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Status unknownNCT03287882Updated Jul 27, 2021

Effect of Micronutrients and Life Skills Education on the Health and Nutrition of Adolescent and Young Women in Pakistan

A Phase 3 interventional study of Multiple micronutrients (UNIMMAP composition) and Life skills based education in Adolescents, Anemia and Pregnancy, sponsored by Aga Khan University. Status unknown at 1 site in Pakistan. Open to female participants aged 15 Years to 24 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2021-07-27.

Sponsored by Aga Khan University · Phase 3, Interventional, and Prevention

The sponsor has not verified this record recently (last verified Jul 2021), so the status shown — last known as Active, not recruiting — may be out of date.
Phase
Phase 3
Study type
Interventional
Enrollment
25,447
Allocation
Randomized
Ages
15 Years to 24 Years
Sex
Female
01

Study summary

The primary aims of this study are: 1) To evaluate the impact of supplementation with multiple micronutrients (MMN) from preconception and life skills education among women 15-18.9 years of age at enrolment on the prevalence of anemia in a population setting; and 2) To evaluate the impact of supplementation with MMN from preconception and life skills education among young women 15-24 years of age on the rate of low birth weight (LBW) in a population setting. Infants born to mothers enrolled in the study will be followed for 1 year. This study aims to enrol 25,400 non-pregnant young women in Matiari district. This sample size is anticipated to equate to 1456 births. Participants will be randomized by cluster to receive either MMN supplements and life skills education or the standard of care at enrolment. Clusters have been defined based on health facility catchment areas. MMN supplements will be provided twice weekly during the preconception period, once daily during the pregnancy period, and once daily until 6 months after giving birth during the postpartum period; and a package of life skills education materials will be provided bi-monthly during the preconception period. In addition to the primary outcomes, measurements will include micronutrient status, anthropometrics, birth outcomes, dietary intake and feeding practices, adherence, and indices of empowerment.

02

Conditions studied

  • Adolescents
  • Anemia
  • Pregnancy
  • Empowerment

Keywords

  • preconception supplementation
  • multiple micronutrients
  • low birth weight
03

Who can participate

Ages eligible
15 Years to 24 Years
Sexes eligible
Female
Accepts healthy volunteers
Yes

Inclusion criteria

  • Minimum age at enrolment: 15 years
  • Maximum age at enrolment: 23 years
  • Any marital status
  • Intend to comply with study intervention and follow up

Exclusion criteria

Exclusion Criteria:

  • Women participating in other nutrition trials
  • Women who intend to leave the study area
  • Women who are already pregnant
04

Study design

Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Double (Investigator, Outcomes assessor)
Enrollment
25,447 participants (actual)

Study arms

  • No intervention
    Standard of care

    1. Preconception period: none 2. Pregnancy period: daily iron (60 mg) and folic acid (400 µg) supplementation from confirmation of pregnancy; daily balanced energy protein supplements will additionally be provided to those participants who are underweight at the confirmation of pregnancy for the duration of the pregnancy 3. Postpartum period: daily iron and folic acid supplementation to 6 months postpartum

  • Experimental
    MMN supplementation and life skills education

    1. Preconception period: twice-weekly MMN supplementation and bi-monthly group session including life skill based education materials 2. Pregnancy period: daily MMN supplementation from confirmation of pregnancy; daily balanced energy protein supplements will additionally be provided to those participants who are underweight at the confirmation of pregnancy for the duration of the pregnancy 3. Postpartum period: daily MMN supplementation to 6 months postpartum

    Dietary Supplement: Multiple micronutrients (UNIMMAP composition) · Behavioral: Life skills based education

Interventions

  • Dietary supplementMultiple micronutrients (UNIMMAP composition)

    The intervention is an oral tablet containing 15 different vitamins and minerals at the UNIMMAP composition (includes 30 mg iron, 400 μg folic acid, 15 mg zinc, 2 mg copper, 65 μg selenium, 800 μg RE vitamin A, 1.4 mg vitamin B1, 1.4 mg vitamin B2, 18 mg niacin, 1.9 mg vitamin B6, 2.6 μg vitamin B12, 70 mg vitamin C, 5 μg vitamin D, 10 mg vitamin E and 150 μg iodine). Each tablet is small (approximately 10 mm diameter) and has been procured using the UNICEF supply catalogue. A single MMN supplementation dose will consist of a single tablet.

    Also known as: UNICEF, Micronutrient tabs, pregnancy/PAC-1000

  • BehavioralLife skills based education

    The life skills based education will be provided bi-monthly in the format of a group session throughout the preconception period. Three topic areas related to empowerment have been prioritized, including preventing early marriage; personal and menstrual hygiene practices; and the importance of nutrition to good health. Integrated within these topics will be messages related to the importance of continuing one's education, mental health, gender norms and equality, decision making, advocacy, resiliency, participation, communication skills, facing challenges, agency, conflict resolution, and the prevention of violence.

05

What researchers measure

Primary outcomes

  1. Anemia status

    Hemoglobin concentration \<12 g/dL

    Time frame: 0, 12*, 24 months (*in subgroup only)

  2. Low birth weight

    Birth weight \<2500 g

    Time frame: At birth

Secondary outcomes

  1. Biomarkers: serum ferritin, serum transferrin receptor, hepcidin, serum retinol, serum 25(OH)D, alpha-glycolytic protein, C-reactive protein (women)

    Time frame: Preconception (subgroup only): enrolment, 1 year, 2 years; Pregnancy: 4-12 weeks, 32 weeks; Postpartum: 1 week

  2. Anthropometrics: height (women)

    Time frame: Preconception: enrolment, 6 months*, 1 year, 2 years (*in subgroup only); Pregnancy: 4-12 weeks, 32 weeks; Postpartum: 1 week, 6 months

  3. Anthropometrics: middle upper arm circumference (women)

    Time frame: Preconception: enrolment, 6 months*, 1 year, 2 years (*in subgroup only); Pregnancy: 4-12 weeks, 32 weeks; Postpartum: 1 week, 6 months

  4. Anthropometrics: weight (women)

    Time frame: Preconception: enrolment, 6 months*, 1 year, 2 years (*in subgroup only); Pregnancy: 4-12 weeks, 32 weeks; Postpartum: 1 week, 6 months

  5. Gestational age

    Time frame: At birth

  6. Preterm birth

    Time frame: At birth

  7. Stillbirth

    Time frame: At birth

  8. Small for gestational age

    Time frame: At birth

  9. Birth size: length

    Time frame: Within 24 hours of birth

  10. Birth size: head circumference

    Time frame: Within 24 hours of birth

  11. Birth size: middle upper arm circumference

    Time frame: Within 24 hours of birth

  12. Birth size: weight

    Time frame: Within 24 hours of birth

  13. Birth defects

    Time frame: At birth

  14. Infant growth: length

    Time frame: 1, 3, 6, 9, 12 months

  15. Infant growth: head circumference

    Time frame: 1, 3, 6, 9, 12 months

  16. Infant growth: middle upper arm circumference

    Time frame: 1, 3, 6, 9, 12 months

  17. Infant growth: weight

    Time frame: 1, 3, 6, 9, 12 months

  18. Age at marriage

    Time frame: Enrolment, 1 year, 2 years

  19. Completion of 10th grade education

    Time frame: Enrolment, 1 year, 2 years

  20. Use of sanitary pad during last menstrual period

    Time frame: Enrolment, 1 year, 2 years

  21. Dietary intake: 24-hour recall (subgroup of women)

    Time frame: Preconception: enrolment; Pregnancy: 4-12 weeks, 32 weeks

06

Study locations

1 site
  • Matiari Research and Training Centre
    Matiari, Sindh, Pakistan
07

References and documents

Publications

  • Baxter JB, Kortenaar JL, Wasan Y, Hussain A, Soofi SB, Ahmed I, Bhutta ZA. Age-Based Anthropometric Cutoffs Provide Inconsistent Estimates of Undernutrition: Findings from a Cross-Sectional Assessment of Late-Adolescent and Young Women in Rural Pakistan. Curr Dev Nutr. 2021 Nov 10;5(11):nzab130. doi: 10.1093/cdn/nzab130. eCollection 2021 Nov. PubMed 34901693 ↗
  • Bhutta ZA. Reply to NF Krebs and KM Hambidge. Am J Clin Nutr. 2019 Aug 1;110(2):521-522. doi: 10.1093/ajcn/nqz078. No abstract available. PubMed 31367763 ↗
  • Bhutta ZA. Balancing the benefits of maternal nutritional interventions; time to put women first! Am J Clin Nutr. 2019 Feb 1;109(2):249-250. doi: 10.1093/ajcn/nqy336. No abstract available. PubMed 30721972 ↗
  • Baxter JB, Wasan Y, Soofi SB, Suhag Z, Bhutta ZA. Effect of life skills building education and micronutrient supplements provided from preconception versus the standard of care on low birth weight births among adolescent and young Pakistani women (15-24 years): a prospective, population-based cluster-randomized trial. Reprod Health. 2018 May 31;15(1):104. doi: 10.1186/s12978-018-0545-0. PubMed 29855317 ↗
  • Baxter JB, Wasan Y, Soofi SB, Suhag Z, Bhutta ZA. 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. Reprod Health. 2018 May 30;15(1):103. doi: 10.1186/s12978-018-0547-y. PubMed 29848335 ↗
08

Registry details

Key details

Study ID
NCT03287882
Lead sponsor
Aga Khan University
Collaborators
The Hospital for Sick Children, National Program for Family Planning and Primary Health Care, Bill and Melinda Gates Foundation
Responsible party
Dr Zulfiqar Ahmed Bhutta (Director, Centre of Excellence in Women and Child Health, Aga Khan University) — Principal investigator
First posted
Sep 19, 2017
Start date
Jun 30, 2017
Primary completion
Mar 12, 2021
Completion
Feb 2022 (estimated)
Last update
Jul 27, 2021

Study contacts

Zulfiqar A Bhutta, PhD, MBBS
principal investigator · Aga Khan University

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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