Comprehensive Anaemia Programme and Personalized Therapies (CAPPT)

综合贫血计划和个性化治疗 (CAPPT)

• 批准号: MR/R020485/1
• 负责人: Sara Hillman
• 金额: $ 107.24万
• 依托单位: University College London
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR020485%2F1
• 关键词: Comprehensive; Anaemia; Programme; Personalized; Therapies

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.

贫血意味着血液中的红细胞比正常少，或者每个红细胞中的血红蛋白比正常少。在任何一种情况下，血液中携带的氧气都会减少。缺铁是引起贫血的最常见原因。这就是缺铁性贫血。在尼泊尔和印度等低收入和中等收入国家，孕期缺铁性贫血是一个巨大的问题。预防孕期贫血非常重要，因为与低铁水平相关的并发症。患有贫血的孕妇在分娩过程中死亡的可能性比没有贫血的孕妇高得多，她们的婴儿出生时小于胎龄的可能性也更大。怀孕期间血红蛋白的增加与改善结局有关。因此，当务之急是把重点放在改善孕妇贫血上，特别是在低收入和中等收入国家。在怀孕期间，女性特别容易贫血，这是一个建议摄入比正常铁更多的时候。即使到那时，为了预防贫血，仍然经常需要口服补铁。尽管印度和尼泊尔两国政府都建议口服补充剂，但贫血症水平仍然高得惊人。服药依从性可能是一个问题，但其他因素，如文化和社会信仰、获得富含铁的食物来源、其他微量营养素缺乏以及家庭中分享和获得食物的不平等，也是妇女仍然贫血的重要原因。该项目旨在通过试验以家庭为基础的干预措施来解决其中一些问题，该干预措施提供关于贫血、良好饮食习惯的教育、咨询和建议，并为妇女在改善怀孕期间健康方面面临的障碍提供一种行为改变机制。一名卫生工作者将在怀孕早期到家里提供这一套护理并测试血红蛋白水平，以便开始量身定做的口服铁补充剂。随后在22周左右的访问将加强练习，并允许进一步评估血红蛋白。接触参与性妇女团体将进一步加强这些信息和获得支持的机会。与继续接受常规产前护理的一组孕妇相比，这一干预措施的目的是提高怀孕28周时的血红蛋白水平。那些在接受干预和口服补充剂后贫血恶化的女性将接受血液测试，以更广泛地调查她们的情况，并评估是否有遗传原因导致她们对目前的治疗没有反应。这将使我们能够确定需要不同干预的妇女群体。这项研究在以家庭为基础和量身定做的方法上具有创新性。它的研究设计是可靠的，有来自印度、尼泊尔和英国多个领域的专家工作。这项研究的总体目标是提供强有力的证据，证明拟议的干预措施是可行的和有效的。通过在两个有大量参与者的国家开展这项工作，我们希望能够表明，干预措施在不同的人群中有效，并能适应不同群体的需求和变化。这增加了它可能在受这一问题影响最严重的世界不同地区推广的前景。我们计划与尼泊尔和印度的国际援助机构和政府组织密切合作，在国家一级实施变革。我们已经对干预的可扩展性和成本进行了大量考虑，并将在我们进行试验的过程中继续进行。这将最大限度地扩大在国家一级迅速推出干预措施的潜力，如果我们发现孕妇的血红蛋白在干预措施后有所改善。

项目成果

Study protocol for a randomised controlled trial of a virtual antenatal intervention for improved diet and iron intake in Kapilvastu district, Nepal: VALID.

• DOI: 10.1136/bmjopen-2022-064709
• 发表时间: 2023-02-16
• 期刊: BMJ open
• 影响因子: 2.9

Addressing anaemia in pregnancy in rural plains Nepal: A qualitative, formative study.

• DOI: 10.1111/mcn.13170
• 发表时间: 2021-07
• 期刊: Maternal & child nutrition
• 影响因子: 3.4
• 作者: Morrison J;Giri R;Arjyal A;Kharel C;Harris-Fry H;James P;Baral S;Saville N;Hillman S
• 通讯作者: Hillman S

Comprehensive Anaemia Programme and Personalized Therapies (CAPPT): protocol for a cluster-randomised controlled trial testing the effect women's groups, home counselling and iron supplementation on haemoglobin in pregnancy in southern Nepal.

• DOI: 10.1186/s13063-022-06043-z
• 发表时间: 2022-03-01
• 期刊: Trials
• 影响因子: 2.5
• 作者: Saville NM;Kharel C;Morrison J;Harris-Fry H;James P;Copas A;Giri S;Arjyal A;Beard BJ;Haghparast-Bidgoli H;Skordis J;Richter A;Baral S;Hillman S
• 通讯作者: Hillman S

Addressing maternal anaemia through family-centric participatory approaches in rural plains Nepal: a qualitative, formative study.

在尼泊尔农村平原通过以家庭为中心的参与方法解决孕产妇贫血问题：一项定性形成性研究。

• 发表时间: 2021
• 期刊: Maternal and Child Nutrition
• 影响因子: 3.4
• 作者: Morrison J