Feasibility and effect of life skills building education and multiple micronutrient supplements versus the standard of care on anemia among non-pregnant adolescent and young Pakistani women (15-24 years): a prospective, population-based cluster-randomized trial

Jo-Anna B Baxter, Yaqub Wasan, Sajid B Soofi, Zamir Suhag, Zulfiqar A Bhutta, Jo-Anna B Baxter, Yaqub Wasan, Sajid B Soofi, Zamir Suhag, Zulfiqar A Bhutta

Abstract

Background: Adolescence is a critical period for physical and psychological growth and development, and vitamin and mineral requirements are correspondingly increased. Health and health behaviours correspond strongly from adolescence to adulthood. Developing a preconception care package for adolescent and young women in resource-limited settings could serve to empower them to make informed decisions about their nutrition, health, and well-being, as well as function as a platform for the delivery of basic nutrition-related interventions to address undernutrition.

Methods: In this population-based two-arm, cluster-randomized, controlled trial of life skills building education (provided bi-monthly) and multiple micronutrient supplementation (provided twice-weekly; UNIMMAP composition), we aim to evaluate the effectiveness of the intervention on the prevention of anemia (hemoglobin concentration < 12 g/dL) among adolescent and young women (15-24 years) in Matiari district, Pakistan compared to the standard of care. Several secondary objectives related to nutrition (anthropometry [height, weight, middle upper arm circumference (MUAC)], nutritional status [iron, vitamin A, vitamin D]); general health (morbidity, mortality); and empowerment (age at marriage, completion of the 10th grade, use of personal hygienic materials during menstruation) will also be assessed. Participants will be enrolled in the study for a maximum of 2 years.

Discussion: Empowering adolescent and young women with the appropriate knowledge to make informed and healthy decisions will be key to sustained behavioural change throughout the life-course. Although multiple micronutrient deficiencies are known to exist among adolescent and young women in low-resource settings, recommendations on preconception multiple micronutrient supplementation do not exist at this time. This study is expected to offer insight into providing an intervention that includes both education and supplements to non-pregnant adolescent and young women for a prolonged duration of time within the existing public health programmatic context.

Trial registration: This study is part of the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial. The MaPPS Trial was registered retrospectively on clinicaltrials.gov (Identifier: NCT03287882 ) on September 19, 2017.

Keywords: Adolescence; Anemia; Education; Empowerment; Micronutrients; Nutrition; Preconception; Young adult.

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval for this trial was obtained from the Aga Khan University Ethics Review Committee on August 16, 2016 (Number: 4324-Ped-ERC-16); and from the Research Ethics Board at the Hospital for Sick Children on November 17, 2016 (Number: 1000054682). All women enrolled in the trial are asked for their written consent to participate in the trial and are free to decline or stop their participation at any time without any consequences.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Matiari emPowerment and Preconception Supplementation (MaPPS) Trial flow diagram for participants who do not become pregnant

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Source: PubMed

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