Behavior change through counselling to improve dietary diversity of pregnant mothers: A lesson from Sri Lanka


  • R.B.B.S. Ramachandra Director, District General Hospital, Embilipitiya, Sri Lanka
  • L.D.J.U. Senarath University of Colombo, Sri Lanka
  • N. Hemachandra World Health Organization, Country Office, Sri Lanka
  • S.H.P. de Silva World Health Organization, Country Office, Sri Lanka


Sri Lanka as a middle-income country performs outstandingly in health-related indicators on a par with the developed world. Continuous political commitment, together with dedication of health professionals, has still been unable to reach the desired level in nutritional indicators. The possibility of improving maternal nutrition without being an economical burden to the country is worthy of study. The objective of this study was to improve the dietary diversity of pregnant mothers through nutritional counselling in the Kalutara district. The study was a cluster randomized community trial (n= 270 per arm) conducted in two phases. The first phase was a nutritional counselling training to the intervention group PHMM; the second phase was intervening to change the diet of pregnant mother through PHMM. Pregnant mothers were recruited to the study before 12 weeks of gestation and followed up until the delivery to assess the birth outcome. During pregnancy, PHMM intervened with the pregnant mother and her family with nutritional counselling. The training was identified as an effective tool in training primary health care workers on nutritional counselling with significant difference in pre-and post-training counselling skills (t=17.48, df=26, p=0.000). Counselling through PHMM was successful in improving dietary diversity of pregnant mothers and family support received by the pregnant mother. Nutritional counselling of pregnant mothers and their family members was an effective intervention in improving DD of pregnant mothers. Training of primary health care workers was one of the effective investments at improving pregnancy nutrition. This can be easily incorporated into the existing health care system but a monitoring mechanism on implementation of family counselling at community level may need identifying.
Keywords: Nutrition counselling, dietary diversity, pregnancy, Sri Lanka