Anaemia manifests when there are less red blood cells or haemoglobin in the blood resulting in reduced amount of oxygen in the bloodstream. There are several causes of anemia, dietary iron deficiency is the most common cause but other micronutrient deficiencies, inherited blood disorders, and parasitic infestations (e.g. malaria and hookworm) are also responsible. Iron-deficiency anaemia is associated with low birth weight, perinatal and maternal mortality with 20% of maternal deaths’ directly related to anaemia. In Nepal the prevalence of anaemia among pregnant women is highest in Terai region (36.4%) and Lumbini province ranks second (43.5%). The government of Nepal provides free iron/folic acid (IFA) to pregnant women from 20 weeks’ gestation during routine antenatal care (ANC) visits. Despite, these efforts anaemia levels in pregnancy continues to remain high. Evidences suggest a 1 g/dL increase in haemoglobin in late pregnancy can reduce the risk of maternal mortality by 20%. HERD International in partnership with University College London, UK is trialing an integrated intervention of tailored dosage of oral IFA, personalized nutrition counseling and Participatory Learning Action (PLA) women’s groups to reduce iron deficiency anaemia in pregnant women.

Objective

The overall aim is to estimate the effectiveness of an integrated intervention of tailored dosages of IFA, nutrition counselling and PLA women’s group meetings in improving maternal nutrition and reducing iron deficiency anaemia in pregnant women.

Methodology

This is a non-blinded cluster randomized controlled trial being conducted in 54 clusters from 9 pallikas in Kapilvastu. Each cluster comprises of 103 old-wards (5 single- and 49 merged pairs of- old-wards), to be randomly allocated to 27 clusters per arm. Trial arms are: 1) control (routine ANC); 2) ‘Home visiting plus PLA’ intervention package comprising a combination of tailored IFA supplementation, two home-based counselling between 12 to 25 weeks of pregnancy, and 15 monthly PLA meetings held in the community, in addition to routine ANC.  At the beginning, semi-structured interviews and focus group discussions were conducted with relevant stakeholders and community people to develop context-specific interventions.  A household census was conducted in selected clusters identifying 12,648 married women aged 13 to 49 years for monthly menstrual monitoring. During the trial, a local female monitor (LFM) will conduct menstrual monitoring of the identified consenting women. The LFMs will conduct urine pregnancy test to women reporting two missed periods and upon positive result they will alert the data assistant to screen eligibility and enroll women into the trial. A total of 983 women (491 per arm, 15.6 per cluster) will be enrolled into the trial to compare haemoglobin (Hb) at 30±2 weeks of pregnancy, IFA intake and diet diversity including micronutrient content in diet.

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