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Published in: Trials 1/2020

Open Access 01-12-2020 | Azithromycin | Study protocol

Nutritional support for lactating women with or without azithromycin for infants compared to breastfeeding counseling alone in improving the 6-month growth outcomes among infants of peri-urban slums in Karachi, Pakistan—the protocol for a multiarm assessor-blinded randomized controlled trial (Mumta LW trial)

Authors: Ameer Muhammad, Yasir Shafiq, Muhammad Imran Nisar, Benazir Baloch, Amna Tanweer Yazdani, Nida Yazdani, Fyezah Jehan

Published in: Trials | Issue 1/2020

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Abstract

Background

Globally, 45% of under-five deaths are either directly or indirectly attributable to malnutrition, and most of these deaths are in low- and middle-income countries (LMICs). Children are particularly vulnerable in the first 6 months of life. An estimated 4.7 million infants under the age of 6 months are moderately wasted, whereas 3.8 million are severely wasted. Although the children of malnourished women have an increased risk of stunting and wasting, there is little information on this issue.

Methods

This is a community-based, open-label, multiarm randomized controlled trial that will include parallel group assignments with a 1:1:1 allocation ratio in low-income squatter settlements in urban Karachi, Pakistan. The women in the control group (control arm) will receive standard counseling only, whereas the lactating women in the first intervention group (intervention arm 1) will receive two sachets of balanced energy protein (BEP) supplementation per day from enrollment until the infant reaches 6 months of age. The lactating women in the second intervention group (intervention arm 2) will receive the same BEP supplementation as those in intervention arm 1 while their babies will also receive a single stat dose (20 mg/kg orally) of azithromycin at 42 days. The primary outcome will be the relative length velocity from 0 to 6 months by intervention arm. The primary analysis will be intention-to-treat analysis.

Trial registration

ClinicalTrials.gov NCT03564652. Registered on 21 June 2018
Literature
1.
go back to reference Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, De Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51.CrossRef Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, De Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51.CrossRef
2.
go back to reference Kerac M, Mwangome M, McGrath M, Haider R, Berkley JA. Management of acute malnutrition in infants aged under 6 months (MAMI): current issues and future directions in policy and research. Food Nutr Bull. 2015;36(1_suppl1):S30–S4.CrossRef Kerac M, Mwangome M, McGrath M, Haider R, Berkley JA. Management of acute malnutrition in infants aged under 6 months (MAMI): current issues and future directions in policy and research. Food Nutr Bull. 2015;36(1_suppl1):S30–S4.CrossRef
3.
go back to reference Manohar H, Pravallika M, Kandasamy P, Chandrasekaran V, Rajkumar RP. Role of exclusive breastfeeding in conferring protection in children at-risk for autism spectrum disorder: results from a sibling case–control study. J Neurosci Rural Pract. 2018;9(1):132.CrossRef Manohar H, Pravallika M, Kandasamy P, Chandrasekaran V, Rajkumar RP. Role of exclusive breastfeeding in conferring protection in children at-risk for autism spectrum disorder: results from a sibling case–control study. J Neurosci Rural Pract. 2018;9(1):132.CrossRef
4.
go back to reference Alemayehu M, Argaw A, Mariam AG. Factors associated with malnutrition among lactating women in subsistence farming households from Dedo and Seqa-Chekorsa districts, Jimma zone, 2014. Dev Country Stud. 2015;5(21):117–8. Alemayehu M, Argaw A, Mariam AG. Factors associated with malnutrition among lactating women in subsistence farming households from Dedo and Seqa-Chekorsa districts, Jimma zone, 2014. Dev Country Stud. 2015;5(21):117–8.
5.
go back to reference Musa S, Atena R. Malnutrition markers and nutritional status in Qashqa’i nomad mothers. EJBS. 2013;17(1):70–5. Musa S, Atena R. Malnutrition markers and nutritional status in Qashqa’i nomad mothers. EJBS. 2013;17(1):70–5.
6.
go back to reference Haidar J, Muroki N, Omwega A, Ayana G. Malnutrition and iron deficiency anaemia in lactating women in urban slum communities from Addis Ababa, Ethiopia. East Afr Med J. 2003;80(4):191–4.PubMed Haidar J, Muroki N, Omwega A, Ayana G. Malnutrition and iron deficiency anaemia in lactating women in urban slum communities from Addis Ababa, Ethiopia. East Afr Med J. 2003;80(4):191–4.PubMed
7.
go back to reference Haileslassie K, Mulugeta A, Girma M. Feeding practices, nutritional status and associated factors of lactating women in Samre Woreda, South Eastern Zone of Tigray, Ethiopia. Nutr J. 2013;12(1):28.CrossRef Haileslassie K, Mulugeta A, Girma M. Feeding practices, nutritional status and associated factors of lactating women in Samre Woreda, South Eastern Zone of Tigray, Ethiopia. Nutr J. 2013;12(1):28.CrossRef
8.
go back to reference Bailey RL, West KP Jr, Black RE. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab. 2015;66(Suppl. 2):22–33.CrossRef Bailey RL, West KP Jr, Black RE. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab. 2015;66(Suppl. 2):22–33.CrossRef
9.
go back to reference Abe SK, Balogun OO, Ota E, Takahashi K, Mori R. Supplementation with multiple micronutrients for breastfeeding women for improving outcomes for the mother and baby. Cochrane Database Syst Rev. 2016;2:CD010647.PubMed Abe SK, Balogun OO, Ota E, Takahashi K, Mori R. Supplementation with multiple micronutrients for breastfeeding women for improving outcomes for the mother and baby. Cochrane Database Syst Rev. 2016;2:CD010647.PubMed
10.
go back to reference Kominiarek MA, Rajan P. Nutrition recommendations in pregnancy and lactation. Med Clin. 2016;100(6):1199–215. Kominiarek MA, Rajan P. Nutrition recommendations in pregnancy and lactation. Med Clin. 2016;100(6):1199–215.
11.
go back to reference Yaya SWR, Tang S, Ghose B. Intake of supplementary food during pregnancy and lactation and its association with child nutrition in Timor Leste. PeerJ. 2018;6:e5935.CrossRef Yaya SWR, Tang S, Ghose B. Intake of supplementary food during pregnancy and lactation and its association with child nutrition in Timor Leste. PeerJ. 2018;6:e5935.CrossRef
12.
go back to reference Das JKLZ, Hoodbhoy Z, Salam RA. Nutrition for the next generation: older children and adolescents. Ann Nutr Metab. 2018;72(3):47–55.CrossRef Das JKLZ, Hoodbhoy Z, Salam RA. Nutrition for the next generation: older children and adolescents. Ann Nutr Metab. 2018;72(3):47–55.CrossRef
13.
go back to reference Allen LH. Multiple micronutrients in pregnancy and lactation: an overview. Am J Clin Nutr. 2005;81(5):1206S–12S.CrossRef Allen LH. Multiple micronutrients in pregnancy and lactation: an overview. Am J Clin Nutr. 2005;81(5):1206S–12S.CrossRef
14.
go back to reference Adu-Afarwuah S, Lartey A, Okronipa H, Ashorn P, Peerson JM, Arimond M, et al. Small-quantity, lipid-based nutrient supplements provided to women during pregnancy and 6 mo postpartum and to their infants from 6 mo of age increase the mean attained length of 18-mo-old children in semi-urban Ghana: a randomized controlled trial, 2. Am J Clin Nutr. 2016;104(3):797–808.CrossRef Adu-Afarwuah S, Lartey A, Okronipa H, Ashorn P, Peerson JM, Arimond M, et al. Small-quantity, lipid-based nutrient supplements provided to women during pregnancy and 6 mo postpartum and to their infants from 6 mo of age increase the mean attained length of 18-mo-old children in semi-urban Ghana: a randomized controlled trial, 2. Am J Clin Nutr. 2016;104(3):797–808.CrossRef
15.
go back to reference Lanou H, Huybregts L, Roberfroid D, Nikièma L, Kouanda S, Van Camp J, Kolsteren P. Prenatal nutrient supplementation and postnatal growth in a developing nation: an RCT. Pediatrics. 2014;133(4):e1001–8.CrossRef Lanou H, Huybregts L, Roberfroid D, Nikièma L, Kouanda S, Van Camp J, Kolsteren P. Prenatal nutrient supplementation and postnatal growth in a developing nation: an RCT. Pediatrics. 2014;133(4):e1001–8.CrossRef
16.
go back to reference Katona P, Katona-Apte J. The interaction between nutrition and infection. Clin Infect Dis. 2008;46(10):1582–8.CrossRef Katona P, Katona-Apte J. The interaction between nutrition and infection. Clin Infect Dis. 2008;46(10):1582–8.CrossRef
17.
go back to reference Christian P, Kim J, Mehra S, Shaikh S, Ali H, Shamim AA, Wu L, Klemm R, Labrique AB, West KP Jr. Effects of prenatal multiple micronutrient supplementation on growth and cognition through 2 y of age in rural Bangladesh: the JiVitA-3 Trial. Am J Clin Nutr. 2016;104(4):1175–82.CrossRef Christian P, Kim J, Mehra S, Shaikh S, Ali H, Shamim AA, Wu L, Klemm R, Labrique AB, West KP Jr. Effects of prenatal multiple micronutrient supplementation on growth and cognition through 2 y of age in rural Bangladesh: the JiVitA-3 Trial. Am J Clin Nutr. 2016;104(4):1175–82.CrossRef
18.
go back to reference Keenan JD, Bailey RL, West SK, Arzika AM, Hart J, Weaver J, et al. Azithromycin to reduce childhood mortality in Sub-Saharan Africa. N Engl J Med. 2018;378(17):1583–92.CrossRef Keenan JD, Bailey RL, West SK, Arzika AM, Hart J, Weaver J, et al. Azithromycin to reduce childhood mortality in Sub-Saharan Africa. N Engl J Med. 2018;378(17):1583–92.CrossRef
19.
go back to reference O’Brien KS, Emerson P, Hooper PJ, Reingold AL, Dennis EG, Keenan JD, Lietman TM, Oldenburg CE. Antimicrobial resistance following mass azithromycin distribution for trachoma: a systematic review. Lancet Infect Dis. 2019;19(1):e14–25.CrossRef O’Brien KS, Emerson P, Hooper PJ, Reingold AL, Dennis EG, Keenan JD, Lietman TM, Oldenburg CE. Antimicrobial resistance following mass azithromycin distribution for trachoma: a systematic review. Lancet Infect Dis. 2019;19(1):e14–25.CrossRef
20.
go back to reference Robertson RC, Manges AR, Finlay BB, Prendergast AJ. The human microbiome and child growth–first 1000 days and beyond. Trends Microbiol. 2019;27(2):131–47.CrossRef Robertson RC, Manges AR, Finlay BB, Prendergast AJ. The human microbiome and child growth–first 1000 days and beyond. Trends Microbiol. 2019;27(2):131–47.CrossRef
21.
go back to reference Marques AH, O’Connor TG, Roth C, Susser E, Bjørke-Monsen AL. The influence of maternal prenatal and early childhood nutrition and maternal prenatal stress on offspring immune system development and neurodevelopmental disorders. Front Neurosci. 2013;7:120.CrossRef Marques AH, O’Connor TG, Roth C, Susser E, Bjørke-Monsen AL. The influence of maternal prenatal and early childhood nutrition and maternal prenatal stress on offspring immune system development and neurodevelopmental disorders. Front Neurosci. 2013;7:120.CrossRef
22.
go back to reference Somé JW, Abbeddou S, Jimenez EY, Hess SY, Ouédraogo ZP, Guissou RM, Vosti SA, Ouédraogo JB, Brown KH. Effect of zinc added to a daily small-quantity lipid-based nutrient supplement on diarrhoea, malaria, fever and respiratory infections in young children in rural Burkina Faso: a cluster-randomised trial. BMJ Open. 2015;5(9):e007828.CrossRef Somé JW, Abbeddou S, Jimenez EY, Hess SY, Ouédraogo ZP, Guissou RM, Vosti SA, Ouédraogo JB, Brown KH. Effect of zinc added to a daily small-quantity lipid-based nutrient supplement on diarrhoea, malaria, fever and respiratory infections in young children in rural Burkina Faso: a cluster-randomised trial. BMJ Open. 2015;5(9):e007828.CrossRef
23.
go back to reference Obanewa O, Newell ML. Maternal nutritional status during pregnancy and infant immune response to routine childhood vaccinations. Futur Virol. 2017;12(9):525–36.CrossRef Obanewa O, Newell ML. Maternal nutritional status during pregnancy and infant immune response to routine childhood vaccinations. Futur Virol. 2017;12(9):525–36.CrossRef
Metadata
Title
Nutritional support for lactating women with or without azithromycin for infants compared to breastfeeding counseling alone in improving the 6-month growth outcomes among infants of peri-urban slums in Karachi, Pakistan—the protocol for a multiarm assessor-blinded randomized controlled trial (Mumta LW trial)
Authors
Ameer Muhammad
Yasir Shafiq
Muhammad Imran Nisar
Benazir Baloch
Amna Tanweer Yazdani
Nida Yazdani
Fyezah Jehan
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Azithromycin
Published in
Trials / Issue 1/2020
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-020-04662-y

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