Effects of third trimester counseling on pregnancy
weight gain, birthweight, and breastfeeding among
urban poor women in Bangladesh
S. M. Akter, S. K. Roy, S. K. Thakur, M. Sultana, W. Khatun, R. Rahman, S.S. Saliheen
and N. Alam
Abstract
Background. Maternal malnutrition and poor gesta-
tional weight gain are the most important causes of low
birth weight and high rates of newborn mortality.
Objective. To assess the effects of nutrition coun-
seling in the third trimester of pregnancy on maternal
weight gain, birth weight of newborn, and breastfeeding
practices.
Methods. This was a longitudinal experimental study
with nutrition intervention for a period of 3 months.
One hundred fifteen women (57 in the intervention
group and 58 in the comparison group) who were visit-
ing the Maternal and Child Health Training Institute
at 6 months of pregnancy were randomly selected. The
intervention group was given nutrition education twice
in the first month and once a month for the next 2
months before delivery; the comparison group received
routine hospital advice on food intake, immunization,
personal hygiene, and breastfeeding. The women were
weighed monthly up to delivery, the newborn infants’
birth weights were measured within 24 hours after deliv-
ery, and breastfeeding practices were observed 1 month
after delivery.
Results. Women in the intervention group gained
1.73 kg more weight during the third trimester than
women in the comparison group (5.61 vs. 3.88 kg,
p < 0.001). The mean birthweight of babies of women
in the intervention group was 0.44 kg greater than that
of babies of women in the comparison group (2.86 vs.
S. M. Akter and S. K. Roy are affiliated with Bangladesh
Breastfeeding Foundation, House 473, Road 31, DOHS,
Mohakhali, Dhaka. S. K. Thakur, W. Khatun, and N. Alam are
affiliated with the ICDDR, B International Centre for Health
and Population Research, Dhaka, Bangladesh; M.Sultana, R.
Rahman, and S. S. Saliheen are affiliated with the Depart-
ment of Food and Nutrition, College of Home Economics,
University of Dhaka, Azimpur, Dhaka;
Correspondence should be addressed to Dr. S. K. Roy, Dr.
S.K.Roy, Chairperson, Bangladesh Breastfeeding Founda-
tion, House 473, Road 31, DOHS, Mohakhali, Dhaka 1212,
Bangladesh; e-mail: skroy1950@gmail.com.
194 Food and Nutrition Bulletin, vol. 33, no. 3 © 2012, The United Nations University.
2.42 kg, p <0.001). In the intervention group, 10.5% of
babies were born with low birthweight, compared with
48.3% of the babies of women in the comparison group
(p < 0.001). In the intervention group, 75.4% of mothers
initiated breastfeeding within 1 hour after birth, com-
pared with 34.5% of mothers in the comparison group
(p < 0.001).
Conclusions. Nutrition education only during the
third trimester improved weight gain during pregnancy,
reduced 78% of low birth weight, and improved breast-
feeding practices.
Key words: Antenatal, birthweight, breastfeeding,
nutrition counseling, pregnancy weight gain
Introduction
In Bangladesh, the high prevalence of malnutrition
among women throughout the life cycle is reflected
by their low body mass index, low weight gain during
pregnancy, and low birthweight (LBW) of their babies
[1, 2]. In developing countries, 16% of infants are born
with LBW. The latest UNICEF national survey found a
36% prevalence of LBW (< 2.5 kg) in Bangladesh [3].
Some previous studies showed that nutrition education
during pregnancy had a positive effect on maternal
weight gain and birth outcome [4, 5]. Weight gain in
the second and third trimester is of greater importance
for ensuring fetal growth than weight gain during the
first trimester [6]. The National Nutrition Programme
Baseline Survey 2004 in Bangladesh showed that only
one-third of women gained more than 4 kg during
the third trimester. The mean weight gain in the third
trimester was 3.44 kg [7].
Childhood malnutrition in Asia is greater than
anywhere else [8]. Seventy percent of the world’s
malnourished children live in Asia [9]. A high propor-
tion of malnourished women and adolescent moth-
ers give birth to LBW babies [10]. This reflects one
major pathway to continued undernutrition from one
Effects of counseling on birthweight in urban poor women
generation to another as a downhill process [11]. At
least 17 million infants are born every year with LBW,
representing about 16% of all newborns in developing
countries [6]. Nearly 80% of all full-term infants with
LBW are born in Asia (mainly south-central Asia, with
Bangladesh having the highest rate in the world) [6].
LBW is generally associated with increased morbidity
and mortality, impaired immune function, and poor
cognitive development for neonates (1 to 28 days of
age) and infants [6]. Infants born with LBW are at risk
of developing acute diarrhea or of being hospitalized
for diarrheal episodes at a rate two to four times greater
than those with normal birthweight [6, 12–13]. The risk
of neonatal death for LBW infants (2,000 to 2,499 g) is
estimated to be four times higher than that for infants
weighing 2,500 to 2,999 g and 10 times higher than that
for infants weighing 3,000 to 3,499 g [14]. LBW approx-
imately doubled the neonatal mortality rate in a periur-
ban setting in Bangladesh; neonatal mortality tends to
occur early; and preterm delivery is the most impor-
tant contributor to the neonatal mortality rate [15].
We performed this study to test the hypothesis
that nutrition education in the third trimester would
improve maternal weight gain, infant birthweight, and
breastfeeding practice.
Materials and methods
Study area and subjects
One hundred fifteen women who attended the govern-
ment Maternal and Child Health Training Institute
(MCHTI) in Dhaka city between April and October
2005 and in the seventh month of pregnancy were
selected. The MCHTI provides maternity care for a
nominal fee or free of change. Women of low socioeco-
nomic status usually visit the MCHTI for free maternity
care. The women were assigned to nutrition educa-
tion and comparison groups with the aid of a random
number table. The purpose of the study and their right
to withdraw from the study any time was explained.
Women who agreed to comply full-time with the study
and gave informed consent were recruited. The study
was approved by the Ethical Review Committee of
International Centre for Diarrhoeal Disease Research,
Mohakhali, Dhaka, Bangladesh.
Nutrition education
The investigators received 2 weeks of training by the
senior author (SKR) (on topics including pregnancy-
related personal hygiene, the need for increased food
intake, early initiation of breastfeeding, and exclusive
breastfeeding) to develop a manual to provide nutri-
tion education to pregnant women. The manual was
developed with reference to the nutrition triangle,
195
including food security, caring practices, and disease
control [16]. The pregnant women were motivated
through scientific explanation of health benefits from
the nutrition education for the new born and the
mothers. The women in the intervention group were
given nutrition education in groups of six to eight for
3 months. All subjects attended four counseling ses-
sions. Counseling and data collection were done by the
investigators. Counseling to the pregnant women on
the need for pregnancy weight gain, dietary intake, and
breastfeeding was given twice in the first month and
then monthly for the last two months before delivery,
and breastfeeding practice was observed at one month
after delivery. Twenty-four-hour recall (standard
method) was used to measure exclusive breastfeed-
ing. Nutrition education emphasized increasing the
frequency of food intake from three times to five times
daily during pregnancy, food hygiene, rest during
the daytime, avoidance of prelactational feeds, early
initiation (1 hour) of breastfeeding and exclusive
breastfeeding. Emphasis was given to the preparation
of khichuri, a nutritionally sound, easy-to-prepare
home diet containing common, inexpensive, and
locally available foods (17, 18).The ingredients are two
fistfuls of rice, one fistful of dal (lentil), one egg, five
teaspoons of soya oil, and one fistful of leafy vegeta-
bles. This amount gave a total of 650 kcal of energy.
The messages delivered were specific to the benefits of
food items and preparation of Khichuri was explained
using IEC materials such as flip charts containing with
key messages and color photographs. The comparison
group had the same frequency of contact with the
investigators as the intervention group but no inter-
vention was given, and they received routine advice
and service from the Government health service
providers such as nurses and doctors at MCHTI. The
routine advice and care included personal hygiene,
routine antenatal check up, immunization with TT,
iron tablet supplementation, and health check up.
Data on socioeconomic status, age, gestational age of
the fetus, monthly family income, the educational level,
occupation of women and their husbands has been
asked using a questionnaire at enrollment. Gestational
age was estimated by counting pregnancy from the first
day of the last menstrual period.
The women’s weight and height were measured at
recruitment using World Health Organization (WHO)
standard techniques [19], and the women were weighed
monthly until delivery by the investigators. Anthropo-
metric instruments were standardized every day and
were adjusted if necessary. Body weight was measured
to the nearest 100 g with an electronic digital scale
(Seca, model 770) standardized with 20-kg weights.
Standing height of the women was measured with a
locally made height scale with a precision of 1 mm.
Three measurements were made of weight and height,
and the average value was used. The infants were
196 S. M. Akter et al.

TABLE 1. Comparison of baseline characteristics between intervention and

comparison groups ( mean ± SD)
Intervention Comparison
group group
Characteristic (n = 57) (n = 58) pa
Age (yr) 22.12 ± 3.44 22.86 ± 4.87 0.350
Respondent’s education (yr) 7.28 ± 3.78 7.38 ± 3.21 0.880
Husband’s education (yr) 8.98 ± 4.07 8.93 ± 3.17 0.940
Age at 1st marriage (yr) 17.86 ± 3.03 17.67 ± 2.83 0.733
Maternal weight (kg) 52.60 ± 5.95 51.05 ± 6.10 0.172
Maternal height (cm) 151.94 ± 4.37 150.43 ± 4.74 0.079
BMI at 6 mo of pregnancy 22.81 ± 2.66 22.53 ± 2.14 0.526
Gestational age (wk) 22.93 ± 2.26 22.35 ± 1.95 0.140
Family income (taka/mo)b 3,523 ± 1,211 3,569± 1,092 0.830
BMI, body mass index
a. Student’s t-test.
b. US$1 = 75.0 taka

weighed within 1 hour after birth by trained nurses
using a Salter scale with an accuracy of 100 g [19, 20].
The scale was standardized every day in the morning
before measurements were taken and at mid-day. All
deliveries took place in the MCHTI. Low birth weight
was defined as less than 2.5 kg.
Quality control measures
Techniques of counseling sessions, interviewing,
anthropometric measurements, and record keeping
were supervised by the senior author (SKR) who also
interviewed 10% of the subjects on issues of educa-
tion sessions and rechecked 5% of anthropometric
measurements to check the validity of the data. The
data collection instruments were field tested before
finalization by interviewing similar pregnant women
who were not in study.
Statistical analysis
All statistical analyses were done with standard statis-
tical software (SPSS for Windows, version 11.5). The
chi-squared test was used to test the difference between
proportions. Student’s t-test was used to test the differ-
ences between two means. Repeated-measures ANOVA
was used to compare means over time. Logistic regres-
sion analysis was performed to estimate the effects of
nutrition counseling on birthweight, controlling for
other factors. Statistical significance was accepted at a
probability level of 5%.
Results
The baseline nutritional status and socioeconomic
characteristics of the intervention and comparison
groups were similar (table 1). At the beginning of the
study, the mean body weight of the women was 52.60 kg
in the intervention group and 51.05 kg in the compari-
son group. The mean body mass index was 22.81 in the
intervention group and 22.53 in the comparison group
(p = 0 .526). The mean monthly household income of
intervention group was 3,550 taka (US$ 52.0) and was
comparable to the comparison group. After 1 month of
nutrition education, mothers in the intervention group
had better body weight than those in the comparison
group (54.80 vs. 52.56 kg, p = 0.038). Mean body weight
was higher in the intervention group after 2nd month
of nutrition education (56.61 vs. 53.76 kg, p = 0.001)
and after the 3rd month (58.20 vs. 54.93 kg, p = 0.001.
Repeated-measures ANOVA showed that mean body
weight was significantly higher in the intervention
group (fig. 1). Table 2 shows that after 3 months of
counseling, pregnancy weight gain was 45% greater in
the intervention group than in the comparison group
(5.61 vs. 3.88 kg, p = 0.001).
Previous rate of LBW, and previous rate of exclu-
sive breastfeeding were similar in the two groups
(39% vs. 37%, p = 0.865; 34% vs. 36%, p = 0.723, respec-
tively). Parity was also similar in both group (18.8%
vs. 23.4% women had 3 and more children, p = 0.435).
The mean birthweight in the intervention group was
18% greater than that in the comparison group (2.86
vs. 2.42 kg, p = 0.001). The prevalence of LBW babies
was 10.5% in the intervention group and 48.3% in the
comparison group (p < 0.001). Babies born with weight
more than 3.0 were 15.8% in the intervention group
compared to 3.4% in the comparison group. The rate of
LBW was three times higher among female babies than
among males (Tables 2 and 3). Thirty-four percent
more women in the intervention group than women
in the comparison group increased the frequency of
meals from three to five times a day as a change in
Effects of counseling on birthweight in urban poor women 197

TABLE 2. Effect of antenatal nutrition education on pregnancy weight gain and

birth weight
Intervention Comparison
group group
Indicator (n = 57) (n = 58) p
Total weight change during 3rd 5.61 ± 0.95 3.88 ± 0.80 0.001a
trimester (kg) — mean ± SD
Birthweight (kg) — mean ± SD 2.86 ± 0.27 2.42 ± 0.35 0.001a
LBW — no. (%)b 0.001c
All infants 6 (10.5) 28 (48.3)
Girls 4 (14.8) 18 (60.0)
Boys 2 (6.7) 10 (35.7)
a. Student’s t-test.
b. LBW, low birth weight (< 2.5 Kg).
c. Chi-square test.

dietary intake.
60
Table 4 shows that there was no significant difference
in weight gain between the two groups of pregnant
Intervention women during the first month of intervention, but
Body weight (kg)

58
during the subsequent 2 month significantly higher
56 weight gain was seen among the mothers in interven-
tion group compared to the comparison group. The
54 difference in weight gain increased more in the last
Comparison month of intervention.
52
Multivariate analysis revealed that the risk of LBW
50 was 81% higher in babies who were born prematurely
6 7 8 9 (< 37 weeks of gestation) than in full-term babies
Gestational age (mo) (p < 0.05). The risk of LBW was 88% lower in the
intervention group than in the comparison group
FIG. 1. Comparison of body weights of women of two (p < 0.001). The mother who had education more than
groups during the third trimester of pregnancy (*Repeated- primary level had a 68% less chance of having a low
measures ANOVA) birth weight baby (p < 0.05) (Table 5).
Table 6 shows that 75.4% of babies in the interven-
tion group initiated breastfeeding within an hour after
TABLE 3. Comparison of birth weight between intervention birth, compared with 34.5% of those in the comparison
and comparison groups no. (%)a group. Seven percent of mothers in the intervention
Intervention group Comparison group group and 24.1% of those in the comparison group
Weight (kg) (n = 57) (n = 58) initiated breastfeeding between 1 and 6 hours after
< 2.5 6 (10.5) 28 (48.3) birth (p = 0.001). In the intervention group, 38.6% of
2.5–3.0 42 (73.7) 28 (48.3) babies were given prelacteal feeds after birth, compared
> 3.0 9 (15.8) 2 (3.4) with 67.2% in the comparison group (p = 0.002). The
proportions of babies receiving all kinds of prelacteal
a. p < .001, chi-square test.
feeds were significantly higher in the comparison
group than in the intervention group. Honey, milk,
water, and sugar water were given to 15.5%, 15.5%,
TABLE 4. Comparison of weight gain during 3rd trimester 13.8%, and 22.4% of babies in the comparison group,
(mean ± SD) (kg) respectively, compared with 3.5%, 7%, 14%, and 14% of
those in the intervention group (p = 0.015). One month
Intervention Comparison
after delivery, the rate of exclusive breastfeeding in the
group group P
Period (n = 57) (n = 58) value a intervention group was almost double that in the com-
parison group (64.9% vs. 37.9%, p = 0.003). The reason
Months 6 to 7 0.83 ± 0.26 0.89 ± 0.29 0.589 for not practicing exclusive breastfeeding was given as
Months 7 to 8 1.89 ± 0.83 1.21 ± 0.89 0.001 “no milk in breasts” by 19.3% of mothers in the inter-
Months 8 to 9 2.89 ± 1.06 1.78 ± 1.19 0.001 vention group and 37.9% of those in the comparison
Total weight gain 5.61 ± 2.21 3.88 ± 2.29 0.001 group. Seven percent of mothers in the intervention
a. Student’s t-test. group and 17.2% of those in the comparison group said
198 S. M. Akter et al.

TABLE 5. Odds ratios for factors influencing low birth weight (LBW)
Risk factor LBW % (no.) Odds ratio 95% CI
Group
Comparison (reference) 48.3 (28) 1 —
Intervention 10.5 (6) 0.124** 0.043–0.358
Mother’s education
Primary (reference) 36.4 (16) 1 —
Secondary or higher 25.4 (18) 0.323* 0.116–0.903
Duration of pregnancy (wk)
< 37 (reference) 63.6 (7) 1 —
≥ 37 26.0 (27) 0.192* 0.039–0.955
Mother’s age (yr)
≤ 20 (reference) 36.0 (18) 1 —
> 20 24.6 (16) 0.435 0.164–1.155
Family income (taka/mo)
≤ 3,000 (reference) 28.0 (14) 1 —
> 3,000 30.8 (20) 1.393 0.517–3.757
Mother’s baseline weight (kg)
≤ 45 (reference) 33.3 (7) 1 —
> 45 28.7 (27) 0.770 0.215–2.758
Mother’s height (cm)
  ≤ 145 (reference) 25.0 (3) 1 —
  > 145 30.1 (31) 1.365 0.272–6.859
*p < .05, **p < .001, logistic regression.

that their babies were unable to suck. Children who
were not exclusively breastfed were given cow’s milk,
powdered milk, and water (with or without sugar).
In the intervention group, 1.8%, 22.8%, and 10.5%
of children were given cow’s milk, powdered milk,
and water, respectively. In the comparison group, the
corresponding percentages were 6.9%, 50%, and 5.2%
(p = 0.005).
Discussion
This study has demonstrated positive effects of nutri-
tion education given to poor urban pregnant women
on weight gain during pregnancy and body weight
of the newborn, as compared with the women of the
comparison group. In Dhaka city, most women who
come for antenatal check-ups in the paid maternity
clinics belong to the higher socioeconomic class, and
those who cannot afford private clinics or other paid
hospitals attend free government maternity clinics such
as the one in this study. Generally, the women from
low socioeconomic status who visit the government
maternity clinic can be selective in terms of motiva-
tion and families may not ensure all supports needed.
Nutrition counseling on the other hand may have met
their knowledge gaps and have helped them to trans-
late knowledge into practices such as the increased
dietary intake.
Weight gain during pregnancy is an efficient process
indicator, which is associated with increased birth
weight [21, 22]. In Bangladesh, maternal malnutri-
tion, poverty, and lack of education are related to LBW
[23]. An earlier study has shown benefits of nutrition
education on birthweight [24, 25]. In Bangladesh, 455
pregnant women were followed up longitudinally; only
one-third had more than 4 kg gain in body weight in
the third trimester. The mean weight gain in the third
trimester was 3.44 kg [7]. In our study, the interven-
tion group gained an average of 0.40 kg per week,
which was higher than the rates reported by studies
in India [26]. The gain in body weight from the sixth
to the ninth month of pregnancy in the intervention
group was much more than in the comparison group.
The intervention provided nutrition information,
advice on increasing the frequency of meals and food
intake, information on the UNICEF nutrition triangle
guidelines, and an easy-to-follow recipe for khichuri
containing oil, egg, lentils, and rice to increase intakes
of energy and protein.
In Bangladesh, a dose–response relationship was
seen between the duration of daily food supplementa-
tion (608 kcal) and birth weight, where 48% of infants
were born as LBW [27]. Improvement in birth weight
was achieved when supplementation was initiated early
in pregnancy and continued for at least 120 to 150 days
up to delivery [28]. The National Low Birth Weight
Survey of Bangladesh showed that the prevalence of
Effects of counseling on birthweight in urban poor women 199

TABLE 6. Effect of antenatal nutrition education on breastfeeding practice — %

of respondents
Intervention Comparison
group group
Indicator (n = 57) (n = 58) p valuea
Time of initiation of breastfeeding 0.001
after birth (h)
≤1 75.4 34.5
> 1 to < 6 7.0 24.1
>6 17.5 41.4
Prelacteal feeding 0.002
No 61.4 32.8
Yes 38.6 67.2
Prelacteal food given 0.015
Honey 3.5 15.5
Milk 7.0 15.5
Water (warm) 14.0 13.8
Sugar water 14.0 22.4
EBF at 1 mo 0.003
Yes 64.9 37.9
No 35.1 62.1
Reason for no EBF 0.035
No milk in breasts 19.3 37.9
Baby unable to suck 7.0 17.2
Sickness of mother 5.3 5.2
Refusal to feed 3.5 1.7
Other food given in addition to 0.005
breast milk
Cow’s milk 1.8 6.9
Powdered milk 22.8 50.0
Water (sweetened or not 10.5 5.2
sweetened)
EBF, exclusive breastfeeding
a. Chi-squared test.

LBW was higher among girls than boys, which was in
agreement with our observation [3].
In our study, nutrition education increased the rates
of initiation of breastfeeding within 1 hour after birth
and of exclusive breastfeeding 1 month after birth.
Improving breastfeeding practices requires behavior
change, something that does not happen spontaneously
and without encouragement and support at the family
and community levels. This is recognized in the Global
Strategy for Infant and Young Child Feeding, which
includes community-based interventions among the
new operational targets [29]. Several studies in India
and around the globe have demonstrated that it is
possible to achieve high rates of exclusive breastfeed-
ing, but this is possible only through education and
counseling [30–32].
The general taboo on breastfeeding is related to the
belief that colostrum is not good for the baby’s health.
Pregnant women are restricted to eating specified foods
and fruits (beef, egg, banana, papaya, etc.), and it is
thought that overindulgence in rich food may cause
the baby to grow so big that the mother may experi-
ence difficulties in delivery. Fear of inadequate milk
production was also seen among the pregnant women.
Several limitations of this study need to be men-
tioned. First, quantitative information on exact food
intake or changes in dietary intake at home during
pregnancy was not obtained. Second, education on
breastfeeding was given during pregnancy before deliv-
ery and not during the lactational period, which could
have limited the impact on postpartum breastfeeding
practices. Third, we did not collect follow-up data on
breastfeeding patterns and infant growth.
The results of this study show a potential strategy to
reduce LBW in Bangladesh. Antenatal nutrition educa-
tion to pregnant women, even during the last trimester,
has a great potential to improve pregnancy weight gain,
birthweight, and breastfeeding practices. The interven-
tion is relatively easy to apply in all maternity facilities
in Bangladesh and should be adopted by involving the
200
family decision makers.
Acknowledgments
The authors gratefully acknowledge the Clinical Sci-
ences Division and the training branch of the Inter-
national Centre for Diarrhoeal Disease Research,
Bangladesh (ICDDR,B) for their collaboration and
technical support. The authors also acknowledge the
References
1. Bangladesh Government/NIPORT/Mitra and Associ-
ates/Macro International. Bangladesh Demographic and
Health Survey, 1999–2000. Dhaka, NIPORT, Mitra and
Association. 2000.
2. Brown JE, Isaacs JS, Krinke UB, Lechtenberg E, Mur-
taugh M. Nutrition through the life cycle, 4th ed. Bel-
mont, Calif., USA: Wadsworth, 2011.
3. Salam A, Haseen F, Yusuf HKM, Torlesse H. National
low birth-weight survey of Bangladesh, 2003–2004. 8th
Commonwealth Congress on Diarrhoea and Malnutri-
tion. 2004;76:170–75.
4. Fowles ER. Prenatal nutrition and birth outcomes. J
Obstet Gynecol Neonatal Nurs 2004;33:809–22.
5. Piirainen T, Isolauri E, Lagström H, Laitinen K. Impact
of dietary counselling on nutrient intake during preg-
nancy. Br J Nutr 2006; 96:6:1095–1104.
6. Kelley JP. Low birth weight. Nutrition Policy Paper No.
18. New York, United Nations Administrative Commit-
tee. 2000.
7. Ahmed T, Roy SK, Alam N, Ahmed AMS, Ara G, Bhuiya
AU, Arifeen SE, Khuda B, Khatun UHF, Rashid H, Sabir
A, Bhadra SK, Sultana S. National Nutrition Programme,
Baseline Survey 2004. Dhaka: NIPORT and Mitra and
Association. 2005.
8. Gillespie L, Haddad S, Allen L, Babu S, Horton S, Kim
S, Mannar V, Popkin B. Attacking the double burden of
malnutrition in Asia and the Pacific, 2002. Manila, Asian
Development Bank, Philipines and International Food
Policy Research Institute, Washington, DC, USA.
9. de Onis M, Frongillo EA, Blossner M. Is malnutrition
declining? An analysis of changes in levels of child
malnutrition since 1980. Bull World Health Organ
2000;78:1222–1233.
10. UNICEF. Maternal and neonatal health in Bangladesh.
Dhaka, UNICEF. 2009. Available at: http://www.unicef.
org/bangladesh/Maternal_and_Neonatal_Health.pdf.
Accessed 21 June 2012.
11. Gillespie S R, Haddad LJ. The double burden of mal-
nutrition in Asia—causes, consequences and solutions.
New Dehli, Sage, Publication Ltd. 2003.
12. Bukenya GB, Barnes T, Nwokolo N. Low birthweight
and acute childhood diarrhoea: evidence of their asso-
ciation in an urban settlement of Papua New Guinea.
Ann Trop Paediatr 1991;11:357–62.
13. Ittiravivongs ASK, Ratthapalo S, Pattaraarechachai J.
Effect of low birth weight on severe childhood diar-
rhea. Southeast Asian J Trop Med Public Health 1991;
S. M. Akter et al.
hospital staff of the Maternal and Child Health Train-
ing Institute and the College of Home Economics,
Azimpur, Dhaka. The study was funded by the Bang-
ladesh Breastfeeding Foundation.
The funding sources had no role in study design,
data collection, analysis, interpretation of data, or in
writing this report. The corresponding author had
full access to the data and had final responsibility for
the decision to submit for publication. All the authors
declare that there is no conflict of interest.
22:557–62.
14. Ashworth A. Effects of intrauterine growth retardation
on mortality and morbidity in infants and young chil-
dren. Eur J Clin Nutr 1998; 52:34–40.
15. Yasmin S, Osrin D, Paul E, Costello A. Neonatal mor-
tality of low-birth-weight infants in Bangladesh. Bull
World Health Organ 2001;79:608–14.
16. UNICEF. Strategy for improved nutrition of children
and women in developing countries. A UNICEF Policy
Review. New York: UNICEF, 1990.
17. Roy SK, Islam K, Ara G, Tanner P, I Wosk, Rahman AS,
Chakraborty B, Jolly SP, Khatun W. Impact of pilot pro-
ject of Rural Maintenance Programme (RMP) on desti-
tute women: CARE, Bangladesh. Food Nutr Bull 2008;
29:67–75.
18. Thakur SK, Roy SK, Paul K, Khanan M, Khatun W,
Sarker D. Effect of nutrition education on exclusive
breastfeeding for nutritional outcome of low birth
weight babies. Eur J Clin Nutr 2012;66:376–378.
19. Ndibazza J, Muhangi L, Akishule D, Kiggundu M,
Ameke C, Oweka J, Kizindo R, Duong T, Kleinschmidt
I, Muwanga M, Elliott AM. Effects of deworming during
pregnancy on maternal and perinatal outcomes in
Entebbe, Uganda: a randomized controlled trial. Clin
Infect Dis 2010;50:510–31.
20. Shaheen R, Francisco AD, Arifeen SE, Ekström EC,
Persson LA. Effect of prenatal food supplementation on
birth weight: an observational study from Bangladesh.
Am J Clin Nutr 2006;83:1355–61.
21. Gigliola BCH, Waslien C, Uyehara S, Krupitsky D, Silao
J. The association of pregnancy weight gain with infant
birth weight and postpartum weight retention: Ethnic
differences in Hawai`i, 1997 and 1998. Califor J Health
Promot 2005;3:144–56.
22. Ludwig DS, Currie J. The association between pregnancy
weight gain and birthweight: a within-family compari-
son. Lancet 2010;376:984–90.
23. Nahar N, Afroza S, Hossain M. Incidence of low birth
weight in three selected communities of Bangladesh.
Bangladesh Med Res Council Bull 1998;24:49–52.
24. Hermann J, Williams G, Hunt D. Effect of nutrition edu-
cation by paraprofessionals on dietary intake, maternal
weight gain, and infant birth weight in pregnant Native
American and Caucasian adolescents. Journal of Exten-
sion 2001;39:58-63. Available at: http://www.joe.org/
joe/2001february/rb2.php. Accessed 5 August 2012.
25. Stephenson T, Symonds M. Maternal nutrition as a
Effects of counseling on birthweight in urban poor women
determinant of birth weight. Arch Dis Child Fetal Neo-
natal Educ 2002;86:4–6.
26. Garg A, Kashyap S. Effect of counseling on nutritional
status during pregnancy. Indian J Pediatr 2006;73:687–92.
27. Shaheen R, Francisco AD, Arifeen SE, Ekström EC,
Persson LA. Effect of prenatal food supplementation on
birth weight: an observational study from Bangladesh.
Am J Clin Nutr 2006;83:1355–61.
28. Sack D A,Roy SK, Ahmed T, Fuchs G. An evaluation of
the impact of a US$60 million nutrition programme in
Bangladesh. Oxford Journals 2005;20:406–407.
29. World Health Organization. Global strategy for infant
and young child feeding. Geneva: WHO/UNICEF, 2003.
201
30. Haider R, Ashworth A, Kabir I, Huttly SRA. Effect of
community-based peer counsellors on exclusive breast-
feeding practices in Dhaka, Bangladesh: a randomised
controlled trial. Lancet 2000;356:1643–7.
31. Nankunda J, Tumwine JK, Soltvedt A, Semiyaga N,
Ndeezi G, Tylleskär T. Community based peer counsel-
lors for support of exclusive breastfeeding: experiences
from rural Uganda. Int Breastfeed J 2006;1:19–23.
32. Bhandari N, Bhal R, Mazumdar S, Martines J, Black
RE, Bhan MK. Effect of community-based promotion
of exclusive breastfeeding on diarrhoeal illness and
growth: a cluster randomised controlled trial. Lancet
2003;361:1418–23.