight increases steadily as the duration of supplementation increased ,
A$able 4#%(B#
,2
Birth1wt in
grams.
.upplement Category
5apasia

2
p1!alue
@o
@H226
"oor
@H112
Doderate
@H/+
8de%uate
@H3)
n N n N n N n N
6!.00 @, %)#2 @2 2E#) %2 %E#& & %4#,
04, 4!.00 %(% E@#E E0 ,%#4 &@ E%#& 2( E&#@ ,#(4
Dean BM.7C 2,20#%E
R@)E#)@
2)2)#2%
R@E%#,,
2)E@#0E
R@2@#E@
2,&2#(4
R@44#E)
2#0^ N.
^? ratio for one way analysis of variance
.upplementation
category
Birth weight 3 p1!alue
@ DeanM.7 Din Da?
"o supplement 22E 2,20#%E R@)E#)@ %&00 @E00
,oor supplement %%2 2)2)#2% R@E%#,, %&00 @&00
*oderate supplement )& 2)E@#0E R@2@#E@ 2000 4000 %0#)4 0#00%
Good supplement @4 2,&2#(4 R@44#E) %(00 @400
0avar no supplementation %2) 24,0#44R@))#0@ %,00 @&00
? ratio for one way /NFO/
)./.2 Birth weight at different le!el of C:7
2irth weight status improved with the ">4 status in contrast to pregnancy weight gain which
was inversely related to ">4 categories# $he severely undernourished group delivered babies
with mean *R .4+weight of 2&&4#@, R @)2#(@ grams and the mild under'nutrition mothers gave
birth of better weighted child# $he variation of mean among the groups were significant at *0 #02
level, ?S @#(2+, A$able 4#20B#
>able ).2= 8!erage birth weight in chronic energy deficient categories
,@
C:7 Birth weight 3 p1!alue
@ DeanMsd Din Da?
9D + 2@2 2),E#%@ @(&#%E %&00 @E00
9D ++ 2@0 2)4E#)@ R@&E#)@ %&00 @&00 @#(2^ #02
9D +++ %0@ 2&&4#@,R @)2#(@ %&00 4000
^? ratio for one way analysis of variance
)./.3 .upplementation status at Birth weight category
$able shows there is significant variation in birth weight category between supplemented and
good supplemented respondents when
2
test was done #*
2
S ,#(4 , pS 0#0& + e!cluding .avar
group# ?or all categories the association of supplementation and birth weight became more
evident, *
2
value

S &0#EE, dfS@, pS M0#00%+, A$able 4#2%B#
>able ).21 .upplementation status at Birth weight categories
)./.) 7istribution of C:7 status among birth1weight categories

>able ).22 Chronic energy deficiency in birth weight categories
$able shows the proportion of low birth weight varies with various level of "hronic >nergy
4eficiency status# More than one third of the ">4III mothers delivered low birth weight child
even though most of them were supplemented# $he variation is statistically significant with a
2
value of E#)E at #0%@ level,A$able 4#22B#
,4
Birth weight category
C:7 Low O2+== @ormal P2+==

2
" !alue
NS%4E NS 4%,
n N n N
9D + &4 @)#& %,E 42#,
#0%2
9D ++ && @,#2 %,& 42 E#(
9D +++ @( 2)#4 )4 %&#@
Birth weight
.upplementation status O !.00 gms P !.00 gms

2
" !alue
@H11/ @H ))<
n N n N
"o supplement @, 2&#0 %(% 4&#E
,oor supplement @2 2%#) E0 %(#2
*oderate supplement %2 E#% &@ %2#, &0#EE 0#00%
Good supplement & @#4 2( ,#0
0avar no supplementation )2 4%#( )4 %&#@
)./.+ .e? of the newborn
$otal &)& babies were included in the study among them @04 *&43+ were male and 2)% *4)3+
were female# $he mean birth weight deferred significantly between male and female babies# $he
male babies delivered with mean *R.4+ 2,04#0*R@,,+gm birth'weight and female babies attained
2&,@#2*R@)4+ gm # $he independent sample t test was done and the difference between the mean
birth'weight of two se! categories was found significant, *tS '4#%,, pSM0#00%+, A$able 4#2@B#
>able ).23 Birth weight status in se? categories
/t this stage researcher wished to know the variation of birth weight of female and male babies
separately among the supplementation categories# Fne way analysis of variance was done and
posthoc -ochbergs 5$2 were performed assuming the e0uality of variance# $here found the
mean birth'weight of Dapasia nonsupplement deferred significantly from .avar no supplement
and Dapasia poor supplement categories in case of female child# ?S &#)&, df 4, pS M0#00% #/like
this procedure were repeated for the male babies too# $he differences were found significant only
between .avar and all other Dapasia categories, *?S )#E%, df 4 , p S M 0#00%+, A$able 4#24B#
,&
.e? of the child Birth1weight t p1!alue
@ Dean BM.7C Din Da?
female 2)% 2&,@#2M@)4#,2 %&00 @E00 ' 4#%, M0#00%
male @04 2,04#0M@,,#0& %&00 4000
>able ).2) .e? differentiation of birth weight among supplement categories'
ANS&)&B
.ignificant weight variation of female babys between non'supplement and poor supplement
group still remain if Dapasia groups were compared with one another# ?S @#02, pS 0#0@% but it
was not the same for male babies of Dapasia, A$able not shownB#
,)
.e? of the
child
.upplement category
3
p1!alue
.a!ar 5apasia
@o supplement
@H12/
@o
supplement
@H226
"oor
supplement
@H112
Doderate
supplement
@H/+
8de%uate
supplement
@H3)
female 2422#4R@4%#) 2)E0R@)&#@ 2&0E#ER@&(#( 2)2&R@00 2&))#,R@)0 &#)& 0#00
male 2&%0R@E2#( 2,&4R@)(#4 2,)%R@)@#( 2,2,R@@E 2E&4R2(, )#E% 0#00
^? ratio for one way analysis of variance
,,
>able ).2+ :ffect of food supplementation on birth weight ad,usting se? of the
newborn and C:7 categories'E@H+/+F
Supplementation Beta t " <+N CI for B
Lower bound pper bound
"o supplement <
,oor supplement '#020 '#42@ #),2 '%0)#@ )E#)2
*oderate supplement #02) #&,@ #&), ',4#2, %@&#42
Good supplement #0)4 %#4) #%44 '@4#4) 2@&#(0
0avar no supplement '#2), ')#%%) 0#000 '@%(#02 %)@#(%
Sex of the ay #%,, 4#42E 0#000 ,4#%,& %(2#4)4
BMI Class[CEDs!] '#%,2 '@#,&( 0#000 '%@4#@2E '42#%2@
^reference group
2eta S standardi9ed co'efficient, t S t statistic
"I S confidence interval for un'standardi9ed regression coefficient
$o find out the absolute effect of supplementation on birth weight linear regression was performed
ad7usting se! of the babies and "hronic >nergy 4eficiency status# ? ratio for the model was %2#@,
with M 0#00% significance level# /d7usted ; s0uare for this model was #%%2 can e!plain the
proportion of variation in birth weight by supplementation# /ssuming Dapasia non'supplement
group as reference only savar group shows noticeable variation in mean difference# None of the
other Dapasia group varied significantly with the reference group# ?or .avar category tS ')#%2, p
M0#00% and "I SA'@%(#02 to %)@#(%B, A$able 4#2&B#
<hen .avar group was e!cluded from the analysis there revealed no significant association between
any level of food supplementation and birth weight# *? S %#0%2, pS0#@(+, A$able shown belowB#
).2+.1 9e!iew analysis e?cluding .a!ar category' @H)3<
Supplementation Beta t " <+N CI for B
8ower bound :pper bound
onstant < E@#) 0#000 2)%)#&% 2,42#&0
,oor supplement '#022 '#@(% 0#)() '%0E#)( ,2#)%
*oderate supplement #02( #&42 #&EE ',E#%0E %@,#)2
Good supplement #0,2 %#40@ #%)% '@(#&@@ 2@)#E,
,E
>able ).2/ :ffect of food supplementation on birth weight category after
ad,usting for se? of the child C:7 le!el among the sample mothers' E@H+/+F
3ood supplementation

2
p1!alue #9 <+N CI for :R" BBC
lower :pper
CED categories %2#%,4 #002
9D ++ @#4(2 #0)2 #)0& #@&, %#02&
9D +++ %2#%)E #000 #@@2 #%,( #)%,
Sex of the ne"orn %,#0), #000 2#@E& %#&,( @#)0@
)ood supplementation status < 4(#@E M0#00%
,oor supplement 0#() 0#@@ 0#,4 0#40 %#@&
*oderate supplement 0#@E 0#&@ %#2E 0#&( 2#E
Good supplement 0#() 0#@@ %#,% 0#&( 4#(E
0avar no supplement @E#,@ M0#00% #%( 0#%2 '#@2
"onstant 42#0,& 0#000 4#4&@
^;eference group
F; S odds ratio
"I S confidence interval

2ivariate regression analysis was done to find out the association of birth weight and food
supplementation# $he model correctly classified 2&3 low birth weight only and (2#E 3 normal
birth weight babys# $he overall classification was ,&3 correct# -osmer 8emeshow goodness'
of'fit test were applied which was not significant and "I for standardi9ed regression co'efficient
was taken#
/fter removing the effect of se! of the child and early pregnancy ">4 status 2irth weight had
no significant association with food supplementation among the kapasia category# 2ut the
statistic of .avar group significantly deferred from Dapasia no supplementation group # ?or the
reference group
2
value was 4(#@E and for .avar group
2
@E#,@ with M0#00% significance level#
?or .avar category F;S 0#%(, "I *0#%2 to '0#@2+, for poor, moderate and good supplelementation
category the F; wereA #,4,%#2E,%#,%B A$able 4#2)B#
<hen analysis was repeated e!cluding the .avar category the statistical inference for Dapasia
remained the same#
>able ).24 Birth weight status among pregnancy weight gain categories
2irth weight increased with the increment of the pregnancy weight gain# .ignificant relationship
was found between the pregnancy weight gain and birth weight of the newborn# B
2
value was
%2#0( , p S #00%+, A$able 4#2,B#
,(
1regnancy weight gain 2irth weight F; (&3 "I

2
1 value
M 2&00gm U2&00gm
M (kg %22 E2#4 2E% ),#4 2#2, %#42 to @#)4 %2#0( #00%
U (kg 2) %,#) %@) @2#)
E0
>able ).26 :ffect of pregnancy weight gain on birth1weight categories after
ad,usting se? of the baby' food supplementation and C:7 status' E@H+/+F
"regnancy weight gain

2
p1!alue #9 <+N CI for :R"BBC
8ower :pper
CED categories %4#42Adf,2B #00%
9D++ 4#&)& #0@@ #&&( #@2E #(&@
9D +++ %4#42@ #000 #2(& #%&, #&&4
Sex of the ne"orn %,#&4) #000 2#4@0 %#)04 @#)E2
Food supplementation @(#%(AdfS4B #000
,oor supplement #,E@ #@,) #,)0 #4%4 %#@(&
*oderate supplement #),, #4%% %#@(0 #)@4 @#04E
Good supplement #,(% #@,4 %#)2& #&&E 4#,@,
0avar no supplement 2(#)E #000 #22, #%@@ #@E,
#regnancy "t$ gain % & 'g &#)&, #0%, %#EE4 %#%2 @#%E
onstant @0#(% #000 @#,&E
1regnancy weight gain category were formed assuming (kg as cut'off value
^ ;eference group,
F; S odds ratio,
"I S "onfidence interval for standardi9ed regression co'efficient
2ivariate logistic regression were done to find out the association between pregnancy weight gain
and birth weight ad7usting the se! of the baby,food supplementation and ">4 status of the mothers#
$he model was ,) 3 correctly classified# -osmer 8emeshow goodness'of'fit test were applied
which was not significant A
2
&#&&4, dfSE,ns B and "I for standardi9ed regression co'efficient were
noted#
/fter removing the effect of se! of the baby, food supplementation and ">4 status of the mothers
/ssuming M (kg pregnancy weight gain as reference group; the variables in the e0uation showed
birth weight had significant relationship with pregnancy weight gain A
2
H &#)&,,pS 0#0%,B # A?or U
(kg weight gain F;S %#E(B# .o the better pregnancy weight gained category was about 2 times less
likely to deliver low birth weight baby, A$able 4#2EB#
E%
>able ).26.1 :ffect of pregnancy weight gain on birth1weight after ad,usting se? of
the baby' food supplementation and C:7 status of the sample mothers(E@H+/+F
"regnancy weight gain B t " <+N CI for B
8ower bound :pper bound
onstant EE#4@% #000 2)00#0)E 2,%E#%()
Sex of the ne" orn #%E% 4#&() #000 ,E#@( %(&#@(,
CED categories '#%,& ' 4#@4, #000 '%@0#@), ' 4(#2%(
Food supplementation* '#2@( ' &#,EE #000 '2#(4E '%#4&4
#regnancy "t$ gain % & 'g #%2) @#02@ 0#00@ @)#)& %,2#)%
<%he contribution of )ood supplementation in increasing birth 1eight may be falsely interpreted if
0avar non-supplement category are taken into count> as they may cause measurement bias ?. 0o the
researcher e@cluded the 0avar participants from the analysis and found the Anot significantB
relationship bet1een birth-1eight and food supplementation > )or Capasia D & = .07!5 t = 1..25 p
= .1!25 confidence interval 1as -7..E to E0..E ?
$he t statistic for pregnancy weight gain category were significant '@#E(2, pS M0#00%# $he mean*R .4+
birth weight for the better weight gained mother was 2,@(#,*R@E%#%)+ and for the less weight gained
mothers it was 2)04#( *R@)E#4)+gms#
8inear regression analysis revealed birth weight increased with the pregnancy weight gain which was
also statistically significant after removing the effects of all the possible confounders in the study, *$ S
@#02@, pS #00@+, A$able 4#2E#%B#
+ 7iscussions
/n operational research with two sample sites was carried out in two different up9ilas to e!plore
the effects of food supplementation program by comparing the pregnancy weight gain P birth
weight of the newborn between food supplemented P non'supplemented mothers of those areas#
$his study assessed the effects of pregnancy interventions in nutrition pro7ect, recogni9ing the
importance more generally of using pro7ect'based data in assessing the effectiveness of
interventions# 5iven the recent inclusion of pregnancy related ob7ectives in large'scale
operational pro7ects and the minimal amount of impact data actually collected in such pro7ects in
the past, some attempt to assess the effects of NN1 appears crucial# "learly, the most valuable
data for such purposes would be that from evaluative studies, comparing baseline and mid'point
or end'point data in the pro7ect and control areas#
$his record'based study was carried out in Dapasia and .avar upa9ila to e!plore the effect of
targeted food supplementation by comparing the pregnancy weight gain and birth weight# 4ata
on %%(@ samples *)&E from .avar and &@& from Dapasia+ were collected# 2ut only &)& of them
met the selection criteria, therefore detailed analysis were done on those data only# $his chapter
presents those data through tables and graphs under following headings#
:ffect of .ocio1demographic !ariables among the participants
/ll the mothers included in the study were of low socioeconomic condition# Fne fifth of the
study population was of destitute category and almost all of them were in Dapasia group# $he
categori9ation criteria for destitute and poor were dissimilar for two organi9ations# /s the criteria
of being a destitute at Dapasia had almost met all the characteristics of .avar poor group, .o all
of them were considered as poor category#
/mong the selected mothers &3 of the respondents were supported by O54 card# Fne'fourth of
the samples in .avar area were -indus whereas only &#)3 of the Dapasia were -indus# /mong
the mothers selected from Dapasia upa9illa 2%% received food supplementation, rest did not
*22E+# In addition to 6.avar non'supplemented and 6Dapasia supplemented a new group
E2
6Dapasia non'supplemented was formed# $he researcher e!plored the social P demographic
status of the mothers of different categories# $he aim of the analysis was to compare their
background characteristics including age, education, and occupation between these groups of
pregnant women#
$he study included samples having their age at pregnancy between %4 and 44 years #$he mean
age at pregnancy were almost same among all three categories *? S 0#@4, pV0#0&+# 8ess than &3
of the study population had their age over @& years# A$able 4#%B
.ignificant differences were observed in the educational status between the mothers of the three
groups *
2
S 4@#4&, df S ) , p M0#00%+# Illiteracy was three times higher in .avar area mothers
*2% 3+ than those of Dapasia area *)#%3 among non'supplemented and ,#%3 in supplemented
mothers+# $he proportion of 1rimary education was least among mothers of .avar which is three
and four times higher in Dapsia non'supplemented and supplemented mothers, respectively#
A$able 4#2B
;esearcher wanted to find out the relationship of education and supplementation status only
among Dapasia categories and it was found not significant with the L
2
value of %&#02 n s*dfS (+#
$he early pregnancy 2MI in different educated group were analy9ed by one way analysis of
variance and found no significant with the mean ranged from %)#& to %)#(kg=m
2
# $he no
education group had lowest mean 2MI and the *&'(+ education group possessed the highest one#
2ut it was interesting to note that the mean 2MI of no education group is slightly higher than the
.." and above group, as only Dapasia data were analy9ed#
In total group analysis 1regnancy weight gain of highly educated category had mean *R .4 +
E#0% R2#@E was higher and significantly differ from the no education subtypes with the mean
*R.4+ )#E0 R 2#%% # Fne way analysis of variance showed ? S @#,E df S@, p S 0#0% but it was
also found no significant when only Dapasia mothers are taken into count#
E@
<eight of the newborn increased slightly but steadily with the increasing education level both in
total analysis and analysis e!cluding .avar# It was not significant statistically with the mean
ranged from *2#&2 kg+ lower to *2#, kg+ higher education category# A$able4#2#%B
Illiteracy among fathers of .avar group was higher *%(#E 3+ than that of Dapasia groups#/lmost
all the mothers were housewife e!cept %0 who were mainly N5F workers./bout &(3 of the
husbands of Dapasia supplementation group were heavy workers in comparison to the .avar
group where it was only @)#&3# .killed labour category is larger in .avar group which included
goldsmith, weaver, sweet'maker, carpenter etc than the fathers in Dapasia area# A$able4#2 B
$he age at marriage ranged from %@ years to 2& years# More than one third of the mothers *20&
among &)&+ were married below the age of %E years# $he mean age was below %E for .avar
population and above %E years for Dapasia non'supplemented group#$he age of marriage of the
husbands ranged from %& to ,2 years# A$able 4#@B
/ge class was formed as two subsets; 6 17 years and 417 years# $he proportion early marriage
ranged from @&'@E3 in all three comparison group# $he age of marriage was not associated to
either pregnancy weight gain category or birth weight category when "hi s0uare test was run,
A$able not shownB#
$here were no significant differences in gravid status among the mothers in the study# $hree
0uarters of the sample mothers conceived at least twice in their reproductive life#A$able 4#@B#
:ffect of reproducti!e health related !ariables among the study population
/nti'natal care status was classified following <-F guideline that is IM 4 visit group and 6U 4
visit group# More than one third of the .avar respondents had less than 4 /N" visit during their
gestational period# 2ut in Dapasia (,3 of the sample mothers were visited for antenatal services
for more than 4 times#A$able 4#4B
Iron and folic acid supplementation were categori9ed according to the duration of supplement, ie
*M (0 days and U (0 days+# More than E2 3 of the .avar respondents got Iron and ?olic acid
supplementation for @ months or more and the percentages were 42#& 3 and 4, 3 in Dapasia
E4
non'supplemented and supplemented group respectively# $he differences are statistically
significant with a
2
value of &4#(2 *p S M 0#00%+, A$able 4#4B#
.ignificant association was found between iron supplementation and pregnancy weight gain# $he
1earson L
2
value for all sample categories was 4#00, p value 0#0&# <hen this was performed only
for Dapasia categories, researcher found no association of iron with the pregnancy weight gain
status as neither 1earson L
2
test nor t test gave any significant test statistic# In detailed
observation he may say the ade0uate iron supplement category showed slightly increased mean
birth weight than the other category# More than E0 3 of the deliveries were conducted at home#
1rivate hospitals and clinics contributed above %03 among both areas in this regard#
$raditional birth attendant conducted more than E03 of the delivery in all three groups of both
areas# $he proportion of delivery conducted by doctors was mostly of caesarian section# $he
proportion of complication during delivery was highest in the supplemented Dapasia group
*%)#)3+ though not statistically significant#A$able 4#&B
Body mass inde? pattern among the participants
/ccording to National Nutrition 1rogram only pregnancies with 2ody Mass Inde! M%E#& were
eligible to get daily on'site supplementary feeding regimen# $o match with the supplemented
samples, mothers with 2MI M %E#&3 were selected from .avar area also# .upplemented mothers
from Dapasia area had, on average, lower 2MI *%)#2%R0#,,+ than non supplemented mothers in
Dapasia *%,#%4R#E2+ and .avar %,#0@R%#%(+ area#
Fneway /NFO/ showed the difference significant and by performing 1osthoc -ochbergs 5$2
test it was further noticed that the mean 2MI level of the supplemented group differed highly
significantly from other two groups# ? value ))#@E, p M0#00%#A$able 4#)B#
More than )0 3 of the non'supplemented mothers both from Dapasia and .avar had ">4 I level
of malnutrition while only )#)3 supplemented mothers were in this category# More than (03 of
Dapasia supplemented categories were at or below ">4 II level of malnutrition# $he variation
was highly significant *_
2
S %,@#%), pM0#00%+#A$able 4#)B
E&
$hree supplementation groups were constructed comprising low, intermediate and high number
of days of supplementation# $his separation was done because duration of food supplementation
varied from % to %)0 days# .o those who were supplemented for fewer days and those who
completed the full course of supplementation should be presented separately for finer
interpretation regarding the effects of supplementation *birth weight and pregnancy weight gain+
among different categories#
$he supplementation groups were defined as no or 0 days, M%20 *poor+ days, %20'%&( *moderate+
days and U%)0 *good+ days of supplementation, respectively# In registration month 4; no, poor,
moderate and good supplementation groups were defined as 0 days, M%00 days, %00'%@( days
and U%40 days, respectively# ;esearcher try to segregate the classification only for Dapasia
respondents as .avar population are normally destitute of supplementation# .o the classification
for Dapasia was no supplementation, poor supplementation, moderate supplementation,
6good=ade0uate supplementation
It should be kept in mind that all the Dapasia samples were eligible to get supplementation from
the NN1 program as all of them had 2MI less than %E#&# 2ut more than half of them were
discarded at the first place and half of the supplemented were dropped out before getting @
months of food support# Fne fourth of the total crossed the three months line to be entitled as
moderately supplemented# Fnly ,#, 3 of the targeted population was supplemented ade0uately,
A$able 4#,B#
$he non'supplemented group of Dapasia were mostly of ">4 I category# Fn the other hand
those who got poor, moderate or ade0uate supplementation were mostly of ">4II P ">4 III
category# $he results showed NN1 implementers of study area tried to ensure supplementation
primarily for most vulnerable ones though the enthusiasm was very much inconsistent, A$able
4#,B#
>ven after starting supplementation at early pregnancy they were unable to manage the on'site
food support consistently to all# In this study, thus only @4 out of 2%% early supplemented
mothers got complete supplementary support up'to the term# /mong E% of the severely
malnourished mothers only %& were managed to complete the full supplementation
E)
$he relationship between the supplement category and ">4 status were found highly significant
in
2
test# A
2
H%,(#2, p S M0#00%, df S EB $he mean *R.4+ 2MI of the good supplementation
group were lowest %)#0) *R,(+ and for Dapasia non supplement group it was highest
*%,#%4R#E2+# /nalysis showed .avar and Dapasia non supplement categories possessed almost
similar 2MI level although there were significant differences of the mean 2MI between these
two categories than the rest of the groups# A? ratio @&#4@, dfS4, pSM0#00%B# A$able 4#,B
<hen the analysis was done only for Dapasia it showed significant difference between the non
supplement and rest of the groups #$his finding is important because the non supplement
category possessed better early pregnancy 2MI than the supplemented ones#*?S &%#2@, p S
M0#00%+A $able not shownB
$his finding simulate the earlier statement, as it was seen before the more severely malnourished
mothers were targeted to provide supplementation as their *NN1+ field level program
implementation strategy#
"regnancy weight gain
$he weight gain ranged from 2#2 kg to %2#@ kg with meanR *.4+ of ,#&, R2#% kg# $here was
significant relationship between food supplementation and pregnancy weight gain in one way
/NFO/ *pM0#00%+# It was found that .avar group with a meanR *.4+ )#&0R *#&@+ deferred
significantly from other groups# $he 6no supplementation and poor supplementation group
gained almost same average weight during pregnancy# 2ut those who were ade0uately
supplemented gained better weight than all other groups as they gained E#&0 *R%#&(+ kg at their
prenatal period# A$able 4#EB
$hen analysis was repeated e!cluding the .avar group *as Dapasia had de novo non'supplement
group for better and logical comparison+ from the analysis to find out more specific relationship
between food supplementation and weight gain# /fter performing one way analysis of variance
no such association was found A? S %#0@ df S@, p S 0#@E ns#B
;epeated measure analysis was done to predict the weight gain pattern of different supplement
category#A ?igure &#% and ?igure &#2B# <eight gained by .avar category significantly differs from
E,
other categories# Dapasia good supplement category crosses the Dapasia poor and moderate
supplement line A2ut we found earlier that all supplemented category had almost similar early
pregnancy 2MIB# $his might suggest that supplementation might have effect on pregnancy
weight gain in severe malnourished woman but the effects of other factors related to pregnancy
weight should be ruled out#
$he average pregnancy weight gain ranged from 2#20 kg to %2#@0 kg# .everely malnourished
mothers gained better weight than those of mild P moderately malnourished category# Fne way
analysis of variance reveals significant variation in gaining weight between the categories# $he
method showed average weight gain in ">4 III category mothers significantly differs from other
two ">4 categories#* ? S (#,& and p SM 0#00%+A $able 4#(B
/fter observing the effect of ">4, 5eneral linear Model was constructed further to find out the
effect of supplementation on pregnancy weight gain considering the contribution of ">4 in this
regard# $he model showed no significant variation in weight gain among different supplement
group ad7usting the ">4 status of the mothers#
8inear regression was performed to find out the association between levels of food
supplementation on pregnancy weight gain# ? ratio for the model was %0#4( with M 0#00%
significance level# /d7usted ; s0uare for this model was #0(2 can e!plain the proportion of
variation in pregnancy weight gain by supplementation# /ssuming Dapasia non'supplement
group as reference only .avar group showed noticeable variation in mean difference# None of the
other Dapasia group varied significantly with the reference group# *tS ')#%&, p M0#00%+ and "I SA'
%#E0) to '#(@B, A$able 4#%0B#
<hen .avar group was e!cluded from the analysis there revealed no significant association
between any level of food supplementation and pregnancy weight gain# A? S %#)(, pS#%)(, nsB
and ad7usted ; s0uare was #0@2B# A$able not shownB
"regnancy weight gain and chronic energy deficiency
/s previously it was noted that the average E#%@ kg pregnancy weight gain in ">4 III category
significantly differ from ,#%@ kg of ">4 I mothers with a ? ratio (#,&, researcher tried to
EE
analy9e the situation more specifically, A$able 4#(B# .o 8inear regression analysis was performed
to find out the association of level ">4 on pregnancy weight gain removing other effects that
might contribute to the significance observed in earlier analysis# ? ratio for this model was )#@4
with p S 0#002 significance level# $he /d7usted ; s0uare was #0E( could e!plain the proportion
of variation in pregnancy weight'gain by ">4# /ssuming ">4I as reference category, only ">4
III group showed noticeable variation in mean difference# ?or ">4 III category tS @#&4, p
M0#00% and "I SA#@,) to %#@%@B#A$able 4#%%B# >ven after removing the .avar data from the
analysis the significance level remained almost same# *tS @#&), p S M0#00%+, A$able not shownB#
/s National Nutrition 1rogram targeted the ">4 mothers to supplement them and monitor
regularly ensuring pregnancy weight gain more than % kg per month for ) months, the researcher
took the opportunity to categori9e the respondents based on their total pregnancy weight gain#
$he categories were 6`&#(( Dg and 6U) Dg# Fn the other hand one of the core ob7ectives of
NN1 program is weight gain during pregnancy increased U ( kg in &0 3 women# .o this
classification was also used# ;esearcher was unable to find out relevant literature regarding
classification of weight gain# In one way it was very much realistic to categori9e weight gain
taking (kg cut'off value *as it is the program ob7ective+, on the other hand as all the samples
were mild to severely malnourished and they were studied from @
rd
to 4
th
month of their
conception it was practically reasonable to take )kg as a cut off value *one kg per month+#
.ignificant relationship between weight gain categories and food supplementation status was
found when all the categories were included in the analysis# *
2
H %0#4, dfS4, p S M0#0@4+# A$able
4#%2B#
/lmost all women of the Dapasia good supplemented category gained 6U ) Dg e!cept two# $he
table shows as the duration of supplementation increased the proportion of 6ade0uate weight
gain 6status increased steadily along'with but this variation is statistically significant at #0& level
as savar category were taken into count in the analysis# >ven though not supplemented, %E0 out
of 22E respondents gained weight ade0uately in Dapasia region# $he proportion of poor
pregnancy weight gain was more or less similar in all groups e!cept in case of .avar where more
than one third of the mothers gained weight O / kg. .electing kapasia mothers only, the
researcher further wished to find out the association between supplementation and weight gain
E(
status and no significant relation was noted# In the good supplementation category the proportion
of e!pected weight gain was almost (& 3# A$able 4#%2B#
$his variation is very important though not statistically significant# Fne of the region for getting
insignificant statistics is that the total number of respondents in ade0uate supplementation group
was only @4# A
2
value &#)2, df S@, pS #%@2, ns#B# A$able not shownB
.ignificant association was found between supplementation and weight gain categories#
2
value
4E#EA$able 4#%@B 2ut if we e!clude .avar group in which almost all of the mother were gained
below ( kg weight e!cept ) samples# $here found no such association *
2
S @#%, pS#@,), ns+#
A$able not shownB
More than one fifth of the samples managed themselves to gain weight U(kg# $he less
malnourished group *">4 I+ gained lesser weight and the severe malnourished group gained
better weight proportionally# More than half of the severe and moderate under'nutrition
subpopulation gained better weight than the mildly malnourished mothers# $here found
significant association between ">4 status and pregnancy weight gain category# *
2
S22#0,,
pSM0#00%+, A$able 4#%&B# 4uring earlier 0ualitative analysis after e!clusion of .avar category
there were no significant relationship between food supplementation and pregnancy weight gain
for the rest of the categories#
2ivariate logistic regression was done to find out the association of pregnancy weight gain and
food supplementation ad7usting the ">4 status of the mothers# /fter removing the effect of early
pregnancy ">4 status the variables in the e0uation shows pregnancy weight gain had significant
relationship with food supplementation e!cept only good supplementation category# A1oor
supplementation F;S#&E, moderate supplementation F;S#4%, .avar no .upplementation
F;S#0EB, A$able 4#%)B#
/s researcher analy9ed only Dapasia data for the same test, he observed Apoor supplementation
group F;S#&& and for moderate supplementation group F;S#@(B, poor and moderate supplement
group were 2 to 2#& times less likely to gain ade0uate weight during pregnancy#A$able not shownB
(0
2ivariate logistic regression was done to find out the association between ">4 status and
pregnancy weight gain ad7usting the food supplementation status of the mothers# /fter removing
the effect of food supplementation status and assuming ">4 I as reference group; the variables
in the e0uation showed pregnancy weight gain had significant relationship with ">4 II A
2
H
%2#%,,M0#00%B and ">4 III categories#A
2
H%)#)0,M0#00%B#
A">4 II, F;S2#& and ">4 III, F;S@#EB# ">4 II and ">4 III mothers were 2 to 4 times more
likely to gain ade0uate pregnancy weight considering effect of food supplementation# A$able
4#%,B
;esearcher was interested to find out the effect of ">4 within Dapasia samples and the data
were analy9ed accordingly# $he results showed even after e!clusion of savar group, the level of
significance remained same with a slight increment# .eparate plot were constructed to measure
the effect of supplementation on weight gain at different level of ">4# A58M# repeated
measureB# 5ood supplementation enhanced ma!imum weight gain in ">4 III mothers with
respect to other supplementation status, A?igure',#@B#
Birth weight among the participants
2irth weight varies from %&00 grams to 4000 grams# $he mean birth weight of .avar category
Mean *R.4+ 24,0R@))#0@ was less than the cut'off value of 8ow birth weight# $he meanR.4
birthweight for Dapasia non'supplemented group 2,20#%E*R@)E#)@+ grams and in Dapasia good
supplemented group it was 2,&2#(4 *R@44#E)+ grams# A$able 4#%EB
2irth weight status improved with the ">4 status in contrast to pregnancy weight gain which
was inversely proportional among ">4 categories# $he severely undernourished group delivered
babies with mean *R .4+ weight of 2&&4#@, R @)2#(@ grams and the mild under'nutrition
mothers gave birth of better weighted child# $he variation among the groups were significant
at0 #02 level# ?S @#(2#A$able 4#20B
/ little less than half of the poor supplemented group delivered low birth weight baby whereas
almost all of the good supplemented mothers delivered normal weight babies e!cept five# $he
relevant statistic suggested that birth weight improved steadily as the duration of
(%
supplementation increased, A$able 4#2%B#?or all categories the association among
supplementation and birth'weight was more evident *
2
S &0#EE, df S@, pS M0#00%+, A$able 4#2%B#
<hen
2
test was done selecting only Dapasia data, significance in variation in birth weight
category persisted between poor supplemented and good supplemented samples *
2
S ,#(4 , pS
0#0&+A$able not shownB
$he proportion of low birth weight varies with various level of "hronic >nergy 4eficiency
status# More than half of the ">4III mothers delivered low birth weight child# /s previous
analysis concluded that weight gain was highest among good supplemented mothers and good
supplemented mothers delivered better weighted child so the proportion of low birth weight
should be lower in this category# Fnly %& out of E% ">4 III mothers were supplemented
completely and for obvious region the role of full supplementation among severely malnourished
mothers regarding birth weight was not reflected when all ">4 III mothers were taken into
count,A $able 4#,BA$able 4#22B#
$otal &)& babies were included in the study among them *&43+ were male and *4)3+ were
female# $he mean birth weight deferred significantly between male and female babies# $he male
babies delivered with mean *R.4+ 2,04#0*R@,,+gm birth'weight and female babies attained
2&,@#2*R@)4+ gm # *tS '4#%,, pSM0#00%#+, A$able 4#2@B# ?emale babies mean birth'weight
deferred significantly between Dapasia non'supplemented from .avar no supplement and
Dapasia poor supplement categories# *?S &#)&, df 4, pS M0#00%+, A$able 4#24B# .ignificant weight
variation of female babies between non'supplement and poor supplement group still remained if
only Dapasia groups were compared# *?S @#02, pS 0#0@%+ but it was not the same for male babies
of Dapasia#
$o find out the absolute effect of supplementation on birth weight linear regression was
performed ad7usting se! of the babies and "hronic >nergy 4eficiency status# ? ratio for the
model was %2#@, with M 0#00% significance level# /d7usted ; s0uare for this model was #%%2 can
e!plain the proportion of variation in birth weight by supplementation# /ssuming Dapasia non'
supplement group as reference only savar group shows noticeable variation in mean difference#
(2
None of the other Dapasia group varied significantly with the reference group# ?or .avar
category tS ')#%2, p M0#00% and "I SA'@%(#02 to %)@#(%B#
<hen .avar group was e!cluded from the analysis there revealed no significant association
between any level of food supplementation and birth weight# ? S %#0%2, ns#A$able 4#2&B# /s only
%& out of E% ">4 III mothers were supplemented completely, so the role of full supplementation
among ">4 III regarding birth weight was not reflected when all ">4III mothers were taken
into count#
2ivariate regression analysis was done to find out the association of birth weight and food
supplementation# $he model was ,& 3 correctly classified# /fter removing the effect of se! of
the child and early pregnancy ">4 status birth weight had no significant association with food
supplementation among the kapasia category, A$able 4#2)B# 8astly researcher tried to find the
relationship between pregnancy weight gain and birth weight status# 2irth weight increased with
the increment of the pregnancy weight gain# .ignificant relationship was found between the
pregnancy weight gain and birth weight of the newborn# *
2
value was %2#0(, p S #00%+#
2ivariate logistic regression was done to find out the association between pregnancy weight gain
and birth weight ad7usting the se! of the baby, food supplementation and ">4 status of the
mothers# $he model was ,) 3 correctly classified# /fter removing the effect of se! of the baby,
food supplementation and ">4 status of the mothers and assuming M (kg pregnancy weight gain
as reference group; the variables in the e0uation showed birth weight had significant relationship
with pregnancy weight gain A
2
H &#)&,,pS 0#0%,B #A?or U (kg weight gain F;S %#E(B# .o the
better pregnancy weight gained category was about 2 times less likely to deliver low birth weight
baby#
8inear regression analysis revealed significant difference of mean birth birth'weight between
pregnancy categories after removing the effect of all possible confounders# ? ratio for the model
was (#%4, pS0#00@# ;esearcher at this stage might conclude 2irth weight increased with the
pregnancy weight as for U ( kg category *t S @#02@, pS #00@#+A$able 4#2E#%B
>ffect of food supplementation on pregnancy weight gain using ">4 as an indicator for under'
nutrition should be interpreted carefully, as pre'pregnancy ">4 or even early'pregnancy ">4 is
(@
often inversely associated with gestational weight gain
4)
#presumably as a physiological
compensatory mechanism for pre'pregnancy under'nutrition.
Comparison of !arious studies

In the present study weight gain was inversely correlated with 2MI and initial weight# ">4 III
women gained relatively more weight during their pregnancy than ">4 I women, a result in
keeping with other studies in 2angladesh,
29,31,33
>ast Yava, Indonesia
4,
, 1akistan
4E
and $aipei,
;epublic of "hina
4(
# $his record based study also showed that supplementation had an
insignificant effect on birth weight, in keeping with some studies
(50 55)
, while other studies
have reported a significant impact of supplementation on birth weight
*&)')%+
# $he most recent food
supplementation trial on undernourished women from the 5ambia
*&)+
reported considerably larger
effects on birth weight# $he present study, however, was unable to show significant improvement
in birth weight and reduction in 82< prevalence# $he difference may be e!plained by the much
higher energy *42&E kY *%0%, kcal++ and protein content *22 g+ of the 5ambian supplement
compared with that used in 2angladesh *2&%2 kY *)00 kcal+ and E#0T(#4 g, respectively+#
/s fully supplemented ">4 III mothers gave birth almost same weighted babies in comparison
to the babies of ">4 I mothers; the recovery from being rather less weighted to the current status
should be considered as a potential effect of food supplementation# $his finding also directed our
view to the composition of the supplementation regimen provided by the NN1, that contain lesser
amount of protein Aall the protein derive from vegetable sourceB than any other regimen trialed so
far#
$he second e!planation may be that the food supplementation in the NN1 may be a replacement
not a supplement, which is supported by the findings of 2IN1 operational research
62
that @03
of the women substituted at least part of their domestic food intake by NN1 food supplements# /
<-F collaborative study
)@
showed that weight gain of %#& kg=month during the last two
trimesters is consistent with good pregnancy outcomes# -owever, the average monthly weight
gain in the present study was considerably lower, averaging only 0#(2 kg=month in the second
(4
and third trimesters. In his meta'analysis Dramer

showed no evidence that supplementation had
a larger effect in undernourished women and concluded that the increment in birth weight
)4
,due
to supplementation was no larger in those women who were undernourished prior to or during
pregnancy# .everal researchers have argued that the degree of maternal undernutrition may affect
the response to supplementation
65, 66
.
$hey suggest that supplementation of mild malnourished women produces an increase in birth
weight but has little impact on maternal weight gain# -owever, when seriously malnourished
women are supplemented they cannot 6afford to direct the energy to the fetus and therefore such
supplementation improves maternal weight gain more than birth weight# $he results of the
present study also show that although severely malnourished women gained significantly more
weight in pregnancy, they had a higher proportion of 82< babies compared with mild
malnourished women#
$he importance of taking data from two areas was not established in a way that it was planned
for# 2ut researcher found it also interesting that why different organi9ations claim different
parameters regarding health matters# $he formats they used to collect data were dissimilar as
well as the workers who involved with this procedure Ain terms of training, e!perience and
educationB# $he logistics were also different Asome used digital machines and others used
calibrated scaleB # Monitoring and data 0uality checking were also not uniform for different
organi9ation# $hat is why researcher, most of the time interpreted and commented on the Dapasia
data alone#
(&
/.1 Conclusions
$his operational research based on recorded data, was conducted to observe the effect of
supplementation comparing pregnancy outcome between two areas# Mostly ">4 II and
">4 III were given priority for intervention# $he program coverage in terms of ade0uate
supplementation was only *,#,4 3+# $he present study found that there were significant
differences in pregnancy weight gain and birth weight between two areas#
1regnancy weight gain was better in severe malnourished *">4 III+ mothers than the other
categories# ;esults suggested that at least one of the ambitious NN1 ob7ectives relating to
pregnancy outcomes, namely attainment of a total pregnancy'related weight gain of ( kg in
403 of ">4 III women; may had been about to met#
2irth weight, on the other hand was not influenced by any level of supplementation after
removing the affects of nutritional status and se! of the child# 2ut pregnancy weight gain
had positive influence on gaining better birth weight when the effects of nutritional status,
supplementation status and se! of the child were removed# $his very interpretation might
helped the researcher to e!plain, even after gaining targeted pregnancy weight gain the ">4
III mothers delivered less weighted child than the ">4I category# Nutritional support
provided by NN1 thus helped ">4 III mothers to meet the unmet energy re0uirements
presumably as a physiological compensatory mechanism for pre'pregnancy under'nutrition
but its contribution regarding birth weight increment was not significant#
()
/.2 9ecommendations
$he researchers failed to e!plain the /sian enigma of low birth weight reduction by
nutritional intervention programs adopted by different population and the basis of our
knowledge about supplementary food is so far weak, with seemingly contradictory results of
various studies# /n e!perienced team of researchers with ade0uate relevant e!perience in
relative fields may guide us to the end of the tunnel# 4efinitely it will be a very tough task
with tremendous challenge#
.ome recommendations are as follwsK
%# National and political commitment should be optimi9ed and operational research works
should be encouraged at regular basis as it is one of the largest budget program A(2
million :. WB involving public'private partnership#
2# /s pregnancy outcome is inevitably related to the pre'pregnancy nutritional status, all
malnourished as well as undernourished women should be targeted for supplementation
at or above the age of %& years# $he adolescent awareness component and mother in law
awareness component of the NN1 program should be strengthen regarding improvement
of pre and early pregnancy 2MI#
@# .upplementation should be provided to all malnourished mothers uniformly and
consistently and off course should be practiced on on'site basis# 4uration of
supplementation should be followed meticulously, so that all of the enrolled mothers may
get the full course supplementation#
4# $he supplementation regimen of NN1 should be enriched with protein content Aat least
%&3 of the total calorie intakeB and the protein should be preferably of animal origin as
trialed in various other similar intervention program#
&# $he logistics and supplies for this program should always be available and accessible;
specially the measuring instruments should be ade0uate in number and also be checked
regularly for accuracy and precision# $he recording and reporting system should be
(,
simpler, precise and accurate# $here should be regular dissemination meeting at all
administrative level#
9:3:9:@C:.
%# Oillar Y, P ;ivera Y# Nutritional .upplementation 4uring $wo "onsecutive
1regnancies and the Interim 8actation 1eriodK >ffect on 2irthweight# ,ediatrics.
%(EE; E%*%+K&%'&,#
2# ;ush 4# Maternal nutrition and perinatal survival# F Health ,opul "utr. 200%;
%(K.2%,')4#
@# Mc"ormick M# $he contribution of low birth weight to infant mortality and childhood
morbidity# " 9ngl F *ed. %(E&;@%2KE2'(0#
4# 2arker 4Y1# Mothers, babies and health in later life# >dinburghK 8ivingstone# %((E;2%,
p#
&# Dramer M.# 2irthweight and infant mortalityK perceptions and pitfalls# ,aediatr
,erinat 9pidemiol. %((0; 4K@E%'(0#
)# Dramer M.# 2alanced protein=energy supplementation in pregnancy *"ochrane review+#
ochrane Libr 200@*2+#
,# "eesay .M, 1rentice /M, "ole $Y, ?oord ?, <eaver 8$, 1oskitt >M> et al# >ffects on
birth weight and perinatal mortality of maternal dietary supplements in rural 5ambiaK &
year randomised controlled trial# &r *ed F. %((,;@%&K,E)'(0#
E# Ca7nik "., 8ubree -5, ;ege .., Naik .., 4eshpande Y/, 4eshpande .. et al#
adiposity and hyperinsulinemia in Indians are present at birth# F lin 9ndocrinol *etab
2002; E,K&&,&'E0#
(# Frtolano .>, Mahmud N, Dabir /?MI, 8evinson ?Y# >ffect of targeted food
supplementation and services in the 2angladesh Integrated Nutrition 1ro7ect on women
and their pregnancy outcomes# F Health ,opul "utr. 200@;2%KE@'(#
%0# 2elsey M/# "hild health and developmentK health of the newborn# InK 2aum Y4, ed#
2irth risk# .# New CorkK ;aven 1ress# %((@;%'24#
(E
%%# Oillar Y, "ogswell M, Destler >, "astillo 1, Menende9 ; P ;epke Y#$# >ffect of ?at and
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Gbstetrics and Gynecology. %((2;%),*&+K%@44'%@&2#
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%@# Oillar Y, de Fnis, M, Destler >, 2olanos ?, "ere9o ; P 2erneded -# $he 4ifferential
Neonatal Morbidity of the Intrauterine 5rowth ;etardation .yndrome# 'merican
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