Comprehensive Anaemia Programme And Personalized Therapies (CAPPT): Protocol For A Cluster-Randomised Controlled Trial Testing The Effect Women’s Groups, Home Counselling And Iron Supplementation On Haemoglobin In Pregnancy In Southern Nepal
Bibliographic record
Abstract
Abstract BackgroundAnaemia in pregnancy remains prevalent in Nepal and causes severe adverse health outcomes.Methods This non-blinded cluster-randomized controlled trial in the plains of Nepal has two study arms: 1) Control: routine antenatal care (ANC); 2) Home visiting, iron supplementation, Participatory Learning and Action (PLA) groups, plus routine ANC. Participants: Women in 54 non-contiguous clusters (mean 2582; range 1299-4865 population) in Southern Kapilbastu district are eligible if they consent to menstrual monitoring, are resident, married, aged 13-49 years and able to respond to questions. After 1-2 missed menses and a positive pregnancy test, consenting women <20 weeks’ gestation, who plan to reside locally for most of the pregnancy, enrol into trial follow-up. Interventions comprise two home-counselling visits (at 12-21- and 22-26-weeks’ gestation) with iron folic acid (IFA) supplement dosage tailored to women’s haemoglobin concentration, plus monthly PLA women’s group meetings using a dialogical problem-solving approach to engage pregnant women and their families. Home visits and PLA meetings will be facilitated by auxiliary nurse midwives.Hypothesis: Haemoglobin of women at 30±2 weeks’ gestation is ≥0.4 g/dL higher in the intervention arm than in the control. A sample of 842 women (421 per arm, average 15.6 per cluster) will provide 88% power, assuming SD 1.2, ICC 0.09 and CV of cluster size 0.27.Outcomes are captured at 30±2 weeks gestation. Primary outcome: Haemoglobin concentration (g/dL). Secondary outcomes: Anaemia prevalence (%), mid-upper arm circumference (cm), Mean Probability of micronutrient Adequacy (MPA) and number of ANC visits at a health facility.Indicators to assess pathways to impact include number of IFA tablets consumed during pregnancy, intake of energy (kcal/d) and dietary iron (mg/d), a score of bioavailability-enhancing behaviours and recall of one nutrition knowledge indicator.Costs and cost-effectiveness of the intervention will be estimated from a provider perspective. Using constrained randomisation we allocated clusters to study arms, ensuring similarity with respect to cluster size, ethnicity, religion and distance to a health facility. Analysis is by intention-to-treat at the individual level, using mixed-effects regression.Discussion: Findings will inform Nepal government policy on approaches to increase adherence to IFA, improve diets and reduce anaemia in pregnancy.Trial registration: ISRCTN 12272130.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.034 | 0.026 |
| Meta-epidemiology (narrow) | 0.005 | 0.003 |
| Meta-epidemiology (broad) | 0.011 | 0.005 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.004 | 0.004 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.004 | 0.002 |
| Research integrity | 0.007 | 0.008 |
| Insufficient payload (model declined to judge) | 0.076 | 0.011 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".