The effect of prenatal food supplementation on child growth in northern Bangladesh

INTERVENTION: Balanced protein energy supplementation; where the protein provided less than 25% of the total energy content (Ota et al. 2012). No micronutrients were added to the mix. The study consists of three phases. Phase 1: Formative research (focus groups, photovoice, systematic literature review) exploring the dietary preferences and food security situation of pregnant women living in northern Bangladesh. This research informs which food items would be appropriate and acceptable for the development of a supplementary food. In addition, the research informs the development of IEC/BCC materials and tools. Phase 2: Development of a balanced protein energy supplement using locally available foods, and 30‐day acceptability trial. Acceptance of the supplement measured at two timepoints in its development (day 15 and day 30). An assessment and focus group at day 15 allowed for modifications to the initial supplement, and an assessment at day 30 allowed for testing acceptance of these modifications. The results of the 30‐day trial will inform Phase 3 of this research. The composition of the supplement was influenced by the organoleptic preferences of women in the selected communities, and the local availability of foods that are accessible year‐round. The production of the supplement involved the establishment of a local business enterprise, building on local capacity and providing an income generation opportunity to the community. Phase 3: Cluster randomised controlled trial of the locally developed supplement in 12 villages in northern Bangladesh. All women in the selected villages are screened on a monthly basis. Undernourished pregnant women are invited to participate in the research project and written consent is obtained. In eight randomly selected intervention villages the women received the supplement until delivery of the child. We selected four control villages to ensure that they were as similar to the intervention villages as possible, and to ensure that the co CONDITION: Maternal undernutrition (defined as Middle Upper Arm Circumference <22.1) ; Nutritional, Metabolic, Endocrine PRIMARY OUTCOME: 1. Birth weight (salter scales) at birth.; 2. Birth length (calibrated length board) at birth; 3. Birth head circumference (measuring tape) at birth; 4. Longer term growth (length/weight and head circumference) at 1, 3, 6 and 12 months of age SECONDARY OUTCOME: 1. Maternal weight gain (salter scales) each month; 2. Maternal dietary diversity (measured used the validated Womens Dietary Diversity Questionnaire developed by Food And Nutrition Technical Assistance FANTA) INCLUSION CRITERIA: 1. Written informed consent 2. Confirmed to be pregnant 3. Undernourished as defined by a mid‐upper‐arm circumference (MUAC) =22.1 cm 4. Did not require medical referral