Promotion of a balanced diet for pregnant women to improve birthweight of infants: a cluster randomised controlled trial in rural Bangladesh

We will conduct a cluster randomized controlled trial to test the impact of a home-based practical demonstration using food from the women’s home with nutrition education during pregnancy on the birthweight of the infants. In this regard, a group of pregnant women will be counseled by BRAC's (Bangladesh Rural advancement Committee) community health workers called - 'Shasthya Kormi' about the quantity and quality food appropriate for healthy pregnancy outcome. Shasthya Kormis will visit all pregnant women once in each month and each of them will receive at four to seven sessions of individual counselling based on their availability during the day of home visits. Shasthya Kormis will fill up the antenatal registers during the visits and at the end of the study the numbers of visits will be calculated from the register records. They will practically demonstrate preparation of food plates containing balanced meal (qualitative and quantitatively) made up of readily available food at the household. The intervention will commence in the first trimester (ideally before 12 weeks of gestation) and will continue every month until birth. The sessions will last for ~30-45 minutes. The primary outcome is the mean difference in birthweight of infants born to mothers in the intervention compared to control groups. All births will be notified within 24 hours and Shasthya Kormis will weigh the infants within 72 hours. Birthweight less than 2500g is considered as low birthweight. The secondary outcome is the maternal dietary behaviour, which includes daily caloric intake and dietary diversity score. Shasthya Kormis will conduct dietary assessments with a semi-structured questionnaire, which will capture detailed information about all foods, beverages and dietary supplements consumed in the past 24 hours with quantity.