Impact of Benazir Nashonuma Program (BNP) on Maternal and Child Nutritional Status
- Conditions
- WastingMalnutrition, ChildDietary HabitsStuntingIron Deficiency AnemiaLow Birthweight
- Interventions
- Other: Benazir Nashonuma Program (BNP)
- Registration Number
- NCT05836961
- Lead Sponsor
- Aga Khan University
- Brief Summary
The purpose of this study is to evaluate the impact of Benazir Nashonuma Program (BNP) which includes specialized nutritious food (SNF) augmented with specific reproductive health interventions during pregnancy on proportion of low birthweight babies and stunting among children, in low income setting of Pakistan. The study aims to answer if:
1. Utilization of Benazir Nashonuma Program (BNP) among pregnant women is effective in reducing the proportion of low birthweight babies, compared to pregnant women who are not utilizing the program, among low income setting population.
2. Utilization of Benazir Nashonuma Program (BNP) is effective in reducing the proportion of stunting among children, compared to those not utilizing the program, among low income setting population.
Participants who are enrolled in the Benazir Nashonuma Program (receiving intervention) and those who are not enrolled (not receiving intervention) will be followed throughout pregnancy till delivery. After delivery mother-baby dyad will be followed for a period of 12 months. Compliance of supplementation will be measured, and outcomes (low birthweight and stunting) observed throughout the follow up.
- Detailed Description
Malnutrition in Pakistan is a major and pervasive public health issue. Every four under five children in our country are reported to be stunted, with a mighty prevalence of 40.2% stunting as reported in the National Nutritional Survey of Pakistan 2018. Pakistan also shares one of the highest burden of low birthweight (LBW) where 19% babies in urban and 32% in rural are born with weight \<2500 grams. LBW babies have a higher risk of death compared to full term babies and contributes to 60-80% of all neonatal deaths.
The first 1000 days of life, the time from conception to 2 years of age, is a critical period, providing a window of opportunity for interventions to improve maternal and child nutrition and health outcomes including stunting and other nutritional markers. Availability and access to primary healthcare and nutrition services during pregnancy and the first two years of life can help prevent undernutrition and reduce infections in early life, helping reduce maternal and infant mortality, and preventing the lifelong and intergenerational consequences of malnutrition. Evidence-based nutrition interventions, especially the combination of BEP and small quantity lipid nutrient supplements have been shown to be effective in improving birth outcomes and reducing child stunting.
BNP is a health and nutrition CCT programme, with the aim to address stunting in children under 23 months of age. The CCT and Specialized Nutritious Food (SNF) are provided to Benazir Income Support Programme (BISP) participating women during pregnancy and lactation up to 6 months and to children aged 6-23 months contingent on their participation in and adherence to BNP interventions. In addition to the programme components, the pre-existing standard of care interventions including antenatal and postnatal care, childhood immunizations, growth monitoring and behavior change communication (BCC) activities, i.e., awareness sessions on health, nutrition and hygiene.
The primary study objectives are to assess the impact of intervention (BNP) on:
* Proportion of babies born with low birthweight.
* Prevalence of stunting among infants at 6 and 12 months of age
The secondary objectives related to maternal outcomes are to assess the impact of intervention on:
* Dietary diversity of women
* Mean nutrient intake including energy in kilo calories.
* Prevalence of iron deficiency anemia among lactating women.
* Proportion of pregnant women using reproductive health services.
The secondary objectives related to newborn and infant outcomes are to assess the impact of the intervention on:
* Prevalence of wasting among infants at 6 and 12 months of age.
* Incidence of anemia among infants at 6- and 12-months of age
* Infant and child feeding practices among infants at 6 and 12 months of age.
* Neurodevelopmental outcomes (cognitive, language and motor development) using Bayley Scales of Infant and Toddler Development (BSID-IV) at 6 months, and 12 months of age among children.
Other objectives include following:
* To measure receipt and utilization of BEP supplementation among pregnant and lactating women enrolled in BNP.
* To measure receipt and utilization on BEP supplementation among children under 12 months of age enrolled in BNP
* Household food insecurity status (using the Food Insecurity Experience Scale).
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- Female
- Target Recruitment
- 5500
Intervention arm: All pregnant women in their first or second trimester, who are enrolled in Benazir Nashonuma Program (BNP).
Non-intervention arm: All pregnant women in their first or second trimester, who are not enrolled in Benazir Nashonuma Program (BNP).
- Women who intend to migrate or relocate for more than 3 months during the study period will be excluded from the study.
- Women in the non intervention group who are consuming specialized nutritious food (SNF) from any source at the time of enrollment will be excluded from the study.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description BNP enrolled Benazir Nashonuma Program (BNP) Pregnant women in their first or second trimester who have been enrolled in BNP
- Primary Outcome Measures
Name Time Method Prevalence of stunting At 12 months of age Height-for-age ≤-2 SD of the WHO Child growth standards median
Prevalence of low birthweight Within 48-hours of delivery Birth weight of less than 2500 g (up to and including 2499 g) within 48 hours of delivery
- Secondary Outcome Measures
Name Time Method Prevalence of Iron deficiency anemia in infants 2 point times: At 6 and 12 months of age Hemoglobin concentration of less than 11.0 g/dl and ferritin levels of less than 15 micrograms/L
Number of antenatal care (ANC) visits during pregnancy At delivery Attending at least 8 ANC consultations in a health facility/clinic
Prevalence of infants who were ever breastfed At 12 months of age Number of infants who were breastfed at least once
Prevalence of infants who were exclusively breastfed At 12 months of age Number of of infants aged 0-5 months who were fed exclusively with breast milk during the previous day
Prevalence of infants with minimum dietary diversity At 12 months of age Number of infants 6-12 months of age who consumed foods and beverages from at least four out of eight defined food groups during the previous day
Prevalence of wasting At 6 and 12 months of age Weight-for-height ≤-2 SD of the WHO Child growth standards median.
Number of women who had Postnatal care (PNC) check ups 3 months after delivery Receiving a postnatal health check while in a facility or at home within 6-weeks of postnatal period
Mean nutrient intake of energy in kilocalories of the pregnant woman At 9th month of pregnancy Mean nutrient intake of energy in kilocalories using 24-hour recall.
Number of women who had Skilled birth attendance At delivery Birth attended by a skilled health personnel
Prevalence of infants who consumed a minimum acceptable diet At 12 months of age Number of infants 6-12 months of age who consumed a minimum acceptable diet during the previous day
Mean scores of Neurodevelopmental outcomes of the infant At 12 months of age Neurodevelopmental outcomes of the children will be assessed using Bayley Scales of Infant and Toddler Development (BSID-IV). Mean scores will be reported for cognitive, language and motor development of the infant using Bayley's scales. Higher scores in the Bayley Scales indicate better outcomes
Prevalence of Iron deficiency anemia in pregnant women At 9th month on pregnancy Hemoglobin levels below 11 g/dl, serum ferritin less than or equal to 30 ng/ml, mean corpuscular volume MCV below 95 fl will be considered diagnostic of iron deficiency anemia
Number of women who had an Institutional delivery At delivery Having delivered in a health facility
Prevalence of infants who had early initiation of breastfeeding At 12 months of age Number of infants who were put to the breast within one hour of birth
Number of infants consuming specialized nutritious food (SNF) At 12 months of age Utilization of supplementation (SNF) by the infant from 6-23 months of age
Number of women consuming specialized nutritious food (SNF) At 6 months after delivery Utilization of supplementation (SNF) by the woman during pregnancy and first 6 months of lactation after delivery
Trial Locations
- Locations (1)
Aga Khan Office
🇵🇰Dadu, Sindh, Pakistan