Intra Uterine Growth Retardation (IUGR) and Low Birth Weight (LBW) have become major public health concerns in developing countries. They are the major contributors towards the high infant mortality and under five mortality rates. Low birthweight is also associated with ill health in adult life eg. heart disease and diabetes. Serious public health interventions are therefore required at this stage to tackle the problem. These interventions cannot be listed unless proved by proper research on the same. Though nutrition is the most talked about intervention, the whats and hows of the factors affecting maternal and child health nutrition are yet to be justifiably answered by researchers.
Serious efforts are being put in globally to answer these questions. One such mega effort, namely MMDS/MMNP, is being carried out in Mumbai through an Indo-UK collaboration, SNEHA-MRC.
The MMDS is a blinded randomised controlled trial of two combinations of vegetables. The primary hypothesis being tested is that micronutrients are limiting for foetal growth. Analysis will be by intention to treat so once randomised it is intended that ALL subjects will be followed IRRESPECTIVE of compliance with the intervention/ supplement.
The trial is nested within the MMNP a longer-term project designed to empower women to independently improve their own nutrition and that of their children
The study area is the Shetanchowki, district of central Mumbai bounded by Dadar, Parel, Prabhadevi and Elphinstone. The Streehitakarini (SHK) Health Centre at the centre of Shetanchowki, is the focal point for data collection, registration and pregnancy follow through. Once data quality has been checked all data is forwarded to the MRC office in Bandra for double entry and further processing.
Initial data to identify and establish eligibility has been collected by household interviews. Eligible women are identified by a household census undertaken by the SHK health workers (HWs). Each worker works within the sector for which she is responsible. More than eleven thousand families have been census surveyed and over 4200 eligible women have been identified as potential subjects for the study.
The census gathered information on the following: type of dwelling, members and ages of the household, marital status of the women. Eligible women are those aged between 16 and 40 who are married and eligible to become pregnant.
Supplementation is being given to all the women on a sectoral basis using the 12 sectors already used by SHK HWs for health promotion. Currently there over 1300 women under supplementation.
A ledger is completed by each HW on a daily basis to check coverage, and monitored by senior staff at SHK. Each sector has a designated distribution centre. The centres are supplied on a daily basis by jeep at a fixed time. One section/table will distribute supplement A and one B. The HWs direct the women to the correct table using the ID card as verification and record compliance on the ledger in tertiles of intake that is none', half and full portion of the one-piece snack.
Outcomes to be measured are mentioned well-being, fetal growth, newborn size and infant mortality.
