Integrating Nutrition Into Health Systems at Community Level:Impact Evaluation of the Community‐Based Maternal Andneonatal Health and Nutrition Projects in Ethiopia, Kenya, and Senegal

Maternal undernutrition and mortality remain high in several African countries. Key nutrition andhealth interventions improve maternal and birth outcomes. Evidence is scarce on how tostrengthen health systems to ensure pregnant women and newborns are reached with theseinterventions. We conducted three quasi‐experimental nonrandomized Community BasedMaternal and Neonatal Health and Nutrition projects in regions of Ethiopia, Senegal, and Kenyato demonstrate how proven nutrition interventions could be integrated into health programs toimprove knowledge and practices during pregnancy, birth, and postpartum. We evaluated impacton knowledge and practices related to maternal and neonatal care using logistic regression andrepeated‐measures models with districts as a fixed variable and adjusted for covariates. Com-bined country analyses show significant positive effects of the intervention on women receivingfirst antenatal care visit (ANC) during first trimester (OR = 1.44;p\u3c .001), those consuming anyiron and folic acid supplement during their latest pregnancy (OR = 1.60;p= .005), those whose\u3c6 months infants were exclusively breastfed (OR = 2.01;p=.003), those whose delivery wasfacility based (OR = 1.48;p=.031), and those whose postnatal care was facility based (OR =2.15;p\u3c.001). There was no significant differences between intervention and control groupsregarding one or more and four or more ANC visits, women consuming iron and folic acid for≥90 days, and early initiation of breastfeeding. We conclude that integrating proven nutritioninterventions into health programs at community level improved components of access to anduse of ANC, delivery services, and postnatal care by women in three African countries