The primary aims of this study are: 1) To evaluate the impact of supplementation with multiple micronutrients (MMN) from preconception and life skills education among women 15-18.9 years of age at enrolment on the prevalence of anemia in a population setting; and 2) To evaluate the impact of supplementation with MMN from preconception and life skills education among young women 15-24 years of age on the rate of low birth weight (LBW) in a population setting. Infants born to mothers enrolled in the study will be followed for 1 year. This study aims to enrol 25,400 non-pregnant young women in Matiari district. This sample size is anticipated to equate to 1456 births. Participants will be randomized by cluster to receive either MMN supplements and life skills education or the standard of care at enrolment. Clusters have been defined based on health facility catchment areas. MMN supplements will be provided twice weekly during the preconception period, once daily during the pregnancy period, and once daily until 6 months after giving birth during the postpartum period; and a package of life skills education materials will be provided bi-monthly during the preconception period. In addition to the primary outcomes, measurements will include micronutrient status, anthropometrics, birth outcomes, dietary intake and feeding practices, adherence, and indices of empowerment.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
25,447
The intervention is an oral tablet containing 15 different vitamins and minerals at the UNIMMAP composition (includes 30 mg iron, 400 μg folic acid, 15 mg zinc, 2 mg copper, 65 μg selenium, 800 μg RE vitamin A, 1.4 mg vitamin B1, 1.4 mg vitamin B2, 18 mg niacin, 1.9 mg vitamin B6, 2.6 μg vitamin B12, 70 mg vitamin C, 5 μg vitamin D, 10 mg vitamin E and 150 μg iodine). Each tablet is small (approximately 10 mm diameter) and has been procured using the UNICEF supply catalogue. A single MMN supplementation dose will consist of a single tablet.
The life skills based education will be provided bi-monthly in the format of a group session throughout the preconception period. Three topic areas related to empowerment have been prioritized, including preventing early marriage; personal and menstrual hygiene practices; and the importance of nutrition to good health. Integrated within these topics will be messages related to the importance of continuing one's education, mental health, gender norms and equality, decision making, advocacy, resiliency, participation, communication skills, facing challenges, agency, conflict resolution, and the prevention of violence.
Matiari Research and Training Centre
Matiari, Sindh, Pakistan
Anemia status
Hemoglobin concentration \<12 g/dL
Time frame: 0, 12*, 24 months (*in subgroup only)
Low birth weight
Birth weight \<2500 g
Time frame: At birth
Biomarkers: serum ferritin, serum transferrin receptor, hepcidin, serum retinol, serum 25(OH)D, alpha-glycolytic protein, C-reactive protein (women)
Time frame: Preconception (subgroup only): enrolment, 1 year, 2 years; Pregnancy: 4-12 weeks, 32 weeks; Postpartum: 1 week
Anthropometrics: height (women)
Time frame: Preconception: enrolment, 6 months*, 1 year, 2 years (*in subgroup only); Pregnancy: 4-12 weeks, 32 weeks; Postpartum: 1 week, 6 months
Anthropometrics: middle upper arm circumference (women)
Time frame: Preconception: enrolment, 6 months*, 1 year, 2 years (*in subgroup only); Pregnancy: 4-12 weeks, 32 weeks; Postpartum: 1 week, 6 months
Anthropometrics: weight (women)
Time frame: Preconception: enrolment, 6 months*, 1 year, 2 years (*in subgroup only); Pregnancy: 4-12 weeks, 32 weeks; Postpartum: 1 week, 6 months
Gestational age
Time frame: At birth
Preterm birth
Time frame: At birth
Stillbirth
Time frame: At birth
Small for gestational age
Time frame: At birth
Birth size: length
Time frame: Within 24 hours of birth
Birth size: head circumference
Time frame: Within 24 hours of birth
Birth size: middle upper arm circumference
Time frame: Within 24 hours of birth
Birth size: weight
Time frame: Within 24 hours of birth
Birth defects
Time frame: At birth
Infant growth: length
Time frame: 1, 3, 6, 9, 12 months
Infant growth: head circumference
Time frame: 1, 3, 6, 9, 12 months
Infant growth: middle upper arm circumference
Time frame: 1, 3, 6, 9, 12 months
Infant growth: weight
Time frame: 1, 3, 6, 9, 12 months
Age at marriage
Time frame: Enrolment, 1 year, 2 years
Completion of 10th grade education
Time frame: Enrolment, 1 year, 2 years
Use of sanitary pad during last menstrual period
Time frame: Enrolment, 1 year, 2 years
Dietary intake: 24-hour recall (subgroup of women)
Time frame: Preconception: enrolment; Pregnancy: 4-12 weeks, 32 weeks
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