Gulshan Ara Associate Scientist Nutrition and Clinical Services Division Icddr,b

1. DELIVERING FOR NUTRITION IN SOUTH ASIA
Implementation Research in the Context of COVID-19
Date:1 December, 2021
Gulshan Ara
Associate Scientist
Nutrition and Clinical Services Division
Icddr,b
Impact of COVID-19 Pandemic on Dietary
Diversity and Nutritional Status of
Pregnant Women and Under Two- Years
Children Among Beneficiaries of a
Livelihood Improvement Program

2. Background and rationale
• The global social and economic crisis triggered by the COVID-19 pandemic poses
grave risks to the maternal and child undernutrition across LMICs (Heady et al., 2020)
• The crisis setbacks to already insufficient progress towards meeting the global nutrition
targets set for 2025 for stunting, wasting, maternal anaemia and breastfeeding
(Headey, D. et al., 2020)
• It is estimated that by 2022, COVID-19-related disruptions could result in an additional
9.3 million wasted children and 2.6 million stunted children
• 168,000 additional child deaths, 2.1 million maternal anaemia cases, 2.1 million
children born to women with a low BMI
• US$29.7 billion in future productivity losses due to excess stunting and child mortality
(Saskia et al, 2021)

3. • The objective of this study was to assess the impact of COVID-19 pandemic on
dietary intake and nutritional status among pregnant women and under two years
children who were exposed to a nutritional intervention from a livelihood improvement
project for two years
Specific objectives:
To assess the impact of COVID-19 pandemic on dietary intake and nutritional status
among pregnant women beneficiaries of a livelihood program
To assess the impact of COVID-19 pandemic on dietary intake and nutritional status
among Under two years children beneficiaries of a livelihood program
Objective

4. •Pregnant women
•U-2 Children
Cross - sectional Population
•24 Upzilas-Project
•14 Upazilas-Control
Multistage cluster
sampling Study area
•Pre-COVID: Feb-Mar, 20
•During COVID- Sep, 20
Duration
Standard Operating
procedure
SES,IYCF, MDD,ANC,
anthropometry,
Haemoglobin
Training
Design
Sampling
procedure
Sample size Pregnant:1701
U-2:3535
Data collection
SES: Socio-economic status, IYCF: Infant and Young Child Feeding, MDD: Minimum Diversity
Both descriptive and inferential statistics were performed in STATA 14
Data analysis
Methods/Analysis

5. Background Characteristics of the Respondents
28
62
10
13
2
16
9
42
17
54
31
28
61
11
15
5
12
22
12
31
43
24
0
10
20
30
40
50
60
70
Percent
*
*
• Significantly higher proportion of households in the project areas were involved in poultry rearing and owned
any homestead garden *p < 0.05

6. Intake of Different Food Groups by the Pregnant
Women
*
*
• Significantly higher proportion of project women consumed pulse/lentil, dairy, egg and vit A rich fruits and vegetables in
last 24 hours in the pre-COVID survey compared to the during - COVID survey
54
60
90
72
57
66
38
36
87
48 47
41
0
20
40
60
80
100
Percent
Project Pre-COVID Project During-COVID
*
* *
30
39
85
50 50
39
41
36
86
44
49
29
Control Pre-COVID Control During-COVID
* p<0.05

7. Dietary Diversity (MDD-W) of Pregnant Women
25
75
50 50
56
44
55
45
0
10
20
30
40
50
60
70
80
< 5 food groups > 5 food groups < 5 food groups > 5 food groups
Percent
Project Control
Pre-COVID During-COVID
• Significantly higher proportion of project women consumed more than 5 food groups before COVID-19
*
*p < 0.05

8. Average Weight of Pregnant Women During Three Trimesters
• Average weight of the project women was 2 kg higher in 2nd and 3rd trimester before COVID-19
52
54
58
52 52
56
49
50
51
52
53
54
55
56
57
58
59
Ist Trimester 2nd Trimester 3rd Trimester
Mean
weight
(kg)
Pre-COVID
52
53
58
50
52
57
46
48
50
52
54
56
58
60
Ist Trimester 2nd Trimester 3rd Trimester
Mean
weight
(kg)
During-COVID

9. Anemia Status of Pregnant Women
41
59
33
67
0
10
20
30
40
50
60
70
80
> 11.0 g/dl (Non -Anemic) < 11.0 g/dl (Anemic)
Percent
Pre-COVID
*
37
63
21
79
> 11.0 g/dl (Non -Anemic) < 11.0 g/dl (Anemic)
During-COVID
•Prevalence of anemia was significantly higher in control area in both study points
*
*p < 0.05

10. IFA Supplementation by Pregnant Women
83
39
61
89
11
61
21
79
89
11
50
22
78
81
19
60
16
84
87
13
0
20
40
60
80
100
IFA Recived > 90 IFA < 90 IFA Daily Weekly IFA Recived > 90 IFA < 90 IFA Daily Weekly
Percent
During - COVID
Pre - COVID
• IFA consumption was significantly higher among the project women before COVID but no difference was
observed in during- COVID survey
*
*
*p < 0.05

11. Antenatal Care (ANC) of the Pregnant Women
19
67
13
45
48
7
0
10
20
30
40
50
60
70
No ANC 1-3 Visit 4 + Visit
Percent
Before- COVID Project Before- COVID Control
*
*
39
56
4
42
51
8
No ANC 1-3 Visit 4 + Visit
During - COVID Project During - COVID Control
• During COVID data collection; a higher percentage of project women did not have ANC check up
*
* p<0.05

12. Infant Feeding Practices
84
95
5
86
77
88
11
82
68
89
22
69
80
92
9
76
0
20
40
60
80
100
EIBF Received
Colostrum
Prelacteals
given
EBF EIBF Received
Colostrum
Prelacteals
given
EBF
Percent
Project Control
During - COVID
Before - COVID
*
*
*
*
• EBF rate was significantly higher in project area in both study points
• Pre-lacteal feeding practice was significantly lower before COVID *p < 0.05

13. Intake of Different Food Groups by Children
95
42 40
65
60
63
45
89
25
40 41
33
39
28
0
20
40
60
80
100
Percent
Pre- COVID Project Pre- COVID Control
* * *
*
91
23
41
59
49 51
33
19
32
56
45 44
31
During-COVID Project During-COVID Control
*
*
• Significantly higher proportion of project children consumed pulse, animal protein, vit A rich fruits and vegetables
in last 24 hours in the before COVID
* p<0.05

14. Complementary Feeding Practices
63
79
53
97
32
55
24
94
0
20
40
60
80
100
MDD MMF MAD Continuation of
BF
percent
*
*
*
46
75
40
96
38
68
32
94
MDD MMF MAD Continuation of
BF
• Uptake of minimum acceptable diet among project children aged 6–23 months was significantly higher before COVID
Before - COVID During - COVID
*p < 0.05

15. Prevalence Stunting, Wasting and Underweight
among the Study Children
• Prevalence of underweight was significantly higher among the control children in the during – COVID survey
*
*p < 0.05
22
7
15
23
9
16
0
5
10
15
20
25
Stunting Wasting Underweight
Pre- COVID Project Pre- COVID Control
21
8
15
22
10
21
Stunting Wasting Underweight
During- COVID Project During- COVID Control

16. Factors Associated with Undernutrition Among Children aged <2years
Underweight Stunting Wasting
Indicators Adjusted OR p-value Adjusted OR p-value Adjusted OR p-value
Project exposure
Project 1 1 1
Control 1.15 (0.93, 1.44) 0.194 1.0 (0.80, 1.20) 0.875 1.09 (0.81, 1.41) 0.576
Study points
Pre-COVID 1 1 1
During- COVID 1.30 (1.24, 1.87) 0.005 0.86 (0.73, 1.01) 0.074 1.09 (0.85, 1.39) 0.480
Asset Index
Poorest 1 1 1
Poorer 0.72 (0.55, 0.93) 0.015 0.90 (0.71, 1.16) 0.423 0.78 (0.55, 1.11) 0.165
Middle 0.66 (0.50, 0.86) 0.003 0.81 (0.63, 1.04) 0.100 0.64 (0.44, 0.92) 0.015
Richer 0.67 (0.51, 0.88) 0.004 0.81 (0.63, 1.04) 0.108 0.63 (0.43, 0.91) 0.014
Richest 0.54 (0.40, 0.72) 0.000 0.60 (0.46, 0.78) 0.000 0.66 (0.48, 0.96) 0.031
Received advice on IYCF
No 1 1 1
Yes 0.87 (0.70, 0.11) 0.206 0.82 (0.67, 0.90) 0.044 0.79 (0.85, 1.38) 0.118
Child Sex
Male 1 1 1
Female 0.56 (0.47 0.67) 0.000 0.6 (0.51, 0.70) 0.000 0.57 (0.45, 0.73) 0.000
Age in months
0-6 months 1 1 1
7-24 months 1.40 (1.15, 1.70) 0.000 1.8 (1.5, 2.1) 0.000 1.44 (1.11, 1.89) 0.007
Multiple logistic regression analysis; Adjusted odds ratio (AOR), 95% confidence interval (C.I.) in parentheses

17. • The dietary diversity of pregnant women and children in the project was
significantly better than control children and women before COVID-19. The during-
COVID survey showed no significant difference in the dietary diversity between the
project and control areas
• The average weight of the project pregnant women were 2 kg higher in their
second and third trimester before COVID – 19
• Prevalence of anemia was significantly higher in control areas in both study points
• Underweight rate was significantly higher in the control children than the project
children in the during-COVID survey
Conclusion and Policy Implications

18. • Recommended intake of IFA supplementation was higher before COVID-19
among the project pregnant women
• Deterioration in dietary diversity, increased underweight among the control
children and low uptake of health services by the pregnant women in during-
COVID survey could be explained by the downward livelihood status of the poor
rural people and disruptions to food and health systems
• In pandemic situations, the availability of and access to food depend on:
opportunities for agricultural production; purchasing power and market access
• Emergency food ration for the marginal income families can be a potential solution
to protect and prevent pregnant women and children from worsening their
nutritional status
• Governments and donors must maintain nutrition as a priority, continue to support
resilient systems and ensure the efficient use of new and existing resources

19. Thank you