Effect of a Fortified Balanced Energy-Protein Supplement on Birth Outcome and Child Growth in Houndé District, Burkina Faso.

NCT ID: NCT03533712

Last Updated: 2022-03-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

1788 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-10-30

Study Completion Date

2022-03-15

Brief Summary

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The 2016 WHO antenatal care guidelines stated that pregnant women in undernourished populations should receive fortified balanced energy-protein (BEP) supplements to reduce the risk of stillbirth and small-for-gestational-age birth. However, acceptable supplements and delivery channels must be determined for different contexts.

The present proposal therefore will 1) perform a formative study to identify the most suitable (acceptability and utilization) BEP supplement for pregnant women in rural Burkina Faso (phase 1) and 2) evaluate the efficacy of this supplement to improve birth weight, fetal and infant growth (phase 2). The nutritional composition of the BEP supplement was established during an expert convening at the BMGF in September 2016. Private sector partners will prepare the supplements in the selected forms with the recommended nutrient composition.

Detailed Description

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Pregnancy remains a challenging period in the life of many women in low- and middle-income countries. Maternal mortality remains high and many newborns suffer from premature delivery and /or gestational growth retardation both in length and in weight accumulation.

The 2016 WHO antenatal care guidelines stated that pregnant women in undernourished populations should receive fortified balanced energy-protein (BEP) supplements to reduce the risk of stillbirth and small-for-gestational-age birth. However, acceptable supplements and delivery channels must be determined for different contexts.

The purpose of this study is to assess the efficacy of a fortified BEP supplement for pregnant and lactating women to improve birth weight, fetal and infant growth.

This research includes 2 phases:

* Phase 1 - part 1: Formative research to identify preferred product types of a fortified BEP supplement;
* Phase 1 - part 2: Formative research with a 10-week home-feeding trial to determine the acceptability of a fortified BEP supplement for longer-term consumption.
* Phase 2: A community-based, individually randomized efficacy trial of the fortified BEP food supplement including 1,776 pregnant and lactating women aimed at testing 2 hypothesis: supplementing pregnant and lactating women with a fortified BEP supplement will improve fetal growth; improving fetal growth will have a positive effect on health and growth during infancy.

Conditions

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Small for Gestational Age at Delivery Low Birth Weight Prematurity Infant Malnutrition

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

The intervention study is a randomized controlled 2x2 factorial efficacy trial. At study inclusion, eligible pregnant women will be randomly assigned to the prenatal intervention or control group, and randomly assigned to a postnatal intervention or control group. The intervention group will receive daily a fortified BEP supplement to be consumed under supervision for the duration of pregnancy/lactation. Both control and intervention group will receive the standard iron and folic acid tablet through the regular ante natal care program.
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Fortified BEP supplement

Intervention: Dietary Supplement: Fortified balanced energy-protein (BEP) supplement + iron and folic acid supplement.

Group Type EXPERIMENTAL

Fortified balanced energy-protein (BEP) supplement

Intervention Type DIETARY_SUPPLEMENT

The product contains the following target nutrients:

* Total energy: 250-500 kcal per daily serving
* Fat content: 10-60% of energy intake
* Protein content: 16 g (range 14-18 g) with a Digestible Indispensable Amino Acid Score (DIAAS) of ≥ 0.9
* Carbohydrate (CHO) Content: no specific recommendations, relative to fat and protein content.
* Trans Fats: \<1% energy intake Micronutrients include the following: A, D, E, K, B1 (thiamin), B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B9 (folate), B12 and C; minerals: iron, zinc, iodine, calcium, phosphorous, copper, and selenium.

The final composition of macro en micronutrients will be available after the acceptability testing (phase 1) and will be determined by 1) the product type and 2) the preferred taste.

Fe and folic acid

Dietary Supplement: Fe and folic acid supplement.

Group Type ACTIVE_COMPARATOR

Fe and folic acid supplement

Intervention Type DIETARY_SUPPLEMENT

Routine iron and folic acid supplementation.

Interventions

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Fortified balanced energy-protein (BEP) supplement

The product contains the following target nutrients:

* Total energy: 250-500 kcal per daily serving
* Fat content: 10-60% of energy intake
* Protein content: 16 g (range 14-18 g) with a Digestible Indispensable Amino Acid Score (DIAAS) of ≥ 0.9
* Carbohydrate (CHO) Content: no specific recommendations, relative to fat and protein content.
* Trans Fats: \<1% energy intake Micronutrients include the following: A, D, E, K, B1 (thiamin), B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B9 (folate), B12 and C; minerals: iron, zinc, iodine, calcium, phosphorous, copper, and selenium.

The final composition of macro en micronutrients will be available after the acceptability testing (phase 1) and will be determined by 1) the product type and 2) the preferred taste.

Intervention Type DIETARY_SUPPLEMENT

Fe and folic acid supplement

Routine iron and folic acid supplementation.

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

* Participant age (15-40 years).
* Pregnant as determined by a pregnancy test and confirmed by ultrasound.
* Women who signed the informed consent form (in case of minors the parents or husband signs)

Exclusion Criteria

* Women planning to leave the area before delivery.
* Women who plan to deliver outside the area.
* Pregnancies with a gestational age \> 20 weeks at study inclusion.
* Women with multi-fetal gestation (exclusion from analysis).
* Women who are allergic to peanuts.
Minimum Eligible Age

15 Years

Maximum Eligible Age

40 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Harvard School of Public Health (HSPH)

OTHER

Sponsor Role collaborator

Institut de Recherche en Sciences de la Sante, Burkina Faso

OTHER_GOV

Sponsor Role collaborator

AfricSanté, Burkina Faso

UNKNOWN

Sponsor Role collaborator

International Food Policy Research Institute

OTHER

Sponsor Role collaborator

University of California, Davis

OTHER

Sponsor Role collaborator

Bill and Melinda Gates Foundation

OTHER

Sponsor Role collaborator

University Ghent

OTHER

Sponsor Role lead

Responsible Party

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VakgroepLevensmiddelentechnologieVoedselveiligheidGezondheid

Prof. dr. Patrick Kolsteren

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Patrick Kolsteren, Prof. dr.

Role: STUDY_CHAIR

University Ghent

Carl Lachat, Prof. dr.

Role: STUDY_DIRECTOR

University Ghent

Katrien W Vanslambrouck, MD

Role: PRINCIPAL_INVESTIGATOR

University Ghent

Brenda PH de Kok, MSc.

Role: PRINCIPAL_INVESTIGATOR

University Ghent

Lieven F Huybregts, PhD

Role: PRINCIPAL_INVESTIGATOR

IFPRI

Laeticia Celine Toe, MD MSc.

Role: PRINCIPAL_INVESTIGATOR

IRSS

Sheila Isanaka, Asst. Prof.

Role: PRINCIPAL_INVESTIGATOR

Harvard School of Public Health (HSPH)

Locations

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Houndé district

Houndé, Tuy, Burkina Faso

Site Status

Countries

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Burkina Faso

References

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Argaw A, Toe LC, Hanley-Cook G, Dailey-Chwalibog T, de Kok B, Ouedraogo L, Compaore A, Ouedraogo M, Sawadogo A, Ganaba R, Vanslambrouck K, Kolsteren P, Lachat C, Huybregts L. Effect of prenatal micronutrient-fortified balanced energy-protein supplementation on maternal and newborn body composition: A sub-study from the MISAME-III randomized controlled efficacy trial in rural Burkina Faso. PLoS Med. 2023 Jul 24;20(7):e1004242. doi: 10.1371/journal.pmed.1004242. eCollection 2023 Jul.

Reference Type DERIVED
PMID: 37486952 (View on PubMed)

Argaw A, de Kok B, Toe LC, Hanley-Cook G, Dailey-Chwalibog T, Ouedraogo M, Compaore A, Vanslambrouck K, Ganaba R, Kolsteren P, Lachat C, Huybregts L. Fortified balanced energy-protein supplementation during pregnancy and lactation and infant growth in rural Burkina Faso: A 2 x 2 factorial individually randomized controlled trial. PLoS Med. 2023 Feb 6;20(2):e1004186. doi: 10.1371/journal.pmed.1004186. eCollection 2023 Feb.

Reference Type DERIVED
PMID: 36745684 (View on PubMed)

Hanley-Cook G, Toe LC, Tesfamariam K, de Kok B, Argaw A, Compaore A, Ouedraogo M, Dailey-Chwalibog T, Kolsteren P, Lachat C, Huybregts L. Fortified Balanced Energy-Protein Supplementation, Maternal Anemia, and Gestational Weight Gain: A Randomized Controlled Efficacy Trial among Pregnant Women in Rural Burkina Faso. J Nutr. 2022 Oct 6;152(10):2277-2286. doi: 10.1093/jn/nxac171.

Reference Type DERIVED
PMID: 35906874 (View on PubMed)

de Kok B, Toe LC, Hanley-Cook G, Argaw A, Ouedraogo M, Compaore A, Vanslambrouck K, Dailey-Chwalibog T, Ganaba R, Kolsteren P, Huybregts L, Lachat C. Prenatal fortified balanced energy-protein supplementation and birth outcomes in rural Burkina Faso: A randomized controlled efficacy trial. PLoS Med. 2022 May 13;19(5):e1004002. doi: 10.1371/journal.pmed.1004002. eCollection 2022 May.

Reference Type DERIVED
PMID: 35560315 (View on PubMed)

Hanley-Cook GT, Argaw A, de Kok B, Toe LC, Dailey-Chwalibog T, Ouedraogo M, Kolsteren P, Huybregts L, Lachat C. Seasonality and Day-to-Day Variability of Dietary Diversity: Longitudinal Study of Pregnant Women Enrolled in a Randomized Controlled Efficacy Trial in Rural Burkina Faso. J Nutr. 2022 Sep 6;152(9):2145-2154. doi: 10.1093/jn/nxac104.

Reference Type DERIVED
PMID: 35524695 (View on PubMed)

de Kok B, Argaw A, Hanley-Cook G, Toe LC, Ouedraogo M, Dailey-Chwalibog T, Diop L, Becquey E, Kolsteren P, Lachat C, Huybregts L. Fortified Balanced Energy-Protein Supplements Increase Nutrient Adequacy without Displacing Food Intake in Pregnant Women in Rural Burkina Faso. J Nutr. 2021 Dec 3;151(12):3831-3840. doi: 10.1093/jn/nxab289.

Reference Type DERIVED
PMID: 34494113 (View on PubMed)

Vanslambrouck K, de Kok B, Toe LC, De Cock N, Ouedraogo M, Dailey-Chwalibog T, Hanley-Cook G, Ganaba R, Lachat C, Huybregts L, Kolsteren P. Effect of balanced energy-protein supplementation during pregnancy and lactation on birth outcomes and infant growth in rural Burkina Faso: study protocol for a randomised controlled trial. BMJ Open. 2021 Mar 24;11(3):e038393. doi: 10.1136/bmjopen-2020-038393.

Reference Type DERIVED
PMID: 33762226 (View on PubMed)

Other Identifiers

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OPP1175213

Identifier Type: -

Identifier Source: org_study_id

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