Effect of multi aspect interventions in reducing Low birth weight and maternal anemia among pregnant women

Arm 1: Provision of Multiple Micronutrient (MMN) supplementation and iron folate during pregnancy Dose for MMN was 1 tablet daily orally after the first trimester throughout the pregnancy until delivery distributed through the Antenatal clinics or by Lady Health Workers. it consisted of Retinol (vitamin A) 800 retinol equivalents (re), Vitamin E 10 mg, Vitamin D 200 International Units (IU), Vitamin B1-1.4 mg, Vitamin B2 1.4 mg, Niacin 18 mg, Vitamin B6 1.9 mg, Vitamin B12 -2.6 microgram, Folic Acid 400 microgram, Vitamin C 70 mg, Iron 30 mg (as iron fumarate or iron sulphate), Zinc 15 mg (as zinc sulphate), Copper 2 mg, Selenium 65 microgram, Iodine 150 microgram - Iron and Folate :60 mg iron + 400 microgram folic acid daily for 6 months as one tablet Arm 2: De-worming of pregnant women in 2nd trimester Where hookworms are endemic (prevalence 20-30% or more) give anti-helminthic treatment once in the second trimester of pregnancy. If hookworms are highly endemic (prevalence more than 50%), repeat anti-helminthic treatment in the third trimester of pregnancy. Drug and dose are as follows Albendazole 400 mg single dose OR Mebendazole 500 mg single dose or 100 mg twice daily for 3 days as oral tablet Micronutrient, Iron-Folate supplementation and de-worming was conducted according to the recommended protocols of WHO/UNICEF and The International Nutritional Anemia Consultative Group (INACG) . Monitoring intake: Lady Health Workers provided multiple micro-nutrient tablets to each enrolled pregnant woman on monthly basis during follow-up visit. 35 tablets per month were provided to every enrolled pregnant women, along with counselling about dietary intake and MMN replenishment date. Contact numbers of research team members were shared with all the participating women for contacting the field team members in case of any problem/side effects from MMN. To ensure intake of MMNs, same methodology as used by DOTS (Direct Observation Treatment Strategy in Tuberculosis Treatment regimens) program was adopted. In this approach the mother in law or elderly woman in the house were made responsible to visually observe the enrolled pregnant women consuming MMN on a daily basis. Furthermore, LHWs visited households on a weekly/fortnightly basis and sometimes with Lady Health Supervisors and district teams to monitor supplement intake. Arm 3: Nutrition/ health education and counseling to pregnant women and their families Lady Health Workers conducted women group meetings on a monthly basis with the help of counselling material developed for this study. Those health education sessions were about maternal nutrition, health and hygiene, breastfeeding, use of iodized salt, de-worming etc. The sessions were attended by enrolled pregnant women, adolescents and young girls, and all married women of all families. LHWs recorded and reported number of sessions, number of participants and topic they covered LHWs were conducting meetings at central place of village where all pregnant women had easy access. Sometimes she conducted meetings at her health house as well and she used diagrammatic flip charts to conduct the sessions. The sessions were on monthly basis lasted for 60 minutes.