Effect of Dietary Counseling During Pregnancy on Infant Birthweight in Mangochi , Malawi
- Conditions
- Maternal Exposure During Pregnancy
- Interventions
- Behavioral: Community based dietary counsellingBehavioral: Community based antenatal counselling
- Registration Number
- NCT03136393
- Lead Sponsor
- University of Oslo
- Brief Summary
High neonatal mortality rates accounts for a substantial early loss of lives in Malawi; and has thus been a hindrance for Malawi to eradicate child deaths. From 2000 to 2011, Malawi achieved an overall reduction of 23% in under-five child mortality. The reduction was more substantial between the second and the fifth year of life, being 28%. However, in the neonatal period the reduction was half, at 14%. Neonatal deaths in developing countries are due to prematurity or low birth weight, neonatal infections, birth trauma related conditions and congenital anomalies.
Being of low birth weight increases the risk of death four fold in the neonatal period. Even when low birth weight infants survive, their poorly developed immune function exposes them to increased morbidity in early life. Maternal nutrition represents by far the greatest influence among pregnancy environmental on birth weight in low income countries. There is strong evidence that health and dietary counselling is effective in improving child nutrition outcomes. Thus we propose to test the effectiveness in improving birth weight by a low cost intervention, community based health and nutrition counselling delivered to mothers during pregnancy in Malawi.
On the other hand, in the Malawian context offering individualized dietetic counselling could be impeded by the healthcare workforce short fall. Currently the health workforce does not include dieticians . The use of lay health workers (LHW) has been identified as one of the effective strategies to meet the health workforce shortage challenges in low resource settings.
It is on this basis that a study was planned, aimed at developing lay health worker delivered community based nutrition counselling to mothers during pregnancy and measuring its effectiveness in improving birth weight in the Malawian context. The study was comprised of an initial i) formative study, followed by ii) a cross-sectional survey. Findings of these two sub-studies were utilized to develop a nutrition counselling intervention. Finally iii) a cluster Randomized Controlled Trial (cRCT) aimed at measuring the effect of the intervention on birth size (weight, length, arm and abdominal circumferences) will now be conducted which is being elaborated in this protocol.
- Detailed Description
High neonatal mortality rates accounts for a substantial early loss of lives in Malawi; and has thus been a hindrance for Malawi to eradicate child deaths. From 2000 to 2011, Malawi achieved an overall reduction of 23% in under-five child mortality. The reduction was more substantial between the second and the fifth year of life, being 28%. However, in the neonatal period the reduction was half, at 14%. Neonatal deaths in developing countries are due to prematurity or low birth weight, neonatal infections, birth trauma related conditions and congenital anomalies.
Being of low birth weight increases the risk of death four fold in the neonatal period. Even when low birth weight infants survive, their poorly developed immune function exposes them to increased morbidity in early life. Maternal nutrition represents by far the greatest influence among pregnancy environmental on birth weight in low income countries. There is strong evidence that health and dietary counselling is effective in improving child nutrition outcomes. Thus we propose to test the effectiveness in improving birth weight by a low cost intervention, community based health and nutrition counselling delivered to mothers during pregnancy in Malawi.
On the other hand, in the Malawian context offering individualized dietetic counselling could be impeded by the healthcare workforce short fall. Currently the health workforce does not include dieticians . The use of lay health workers (LHW) has been identified as one of the effective strategies to meet the health workforce shortage challenges in low resource settings.
It is on this basis that a study was planned, aimed at developing lay health worker delivered community based nutrition counselling to mothers during pregnancy and measuring its effectiveness in improving birth weight in the Malawian context. The study was comprised of an initial i) formative study, followed by ii) a cross-sectional survey. Findings of these two sub-studies were utilized to develop a nutrition counselling intervention. Finally iii) a cluster Randomized Controlled Trial (cRCT) aimed at measuring the effect of the intervention on birth size (weight, length, arm and abdominal circumferences) will now be conducted which is being elaborated in this protocol.
Three hundred pregnant women, at ≥12 weeks but ≤ 16 weeks of gestation, will be recruited from Nankumba Traditional Authority (TA) area, in Mangochi district. They will be offered community based dietary counselling aiming at improving dietary intake to meet their nutritional needs.
Measurement of study outcomes will be as follows: Infant birthweight will be collected at the end of the study while as dietary intake (including dietary perceptions), anthropometric status, and biochemical nutrition status will be assessed at enrollment, and two additional time points before the end point.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 300
- Pregnant at ≥ 6 weeks but ≤ 17 weeks of gestation
- Available during the period of the study.
- Intention to reside in the study area in the next 6 months
- Intention to give birth at the health facilities within the study area
- Consent to participate (indicated by a signature or fingerprint)
- Severe illness, where the mother is bed ridden
- Multiple births
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention Community based dietary counselling Community based dietary counselling Control Community based antenatal counselling Community based antenatal counselling Intervention Community based antenatal counselling Community based dietary counselling
- Primary Outcome Measures
Name Time Method Infant birthweight 1 hour Infant birthweight measured within an hour after birth
- Secondary Outcome Measures
Name Time Method Knowledge of healthy foods At 8-22 weeks; 35 weeks of gestation Perceptions towards food, eating habits
Infant birth length 1 hour Infant birth length measured within an hour after birth
Infant birth abdomen circumference 1 hour Infant birth abdomen circumference measured within an hour after birth
Pregnancy skinfold thickness At 8-22 weeks; 35 weeks of gestation Skinfold thicknesses (subscapular, biceps, triceps, suprailiac)
Pregnancy food intake At 8-22 weeks; 35 weeks of gestation Quantified food intake past 24 hours
Pregnancy hemoglobin count At 8-22 weeks; 35 weeks of gestation Hemoglobin count in grams per decilitre
Infant birth head circumference 1 hour Infant head circumference measured within an hour after birth
Pregnancy body mass index At 8-22 weeks; 35 weeks of gestation Weight, Height, during
Pregnancy blood glucose level At 8-22 weeks; 35 weeks of gestation Blood glucose measured in milligram per decilitre
Trial Locations
- Locations (1)
Monkey bay community hospital
🇲🇼Mangochi, Malawi