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| Name | Class |
|---|---|
| International Food Policy Research Institute | OTHER |
| Bill and Melinda Gates Foundation | OTHER |
| London School of Hygiene and Tropical Medicine | OTHER |
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The purpose of this study is to evaluate the impact of Benazir Nashonuma Program (BNP) which includes specialized nutritious food (SNF) augmented with specific reproductive health interventions during pregnancy on proportion of low birthweight babies and stunting among children, in low income setting of Pakistan. The study aims to answer if:
Participants who are enrolled in the Benazir Nashonuma Program (receiving intervention) and those who are not enrolled (not receiving intervention) will be followed throughout pregnancy till delivery. After delivery mother-baby dyad will be followed for a period of 12 months. Compliance of supplementation will be measured, and outcomes (low birthweight and stunting) observed throughout the follow up.
Malnutrition in Pakistan is a major and pervasive public health issue. Every four under five children in our country are reported to be stunted, with a mighty prevalence of 40.2% stunting as reported in the National Nutritional Survey of Pakistan 2018. Pakistan also shares one of the highest burden of low birthweight (LBW) where 19% babies in urban and 32% in rural are born with weight <2500 grams. LBW babies have a higher risk of death compared to full term babies and contributes to 60-80% of all neonatal deaths.
The first 1000 days of life, the time from conception to 2 years of age, is a critical period, providing a window of opportunity for interventions to improve maternal and child nutrition and health outcomes including stunting and other nutritional markers. Availability and access to primary healthcare and nutrition services during pregnancy and the first two years of life can help prevent undernutrition and reduce infections in early life, helping reduce maternal and infant mortality, and preventing the lifelong and intergenerational consequences of malnutrition. Evidence-based nutrition interventions, especially the combination of BEP and small quantity lipid nutrient supplements have been shown to be effective in improving birth outcomes and reducing child stunting.
BNP is a health and nutrition CCT programme, with the aim to address stunting in children under 23 months of age. The CCT and Specialized Nutritious Food (SNF) are provided to Benazir Income Support Programme (BISP) participating women during pregnancy and lactation up to 6 months and to children aged 6-23 months contingent on their participation in and adherence to BNP interventions. In addition to the programme components, the pre-existing standard of care interventions including antenatal and postnatal care, childhood immunizations, growth monitoring and behavior change communication (BCC) activities, i.e., awareness sessions on health, nutrition and hygiene.
The primary study objectives are to assess the impact of intervention (BNP) on:
The secondary objectives related to maternal outcomes are to assess the impact of intervention on:
The secondary objectives related to newborn and infant outcomes are to assess the impact of the intervention on:
Other objectives include following:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| BNP enrolled | Experimental | Pregnant women in their first or second trimester who have been enrolled in BNP |
|
| BNP non-enrolled | No Intervention | Pregnant women in their first or second trimester who are not enrolled in BNP |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Benazir Nashonuma Program (BNP) | Other | Dietary supplement for pregnant women and lactating mothers during the first six months of lactation: Maamta is a 75-gram sachet made from peanut butter with 400 kcal of energy Dietary supplement for children aged 6-23 months: Wawamum is a lipid-based nutrient supplement consisting of skimmed milk powder, micronutrients, vegetable oil, roasted chickpeas and antioxidants. Wawamum covers the recommended daily dose of most micronutrients and 255 kcal of energy (1/4 of daily energy requirements for children in this age range) Conditional Cash Transfers (CCT): This includes stipends of PKR 2000 during pregnancy contingent on three antenatal care visits, consuming SNF, attending awareness sessions on health and nutrition, getting two doses of tetanus toxoid and institutional delivery. After delivery PKR 2000/- for boys and 2500/- for girls are paid as incentives conditioned on getting child's birth registered, routine immunization and consumption of SNF by the child from 6-23 months |
| Measure | Description | Time Frame |
|---|---|---|
| Prevalence of low birthweight | Birth weight of less than 2500 g (up to and including 2499 g) within 48 hours of delivery | Within 48-hours of delivery |
| Prevalence of stunting | Height-for-age ≤-2 SD of the WHO Child growth standards median | At 6 months of age |
| Prevalence of stunting | Height-for-age ≤-2 SD of the WHO Child growth standards median | At 12 months of age |
| Measure | Description | Time Frame |
|---|---|---|
| Prevalence of wasting | Weight-for-height ≤-2 SD of the WHO Child growth standards median. | At 6 and 12 months of age |
| Prevalence of Iron deficiency anemia in pregnant women | Hemoglobin levels below 11 g/dl, serum ferritin less than or equal to 30 ng/ml, mean corpuscular volume MCV below 95 fl will be considered diagnostic of iron deficiency anemia |
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Inclusion Criteria:
Intervention arm: All pregnant women in their first or second trimester, who are enrolled in Benazir Nashonuma Program (BNP).
Non-intervention arm: All pregnant women in their first or second trimester, who are not enrolled in Benazir Nashonuma Program (BNP).
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Dr Sajid Bashir Soofi | Contact | +923002769398 | sajid.soofi@aku.edu | |
| Dr Asma Abdul Malik | Contact | +923311388051 | asma.qureshi@aku.edu |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Aga Khan Office | Recruiting | Dadu | Sindh | Pakistan |
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| ID | Term |
|---|---|
| D006130 | Growth Disorders |
| D002100 | Cachexia |
| D015362 | Child Nutrition Disorders |
| D018798 | Anemia, Iron-Deficiency |
| D005247 | Feeding Behavior |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D015431 | Weight Loss |
| D001836 | Body Weight Changes |
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| At 9th month on pregnancy |
| Prevalence of Iron deficiency anemia in infants | Hemoglobin concentration of less than 11.0 g/dl and ferritin levels of less than 15 micrograms/L | 2 point times: At 6 and 12 months of age |
| Number of antenatal care (ANC) visits during pregnancy | Attending at least 8 ANC consultations in a health facility/clinic | At delivery |
| Number of women who had an Institutional delivery | Having delivered in a health facility | At delivery |
| Number of women who had Skilled birth attendance | Birth attended by a skilled health personnel | At delivery |
| Number of women who had Postnatal care (PNC) check ups | Receiving a postnatal health check while in a facility or at home within 6-weeks of postnatal period | 3 months after delivery |
| Mean nutrient intake of energy in kilocalories of the pregnant woman | Mean nutrient intake of energy in kilocalories using 24-hour recall. | At 9th month of pregnancy |
| Prevalence of infants who were ever breastfed | Number of infants who were breastfed at least once | At 12 months of age |
| Prevalence of infants who had early initiation of breastfeeding | Number of infants who were put to the breast within one hour of birth | At 12 months of age |
| Prevalence of infants who were exclusively breastfed | Number of of infants aged 0-5 months who were fed exclusively with breast milk during the previous day | At 12 months of age |
| Prevalence of infants who consumed a minimum acceptable diet | Number of infants 6-12 months of age who consumed a minimum acceptable diet during the previous day | At 12 months of age |
| Prevalence of infants with minimum dietary diversity | Number of infants 6-12 months of age who consumed foods and beverages from at least four out of eight defined food groups during the previous day | At 12 months of age |
| Mean scores of Neurodevelopmental outcomes of the infant | Neurodevelopmental outcomes of the children will be assessed using Bayley Scales of Infant and Toddler Development (BSID-IV). Mean scores will be reported for cognitive, language and motor development of the infant using Bayley's scales. Higher scores in the Bayley Scales indicate better outcomes | At 12 months of age |
| Number of women consuming specialized nutritious food (SNF) | Utilization of supplementation (SNF) by the woman during pregnancy and first 6 months of lactation after delivery | At 6 months after delivery |
| Number of infants consuming specialized nutritious food (SNF) | Utilization of supplementation (SNF) by the infant from 6-23 months of age | At 12 months of age |
| D001835 | Body Weight |
| D012816 | Signs and Symptoms |
| D013851 | Thinness |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
| D000747 | Anemia, Hypochromic |
| D000740 | Anemia |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D000090463 | Iron Deficiencies |
| D019189 | Iron Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D001522 | Behavior, Animal |
| D001519 | Behavior |