Comprehensive Anaemia Programme and Personalized Therapies (CAPPT)

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Anaemia means that there are fewer red blood cells than normal in the blood or there is less haemoglobin than normal in each red blood cell. In either case, a reduced amount of oxygen is carried around in the bloodstream. Lack of iron is the most common cause of anaemia. This is called iron-deficiency anaemia. Iron deficiency anaemia during pregnancy is a huge problem in low and middle-income countries such as Nepal and India.It is important to prevent anaemia in pregnancy due to the complications that are associated with low iron levels. Pregnant women who are anaemic are much more likely to die during childbirth than those women who are not and their infants are much more likely to be born small for gestational age.A rise in haemoglobin during pregnancy is associated with improved outcomes. It is, therefore, imperative that a focus is placed on improving anaemia in pregnant women, especially in low and middle-income countries. During pregnancy, women are particularly prone to becoming anaemic and it is a time when eating more iron than normal is recommended. Even then, oral supplements of iron are often still needed in order to prevent anaemia. Despite oral supplementation being recommended by both the Governments of India and Nepal, levels of anaemia remain alarmingly high. Compliance about taking medication may be an issue but other factors such cultural and social beliefs, access to iron rich food sources, other micronutrient deficiencies and inequalities to sharing and access to food in the household are also significant reasons why women remain anaemic. This project is designed to address some of these issues by trialling a home based intervention that provides education, counselling and advice about anaemia, good food practises and provides a mechanism of behaviour change for barriers women face in improving their health during pregnancy. A health worker will attend the family home early in pregnancy to deliver this package of care and test haemoglobin levels so that tailored oral iron supplements can be initiated. A subsequent visit at around 22 weeks will reinforce practises and allow for further assessment of haemoglobin. Access to participatory women's group will further reinforce the messages and access to support. The aim of this intervention is an improved haemoglobin level at 28 weeks of pregnancy in this intervention group, when compared with a group of pregnant women who continue to have routine antenatal care. Those women whose anaemia becomes worse despite uptake of intervention and oral supplements, will be offered a blood test to investigate their condition more extensively and assess if there is a genetic reason why they may not respond to the current treatment. This would enable us to identify groups of women who would require a different intervention. This study is innovative in its home based and tailored approach. It is robust in its study design and has experts from many fields working in India, Nepal and the UK.The overarching aim of this study is to provide robust evidence that the proposed intervention is feasible and works. By carrying it out in two countries with a large number of participants we hope to be able to show that the intervention works in different populations and is adaptable to the needs and variation across different groups. This enhances the prospect that it could be rolled out in different parts of the world most affected by the problem. We plan to work closely with international aid agencies and Governmental organisations within Nepal and India to enact change at a national level. Much thought has been put into the scalability of and cost of the intervention and will continue as we run the trial. This will maximise the potential to roll out the intervention rapidly at a national level if we find that in pregnant women, haemoglobin improves in response to the intervention.