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ORIGINAL ARTICLE
Year : 2022  |  Volume : 12  |  Issue : 2  |  Page : 66-71

Nutritional Impact of Millet-based Foods on Pregnant and Nursing Women from Anganwadi Centers in Mahabubnagar


1 Office of the District Collector, Mahabubnagar Collectorate, Mahabubnagar, Telangana, India
2 Department of Nutrition and Dietetics, Symbiosis Institute of Health Sciences, Symbiosis International (Deemed) University, Pune, Maharashtra, India

Date of Submission18-Sep-2021
Date of Decision06-Dec-2021
Date of Acceptance17-Dec-2021
Date of Web Publication10-May-2022

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnpnd.ijnpnd_60_21

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   Abstract 


Background: In 1975, the Government of India initiated the Integrated Child Development Services (ICDS) Scheme. The Supplementary Nutrition Program (SNP) under the ICDS provides meals to pregnant and nursing women at Anganwadi centres (AWCs) to improve their nutritional status. Aim: The current interventional study focused on identifying nutritional impact of millet-based foods (such as millet health mix, millet energy bars, finger millet cutlets, and finger millet biscuits) pre- and postintervention on weight, Body Mass Index (BMI), and hemoglobin of pregnant women and nursing mothers. Methods: Pregnant (n = 22) and nursing women (n = 16) from four AWCs of Gangapur village, Mahabubnagar, Telangana voluntarily participated in this study. Statistical analysis was conducted using SPSS and P-value of <0.05 was considered statistically significant. Results: The mean weight gain for pregnant women was 3.63 ± 5.29 kg with mean hemoglobin improvement of 0.5 ± 1.30 g/dL. Similarly, the mean weight gain for nursing women was 3.0 ± 6.00 kg and mean hemoglobin improvement of 0.9 ± 1.60 g/dL. A paired t test analysis revealed statistically significant change in weight (P = 0.001, P = 0.002) and BMI (P = 0.001, P =0.004) pre- and postintervention at 95% CI, indicating a positive impact of these millet-based foods on weight and BMI. Conclusion: Since these millet-based foods have a positive impact on the nutritional status of pregnant women, it is recommended that these foods be incorporated into the SNP Program for ICDS beneficiaries.

Keywords: Anganwadi centers (AWC), Body Mass Index (BMI), hemoglobin, millet-foods, Supplementary Nutrition Program (SNP), weight


How to cite this article:
Sharat Dhruthi D, Gokhale D. Nutritional Impact of Millet-based Foods on Pregnant and Nursing Women from Anganwadi Centers in Mahabubnagar. Int J Nutr Pharmacol Neurol Dis 2022;12:66-71

How to cite this URL:
Sharat Dhruthi D, Gokhale D. Nutritional Impact of Millet-based Foods on Pregnant and Nursing Women from Anganwadi Centers in Mahabubnagar. Int J Nutr Pharmacol Neurol Dis [serial online] 2022 [cited 2022 May 22];12:66-71. Available from: https://www.ijnpnd.com/text.asp?2022/12/2/66/345020


   Introduction Top


Pregnancy is a physiological condition with an increased demand for nutrients to promote growth and development of the fetus. Consequently, changes in weight, plasma and blood volume, and alterations in hormonal activity occur during pregnancy.[1] Iron-deficiency anemia is one of the immediate concerns resulting due to an inadequate intake, lowered absorption, poor stores, and infections. [2,3] Similarly, nursing mothers too experience iron-deficiency anemia due to iron loss that is further aggravated due to menstruation that occurs post-delivery.[4] Hence, there is a need to provide complete nutrition in terms of calories and proteins, with an emphasis on iron among pregnant and nursing mothers.[4] A study conducted in Kerala indicated that reiterating nutritional practices in prenatal and postnatal interventions with nursing mothers play an important role in improving their nutritional status.[5]

The Integrated Child Development Services (ICDS) is a platform for the delivery of nutritional interventions under the Supplementary Nutrition Program (SNP) at community level through Anganwadi Centers (AWCs) operated by Anganwadi Workers (AWWs). Despite the efforts of ICDS, high rates of malnutrition are prevalent evidenced by reports from the National Family Health Survey (NFHS), the United Nations Children’s Emergency Fund, and the World Health Organization (WHO).[2] The NFHS 5 statistics indicated that 18.7% of women in India, 18.8% in Telangana, and 24% in Mahabubnagar had a BMI less than 18.5 kg/m2. Further, the NFHS 5 statistics also highlighted that 57% of women in India, 57.6% in Telangana, and 54.7% in Mahabubnagar were anemic between 15 to 49 years.[6] These statistics clearly depict the poor nutritional status and compliance to SNP. Further, studies[7] have highlighted that various factors such as quality, hygiene delivery of the foods served, and gaps in programmatic policies at AWCs contribute to poor compliance with SNP.[8] AWWs prioritized providing preschool education, conducting home visits or surveys, and record maintenance over the SNP.[9] On the other hand, the planning commission report stated that AWWs face challenges in meeting the high expectations of the communities. [9,10] This further results in poor utilization of SNP services at AWCs[2] among both pregnant (46%) and lactating mothers (56.8%).[10] Hence, it is essential that food-based interventions are planned considering these challenges.[10]

Previous food-based interventions highlighted that millets contain 60% to 70% of carbohydrates, 7% to 11% proteins, 1.5% to 5% fats, and 2% to 7% crude fiber. They are also a rich source of vitamins and minerals such as B complex, magnesium, iron, and antioxidants.[11],[12],[13],[14] Previous studies[14],[15] demonstrated that malted millet-based foods such as ladoos, kheer, and porridge have a positive impact on the nutritional status of pregnant and nursing mothers and children.[14],[15] Hence, this study utilized energy-dense millet-based formulations to assess the impact on weight, hemoglobin, and BMI of pregnant and nursing women.

[TAG:2]Materials and Methods[TAG:2]

Study design

This interventional study [[Figure 1]] was conducted at four AWCs of Gangapur Village in Jadcherla mandal of Mahabubnagar district, Telangana. The study was conducted between November 2018 and February 2019 among pregnant (n = 22) and nursing (n = 16) women who were ICDS beneficiaries. The study included pregnant and nursing women enrolled into four AWCs at the beginning of the intervention, that is, November 2018. All other women enrolled after the stated period were excluded from the study. Millet-based foods were supplied to these women on all working days. The formulations of these millet based were developed by an urban food–producing company Healthy Farm Foods LLP, Hyderabad. The company was responsible for the formulation, preparation, sensory evaluation, and hygiene maintenance of the millet-based foods. These foods were prepared by the following steps depicted in [Figure 1]. The composition, serving size, and nutritional value of millet-based foods are depicted in [Table 1].
Figure 1 The various steps involved in the preparation of millet-based foods undertaken by the food processing company.

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Table 1 Description of millet-based recipes

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The millet-based complementary food products supplied include:Mixed millet milk malt: A mixed millet malt was prepared from the flour of various millets, jaggery, and milk powder. Jaggery is a sugar product developed from sugarcane. It contributes to sweetness and is a source of iron.[16] Milk powder enhances the nutrient density. Fifteen grams of the malt was served in 100 mL water every day.Ragi cutlets: Ragi cutlets were prepared from Ragi (finger millets) flour. Ragi is rich in proteins, iron, calcium, phosphorus, and fiber.[17] A premix was prepared and distributed to AWWs. AWWs added 50 g of drumstick/spinach/fenugreek leaves, 15 g carrot, and 15 g of beetroot to prepare cutlets at AWCs. Two ragi cutlets weighing 30 g each were served once a week.Mixed Millet Energy Bars: Mixed millet malt energy bars were prepared from various millets and jaggery flour. The flour was processed into a bar. Two bars of 25 g each were served once a week.Ragi biscuits: Ragi biscuits were prepared from Ragi (finger millets). Two Ragi biscuits weighing 20 g each were served four times a week.

These millet-based foods were first introduced to five pregnant and five nursing mothers to understand their acceptance. It was observed that these foods had a strong acceptability by beneficiaries. The cost of the intervention was between Rs 4 and Rs 8 per beneficiary per day. The financial support for the intervention was provided by the Government of Telangana through the district collector funds.

Sampling

Purposive sampling technique was followed to select the mandal based on its proximity to the district headquarters. Gangapur village was chosen because it was the biggest village in the mandal. All four AWCs in this village were included in this study.

Data collection

Data on weight, BMI, and hemoglobin were collected during baseline and endline. An AWW measured the monthly weight gain through an adult weighing scale and the height through a stadiometer during the baseline. These measurements were used to calculate the BMI using a standard formula of weight in kilograms/(height in meters)2.[18] Data on hemoglobin were collected by official laboratory technicians using Sahli hemoglobinometer. The beneficiaries were categorized into various categories of anemia based on WHO (2007) standards[19] and BMI based on Institute of Medicine (IOM 2009) guidelines[20] for pregnant women, respectively.

Human research

The institutional review committee from Government Medical College Mahabubnagar reviewed and approved the study. Although pregnant (n = 37) and nursing (n = 27) women under the ICDS system women were enrolled in the study, only 22 pregnant and 16 nursing mothers consumed the millet-based foods continuously for 3 months and were considered as the final sample. The research was conducted as per the ethical standards of the review committee and verbal consent was taken from the participants.

Statistical methods

The collected data were entered in Microsoft Excel, cleaned, and exported to SPSS. Data were analyzed using SPSS (IBM) version 27. Descriptive statistics were conducted to determine the frequency, percentage, mean, and standard deviation. A paired t test was conducted to observe the difference of means for weight, hemoglobin, and BMI on pre- and post-intervention parameters at 95% confidence interval (CI) and P-value of <0.05 was considered statistically significant.


   Results Top


The objective was to introduce millet-based foods to pregnant and nursing women at AWCs and to assess their impact on weight, hemoglobin, and BMI. The findings are presented in [Table 2].
Table 2 The pre- interventional and post-interventional weight, hemoglobin, and BMI of pregnant and nursing women

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An improvement in mean weight from 51.1 ± 2.76 kg to 52.23 ± 5.81 kg was observed with an increase in the number of pregnant women weighing between 51 to 60 kg and more than 61 kg. It was observed that preintervention 18.1% and postintervention 31.8% of the pregnant women weighed between 51 and 60 kg [[Table 2]]. Similarly, an improvement in hemoglobin was observed. An improvement in mean hemoglobin from 8.9 ± 1.17 to 9.44 ± 0.75 g/dL with an increase in the number of pregnant women having blood hemoglobin levels within 10.0 to 10.9 g/dL (WHO, 2007) was observed. Preintervention 9% and postintervention 31.8% of the pregnant women had hemoglobin between 10.0 and 10.9 g/dL [[Table 2]]. Furthermore, an improvement in BMI was also observed. An improvement in mean BMI from 20.96 ± 3.45 to 22.54 ± 3.99 kg/m2 with an increase in the number of pregnant women having BMI in the overweight category (IOM, 2009) was observed. Preintervention 4.50% and postintervention 18.2% of the pregnant women had BMI in overweight category (25–29.9) [[Table 2]].

An improvement in mean weight from 50.92 ± 0.57 to 51.5 ± 2.68 kg was observed with an increase in the number of nursing mothers weighing between 41 to 50 and 51 to 60 kg. It was observed that preintervention 56.5% and postintervention 75% of the nursing women weighed between 41 and 50 kg [[Table 2]]. Similarly, an improvement in hemoglobin was observed. An improvement in mean hemoglobin from 6.26 ± 0.23 to 7.70 ± 0.16 g/dL with an increase in the number of nursing mothers having blood hemoglobin levels within 10.0 to 10.9 g/dL and more than 11.0 g/dL (WHO, 2007) was observed. Preintervention 6.3% and postintervention 18.8% of the nursing mothers had hemoglobin between 10.0 and 10.9 g/dL [[Table 2]]. Furthermore, an improvement in BMI was also observed. An improvement in mean BMI from 19.85 ± 2.56 to 21.19 ± 3.22 kg/m2 with an increase in the number of nursing women having BMI in the overweight category (IOM, 2009) was observed. Preintervention 6% and postintervention 19% of the nursing mothers had BMI in overweight category (25–29.9) [[Table 2]].

A paired t test was conducted to analyze the difference between mean values of pre- and postintervention weight, hemoglobin, and BMI [[Table 3]]. It was observed that the mean weight gain for pregnant women was 3.63 kg and hemoglobin improvement was 0.5 g/dL. Similarly, the mean weight gain for nursing women is 3.0 kg and hemoglobin was 0.9 g/dL [[Table 3]]. The results also indicate that the intervention showed a statistically significant impact on weight gain (P = 0.000, P = 0.002) and BMI (P = 0.000, P = 0.004) for pregnant and nursing women, respectively [[Table 4]].
Table 3 T-test for pre-interventional and post-interventional comparison of weight, hemoglobin, and BMI of pregnant and nursing women

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Table 4 T test for preinterventional and postinterventional comparison of weight, hemoglobin, and BMI of pregnant and nursing women

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[TAG:2]Discussion[TAG:2]

This study aimed to assess the impact of millet-based foods on the weight, BMI, and hemoglobin of pregnant and nursing mothers. Millet-based foods were used because they have high nutritional properties, and they contribute to improvement in weight and hemoglobin.[21] The results showed an average increase in weight (3.64 ± 5.29 kg), hemoglobin (0.5 ± 1.30 g/dL) and BMI (1.58 ± 2.2 kg/m2) for pregnant women. Moreover, a similar increase in weight (3.00 ± 6.00 kg), hemoglobin (0.9 ± 1.60 g/dL), and BMI (1.34 ± 2.43 kg/m2) for nursing mothers.

Postintervention, a 13% improvement in the BMI of pregnant and nursing women was observed. These findings were similar to another study that demonstrated a positive impact of millet-based foods on weight and BMI.[22] It was also observed that there was a 13.8% increase in the number of pregnant women in the overweight category. However, these findings were contradictory to those of another study which showed that a millet-based intervention reduced BMI.[23] A paired t test showed a statistically significant impact on weight (P < 0.01), on BMI (P < 0.01) for pregnant women and on weight (P < 0.05), BMI (P < 0.01) for nursing women at 95% CI. Similar results (P < 0.01) for weight gain were observed in another study conducted among nursing women.[15] The significant improvements in weight and BMI evidenced in this study are attributed to the energy-dense formulation of millet-based foods. Similarly, another study also proved that these millet-based formulations have a positive impact on the anthropometric indicators because they are calorie-rich formulations with required quantities of carbohydrates, proteins, and fats.[22]

Postintervention, a 5% decrease in the number of pregnant women with hemoglobin less than 7 g/dL and a 17.8% decrease in the number of pregnant women with 7 to 9.9 g/dL was observed. These findings were similar to those of other studies showing that millet-based foods contribute to an increase in blood hemoglobin levels of beneficiaries. [15, 22, 24]

Furthermore, a study evidenced that these millet-based food products were beneficial to children, teenagers, and anemic patients and contribute to the improvement in weight, BMI, and hemoglobin of beneficiaries.[15]

Millets have superior nutritional properties, and hence, there exists a vast scope to optimize them to produce processed products.[14] Thus, these value-added, nutrient-dense millet-based food formulations possess a strong potential to improve nutritional outcomes and should be introduced into the nutrition program of various states in India. [22,25] They can be used for large scale utilization in various forms such as baby foods, snack foods, powders, porridges, and wine.[26] Therefore, this study presents a strong case for introducing millet-based foods in nutrition programs across AWCs.

The limitation of this study was the small sample size due to dropouts. These dropouts occurred majorly due to sociocultural reasons such as migrations and family traditions. Furthermore, assessing the exact impact of the intervention was limited in a community setting. However, this study emphasized on findings that highlighted the positive impact on the anthropometrical and clinical parameters of pregnant and nursing mothers.


   Conclusion Top


Millet-based foods such as mixed millet malt, ragi biscuits, ragi cutlets, and mixed millet energy millet bars developed with ragi, jowar, and bajra demonstrated a positive impact on weight and BMI for pregnant and nursing women in a community setting. This study highlights that the intervention can be rolled out on pregnant and nursing women across all the AWCs of the district as a part of the ICDS program. The introduction of these foods at AWCs has the potential for improving the footfall and increasing for the utilization of SNP services. Consequently, these foods will be accepted by the communities and will contribute to the improvement in the nutritional status of the community at large.

Authors’ contribution

DD worked closely with the government authorities and was involved in conducting the study on the field. DD was involved in study design, sampling, data collection, analysis of results, and manuscript writing, and DG contributed to guiding the scientific content and structuring of the manuscript.

Acknowledgments

The authors sincerely acknowledge all the government officials of Mahabubnagar district, Telangana for funding the intervention and extending immense support while implementation. They also thank all the stakeholders involved viz anganwadi workers, supervisors, pregnant women, and nursing mothers for participating in the study.

Financial support and sponsorship

The financial support for intervention was from Government of Telangana.

Conflicts of interest

There are no conflicts of interest.

 
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