Assessing the Feasibility of Integrating a Package of Maternal Nutrition Interventions Into Antenatal Care Services in Burkina Faso: A Cluster-Randomized Evaluation
Phase: NA
Conditions: Maternal Dietary Diversity, Iron-Folic Acid Supplementation, Early Initiation of Breastfeeding
Sponsor: International Food Policy Research Institute

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Assessing the Feasibility of Integrating a Package of 
Maternal Nutrition Interventions into Antenatal Care 
Services in Burkina Faso: 
A Cluster-Randomized Evaluation 
 
 
Study Protocol1 
 
 
 
International Food Policy Research Institute 
 
October 23, 2020 
VERSION: 2 
 
Trial registration number: ClinicalTrials.gov NCT04155437 
 
 
 
 
 
1 This protocol follows the Standard Protocols Items: Recommendations for Intervention Trial (SPIRIT, 2013).  

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Funding: We acknowledge funding support from the Bill & Melinda Gates Foundation (grant no. 
OPP1170427), through Alive & Thrive, managed by FHI Solutions LLC. Additional financial support was 
provided by CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by the 
International Food Policy Research Institute. 
Roles and responsibilities: 
Co-Investigators: 
Dr. Sunny S. Kim 
Research Fellow 
Poverty, Health and Nutrition Division 
International Food Policy Research Institute  
1201 I St. NW 
Washington, DC 20005-3915 
USA 
Phone: +1 202-862-4611 
Email: sunny.kim@cgiar.org 
 
Dr. Purnima Menon 
Senior Research Fellow 
Poverty, Health and Nutrition Division 
International Food Policy Research Institute 
9th Floor, Aggarwal Corporate Tower 
Govind Lal Sikka Marg, Rajendra Place 
New Delhi 110008 
India 
Phone: +91 11-66219-276 
Email: p.menon@cgiar.org 
 
Dr. Rasmané Ganaba  
AFRICSanté  
01 BP 298 Bobo-Dioulasso 
Burkina Faso  
Phone : +226 20 986 368 
Email : rganaba@hotmail.com   
 
Protocol Contributors:  Sunny Kim (Principal Investigator), Cesaire Ouedraogo (Consultant/In-Country 
Researcher), Celeste Sununtnasuk (Project Manager), Rasmané Ganaba (Co-
Investigator/AFRICSanté Director), Purnima Menon (Co-Principal Investigator) 
 
Sponsor: 
 
International Food Policy Research Institute (IFPRI)  
1201 I St. NW 
Washington, DC 20005-3915 
USA 
Phone: +1 202-862-3915 

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Contents 
I. 
Introduction .......................................................................................................................................... 5 
1.1 Background and rationale ............................................................................................................... 5 
1.2 Objectives ....................................................................................................................................... 6 
1.3 Trial design ...................................................................................................................................... 6 
II. 
Methods: Participants, Interventions and Outcomes .......................................................................... 8 
2.1 Study setting ................................................................................................................................... 8 
2.2 Eligibility criteria ............................................................................................................................. 9 
2.3 Interventions ................................................................................................................................. 10 
2.4 Outcomes ...................................................................................................................................... 12 
2.5 Sample size .................................................................................................................................... 12 
2.6 Recruitment .................................................................................................................................. 13 
III. 
Methods: Assignment of interventions .............................................................................................. 14 
3.1 Allocation ...................................................................................................................................... 14 
3.2 Blinding ......................................................................................................................................... 14 
IV. Methods: Data collection, management, and analysis ...................................................................... 14 
4.1. Data collection methods .............................................................................................................. 14 
4.1.1 Health facility observation checklist .......................................................................................... 15 
4.1.2 ANC observation checklist and exit interview with pregnant women....................................... 16 
4.1.3 Nurse-midwife questionnaire .................................................................................................... 16 
4.1.4 Interviews with ASBCs ................................................................................................................ 17 
4.1.5 Pregnant women questionnaire ................................................................................................ 18 
4.1.6 Recently delivered women ........................................................................................................ 19 
4.1.7 Multi-pass 24h-recall ................................................................................................................. 21 
4.2 COVID-19 precautionary measures............................................................................................... 21 
4.3 Data management ........................................................................................................................ 22 
4.4 Statistical methods........................................................................................................................ 22 
V. 
Methods: Monitoring ......................................................................................................................... 22 
5.1 Data monitoring and storage ........................................................................................................ 22 
5.2 Harms ............................................................................................................................................ 23 
5.3 Auditing ......................................................................................................................................... 23 
VI. Ethics and dissemination .................................................................................................................... 23 
6.1 Research ethics approval .............................................................................................................. 23 

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6.2 Protocol amendments .................................................................................................................. 23 
6.3 Consent ......................................................................................................................................... 23 
6.4 Risks and benefits ......................................................................................................................... 24 
6.5 Confidentiality ............................................................................................................................... 24 
6.6 Declaration of interests ................................................................................................................ 24 
6.7 Access to data ............................................................................................................................... 24 
6.8 Ancillary and post-trial care .......................................................................................................... 24 
6.9 Dissemination policy ..................................................................................................................... 24 
VII. Timeline .............................................................................................................................................. 25 
7.1 Study timeline ............................................................................................................................... 25 
References .................................................................................................................................................. 27 
 
List of Tables 
Table 1: Description of interventions for intervention and control areas .................................................. 10 
Table 2: Estimated sample sizes ................................................................................................................. 13 
Table 3: Data collection methods ............................................................................................................... 15 
Table 5: Description of modules in the ANC observation checklist and exit interview .............................. 16 
Table 6: Description of modules in the nurse-midwife questionnaire ....................................................... 16 
Table 7: Description of modules in the community health worker questionnaire ..................................... 17 
Table 8: Description of modules in pregnant women questionnaire ......................................................... 18 
Table 9: Description of modules in RDW’s questionnaire .......................................................................... 19 
Table 10: Description of the four passes for the multi-pass 24-h recall ..................................................... 21 
 
List of Figures 
Figure 1. Trial flow ........................................................................................................................................ 7 
Figure 1: Study regions ................................................................................................................................. 8 
 
 
 

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I. 
Introduction 
1.1 Background and rationale 
Adequate maternal nutrition is important for maternal health and wellness and is a major determinant 
of pregnancy outcomes [1]. In low-and middle-income countries (LMICs), maternal and child 
malnutrition is a public health concern resulting in increases of morbidity and mortality [2]. Poor 
maternal nutrition is associated with adverse pregnancy outcomes such as low birth weight (LBW), 
preterm birth, large- and small-for-gestational age, intrauterine growth restriction, cesarean delivery 
and gestational diabetes mellitus [1, 2]. In the long term, maternal undernutrition is associated with 
chronic diseases (e.g., glucose intolerance, coronary heart disease, obesity, and increased risk of breast 
cancer), less schooling and reduced economic productivity in offspring exposed to undernutrition during 
fetal life [1-3]. 
Routine antenatal care (ANC) offers opportunities to receive a broad range of health promotion and 
prevention services including support for adequate nutritional care for pregnant women and their 
newborns, and any required medical treatment [4]. However, it has been shown that in LMICs half of 
women did not receive the four ANC visits (recommended until 2016) and the quality of ANC was 
suboptimal for those who met the recommendation [5, 6]. In 2016, World Health Organization (WHO) 
updated its guidelines on ANC with a high priority placed on nutrition interventions. These new 
guidelines recommended increasing the number of ANC from four to at least eight contacts to improve 
women’s positive experience of care and to reduce perinatal morbidity and mortality [7]. Following 
these new recommendations, the government of Burkina Faso is working with WHO and other partners 
to revise the national guidelines on ANC and eventually test elements of the essential core package of 
routine ANC needed by women throughout pregnancy.  
In Burkina Faso, despite continued improvement, the adjusted maternal mortality ratio (371 deaths per 
100,000 live births) [8] and the neonatal mortality rate (25 deaths per 1,000 live births) remain high [9]. 
Anemia and severe acute malnutrition are among the ten principal causes of death among children 
under five years, in health facilities [10]. According to the findings from the 2017 Performance 
Monitoring and Accountability (PMA) 2020 nutrition survey, among women age 10-49 years who had a 
live birth in the last two years, 83% visited a qualified ANC provider. Among those who sought prenatal 
care, 70% of women reported attending at least four visits [11]. However, information on nutritional 
status shows that undernutrition is highly prevalent among women and children. According to the 2010 
DHS, 16% of women of child-bearing age were undernourished (BMI <18.5kg/m2), and 58% of pregnant 
women were anemic [12]. There is still a high prevalence of LBW (14%) and stunting among under five 
years of age (33%) [8]. All this suggests the need to reinforce nutrition interventions provided during 
pregnancy and enhance coverage and utilization of ANC services.  
Alive and Thrive (A&T) is an initiative that supports the scaling up of nutrition interventions to save lives, 
prevent illnesses, and contribute to healthy growth and development through improved maternal 
nutrition, breastfeeding and complementary feeding practices in several countries. Since 2014, A&T has 
worked with the Burkina Faso Ministry of Health (MOH) to scale up breastfeeding nationally and is now 
working to support the MOH and various international and local partners to scale up interventions to 
address a full range of maternal, infant, and young child nutrition (MIYCN) practices.  

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In Burkina Faso, A&T will develop and test the integration of an intensive package of maternal nutrition 
interventions into existing ANC services delivered through government health facilities that will align 
with the latest global evidence [7]. These include intensified counseling and support on dietary diversity 
and quality during pregnancy, iron-folic acid (IFA) supplements consumption, importance of ANC and 
increasing the number of visits, adequate weight-gain monitoring, and early initiation of and exclusive 
breastfeeding. The International Food Policy Research Institute (IFPRI) will carry out a research study to 
assess the feasibility of integrating this package of maternal interventions into existing ANC services and 
to identify enabling factors and challenges.  The findings of this evaluation study will provide the MOH 
and its partners with important information needed to scale up interventions to achieve the new ANC 
recommendations. 
1.2 Objectives 
The overall study objective is to evaluate the feasibility and impact of integrating locally relevant 
maternal nutrition interventions into existing ANC services on diet quality and utilization of nutrition 
interventions during pregnancy. 
Research questions for the evaluation include: 
1) Is it feasible to integrate locally relevant maternal nutrition interventions based on the WHO 
ANC guidelines into existing ANC services delivered through government health facilities? 
2) Can the coverage and utilization of key nutrition interventions (nutrition counseling, weight 
gain monitoring, IFA supplement consumption) be improved by integrating nutrition-focused 
social and behavior change communication (SBCC; community mobilization and interpersonal 
communication) and systems strengthening approaches into existing ANC services? 
3) Can the quality of diets (dietary diversity and adequate intake of micronutrients, protein, and 
energy) among pregnant women and early breastfeeding practices (early initiation of and 
exclusive breastfeeding) be improved by the nutrition-focused SBCC interventions? 
4) What are the barriers and opportunities for completing 8 ANC contacts?  
 
1.3 Trial design 
The present study is designed as a two-arm cluster-randomized, non-masked trial, consisting of two 
cross-sectional surveys at baseline and endline. The unit of randomization is the health and social 
promotion center (CSPS) catchment area. The study is designed to have sufficient power to estimate 
differences between study groups across regions (Figure 1). A baseline cluster/facility-level and 
household survey will take place in November-December 2019. As soon as the baseline survey is 
completed, the intervention will be implemented at the CSPS and in the villages of the intervention 
group for up to 12 months. The endline survey will take place approximately one year later in January-
February 2021. The repeated cross-sectional study design will allow us to assess the impact of the 
maternal nutrition interventions on currently pregnant and recently delivered women.

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Figure 1. Trial flow 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Note: CSPS: Centre de Santé et de Promotion Social. The baseline and endline surveys will include cross-sectional interviews of 
pregnant, and recently delivered women and their husbands, as well as providers of ANC services. 
Hauts-Bassins 
2 Health Districts 
40 CSPS 
Boucle du Mouhoun 
2 Health Districts 
40 CSPS 
2019 Baseline: Household and health facility-level surveys 
40 CSPS catchment areas 
A&T intervention areas 
Intensified maternal nutrition 
interventions integrated in ANC services 
40 CSPS catchment areas 
Comparison areas 
Standard services provided through 
ANC  
2021 Endline: Household and health facility-level surveys 
Comparison between program groups 
Randomization 

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II. 
 Methods: Participants, Interventions and Outcomes 
2.1 Study setting 
The study will be conducted in Boucle du Mouhoun and Hauts-Bassins, two of the 13 regions of Burkina 
Faso (Figure 2), often referred to as the country’s breadbasket. Their capital cities are located 273 km 
and 360 km respectively, from Ouagadougou (the capital of the country). The regions were selected with 
the Government of Burkina Faso based on regional-level engagement and ownership, presence of 
community health workers and functioning community-women’s groups known as Groupes 
d'Apprentissage et de Suivi des Pratiques Optimales d'Alimentation du Nourrisson et du Jeune Enfant 
(GASPA), size of the region, ANC attendance and security concerns.  
 
 
 
 
 
 
 
 
 
 
In Burkina Faso, the health care system is organized into three administrative levels: central, 
intermediate and peripheral [10]. Health facilities are also organized in three levels as follows: the first 
level known as health district includes medical centers with surgical services (CMA), health and social 
promotion centers (CSPS) and isolated maternity units; the second level with regional hospitals (CHR); 
and the third level includes university/national hospitals (CHU). At the district level, CMA represents the 
referral center for health centers of the first level. In Boucle du Mouhoun, two out of six health districts 
and two out of eight in Hauts-Bassin were selected as part of the study.  
ANC coverage with at least one ANC visit is very high in Burkina Faso. About 97% of recently-pregnant 
women reported attending ANC at least once during their last pregnancy in 2017 [13]. The majority of 
women who received ANC also received it from a skilled provider, mostly from a midwife (71.3% in 
Boucle du Mouhoun, 85.8% in Hauts-Bassins) or nurse (19.1% in Boucle du Mouhoun, 17.9% in Hauts-
Bassins) [13]. Most women attended ANC at least twice during their pregnancy, and roughly one-third of 
women in Boucle du Mouhoun and half of women in Hauts-Bassins are within their first trimester at the 
time of their first ANC visit. At national and regional levels, approximatively one-third of women 
attended at least four ANC visits (as recommended until 2016) during pregnancy [12]. 
IFA consumption is nearly universal in Burkina Faso [13]. Current WHO guidelines recommend daily IFA 
supplementation (30-60 mg elemental iron and 400 mcg folic acid) for women during pregnancy, 
 
Figure 1: Study regions 

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beginning as early as possible to prevent maternal anemia, puerperal sepsis, low birth weight, preterm 
birth, maternal anemia and iron deficiency [14]. Ideally, pregnant women should receive IFA tablets no 
later than the first trimester, corresponding to 6 months (180 days) of supplementation. Ninety-seven 
percent of women in Boucle du Mouhoun and Hauts-Bassins reported taking at least one IFA or iron 
tablet during their most recent pregnancy, with 70.6% and 86.0% of women taking at least 90 tablets, 
respectively [13].  
According to the 2017 PMA2020 nutrition survey, calcium supplementation is not common [13]. WHO 
currently recommends daily calcium supplementation (1.5-2.0 g oral elemental calcium) in populations 
with low dietary calcium intake to reduce the risk of pre-eclampsia. However, in Burkina Faso calcium 
supplementation during pregnancy is not yet recommended until further evidence becomes available.  
Women’s dietary diversity is poor. The mean dietary diversity score (out of 10 food groups) among 
recently-pregnant women is 3.9 in both regions, slightly higher than the national average of 3.4 [13]. 
Health providers are nearly twice as likely to provide women information on the importance of diet 
quality (such as eating a variety of foods and high iron foods) during pregnancy than the importance of 
quantity (i.e. eating extra food) during ANC services [13]. 
ANC services are provided in nearly all health facilities, and ANC services are offered, on average, 5-6 
days per week [11]. Weighing, nutrition counseling, and IFA supplementation are routine ANC services. 
Weight gain monitoring during pregnancy is important as body mass index and gestational weight gain 
are indicators of maternal nutrition and are associated with pregnancy outcomes. Among women who 
attended ANC during their most recent pregnancy during the past two years, nearly all of them were 
weighed at least once. However, among them, only 62% of women reported receiving information 
about their weight gain. This proportion was 72.7% in Hauts-Bassin, higher than in Boucle du Mouhoun. 
[13]. Roughly half of all facilities support community health workers to provide nutrition services. 
 
Breastfeeding is a common practice: in 2017, 97.4% of Burkinabe women have ever breastfed [13]. Early 
initiation breastfeeding (within one hour) was 60.2 % in Boucle du Mouhoun and 60.3 % in Hauts-
Bassins. About 91% and 74% of women reported receiving information on breastfeeding immediately 
after birth in Boucle du Mouhoun and Hauts-Bassins, respectively. Among those who received 
information about breastfeeding their newborn, 59% reported breastfeeding within one hour of birth, 
and 55% of women reported exclusively breastfeeding their baby.  
 
In the two health districts in Boucle du Mouhoun and two in Hauts-Bassin selected as potential 
intervention areas, an exhaustive list of all CSPS was prepared (total of 223 CSPS in Boucle du Mouhoun 
and 182 CSPS in Hauts-Bassins).  Areas with high security risk, physical inaccessiblity, and presence of 
similar intervention programs were excluded from the study.  The final list of 80 CSPS catchment areas 
included in the study is provided in Appendix 1. 
2.2 Eligibility criteria 
The study includes two main samples: pregnant women (PW) and recently delivered women (RDW), to 
assess diet during pregnancy (among PW) and intervention exposure throughout pregnancy (among 
RDW).   
Inclusion criteria: 
1) Women of reproductive age (15 to 49 years old) 

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2) Currently pregnant or having a living child under 6 months of age (recently delivered) at the 
time of the survey 
3) Residency in the health center catchment area  
4) Informed consent  
Exclusion criteria:  
1) Severe illness (e.g., any severe illness symptoms mentioned/identified by the woman, a relative 
or the enumerator) in woman and/or child requiring immediate hospital referral 
2) Chronic or congenital illness (e.g., any health condition mentioned/identified by the woman, a 
relative or the enumerator) in women and/or child interfering with dietary intake  
At the health center level, health staff particularly the nurse-midwife responsible for providing ANC, and 
community health workers are eligible to participate in one-to-one interviews after providing informed 
consent. 
2.3 Interventions 
The package of maternal nutrition interventions will include intensified counseling on diet quality during 
pregnancy, distribution of and counseling on IFA supplements for better adherence, counseling on early 
initiation of and exclusive breastfeeding, weight-gain monitoring, systems strengthening through 
training and supportive supervision, as well as community mobilization. Intervention components are 
presented in Table 1. 
Table 1: Description of interventions for intervention and control areas 
CORE INTERVENTIONS 
INTERVENTION AREAS 
CONTROL AREAS 
HEALTH FACILITY LEVEL: 
Counseling on diet 
quality  
• 
Intensified counseling on dietary 
diversity and quality using job aids  
• 
Standard nutrition 
counseling  
Distribution and 
promotion of IFA 
supplementation  
• 
Intensified counseling on purpose of 
IFA supplements, managing side 
effects, and importance on 
adherence to daily consumption 
• 
Distribution/prescription of 
sufficient IFA supplements at each 
ANC visit/contact  
• 
Use of reminders for women and 
their spouses   
• 
Monthly stock monitoring to assure 
sufficient supplies  
• 
Standard counseling on 
consumption of IFA and how 
to manage side effects  
• 
Distribution/prescription of 
IFA at each ANC visit  
• 
Routine stock monitoring  
Weight-gain monitoring 
• 
Measurement of weight gain during 
each ANC visit and advise on 
healthy weight gain  
• 
Use of monitoring sheets  
• 
Standard weight 
measurement   
Counseling on early 
breastfeeding practices  
• 
Intensified counseling on early 
initiation of breastfeeding and 
exclusive breastfeeding using job 
aids  
• 
Standard breastfeeding 
counseling  

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Reminders on ANC 
attendance 
• 
Reminder on importance of early 
ANC attendance and 8 
visits/contacts (at least 4 visits at 
health facility) 
• 
Standard reminder 
COMMUNITY LEVEL: 
Community 
mobilization 
• 
Orientation sessions for community 
leaders (traditional and religious 
leaders, local associations, etc.) 
about ANC 
• 
Gatherings among mothers-in-law, 
husbands, and other influencers 
about ANC and their roles  
• 
Promotion of ANC service utilisation 
and the importance of early ANC 
visit during the first trimester.  
• 
Identification of pregnant women 
for early ANC 
• 
Standard ASBC activities  
Interpersonal 
communication in 
GASPA (women’s 
groups) and during 
home visits 
• 
Focused discussions during GASPA 
meetings 
• 
2-3 home visits per pregnant 
woman by ASBCs (Counseling on 
diet quality, breastfeeding, 
importance on adherence to daily 
IFA consumption and side effect 
management, etc.)  
• 
Standard GASPA meetings 
• 
Standard ASBC activities  
SYSTEM SUPPORTS: 
Training/refreshers 
• 
Training on nutrition interventions 
during ANC for all ANC providers 
and community health workers 
• 
Standard government 
training 
Supervision 
• 
Semi-annual supervision by DRS 
• 
Quarterly supportive supervision of 
health facility staff by the health 
district management team 
• 
Monthly supportive supervision of 
ASBC  
• 
Quarterly integrated 
supervision for all care 
providers 
• 
Standard supervision of 
ASBC every 2 months  
Progress review 
• 
Monthly review between health 
facilities and ASBC 
• 
None 
Data recording and 
monitoring 
• 
Training and recording of  up to 8 
ANC visits and nutrition services on 
registers 
• 
Training on data utilization to 
improve service coverage and 
quality 
• 
Routine data recording and 
monitoring 

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2.4 Outcomes 
The primary outcome indicators of the study are focused on diet quality and IFA supplementation. These 
include: 
1) Maternal dietary diversity among pregnant women 
i. Mean number of food groups consumed by pregnant women 
2) Use of iron-folic acid (IFA) supplements among RDW 
i. Mean number of IFA tablets consumed during pregnancy 
The secondary outcomes relate to exposure to and utilization of key maternal nutrition, weight gain 
monitoring, and early breastfeeding interventions, as well as health worker knowledge and capacities at 
the points of service delivery. These include: 
3) Maternal diet quality: proportion of pregnant women who achieve minimum dietary diversity; 
and micronutrient, protein and energy adequacy among pregnant women compared to the 
recommended dietary intake 
4) Proportion of women who received 90+ IFA supplements during pregnancy 
5) Early initiation of breastfeeding and exclusive breastfeeding practices of children 
6) Use of ANC services (total number of ANC visits/contacts at facility and community levels and 
timing of the first ANC visit) 
7) Exposure to nutrition interventions during ANC, including weight gain monitoring (proportion of 
women who are weighed and counselled about adequate weight gain, total number of times 
women are weighed during pregnancy)  
8) Exposure to nutrition information from community health workers (proportion of women who 
were visited at home during pregnancy, total number of times visited), community groups, and 
other sources 
9) Health worker knowledge on benefits and service provision for IFA supplementation, dietary 
diversity counselling, weight gain monitoring, and breastfeeding counselling 
10) Availability of service supports (IFA supplies, records/registers, weight measurement equipment, 
counseling materials, and training and supervision for health workers) 
2.5 Sample size 
The two main samples for the primary outcomes are: 1) pregnant women (PW) as this sample allows the 
assessment of diet quality during pregnancy; and 2) recently delivered women (RDW) who have children 
under 6 months of age, as this sample provides the best opportunity to assess the primary outcome 
related to intervention exposure throughout pregnancy (i.e., IFA consumption). Based on an initial mean 
dietary diversity score of 3.52 food groups across both regions and intra-cluster correlation of 0.110 
from the 2019 baseline data (Kim et al., 2020) , a significance level of 5% and power of 80%, the sample 
size of 480 PW per arm is estimated to detect a difference of 0.37 in the mean dietary diversity score 
after intervention.  

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For RDW, using an initial mean of 108.64 IFA tablets consumed across both regions and intra-cluster 
correction of 0.206 at baseline (Kim et al., 2020) and the same assumptions above for statistical 
significance, the sample size of 960 RDW per arm is estimated to detect a difference of 15 tablets in the 
mean IFA tablets consumed after intervention. If husbands of RDW are present at the time of the 
survey, they will also be interviewed briefly about their health and nutrition knowledge and any support 
provided during pregnancy. Approximately half of the expected sample size of husbands was available at 
baseline.   
Outside of these two main samples, nurses-midwives (1 per CSPS) and community health workers 
(within 3 villages per CSPS) will be interviewed. In addition, direct observations of ANC visits (2 per CSPS) 
to assess service quality, followed by exit interviews to assess client satisfaction, will be conducted 
among a subgroup of pregnant women attending ANC at the time of survey. 
The overall study samples sizes are presented in Table 2.  
Table 2: Estimated sample sizes 
 
Baseline 2019 
Endline 2020 
 
Intervention 
Control 
Intervention 
Control 
Pregnant women 
480 
480 
480 
480 
Women with children 0-5 months old  
960 
960 
960 
960 
Husbands of women with children 0-5 
months old 
960 
960 
960 
960 
Nurses-midwives 
40 
40 
40 
40 
Community health worker (ASBCs) 
120 
120 
120 
120 
ANC observation & exit interview  
80 
80 
80 
80 
Total 
2,640 
2,640 
2,640 
2,640 
 
2.6 Recruitment 
In the catchment area of the pre-selected CSPS, a census will be conducted in three randomly selected 
villages representing the CSPS catchment area to identify PW and RDW. From two separate lists (for PW 
and RDW), women will be randomly selected by simple random sampling until the required sample sizes 
are reached. At least 10 and 24 households per cluster need to be visited in the villages to identify PW 
and RDW, respectively.  
At each CSPS, the nurse-midwife mainly responsible for providing ANC services will be invited participate 
in the study.  In each surveyed village, the community health worker (ASBC) mainly responsible for 
ANC/care for pregnant women or, in the case that more than one ASBC is responsible, with the longest 
duration in that position will be invited to participate in the study.  In addition, at each CSPS, two ANC 
sessions that take place during the time of the survey will be observed, with prior permission and 
consent for observation and post-observation exit interview.  
  

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III. 
Methods: Assignment of interventions   
3.1 Allocation 
We applied stratified random allocation to obtain a more balanced distribution of cluster-level 
covariates between study arms. First, we divided clusters/CSPS by health districts. Then we stratified 
clusters into 2 strata using available data on a set of criteria:  
• 
Type of catchment area 
• 
Number of villages covered  
• 
Total population size  
• 
Total number of pregnant women and total number of children <6 months  
• 
Number of ANC admissions and proportion of ANC attended 
• 
Distance between CSPS and district hospital   
Then we used Stata to assign unique computer-generated random numbers to each cluster, sort 
numbers, and allocate each cluster in order to one of two study arms (intervention or control).  
 
3.2 Blinding 
This evaluation study will be unblinded. Women in the intervention areas will not be informed about the 
results of the randomization. However, there will be no blinding of the interventions at the level of 
service delivery. 
 
IV. 
Methods: Data collection, management, and analysis 
4.1. Data collection methods 
Data will be collected at the health facility and household levels by trained field staff, using pretested 
questionnaires. The following set of tools will be translated from English to French and most spoken 
local languages and used during the baseline and endline surveys: 
i. 
Health facility observation checklist 
ii. 
ANC observation checklist and exit interview 
iii. 
Nurse-midwife questionnaire 
iv. 
Community Health Worker (ASBC) questionnaire 
v. 
Pregnant women questionnaire 
vi. 
Recently delivered women and Husband questionnaire  
vii. 
Multi-pass 24-hour recall (for pregnant women only)  
Topics included in each of the data collection methods are presented in Table 3. 

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Table 3: Data collection methods  
Data collection method 
Topics included 
Health facility observation 
checklist 
Condition of the facility infrastructure, service readiness, services 
provided by the facility, human resources, and ANC monitoring 
system 
ANC observation checklist 
with exit interview   
Direct observation checklist of ANC session to document services 
provided, perceptions of counseling received, patient satisfaction 
Nurse-midwife questionnaire 
Nurse-midwife ’s responsibilities, capacity, knowledge, motivation, 
and ANC service provision at the health center 
Community health worker 
(ASBC) questionnaire 
ASBC’s responsibilities, capacity, knowledge, motivation, and ANC 
service provision in the community  
Pregnant women 
questionnaire  
Household composition, household socioeconomic status, obstetric 
history, use of ANC, exposure to ANC, maternal nutrition and 
breastfeeding knowledge, household food security, social 
desirability, decision-making power, and mental health 
Recently delivered women 
and husband questionnaire   
Household composition, household socioeconomic status, obstetric 
history, use of ANC, exposure to ANC, maternal nutrition and 
breastfeeding knowledge and practices, pregnancy and postnatal 
care, household food security, social desirability, decision-making 
power, mental health, anthropometry, husband’s health and 
nutrition knowledge, and husband’s perceptions of maternal 
nutrition and roles of husbands, other family members and 
community/village during pregnancy 
Multi-pass 24-hour recall 
(pregnant women) 
Food intake over the previous 24-hours, recipes of prepared dishes 
 
4.1.1 Health facility observation checklist 
A facility observation checklist will be included to obtain information on facility characteristics, the 
presence and condition of infrastructure, service readiness, services provided, caseload, human 
resources, and ANC monitoring system at the facility. Checklists will be the same for all the CSPS as 
presented in Table 4. 
Table 4: Description of topics in the health facility checklist 
Module 
Topic 
Description 
Respondent 
1 
Identification 
Location, type of facility 
Enumerator (direct 
observation) 
2 
Infrastructure 
Building amenities and condition 
Enumerator (direct 
observation) 
3 
Facility and staff 
characteristics 
Hours of operation, type and number 
of staff, catchment population 
Enumerator (direct 
observation) 
4 
ANC equipment, 
materials and 
medications 
Availability of functioning ANC 
equipment, counseling materials and 
medications 
Enumerator (direct 
observation) 

16 
 
5 
ANC services provided 
Services provided in-facility or through 
out-patient care, including ANC, 
nutrition counseling, provision of IFA, 
breastfeeding counseling 
Enumerator (ANC 
registers, inquire with 
health worker) 
6 
Patient caseload 
Caseload for ANC, referrals and 
counselling 
Enumerator (ANC 
registers, inquire with 
health worker) 
7 
Monitoring system 
Monitoring and tracking of ANC 
clients, data registers  
Enumerator 
(pharmacy and ANC 
registers, inquire with 
health worker) 
 
4.1.2 ANC observation checklist and exit interview with pregnant women 
Direct observation of ANC sessions will be conducted by the enumerators to document the ANC process. 
In addition, post-observation exit interviews with pregnant women will be conducted immediately after 
observation to assess their satisfaction regarding the services received. The modules in the checklist are 
presented in Table 5. 
 
Table 5: Description of modules in the ANC observation checklist and exit interview  
Module 
Topic 
Description 
Respondent 
1 
Identification 
Location, type of facility, and type of 
service provider 
Enumerator (direct 
observation) 
2 
Identification 
Pregnant woman’s name, birthdate, 
age, and antenatal care visit number 
Enumerator (direct 
observation or 
pregnant woman) 
3 
Observation of 
antenatal care 
session 
Provision and coverage of services 
such as medical history, danger signs 
of current pregnancy, physical 
examination, routine tests, IFA and 
other prophylaxis, and 
counseling/advice about nutrition 
Enumerator (direct 
observation) 
4 
Exit interview 
Services and messages received from 
the provider, and satisfaction with 
services received 
Pregnant woman 
 
4.1.3 Nurse-midwife questionnaire  
Interviews with nurse-midwives who provide ANC services at health centers will be conducted at 
baseline and endline and will gather information on workload and time commitments, ANC service 
provision, knowledge of maternal nutrition and optimal breastfeeding practices, exposure to nutrition 
training, and supervision. The modules in the questionnaire are presented in Table 6. 
Table 6: Description of modules in the nurse-midwife questionnaire 
Module 
Topic 
Description 
Respondent 
1 
Identification 
Facility identification, nurse-midwife ‘s 
name  
Enumerator 

17 
 
2 
Demographic 
characteristics 
Age, education, years of experience 
and other characteristics of the nurse-
midwife 
Nurse-midwife 
3 
Time commitments 
and workload 
Workload of the nurse-midwife, 
including responsibilities, supervision 
provided to ASBCs, time commitments, 
number of consultations, and number 
of patients 
Nurse-midwife 
4 
Nutrition counseling 
information 
Topics/messages provided as part of 
nutrition counseling during ANC 
Nurse-midwife 
5 
Maternal health and 
nutrition knowledge 
General knowledge on health and 
nutrition, nutrition during pregnancy, 
anemia, and IFA supplementation 
Nurse-midwife 
6 
Breastfeeding and 
feeding knowledge 
Knowledge of the importance of early 
initiation of breastfeeding, exclusive 
breastfeeding, and timing of the 
introduction of other liquids foods 
Nurse-midwife 
7 
Training exposure 
Exposure to and training received on 
maternal nutrition 
Nurse-midwife 
8 
Supervision and 
contact with other 
health workers 
Frequency and content of supervision 
received from superiors, and contact 
with other health workers 
Nurse-midwife 
 
4.1.4 Interviews with ASBCs 
Interviews with community health workers who provide ANC services (ASBCs) in the communities will be 
conducted at baseline and endline and will gather information on workload and time commitments, 
ANC service provision, knowledge of maternal nutrition and optimal breastfeeding practices, exposure 
to nutrition training, and supervision. Table 7 presents the modules in ASBC questionnaire. 
Table 7: Description of modules in the community health worker questionnaire 
Module 
Topic 
Description 
Respondent 
1 
Identification 
Location, health facility, ASBC’s name 
Enumerator 
2 
Demographic 
characteristics 
Age, education, years of experience 
and other characteristics of the ASBC 
ASBC 
3 
Time commitments 
and workload 
Workload of the ASBC, including 
responsibilities, time commitments, 
number of consultations, and number 
of patients 
ASBC 
4 
Nutrition counseling 
information  
Topics/messages provided as part of 
nutrition counseling during ANC 
ASBC 
5 
Maternal health and 
nutrition knowledge 
General knowledge on health and 
nutrition, nutrition during pregnancy, 
anemia, and IFA supplementation 
ASBC 
6 
Breastfeeding and 
feeding knowledge 
Knowledge of the importance of early 
initiation of breastfeeding, exclusive 
breastfeeding, and timing of the 
introduction of other liquids foods 
ASBC 

18 
 
7 
Training exposure 
Exposure to and training received on 
maternal nutrition 
ASBC 
8 
Supervision and 
contact with other 
actors 
Frequency and content of supervision 
received from superiors, and contact 
with village elders  
ASBC 
 
4.1.5 Pregnant women questionnaire 
Detailed interviews with pregnant women will be conducted in their homes at baseline and endline. 
Information on household composition, household socioeconomic status, household food security, 
dietary diversity, obstetric history, use of ANC, social desirability, and maternal nutrition and 
breastfeeding knowledge will be collected. The modules in questionnaire are presented in Table 8. 
Table 8: Description of modules in pregnant women questionnaire 
Module 
Topic 
Description 
Respondent 
1 
Identification 
Name, ethnicity, religion, phone 
number 
Enumerator 
2 
Household roster 
Information on the composition of the 
household, including designation of 
the head of household, a list of all 
household members, their ages and 
sex, and their relationship to the 
pregnant woman, and the highest 
educational level attained and 
activity/employment  
Pregnant woman 
3 
Obstetric history 
Age at first marriage, last menstrual 
period, gestational age, number of 
pregnancies, number of living children, 
date of last birth  
Pregnant woman 
4 
Use of antenatal care 
(facility-based) 
Frequency and timing of ANC use and 
exposure to nutrition counseling and 
messages during facility-based ANC 
contacts 
Pregnant woman 
5 
Exposure to maternal 
nutrition interventions 
in the community 
Exposure to maternal nutrition 
counseling and messages during home 
visits and community meetings and 
gatherings 
Pregnant woman 
6 
Consumption of IFA 
Current consumption of IFA tablets, 
receipt/purchase of IFA tablets; 
observation of IFA 
tablets/packs/bottles 
Pregnant woman 
7 
Dietary diversity  
Dietary diversity of the pregnant 
woman and household in the past 24 
hours 
Pregnant woman 
8 
Maternal health and 
nutrition knowledge 
and perceptions 
General knowledge on health and 
nutrition, nutrition during pregnancy, 
anemia, and IFA supplementation; 
perceptions about maternal nutrition 
Pregnant woman 

19 
 
and roles of husbands, other family 
members and community/village 
9 
Food security 
Prevalence of household hunger using 
the FANTA household food insecurity 
access scale (HFIAS) 
Pregnant woman 
10 
Dwelling 
House construction (materials used for 
floor, walls, and roof), availability of 
water and electricity, sources of 
fuel/energy for cooking, WASH 
facilities 
Pregnant woman 
11 
Assets 
Ownership of durable household 
goods (in working condition), including 
tools for agricultural production 
Pregnant woman 
12 
Social desirability  
Desire for social approval 
Pregnant woman 
13 
Women’s decision-
making power 
Perceptions on women’s role in the 
household, ownership of productive 
assets and decision-making power   
Pregnant woman 
14 
Mental health 
Mental health status over the past 
month 
Pregnant woman 
 
4.1.6 Recently delivered women 
Detailed interviews with RDW will be conducted in their homes at baseline and endline. Information on 
household composition, household socioeconomic status, household food security, exposure to ANC 
and delivery and postnatal care, dietary diversity, social desirability, maternal nutrition knowledge, and 
breastfeeding practices and knowledge will be collected. If husbands of RDW are present at the time of 
the survey, they will also be interviewed briefly about their health and nutrition knowledge and any 
support provided during pregnancy. The description of modules in RDW is presented in Table 9.  
Table 9: Description of modules in RDW’s questionnaire 
Module 
Topic 
Description 
Respondent 
1 
Identification 
Location, household 
Enumerator 
2 
Household roster 
Information on the composition of the 
household, including designation of 
the head of household, a list of all 
household members, their ages and 
sex, and their relationship to the 
pregnant woman, and the highest 
educational level attained and 
activity/employment 
Recently delivered 
woman 
3 
Obstetric history 
Marriage, pregnancy and childbirth 
history 
Recently delivered 
woman 
4 
Use of antenatal and 
postnatal care 
services 
Frequency and timing of ANC use at 
health facility and/or in the 
community), services/messages 
received during ANC 
Recently delivered 
woman 

20 
 
5 
Exposure to maternal 
nutrition interventions 
in the community 
Exposure to maternal nutrition 
information outside of ANC services 
Recently delivered 
woman 
6 
Consumption of IFA 
supplements 
Current consumption of IFA tablets, 
receipt/purchase of IFA tablets 
Recently delivered 
woman 
7 
Dietary diversity  
Dietary diversity of the pregnant 
woman and household in the past 24 
hours 
Recently delivered 
woman 
8 
Breastfeeding and 
child feeding practices 
Early initiation and exclusive 
breastfeeding practices 
Recently delivered 
woman 
9 
Maternal health and 
nutrition knowledge 
and perceptions 
General knowledge on health and 
nutrition, nutrition during pregnancy, 
anemia, and IFA supplementation; 
perceptions about maternal nutrition 
and roles of husbands, other family 
members and community/village 
Recently delivered 
woman 
10 
Breastfeeding and 
child feeding 
knowledge 
Knowledge, beliefs and attitudes 
toward early initiation of 
breastfeeding, exclusive breastfeeding, 
and continued breastfeeding 
Recently delivered 
woman 
11 
Food security 
Prevalence of household hunger using 
the FANTA household food insecurity 
access scale (HFIAS) 
Recently delivered 
woman 
12 
Dwelling 
House construction (materials used for 
floor, walls, and roof), availability of 
water and electricity, sources of 
fuel/energy for cooking, WASH 
facilities 
Recently delivered 
woman 
13 
Assets 
Ownership of durable household 
goods (in working condition), including 
tools for agricultural production 
Recently delivered 
woman 
14 
Social desirability  
Desire for social approval 
Recently delivered 
woman 
15 
Women’s role and 
decision-making 
power 
Perceptions on women’s role in the 
household, ownership of productive 
assets and decision-making power  
Recently delivered 
woman 
16 
Mental health 
Mental health status over the past 
month 
Recently delivered 
woman 
17 
Postnatal functional 
disability 
Ability to perform physical tasks and 
activities following birth 
Recently delivered 
woman 
18 
Anthropometry 
Weight and height measurements 
Recently delivered 
woman 
19 
Husband’s support 
during pregnancy  
Support provided during pregnancy 
Husband 
20 
Husband’s exposure 
to maternal nutrition 
information 
Exposure to maternal nutrition 
messages and method of receipt 
Husband 

21 
 
21 
Husband’s knowledge 
about maternal 
nutrition  
General knowledge on health and 
nutrition, nutrition during pregnancy, 
anemia, and IFA supplementation 
Husband 
22 
Husband’s 
perceptions about 
maternal nutrition 
Husband’s perceptions on maternal 
nutrition and roles of husbands, other 
family members and 
community/village 
Husband  
 
4.1.7 Multi-pass 24h-recall 
Dietary intake data of pregnant women will be collected in women’s homes using multi-pass 24-hour 
recall interviews (Gibson and Ferguson 2008), which have been validated in many low-income countries 
(Gibson et al. 2017). Standardized quality-control procedures will be implemented to mitigate potential 
underreporting of energy and nutrient intake and other reporting errors (Alemayehu et al. 2011).  
The multi-pass 24-hour recall approach uses a special method to help individuals remember what they 
consumed. Enumerators will review the pregnant woman’s food and drink taken over the past 24-hours 
several times. Each time, or “pass”, more detailed information is collected, thus reducing the probability 
that foods and drinks are omitted. To help estimate portion sizes, respondents will be visited prior to the 
24-hour recall and provided with standardized dishes (e.g. cups, bowls and spoons) to use for consuming 
and preparing food the following day (the anticipated day of recall). Descriptions of each pass are 
presented in Table 10. 
Table 10: Description of the four passes for the multi-pass 24-h recall 
Pass 
Description 
1 
Obtain a list of all foods and beverages and indicate the time period 
when they were consumed. 
2 
Use probing questions to get more details about each food item or 
beverage, such as whether the food was cooked or raw when 
consumed.  
3 
Estimate the amounts of each food, beverage and dish consumed. 
4 
Verify the list of foods, beverages, and dishes from the first pass to 
capture any missed items. 
 
In addition to the amounts of foods and beverages, enumerators will collect information on recipes of 
mixed dishes consumed. Weights of each ingredient and the total cooked weight of dishes will be 
collected. If the pregnant woman is not the individual in charge of food preparation, effort will be made 
to interview the food preparer. 
4.2 COVID-19 precautionary measures 
Since early 2020, close-range contacts between enumerators and household members present a 
particular risk for spreading COVID-19 in communities with vulnerable populations. The collaborating 
survey firm, AFRICSanté, has developed a formal standard operating procedure (SOP) on improved 
hygiene that enumerator staff will be trained on during survey training and must sign as part of a 
contract amendment. As part of the SOP, all enumerators and study participants will wear masks 
(provided to them) and wash or sanitize their hands before and after each interview. Enumerators will 
maintain two meters of distance between themselves and respondents during the interview. When 

22 
 
conducting anthropometric measurements, enumerators will use additional protective equipment 
including disposable gloves and overalls which will be disposed of after each survey. Measuring boards 
will be sanitized after every measurement. Before the interview begins, respondents will be asked if 
they have had any symptoms of illness in the past two weeks. If respondents have had at least three 
symptoms, they will be considered high risk and additional precautions will be observed. 
Testing enumerators for COVID-19 before starting data collection is unlikely given the scant resources 
available for testing in Burkina Faso. However, all survey staff will be assessed for COVID-19-related 
symptoms (including fever, dry cough, extreme fatigue, body aches, sore throat, etc.) each day before 
enumerator training begins, and field supervisors will assess enumerators each day before starting data 
collection. In addition, Co- and Principal Investigators of the project will be in daily contact with 
AFRICSanté and in-country partners during data collection to assess the changing risks and government 
measures. 
4.3 Data management 
A secure data file structure will be established in an IFPRI-server-based Dropbox Professional folder for 
use by the IFPRI research team and potential collaborators. Original, sensitive (non-anonymized) data 
files and documents will be stored in a folder with access restricted to senior IFPRI researchers. A do file 
will be written to anonymize survey data files and export the anonymized data to a shared Dropbox 
folder for data cleaning and analysis by research support staff and other project team members. 
All changes to the raw data output files from the Computer-Assisted Personal Interviews (CAPI) software 
will be recorded. Formatting, reshaping, and labeling of data will be documented using detailed and 
well-annotated do files. 
4.4 Statistical methods 
Descriptive analyses will be used to describe characteristics of the two groups.  Testing of differences 
between the two groups will be done using a random effects regression, accounting for the clustering of 
errors within and across health center catchment areas. 
The randomized study design allows for the identification of causal effects of the maternal nutrition 
intervention through comparisons of mean outcomes between the treatment and control groups. Key 
indicators will include dietary diversity (among pregnant women), IFA consumption, weight gain 
monitoring, and breastfeeding practices (early initiation and exclusive breastfeeding). Impacts will be 
assessed using difference-in-difference (DID) estimation. Data management, data cleaning and statistical 
analyses will be conducted using Stata version 15 (Statacorp, USA).  
 
V. 
Methods: Monitoring 
5.1 Data monitoring and storage 
All data collection will be done using electronic tablets. Checks will be built into the CAPI software and 
applied at the time of data entry. These will include logic checks, valid values, skip patterns, and range 
checks among others to ensure efficiency and high data quality. In addition, enumerator monitoring will 
be incorporated into the CAPI software including recording the duration of interviews and GPS location 
of enumerators during data collection. 

23 
 
Field supervisors will closely monitor enumerators and the quality of data collected to ensure the 
integrity of the data during data collection. Project manager, principal and co-principal investigators of 
the survey firm and IFPRI will also closely monitor the quality of data collected. 
5.2 Harms 
Given that the nutrition interventions during ANC are provided according to government guidelines for 
standard health service, we do not anticipate any harms from the study. Any adverse events or 
unintended effects during provision of ANC will be handled according to standard care practices.  
5.3 Auditing 
Not applicable.  
 
VI. 
Ethics and dissemination  
6.1 Research ethics approval 
This protocol, informed consent forms, and study questionnaires will be reviewed and approved by the 
IFPRI Institutional Review Board (IRB) based in Washington, DC. In Burkina Faso, ethical clearance will be 
obtained from a local IRB, Centre Muraz in Bobo-Dioulasso. 
A COVID-19 country risk assessment system was developed by IFPRI to help researchers and IFPRI’s IRB 
assess COVID-19 risk in countries where fieldwork is planned. In function of the level of COVID-19 risk 
identified in country, data collection methods will be adapted to minimize the transmission risk of 
COVID-19. Justification for resuming fieldwork with in-person contacts will be provided and accepted by 
the IRB.  
6.2 Protocol amendments 
All amendments to the protocol will be reported (by IFPRI Co-Investigators) to and agreed upon with 
Alive & Thrive. Any modifications to the protocol which may impact the safety of participants or the 
scientific validity including changes of study objectives, study design, participants, sample sizes, and 
study procedures will be reviewed by the IFPRI IRB and the local IRB.  
Version control using protocol version identifiers and dates will be used to track the history of 
amendments and identify the most recent protocol version. 
6.3 Consent 
After explaining the study’s objectives and procedures, enumerators will seek and obtain written 
informed consent from eligible study participants. Participation in the study is completely voluntary. 
Participants are free to withdraw at any time by informing survey team and it will not be held against 
them. 
All COVID-19 transmission risks to study participants (including close contact required for taking 
anthropometric measurements) and the precautionary measures that will be followed during data 
collection to limit the risk of transmission will be included in the informed consent.  

24 
 
6.4 Risks and benefits 
Close-range contacts between enumerators and household members present a particular risk for 
transmission of COVID-19 in communities with vulnerable populations.  Precautionary measures to 
mitigate this risk are outlined in section 4.2. 
For their time spent being interviewed, survey respondents will receive a monetary compensation. 
Pregnant women, recently delivered women, husbands of recently delivered women, nurse-midwives, 
ASBCs, and the heads of CSPS (who assist with the health facility observation checklist) will receive 1,000 
CFA francs. Pregnant women who participate in the ANC observation and exit interview will receive 500 
CFA francs. 
6.5 Confidentiality 
Precautions will be taken to ensure data confidentiality. Immediately after data collection, all data will 
be uploaded and stored securely in an IFPRI-server-based Dropbox Professional folder. To protect 
respondent confidentiality, only senior IFPRI researchers will have access to data and documents 
containing personally identifiable information. Research support staff and other project team members 
will have access to depersonalized data—located in a separate IFPRI-server-based Dropbox Professional 
folder—where direct identifiers have been replaced by randomly generated numeric IDs. 
Data that is made publicly available will be carefully screened to remove any indirect and geographic 
identifiers which may breach the confidentiality of respondents. 
6.6 Declaration of interests 
The authors declare that they have no competing interests. 
6.7 Access to data 
All Co- and Principal Investigators of the project will have full access to the cleaned data. Other project 
team members will have access to data that has had all personally identifiable information removed. 
In compliance with donor (Bill & Melinda Gates Foundation) open access policy requirements, fully 
anonymized datasets will be made publicly available one year after the end of the project. Metadata and 
other documentation of data collection procedures (such as the codebook, data collection instruments 
and interviewer guides/protocols) will also be made publicly available. 
6.8 Ancillary and post-trial care 
Not applicable. 
6.9 Dissemination policy 
Close engagement with the government of Burkina Faso is of high importance to the project. The A&T 
Burkina Faso team will be working in close partnership with government entities on strengthening 
maternal health systems at the national and regional levels throughout the duration of the project. 
Findings will be disseminated through in-country events, presentations, and conferences.  
Within the research community, we aim to have the research peer-reviewed and published in high 
quality journals. Preliminary research findings may be presented at international conferences and 
internal IFPRI seminars. 

25 
 
VII. 
Timeline 
7.1 Study timeline  
Deliverables/Activities 
2019 
2020 
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec  Jan Feb Mar Apr May Jun 
1. Study protocol  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Discuss study design with A&T 
x 
x 
x 
x 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Prepare study protocol 
 
 
 
 
x 
x 
 
 
 
 
 
 
 
 
 
 
 
 
2. Baseline data collection tools 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Develop questionnaires/data collection 
tools 
 
 
 
 
 
x 
x 
 
 
 
 
 
 
 
 
 
 
 
Select and contract survey firm 
 
 
 
 
 
x 
x 
 
 
 
 
 
 
 
 
 
 
 
Translate questionnaire 
 
 
 
 
 
 
x 
x 
 
 
 
 
 
 
 
 
 
 
Program CAPI questionnaire 
 
 
 
 
 
 
 
x 
x 
 
 
 
 
 
 
 
 
 
8. Dietary assessment formative work  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Review programming and conduct focus 
groups as needed  
 
 
 
 
 
 
 
 
x 
 
 
 
 
 
 
 
 
 
Refine tools and questionnaires  
 
 
 
 
 
 
 
 
x 
x 
 
 
 
 
 
 
 
 
3. Local and US-based IRB approvals 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IRB application at IFPRI 
 
 
 
 
 
 
x 
 
 
 
 
 
 
 
 
 
 
 
IRB application in Burkina Faso 
 
 
 
 
 
 
x 
 
 
 
 
 
 
 
 
 
 
 
4. Baseline survey implementation 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pretest, revise and finalize questionnaire 
 
 
 
 
 
 
 
 
x 
x 
 
 
 
 
 
 
 
 
Enumerator training 
 
 
 
 
 
 
 
 
 
x 
 
 
 
 
 
 
 
 
Data collection 
 
 
 
 
 
 
 
 
 
 
x 
x 
 
 
 
 
 
 
5. Data cleaning and analyses 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Data cleaning 
 
 
 
 
 
 
 
 
 
 
 
x 
x 
 
 
 
 
 
Data analyses 
 
 
 
 
 
 
 
 
 
 
 
 
x 
x 
x 
x 
x 
x 
6. Baseline results  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Prepare preliminary results 
 
 
 
 
 
 
 
 
 
 
 
 
 
x 
x 
 
 
 
Draft and finalize baseline results 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
x 
x 
 
Prepare clean datasets 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
x 
 
 
 
 

26 
 
 
Deliverable/Activities 
2020 
2021 
 
Jul 
Aug 
Sep 
Oct 
Nov 
Dec 
Jan 
Feb 
Mar 
Apr 
May 
Jun 
Jul 
7. Study protocol 
 
 
 
 
 
 
 
 
 
 
 
 
 
Review study protocol 
 
 
 
x 
 
 
 
 
 
 
 
 
 
8. Endline data collection tools 
 
 
 
 
 
 
 
 
 
 
 
 
 
Develop questionnaires/data collection tools 
 
 
 
x 
x 
 
 
 
 
 
 
 
 
Translate questionnaire 
 
 
 
 
x 
 
 
 
 
 
 
 
 
Program CAPI questionnaire 
 
x 
x 
 
x 
x 
 
 
 
 
 
 
 
9. Local and US-based IRB approvals 
 
 
 
 
 
 
 
 
 
 
 
 
 
Obtain IRB approvals at IFPRI 
 
 
 
 
x 
 
 
 
 
 
 
 
 
Obtain IRB approvals in Burkina Faso 
 
 
 
 
x 
 
 
 
 
 
 
 
 
10. Endline survey implementation  
 
 
 
 
 
 
 
 
 
 
 
 
 
Pretest, revise and finalize questionnaire 
 
 
 
 
 
 
x 
 
 
 
 
 
 
Enumerator training 
 
 
 
 
 
 
x 
 
 
 
 
 
 
Data collection 
 
 
 
 
 
 
x 
x 
 
 
 
 
 
11. Data cleaning and analysis 
 
 
 
 
 
 
 
 
 
 
 
 
 
Data cleaning 
 
 
 
 
 
 
 
x 
x 
 
 
 
 
Data analyses 
 
 
 
 
 
 
 
 
x 
x 
x 
x 
x 
12. Endline results tables and datasets 
 
 
 
 
 
 
 
 
 
 
 
 
 
Draft endline results 
 
 
 
 
 
 
 
 
 
x 
x 
 
 
Finalize endline report and findings 
 
 
 
 
 
 
 
 
 
 
 
x 
x 
Prepare clean datasets  
 
 
 
 
 
 
 
 
 
 
 
 
x 
 
 
 

27 
 
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Hanson MA, Bardsley A, De-Regil LM, Moore SE, Oken E, Poston L, Ma RC, McAuliffe FM, Maleta 
K, Purandare CN et al (2015): The International Federation of Gynecology and Obstetrics (FIGO) 
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Int J Gynaecol Obstet, 131 Suppl 4:S213-253. 
2. 
Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J, Maternal, 
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United Nations  The Millennium Development Goals Report 2015 New York. 
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World Health Organization (2016) WHO recommendations on antenatal care for a positive 
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United Nations Children’s Fund (2016) The state of the world's children: a fair chance for every 
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United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) (2018) Level & 
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12. 
Institut National de la Statistique et de la Demographie (INSD) & ICF International (2012): 
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13. 
Institut Supérieur des Sciences de la Population (ISSP) and  Bill & Melinda Gates Institute for 
Population and Reproductive Health (2017) Performance Monitoring and Accountability 2020 
(PMA2020) Nutrition Survey round 1, PMA2017/Burkina Faso Nutrition-R1. 2017 Ouagadougou, 
Burkina Faso and Baltimore, Maryland, USA. 
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World Health Organization (2016b) Guideline: daily iron supplementation in adult women and 
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