Evaluating the impact of a countrywide, market-based roll-out of multiple micronutrient supplementation on low birth weight in Bangladesh: protocol for a two-arm, quasi-experimental and mixed-methods evaluation study

Muttaquina Hossain, Kazi Ishtiaque Sanin, Md Ahshanul Haque, Mduduzi N N Mbuya, Samik Ghosh, Sufia Aksari, Sarah Gibson, Lynnette Neufeld, Moniruzzaman Bipul, Shahajahan Matubbar, Md Moshiur Rahman, Rudaba Khondker, Mihretab Salasibew, Tahmeed Ahmed, Muttaquina Hossain, Kazi Ishtiaque Sanin, Md Ahshanul Haque, Mduduzi N N Mbuya, Samik Ghosh, Sufia Aksari, Sarah Gibson, Lynnette Neufeld, Moniruzzaman Bipul, Shahajahan Matubbar, Md Moshiur Rahman, Rudaba Khondker, Mihretab Salasibew, Tahmeed Ahmed

Abstract

Introduction: Multiple micronutrient supplementation (MMS) during pregnancy has a greater potential for reducing the risk of low birth weight (LBW) compared with the standard iron-folic acid supplementation. WHO recently included MMS on their Essential Medicines List. The Social Marketing Company (SMC) in Bangladesh is implementing a countrywide, market-based roll-out of MMS to pregnant women. We aimed to evaluate the implementation of the supplementation programme and its impact on reducing LBW.

Methods and analysis: A two-arm, quasi-experimental and mixed-methods evaluation design will be used to evaluate the impact of this 36-month roll-out of MMS. In the intervention areas, pregnant women will purchase MMS products from the SMC's pharmacy networks. Pregnant women in comparison areas will not be exposed to this product until the end of the study. We will collect 4500 pregnant women's data on anthropometric, socioeconomic, nutrition-related and relevant programme indicators during recruitment and bimonthly follow-up until the end of their pregnancy. We will measure children's birth weight within 72 hours of birth and evaluate the changes in LBW prevalence. We will observe market-based MMS service delivery-related conditions of the pharmacies and the quality of the provider's service delivery. Concurrently, we will carry out a process evaluation to appraise the programme activities and recommend course correction. Cluster-adjusted multivariable logistic regression or log-binomial regression analysis of quantitative outcome data will be performed. For qualitative data, we will follow a thematic analysis approach. We will consolidate our study findings by triangulating the data derived from different methods.

Ethics and dissemination: This study received ethical approval from the institutional review board of icddr,b (PR number 21001). We will recruit eligible participants after obtaining their informed written/verbal consent (and assent where needed) with full disclosure about the study. The results will be disseminated through peer-reviewed publications and conference presentations.

Trial registration number: NCT05108454.

Keywords: Maternal medicine; NUTRITION & DIETETICS; PREVENTIVE MEDICINE; PUBLIC HEALTH.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Sampling procedure.
Figure 2
Figure 2
Flow of the participant diagram. CC, community clinic; LBW, low birth weight; MMS, multiple micronutrient supplementation; SMC, Social Marketing Company.
Figure 3
Figure 3
Key functions of process evaluation and relationships among them.

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