Nutrition Intervention to Address Anemia Among Adolescent Girls in Liberia

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the feasibility and effectiveness of weekly iron and folic acid (IFA) supplementation and one-time deworming treatment at the community level in improving hemoglobin levels among adolescent girls in Liberia, West Africa, and to assess the feasibility and effectiveness of a targeted nutrition education program in improving nutrition knowledge, attitudes, and practices in the same population.

Official Title
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A Study on the Effectiveness of IFA Supplementation, Deworming, and Nutrition Education in Addressing Anemia Among Adolescent Girls in Two Counties in Liberia

Conditions
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Nutritional Anemia, Nutritional Deficiency, Iron Deficiency Anemia Treatment, Folic Acid Deficiency Anemia, Dietary, Adolescent Development, Knowledge, Attitudes, Practice, Food Habits

Intervention / Treatment
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* Dietary Supplement: Iron and folic acid (IFA) supplementation
* Behavioral: Targeted nutrition education
* Drug: Mebendazole Pill
* Other: Standard nutrition services


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adolescent girl aged 10 - 19 years at the time of enrollment Lives within the selected study communities in Montserrado or Margibi counties Caregiver/adolescent consents to participate in the study Exclusion Criteria: Currently pregnant Active malaria infection as defined by positive rapid diagnostic test (RDT) Severe acute malnutrition at the time of enrollment Known malignancy Known sickle cell disease

Ages Eligible for Study
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Minimum Age: 10 Years
Maximum Age: 19 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Nutrition+ Intervention<br>This group will receive a structured nutrition education package provided by Community Health Assistants (CHAs) based on a handbook on nutrition education developed by UNICEF with collaboration from the Liberia Ministry of Health. The structured nutrition education package will focus on four key areas: causes and prevention of anemia, healthy eating and food choices, hand washing, and physical exercise. Participants in the intervention group will also receive IFA supplementation on a weekly basis for the duration of the study, and a one-time oral deworming treatment (mebendazole), which will be administered once at the beginning of the study. | Dietary Supplement: Iron and folic acid (IFA) supplementation<br>* Weekly IFA supplementation for duration of the study.<br>Behavioral: Targeted nutrition education<br>* Structured nutrition education package delivered at household level by trained Community Health Assistants (CHAs)<br>Drug: Mebendazole Pill<br>* One-time deworming treatment with mebendazole.<br>|
| Active Comparator: Control group - standard services only<br>This group will receive only the current package of basic nutrition services provided at the health facility and at community level by health workers and CHAs, respectively. | Other: Standard nutrition services<br>* Basic nutrition services currently provided at the health facility and at community level in Liberia<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in participants' hemoglobin level from enrollment to completion of the study | Point of care hemoglobin testing will be conducted at enrollment and at the conclusion of the study. | Baseline and Week 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in responses to questions in the Nutrition Knowledge, Attitudes, and Practice (KAP) survey from baseline to follow up evaluation | Increase in nutrition-related knowledge, and improvements in nutrition practices as evidenced by changes in responses to the KAP survey, which is based on validated measures of nutrition-related knowledge, attitudes, and practices, and has been modified for appropriateness to the target population of this study. | Baseline and Week 12 | 
| Feasibility of targeted intervention for scale-up to country-wide enhanced nutrition services | Successful completion of study visits by Community Health Assistants, specifically ability to conduct every scheduled visit without skipping visits or households, within the timeframe of scheduled work day. | 12 weeks |