Discussion
trimester-based
WEST
This community-based cluster-randomized controlled trial was designed to assess the effect of nutrition education and home gardening during pregnancy on feto-maternal outcomes in Southwest Ethiopia. The findings of this study demonstrated the effectiveness of the intervention in improving the neonatal mean birth weight, maternal hemoglobin level, MDD-W, and KAP scores of the women in the husband group of the intervention arm as compared to the controls.Thus, this trial showed that there was a significant mean birth weight difference among the study arms. Neonates born in the husband group of the study were 232 g heavier than the controls. In line with the current finding, a study from West Gojam revealed that nutritional education intervention increased the mean neonatal birth weight as compared to controls [Similarly, after controlling the confounding factors women in the husbands’ group of the intervention had significantly higher hemoglobin levels as compared to the controls. In support of this finding, a study from India showed that behavioral change communication intervention to enhance the dietary and iron-folate intake during pregnancy increased the mean hemoglobin level of the intervention group as compared to the controls [This study also revealed that the mean dietary diversity score of pregnant women in the husband group of the intervention arm was significantly higher compared to the control group. Similarly, another study conducted in Ethiopia also reported that pregnant women who received nutritional counseling during pregnancy were seven times more likely to consume a diversified diet than the controls [This study also showed that maternal nutritional knowledge, attitude, and practice scores were significantly higher in the intervention groups as compared to the controls. This finding is consistent with the study carried out in Dessie Town, Northeast Ethiopia, which reported that there was a significant improvement in the mean nutritional knowledge level and dietary practices of pregnant women after attending nutritional education [The findings of this study indicate that community-based nutritional education intervention during pregnancy that involves other influential community-level actors, especially husbands, combined with the promotion of locally available home garden consumption is effective and significantly improves nutritional knowledge, attitude, and practice of pregnant women, which in turn improves maternal nutritional status and birth weight.The strengths of this study were the strong study design used, and trimester-based community-level nutrition education, combined with agricultural interventions involving community-level actors. However, the responses to the subjective questions during data collection were dependent on maternal self-reported and memory, which might introduce some social desirability and recall biases. Though, efforts were made to probe the respondents to minimize these biases. In addition, intake was assessed using a qualitative indicator ((MDD-W score) that lacks quantification of food consumed and nutrient intake profiles.