Low Birth Weight in South Asia Trial

A study into cost-effective interventions

Funder Department for International Development (DFID)

Mother and Infant Research Activities (MIRA), Nepal

World Food Programme, Italy

Save the Children, UK

Institute of Fiscal Studies, UK

Duration 1 Sept 2012 - 20 Sept 2016
Project Location(s)
PI Anthony Costello, Naomi Saville (Co-PI)

David Osrin

Jolene Skordis-Worrall

Andrew Copas

Joanna Morrison

Anni Pulkki-Brannstrom

James Beard

Contact Mary Caspillo-Brewer

The programme has two phases: in Phase 1, a cluster randomised controlled trial (cRCT) will assess the relative impacts on birth weight of enhanced nutrition behaviour change strategies (BCS), with and without an unconditional cash transfer or a food supplement, compared with current programmes, in two districts in southern Nepal. The study is powered to detect a 50 g difference in birth weight between allocation groups: BCS, BCS plus cash, BCS plus food, and control.

Low Birth Weight in South Asia Trial

BCS will be based around women’s group action cycles, which we have evaluated and implemented in different settings in Nepal. The monthly cash transfer will be NPR 750, or NPR 5250 per pregnancy over which a woman receives 7 transfers. The food transfer will be 10 Kg, supplied monthly to pregnant women, of a fortified blend of wheat soya sugar, branded by the World Food Programme as Super Cereal. This has an improved micronutrient profile, and has been field tested and shown to be acceptable in Nepal.

Outcome data will describe at least 3230 infants per arm - 12 920 infants in total - enrolled and exiting over 22 months. The primary outcome will be birth weight measured on infant scales accurate to 10 g. Secondary outcomes will include prevalence of low birth weight (% < 2500 g), maternal weight gain during pregnancy, preterm delivery, miscarriages, stillbirths, neonatal mortality, maternal and newborn illness, maternal eating behaviour, exposure to women’s groups for pregnant women and family members, access to food transfers and cash transfers, and intra-household food allocation. The richness of the data will allow us to measure not only the outcomes of interest, but also to model the mediating mechanisms that generate such outcomes.

The programme team brings together MIRA, Nepal’s leading health research organisation, with 20 years’ experience of trials in poor populations; University College London, with world-class expertise in perinatal care, nutrition, women’s development and the economics of cash transfers and their effects on nutrition; Save the Children, with 40 years’ experience of pro-poor interventions and scale-up in Nepal; and the World Food Programme’s global experience in food supplementation and dietary analysis. The team emphasises value for money, clearly delineated contributions from each partner, a partnership ideology that emphasises Nepalese leadership, strong technical support in all the required domains, and mature links with the Government of Nepal and relevant institutions.

If the findings of the trial in Phase 1 warrant scale-up, Phase 2 will assess whether a new intervention can be delivered at acceptable cost-effectiveness under normal operating conditions, including in challenging environments.