Comprehensive Anaemia Programme and Personalized Therapies (CAPPT)

贫血意味着血液中的红细胞比正常的少，或者每个红细胞中的血红蛋白比正常的少。在这两种情况下，血液中携带的氧气量减少。缺乏铁是贫血最常见的原因。这就是所谓的缺铁性贫血。在尼泊尔和印度等中低收入国家，孕期缺铁性贫血是一个严重的问题。预防孕期贫血非常重要，因为缺铁会导致并发症。患有贫血的孕妇比没有贫血的孕妇更有可能在分娩过程中死亡，她们的婴儿更有可能出生时小于胎龄儿。因此，当务之急是重点改善孕妇的贫血状况，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，这是一个比正常情况下摄入更多铁的时候。即使这样，为了预防贫血，仍然经常需要口服铁补充剂。尽管印度和尼泊尔政府都建议口服补充剂，但贫血症的发病率仍然高得惊人。遵守服药规定可能是一个问题，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。该项目旨在解决其中一些问题，试行一种家庭干预措施，提供有关贫血、良好饮食的教育、咨询和建议，并提供一种改变行为的机制，以消除妇女在改善怀孕期间健康方面面临的障碍。一名卫生工作者将在怀孕早期到家庭家中提供这一整套护理和测试血红蛋白水平，以便可以开始定制的口服铁补充剂。随后在22周左右进行的访视将加强血糖水平，并允许进一步评估血红蛋白。与参与性妇女团体的接触将进一步加强信息和获得支持的机会。这一干预措施的目的是，与继续接受常规产前护理的孕妇相比，这一干预组孕妇在怀孕28周时血红蛋白水平有所改善。那些尽管接受了干预和口服补充剂但贫血恶化的妇女将接受血液检查，以更广泛地调查她们的病情，并评估是否有遗传原因导致她们可能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。这项研究是创新的，在其家庭为基础和量身定制的方法。它的研究设计是强大的，有来自印度，尼泊尔和英国工作的许多领域的专家。这项研究的首要目标是提供强有力的证据，表明拟议的干预措施是可行的，有效的。通过在两个有大量参与者的国家进行，我们希望能够表明干预措施在不同人群中有效，并且能够适应不同群体的需求和差异。这增强了在世界上受这一问题影响最严重的不同地区推广这一方案的前景。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思考，并将在我们进行试验时继续进行。如果我们发现孕妇的血红蛋白在干预后有所改善，这将最大限度地提高在国家一级迅速推广干预的潜力。

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.