A grandmother-inclusive approach to maternal nutrition is associated with improved maternal diet, health-seeking practices, and birthweights in rural Sierra Leone

BackgroundIn many communities across the Global South, senior women are key advisors on nutrition and health to younger women. Yet most maternal nutrition and health education continues to focus on the mother–child dyad with limited results. Formative research in rural Sierra Leone identified grandmothers as influential advisors on maternal diet and health practices. Based on these findings, World Vision and partners piloted the grandmother-inclusive approach (GMIA) to improve maternal diets, health-seeking practices, and birth outcomes.ObjectiveThis pilot study compared a family systems approach focused on grandmothers as change agents with the traditional mother-focused education approach to improve maternal nutrition and health practices.MethodsUsing a quasi-experimental design, we compared maternal dietary practices, health-seeking behaviors, and birth outcomes in GMIA intervention communities with other communities receiving standard nutrition and health education in rural Sierra Leone. This paper reports findings from the quantitative endline survey of 375 households with pregnant women and children under two years in intervention and comparison communities. Differences in maternal dietary practices, health-seeking behaviors, and birthweights were assessed using multiple regression analysis, adjusting for sociodemographic characteristics.ResultsIn adjusted models, women in intervention communities had greater odds of achieving minimum dietary diversity (adjusted odds ratio [AOR] 13.5; 95% CI: 4.9–37.3), consuming more frequent meals (mean difference=0.5; 95% CI: 0.2, 0.9) and reporting four or more antenatal care visits (AOR 9.1; 95% CI: 1.8–45.2) than women in comparison communities. Women in intervention communities also reported higher adherence to daily iron–folic acid supplementation (AOR 6.4; 95% CI: 2.3–17.3). Mean birthweights were higher in intervention communities, with an adjusted difference of 0.22 kg (95% CI: 0.07–0.36).ConclusionFindings from this pilot study suggest that a grandmother-inclusive approach may improve maternal nutrition and health practices and increase birthweights in ruralSierra Leone.