Comprehensive Anaemia Programme and Personalized Therapies (CAPPT): protocol for a cluster-randomised controlled trial testing the effect women’s groups, home counselling and iron supplementation on haemoglobin in pregnancy in southern Nepal

Saville, Naomi; Kharel, Chandani; Morrison, Joanna; Harris‐Fry, Helen; James, Philip; Copas, Andrew; Giri, Santosh; Arjyal, Abriti; Beard, B James; Haghparast‐Bidgoli, Hassan; Skordis‐Worrall, Jolene; Richter, A; Baral, Sushil; Hillman, Sara

doi:10.1186/s13063-022-06043-z

Cited by 2 publications

(1 citation statement)

References 101 publications

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“…This study was conducted to inform the design of a nutrition counselling intervention aiming to reduce anaemia in pregnancy in plains (terai) of Nepal ( 28 ) . The terai makes up only 23 % of Nepal’s landmass, but around 50 % of the population live there.…”

Section: Methodsmentioning

confidence: 99%

Assessing food-based strategies to address anaemia in pregnancy in rural plains Nepal: a mixed methods study

Morrison

Giri²,

James³

et al. 2022

Br J Nutr

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Anaemia in pregnancy is a persistent health problem in Nepal and could be reduced through nutrition counselling and strengthened iron folic acid supplementation programmes. We analysed 24-hour diet recall data from 846 pregnant women in rural plains Nepal, using linear programming to identify the potential for optimised food-based strategies to increase iron adequacy. We then conducted qualitative research to analyse how anaemia was defined and recognised, how families used food-based strategies to address anaemia, and the acceptability of optimised food-based strategies. We did 16 interviews of recently pregnant mothers, three focus group discussions with fathers, three focus group discussions with mothers-in-law, and four interviews with key informants. Dietary analyses showed optimised diets did not achieve 100% of recommended iron intakes, but iron intakes could be doubled by increasing intakes of green leaves, egg, and meat. Families sought to address anaemia through food-based strategies but were often unable to because of the perceived expense of providing an ‘energy-giving’ diet. Some foods were avoided because of religious or cultural taboos, or because they were low-status and could evoke social consequences if eaten. There is a need for counselling to offer affordable ways for families to optimise iron adequacy. The participation of communities in tailoring advice to ensure cultural relevance and alignment with local norms is necessary to enable its effectiveness.

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Section: Methodsmentioning

confidence: 99%

Assessing food-based strategies to address anaemia in pregnancy in rural plains Nepal: a mixed methods study

Morrison

Giri²,

James³

et al. 2022

Br J Nutr

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Study protocol for a randomised controlled trial of a virtual antenatal intervention for improved diet and iron intake in Kapilvastu district, Nepal: VALID

Saville

Bhattarai²,

Harris‐Fry

et al. 2023

BMJ Open

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IntroductionDespite evidence that iron and folic acid (IFA) supplements can improve anaemia in pregnant women, uptake in Nepal is suboptimal. We hypothesised that providing virtual counselling twice in mid-pregnancy, would increase compliance to IFA tablets during the COVID-19 pandemic compared with antenatal care (ANC alone.Methods and analysisThis non-blinded individually randomised controlled trial in the plains of Nepal has two study arms: (1) control: routine ANC; and (2) ‘Virtual’ antenatal counselling plus routine ANC. Pregnant women are eligible to enrol if they are married, aged 13–49 years, able to respond to questions, 12–28 weeks’ gestation, and plan to reside in Nepal for the next 5 weeks. The intervention comprises two virtual counselling sessions facilitated by auxiliary nurse midwives at least 2 weeks apart in mid-pregnancy. Virtual counselling uses a dialogical problem-solving approach with pregnant women and their families. We randomised 150 pregnant women to each arm, stratifying by primigravida/multigravida and IFA consumption at baseline, providing 80% power to detect a 15% absolute difference in primary outcome assuming 67% prevalence in control arm and 10% loss-to-follow-up. Outcomes are measured 49–70 days after enrolment, or up to delivery otherwise. Primary outcome: consumption of IFA on at least 80% of the previous 14 days. Secondary outcomes: dietary diversity, consumption of intervention-promoted foods, practicing ways to enhance bioavailability and knowledge of iron-rich foods. Our mixed-methods process evaluation explores acceptability, fidelity, feasibility, coverage (equity and reach), sustainability and pathways to impact. We estimate costs and cost-effectiveness of the intervention from a provider perspective. Primary analysis is by intention-to-treat, using logistic regression.Ethics and disseminationWe obtained ethical approval from Nepal Health Research Council (570/2021) and UCL ethics committee (14301/001). We will disseminate findings in peer-reviewed journal articles and by engaging policymakers in Nepal.Trial registration numberISRCTN17842200.

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Comprehensive Anaemia Programme and Personalized Therapies (CAPPT): protocol for a cluster-randomised controlled trial testing the effect women’s groups, home counselling and iron supplementation on haemoglobin in pregnancy in southern Nepal

Cited by 2 publications

References 101 publications

Assessing food-based strategies to address anaemia in pregnancy in rural plains Nepal: a mixed methods study

Assessing food-based strategies to address anaemia in pregnancy in rural plains Nepal: a mixed methods study

Study protocol for a randomised controlled trial of a virtual antenatal intervention for improved diet and iron intake in Kapilvastu district, Nepal: VALID

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