- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05311436
Nutri-CAP: Nutrition for Children, Adolescent Girls, and Pregnant Women in Slums of Dhaka City
The objective of the research project is to establish an evidence-based sustainable nutrition service delivery platform for optimizing pregnancy weight gain, increasing dietary diversity of adolescent girls, and ensuring proper physical growth of under 2 children.
Hypothesis
- Pregnant Women: Intensive nutrition and WASH counseling, iron-folate, calcium supplementation during pregnancy, can improve gestational weight gain and improve hemoglobin status in pregnant women in a slum of Dhaka city
- Adolescent girl: Iron and zinc supplementation and nutrition counseling on dietary diversity could improve nutritional status and dietary diversity score in adolescent girls of slums in Dhaka
- Children <2 years: Counselling on IYCF, growth monitoring, and promotion, ensuring six-monthly vitamin A supplementation, counseling on WASH, treatment of acute malnutrition, and daily 1 egg supplementation for 3 months for severely stunted children can improve the nutritional status of children
- Counselling to improve Water, Sanitation and Hygiene (WASH) practice: WASH intervention can improve EED biomarkers
Study Overview
Status
Detailed Description
Background
- Burden: The emergence of COVID-19 poses a substantial public health risk to the world. Our research done at the peak of the lockdown in Dhaka city showed that 90% of more than 200 households surveyed in a slum in Dhaka city and villages of Matlab in rural Bangladesh suffered from food insecurity, the situation was worse in the slum areas. Our previous work demonstrated that 50% of under-five children in slums have stunted growth, half of all children suffer from deficiency of zinc. Our recently completed study revealed that third-trimester weight gain was poor in general among rural women in Matlab, Bangladesh, and 54% of the women failed to gain adequate weight (>4 kg) in the third trimester.
- Knowledge gap: Although the burden of undernutrition, as well as adverse consequences of nutritional impairment, is prominent in Bangladesh, there is no platform to implement sustainable nutrition delivery services in slums, particularly for children, adolescent girls, and mothers with pregnancy. In addition, there lack of data on the status of pregnancy weight gain, dietary diversity both in pregnant women and adolescent girls in slums. Evidence on the role of Infant and Young Child Feeding (IYCF), growth monitoring and promotion, micronutrient supplementation, and counseling on Water, Sanitation, and Hygiene (WASH) in improving childhood growth and ameliorating Environmental Enteric Dysfunction (EED) is also limited.
- Relevance: Such lack of knowledge limits the success of nutritional programs being done in slums. Moreover, it is causing obstacles in reducing the nutritional burden among three vulnerable groups of the population.
Methods
This study will be conducted in the Bauniabadh and the adjacent slum areas of Dhaka city. This study includes a community survey, formative study, community-based nutrition intervention, and an evaluation of the programmatic intervention using a quasi-experimental design.
Bauniabadh slum area has a population of ~150,000. It has five blocks: A, B, C, D, and E. Blocks B, C, and E will be the intervention area for programmatic intervention and A and D will be the control area where no intervention will be provided. Blocks A, and D is separated from other blocks by a road, a school, and a water body.
At first, a community survey will be conducted to identify the total number of beneficiaries in both the control and intervention areas: under 2 years old children, adolescent girls, and pregnant women at or before 16 weeks of gestation.
The formative research includes 24-h dietary recalls, in-depth interviews with purposively selected household heads, women, adolescent girls, and focus group discussions with women and adolescent girls to explore the locally available foods to prepare nutritious diets for pregnant women and adolescent girls. Moreover, this formative study will help in tailoring the messages for group counseling sessions on nutrition and WASH on the perspectives of the slum dwellers in Dhaka city. All counseling materials for the programmatic intervention will be developed from data generated from the formative research and using existing materials.
In the intervention area, nutrition intervention will be provided to all pregnant women, adolescent girls, and children under the age of 2 years. For pregnant women, intensive dietary counseling will be provided through household visits. The intervention also includes daily iron-folate and calcium supplementation to the pregnant women for the remaining pregnancy period till childbirth, and at least four antenatal visits to local ANC service providers will be ensured. For all adolescent girls, monthly two nutrition education sessions for six months will be organized to improve dietary diversity. Adolescent girls will also receive weekly iron and folate supplementation for 3 months and 10 mg of zinc sulfate tablet daily for 1 month. Training research staff will do monthly growth monitoring and promotion for all under 2-year-old children. All children suffering from acute malnutrition will be treated and severely stunted children will be supplemented with one egg daily for 3 consecutive months and multiple micronutrient powders for six months. Additionally, counseling on water sanitation and hygiene, and food safety will be provided to all beneficiary households. This program will ensure community participation to improve the garbage disposal system, water supply and cleaning of drains in the area.
The primary outcome measures will be total pregnancy weight gain (kg) and rate of weight gain (kg/week) for pregnant women. Change in dietary diversity scores in adolescent girls and change in length-for-age z-score for children under the age of 2 years.
Evaluation will be done using a quasi-experimental design. Data related to outcome indicators will be collected from target groups from both the intervention and the controls areas.
At the end of the intervention, based on calculated sample sizes to see the changes in outcome variables, at a 5% level of significance with 90% power, we will need to enroll at least 199 pregnant women, 572 adolescent girls, 420 <2 children in each group. Based on previous data, we assume that the total available sample sizes for the programmatic intervention will be 400 pregnant women, 1200 adolescent girls, and 1500 for children <2 years. Therefore, our sample size will have more than enough power to test our hypotheses.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Mustafa Mahfuz, MBBS, MPH
- Phone Number: 2304 _+880-2-2222277001-10
- Email: mustafa@icddrb.org
Study Contact Backup
- Name: Fahmida Farzana, MSc, MPH
- Phone Number: 2280 _+880-2-2222277001-10
- Email: fahmidaf@icddrb.org
Study Locations
-
-
-
Dhaka, Bangladesh, 1236
- Recruiting
- International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b)
-
Contact:
- Mustafa Mahfuz, MBBS, MPH
- Phone Number: 2304 +8802222277001
- Email: mustafa@icddrb.org
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Pregnant women:
- Age 18-39 years
- Before 16 weeks of gestation
- BMI 15-24.99 kg/m2 measured on enrolment
- Have the plan to stay in the study area till delivery
- Willing to participate in the study
- Not enrolled in any nutrition project/programme currently
Adolescent girls:
- Aged 11-19 years
- Willing to participate in the study
- Not involved in any nutrition project/programme
- Will stay in the study area for the next 2 years
Children:
- Aged 0-24 months
- Youngest child of the household
- Caregivers have the plan to stay in the study area at least up to two years of age
- Not enrolled in any nutrition project/programme currently
Exclusion Criteria:
Pregnant women:
- Subject not willing to provide consent
- Subject has the plan to migrate outside of the study area during the study period
- Subject has a plan to go elsewhere ( village/ parents' house) for delivery
- Any reported/diagnosed chronic diseases (such as hypertension, heart disease, chronic obstructive pulmonary disease, chronic kidney disease, chronic liver disease, pancreatic diseases, diabetes mellitus, thyroid dysfunction, immunological diseases, malignancy, or any other diseases which could impede compliance with the study protocol)
- Extremely obese
- Subject involved in any nutrition programme/ intervention currently
Adolescent girls:
- Subject not willing to give assent/consent
- Subject has the plan to migrate outside the study area during the study period
- Subject involved in any nutrition programme/intervention currently
Children:
- Caregiver/guardian not willing to provide consent
- Have the plan to migrate outside of the study area during the study period
- Child with any congenital anomaly
- Subject involved in any nutrition programme/intervention currently
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Experimental
|
Pregnant women: Intensive dietary counseling using diet chart for locally available food, and to attend antenatal care services from local ANC providers, daily Iron, folic acid, and calcium supplementation Adolescent girls: Behavioral: Group sessions in the nutrition centers with the adolescent girls will be conducted twice monthly for six months. Iron and folic acid (200 mg ferrous fumarate and 200 μg folic acid); once weekly for 3 months; zinc 10 mg daily for 1 month Children <2 years: Behavioral counseling sessions through monthly home visits on Infant and Young Child feeding, Growth monitoring and promotion, and water sanitation and hygiene, and food safety, Severely stunted children: 1 egg supplementation for 3 months and 1 sachet of multiple micronutrient powder (1 RDA of vitamin A and C, iron-folic acid, and zinc) daily for 6 months.
Other Names:
|
No Intervention: Control
Participants will receive the standard of care in the area
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Gestational weight gain
Time Frame: From the 16th week of gestation to child birth
|
Change in gestational weight gain and rate of weight gain in the pregnant woman
|
From the 16th week of gestation to child birth
|
Dietary Diversity
Time Frame: 6 months
|
Change in Dietary Diversity of Adolescent Girl
|
6 months
|
Improve linear growth
Time Frame: 1 year
|
Change in length for age z-score of children less than 2 years
|
1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hemoglobin level of adolescent girl
Time Frame: 6 months
|
A change in hemoglobin level Adolescent Girl
|
6 months
|
IYCF indicators
Time Frame: 1 year
|
A change in WHO's core IYCF indicators for Children <2 years
|
1 year
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hemoglobin level of Pregnant woman
Time Frame: 16 week of pregnancy to child birth
|
A change in hemoglobin level of Pregnant woman
|
16 week of pregnancy to child birth
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Mustafa Mahfuz, MBBS, MPH, International Centre for Diarrhoeal Disease Research, Bangladesh
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- PR-21082
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Health Behavior
-
Holbaek SygehusRecruitingHealth Behavior | Health Knowledge, Attitudes, Practice | Health-Related Behavior | Health LiteracyDenmark
-
Finnish Institute for Health and WelfareCompletedHealth Behavior | Health Care Utilization | Health Care Seeking BehaviorFinland
-
Basque Health ServiceUnknownHealth Promotion | Health Behavior | Health Education | Patient Education | Counseling | Behavior TherapySpain
-
University Hospital, Basel, SwitzerlandSolidarMed LesothoRecruitingRecruitment | Health Behavior | Motivation | Social Behavior | Health Care Utilization | Consumer Behavior | Health Care Seeking Behavior | Researcher-Subject RelationsLesotho
-
Imperial College LondonRecruitingHealth Attitude | Disease | Cancer | Health Behavior | Health Knowledge, Attitudes, Practice | Health-Related BehaviorUnited Kingdom
-
Research on Healthcare Performance Lab U1290RecruitingStress | Health Behavior | Health-Related BehaviorFrance
-
Azienda Sanitaria Locale CN2 Alba-BraUniversity of Turin, Italy; University of Eastern Piedmont; Eclectica Sas di...CompletedEffectiveness of the Updated Version of the School-based Program Diario Della Salute (DDS-2) (DDS-2)Mental Health Wellness 1 | Health Behavior | Adolescent BehaviorItaly
-
Research on Healthcare Performance Lab U1290RecruitingSedentary Behavior | Sedentary Time | Health Behavior | Health-Related Behavior | Physical InactivityFrance
-
World Health OrganizationLondon School of Hygiene and Tropical Medicine; University of Ghana; Biomedical... and other collaboratorsRecruitingHealth-Related Behavior | Adolescent Behavior | Adolescent Development | Health Care Seeking BehaviorGhana, Tanzania, Zimbabwe
-
Ankara Yildirim Beyazıt UniversityNot yet recruitingHealth Attitude | Health Behavior | Health KnowledgeTurkey