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PREPARE* Project: Examining Impacts of the COVID-19 Pandemic on Maternal Health and Infant and Young Child Feeding Practices. *PREPARE: Perinatal Remote Education for Pandemic Resilience

Maternal and child health services improve health literacy, birth outcomes and infant feeding in the postpartum period. However, disruptions resulting from COVID-19-related restrictions have caused changes in dietary and lifestyle habits of mothers. Also, the psychosocial impacts of the pandemic have exacerbated maternal and child health outcomes, especially in resource-deprived environments. This project examined impacts of the COVID-19 pandemic on maternal health, pregnancy outcomes, and infant health, while pilot testing strategies for delivering remote nutrition and health education to mothers in Ghana. In chapter 1, the theoretical and conceptual framework and methodological approach for the study aims are outlined. Study 1 (Chapter 2) presents a narrative literature review of the impacts of the pandemic on maternal and child health and nutrition. We examined the literature on the role of COVID-19-related psychosocial health on maternal nutritional status and infant feeding practices, as well as impacts on access to maternal and child health services during the perinatal period. We also explored literature on the antenatal and telehealth care frameworks in Ghana. For Study 2 (chapter 3), an online survey of 221 Ghanaian mother-infant dyads was conducted. Using mixed methods, mothers were asked about their perceived stress and anxiety during their pregnancy, and their dietary and lifestyle practices. There was no statistically significant association between COVID-related anxiety and infant minimum dietary diversity (aOR 0.974 CI 0.817-1.162), however social support was independently and positively associated with infant dietary diversity (aOR=2.873 CI 1.173-7.037). For Study 3 (chapter 4), a subset of 65 women were provided a remote 6-week, intensive nutrition education intervention focused on improving maternal and child dietary diversity and health literacy in women. We found that both maternal and infant dietary diversity significantly increased at the end of the intervention (0.78 and 0.71 food groups respectively). Health literacy in women increased by 0.23 points. Ultimately, the overall goal of this project and pilot test is to provide necessary evidence required for future studies examining the long-term impact of the pandemic on maternal and child health, while identifying opportunities for mitigating them through remote provision of nutrition education services.
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