Disruptions and adaptations of an urban nutrition intervention delivering essential services for women and children during a major health system crisis in Dhaka, Bangladesh.

Systematic crises may disrupt well‐designed nutrition interventions. Continuing services requires understanding the intervention paths that have been disrupted and adapting as crises permit. Alive & Thrive developed an intervention to integrate nutrition services into urban antenatal care services in Dhaka, which started at the onset of COVID‐19 and encountered extraordinary disruption of services. We investigated the disruptions and adaptations that occurred to continue the delivery of services for women and children and elucidated how the intervention team made those adaptations. We examined the intervention components planned and those implemented annotating the disruptions and adaptations. Subsequently, we detailed the intervention paths (capacity building, supportive supervision, demand generation, counselling services, and reporting, data management and performance review). We sorted out processes at the system, organizational, service delivery and individual levels on how the intervention team made the adaptations. Disruptions included decreased client load and demand for services, attrition of providers and intervention staff, key intervention activities becoming unfeasible and clients and providers facing challenges affecting utilization and provision of services. Adaptations included incorporating new guidance for the continuity of services, managing workforce turnover and incorporating remote modalities for all intervention components. The intervention adapted to continue by incorporating hybrid modalities including both original activities that were feasible and adapted activities. Amidst health system crises, the adapted intervention was successfully delivered. This knowledge of how to identify disruptions and adapt interventions during major crises is critical as Bangladesh and other countries face new threats (conflict, climate, economic downturns, inequities and epidemics). Key messages: Well‐designed nutrition interventions may be disrupted by crises that affect the interventions themselves and the platforms on which they run.Combining contextualized expertise in operational settings with a data‐driven decision‐making process can facilitate the timely identification of intervention disruptions and enable swift adaptations.Continuity of nutrition services amidst crises is feasible by adopting hybrid modalities including both original and adapted implementation paths.Visualizing adaptations to the intervention paths sheds light on how to deliver nutrition services during major systematic disruptions.Knowledge of how to adapt nutrition interventions during crises is critical going forward to respond successfully in future disruptive events. [ABSTRACT FROM AUTHOR]