Background and Objective: Maternal under nutrition and low birth weight babies are among the common tragedies of developing countries like Pakistan. Preeclampsia and its significant association with fetal growth restriction due to spiral arteries remodeling and trophoblastic invasion decreases nutritional supply to growing fetus added by maternal under nutrition. This study was designed to see the effects of lipid based nutritional supplements for pregnant and lactating women LNS-PLW on maternal and fetal outcome of pre-eclampsia. Methods: Sixty underweight pre-eclamptic women were randomly assigned into two study Groups from April 2018 to December 2019 at the antenatal units of the tertiary Health care facilities of Lady Reading Hospital, Hayatabad Medical Complex Peshawar and Civil Hospital Matta Swat, KPK Pakistan in a randomized clinical trial. Participants were on routine drugs for pre-eclampsia and Iron and Folic Acid (60mg, 400 μg) daily, while participant of Group-2 (n=30) received one sachet of Lipid based nutritional supplement for pregnant and lactating women LNS-PLW in addition daily till delivery. The birth weight, gestational age, head-circumference, and birth length of babies were measured. Results: The significant improvement found in the birth weight (p-value 0.003), gestational age (p-value 0.006), head circumference (P-value of 0.0006) and birth length (P-value of 0.0017) of babies of Group-2 women. We observed that addition of Lipid based nutritional supplement for pregnant and lactating women LNS-LPW improved the birth outcome in underweight women of pre-eclampsia. Conclusion: The Prenatal supplementation of Lipid based nutritional supplement for pregnant and lactating women LNS-PLW can improve birth weight, gestational age, length and head circumference of babies of underweight preeclamptic women. Trial Registration: ISRCTN15485068, April 2018:https://doi.org/10.1186/ISRCTN15485068. doi: https://doi.org/10.12669/pjms.38.1.4396 How to cite this:Mohammad NS, Nazli R, Zafar H, Fatima S. Effects of lipid based Multiple Micronutrients Supplement on the birth outcome of underweight pre-eclamptic women: A randomized clinical trial. Pak J Med Sci. 2022;38(1):219-226. doi: https://doi.org/10.12669/pjms.38.1.4396 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Biofortification of wheat is potentially a sustainable strategy to improve zinc intake; however, evidence of its effectiveness is needed. A household-based, double-blind, cluster-randomized controlled trial (RCT) was conducted in rural Pakistan. The primary objective was to examine the effects of consuming zinc-biofortified wheat flour on the zinc status of adolescent girls aged 10–16 years (n = 517). Households received either zinc-biofortified flour or control flour for 25 weeks; blood samples and 24-h dietary recalls were collected for mineral status and zinc intake assessment. Plasma concentrations of zinc (PZC), selenium and copper were measured via inductively coupled plasma mass spectrometry and serum ferritin (SF), transferrin receptor, alpha 1-acid glycoprotein and C-reactive protein by immunoassay. Consumption of the zinc-biofortified flour resulted in a moderate increase in intakes of zinc (1.5 mg/day) and iron (1.2 mg/day). This had no significant effect on PZC (control 641.6 ± 95.3 µg/L vs. intervention 643.8 ± 106.2 µg/L; p = 0.455), however there was an overall reduction in the rate of storage iron deficiency (SF < 15 µg/L; control 11.8% vs. 1.0% intervention). Consumption of zinc-biofortified flour increased zinc intake (21%) but was not associated with an increase in PZC. Establishing a sensitive biomarker of zinc status is an ongoing priority.

Background: Zinc-biofortified cereals are a promising strategy to combat zinc deficiency, though evidence on health outcomes is limited. This study assessed the effectiveness of consuming zinc-biofortified wheat flour on growth and zinc-related morbidity among adolescent girls (10–16 years; N = 517) and children (1–5 years; N = 517) living in rural north-west Pakistan. Methods: In this double-blind, cluster-randomised controlled effectiveness trial, 486 households received either zinc-biofortified or control wheat flour for 25 weeks. Anthropometric measurements and lung function tests (LFTs) were performed at the beginning, middle, and endline. Data on the incidence and duration of respiratory tract infection (RTI) and diarrhoea in the preceding two weeks were collected fortnightly. Analyses included baseline-adjusted linear mixed models for continuous outcomes and Pearson’s chi-square for categorical data. Results: At a zinc differential of 3.7 mg/kg for adolescent girls provided by zinc-biofortified wheat flour, the intervention had no significant effect on height or weight. For children, head circumference was significantly greater in the biofortified group at endline (control 48.47 ± 2.03 cm vs. intervention 48.76 ± 1.82 cm; p = 0.003), with no differences in other anthropometric parameters. Towards the end of the trial, a lower incidence of RTIs was reported in the intervention arm compared to the control arm for both children (week 26: control 27.4% vs. intervention 17.6%, p = 0.036) and adolescent girls (week 24: control 19.3% vs. intervention 11.5%, p = 0.037; week 26: control 14.5% vs. intervention 6.1%, p = 0.014). When the longitudinal prevalence (cumulative days of sickness as a percentage of total days) of RTI was considered, no treatment effects were observed. No benefits of treatment were reported for diarrhoea or LFT. Conclusions: The provision of zinc-biofortified wheat flour for 25 weeks did not have a significant effect on the growth of adolescent girls but modestly improved head circumference in children. Longer-term interventions are needed to monitor changes in functional outcomes with the national scale-up of zinc-biofortified wheat varieties.

Background: Community engagement has shown to be fundamental component of the response to previous disease outbreaks. This study aimed co-design and implement a culturally appropriate COVID-19 risk communication and community engagement strategy with a resource-poor rural community in Northwest Pakistan.Methods: Participatory Action Research (PAR) was conducted from January 2021 to March 2022. Five PAR meetings took place with community members (n = 30) to: (1) explore how the COVID-19 pandemic impacted on the community; (2) identify challenges to limit the spread of the virus; (3) identify and implement solutions to these challenges; and (4) highlight the enablers, challenges and knowledge of the cultural context needed to optimize safety during emergencies. Focus group discussions (N = 6) with community members not involved in the PAR meetings (N = 50) and children of the community (N = 26) were conducted following the PAR meetings. Thematic analysis of the PAR and focus group data was conducted.Results: Delivery of messages on how to keep families safe, provision of personal protective equipment and improved water systems were part of the strategies taken by the community to create awareness and reduce the spread of COVID-19. Nine themes were identified: Attitudes to the pandemic: From skepticism to acceptance, Changing attitudes about vaccination: rumors and trust, COVID-19 and Faith, Social impact of the pandemic, Access to water, Resource mobilization: personal protective equipment, Spaces where collaborative effort can bring to solutions, Agents of change, and Empowerment of women.Discussion: The participatory approach of this research allowed understanding of the challenges faced by the community to engage in behavior change strategies to reduce the spread of COVID-19 and enabled the community to find sustainable solutions. Engagement with the community empowered men and women to be agents of change and promoted necessary precautionary actions to reduce the risk of infection within their community.Conclusion: Participatory approach highlighted the importance of engaging with and integrating to local culture and values to overcome challenges such as gender imbalance and distrust. Findings of this study are relevant to others working in diverse cultural settings in similar crises events regardless of particular cultural variations.

Cost-effective interventions are needed to address undernutrition, particularly micronutrient deficiencies, which are common in children under the age of five in low- and middle-income countries. A community-based, non-randomized clinical trial was undertaken in the Kurram district of Khyber Pakhtunkhwa from January 2018 to June 2019, to evaluate the effect of locally produced micronutrient powder (local name: Vita-Mixe) on plasma micronutrient status, hemoglobin level, and anthropometric outcomes. Children aged 24–48 months old were recruited and allocated to the intervention and control arm of the study. The enrolled children in the intervention arm received one micronutrient powder (MNP) sachet for consumption on alternate days for 12 months. To assess the impact of the intervention on plasma levels of zinc, vitamin D, vitamin A, and hemoglobin level, blood samples were taken at baseline and after one year following the intervention. The analysis was conducted using Enzyme-Linked Immunosorbent Assay (ELISA), atomic absorption spectrometry, and an automated hematology analyzer. For the impact on growth parameters, the anthropometric assessment was performed using WHO standard guidelines. A 24 h dietary recall interview was used to assess the nutrient intake adequacy. Results showed that in the intervention arm, children had on average a 7.52 ng/mL (95% CI 5.11–9.92, p-value < 0.001) increase in the plasma level of vitamin A, 4.80 ng/mL (95% CI 1.63–7.95, p-value < 0.002) increase in vitamin D levels and 33.85 µg/dL (95% CI 24.40–43.30, p-value < 0.001) increase in the plasma zinc level, as well as a 2.0g/dL (95% CI 1.64–2.40, p-value < 0.001) increase in hemoglobin level. Statistically significant improvement was observed in the weight-for-height z-score (WHZ) (from −1.0 ± 0.88 to −0.40 ± 1.01, p < 0.001) and weight-for-age z-score (WAZ) (from −1.40 ± 0.50 to −1.05 ± 0.49, p < 0.001) in the intervention group compared to the control group. No statistically significant change was observed in the height-for-age z-score (HAZ) in the intervention group (p = 0.93). In conclusion, micronutrient powder supplementation is a cost-effective intervention to improve the micronutrient status, hemoglobin level, and growth parameters in under-five children, which can be scaled up in the existing health system to address the alarming rates of undernutrition in Pakistan and other developing countries.

Background: Undernutrition including micronutrient deficiency results in adverse health-related outcomes in children of low-medium income countries. This study aims to explore the effect of four weeks of Lipid-based nutritional supplement (LNS) on energy intake, anthropometry and micronutrient status in moderate acute malnourished children. Methods Thirty-four children with mean age 7.08±1.47 years and a BMI Z score between -2 and -3 SDS were randomized into LNS and Placebo groups in a single blind randomized control trial. Energy intake, fasting blood samples, and anthropometric measurements were obtained prior to and after four weeks of LNS (535 kcal) or Placebo (92kcal) supplementation in addition to their habitual dietary intake. Results: During four weeks of supplementation, energy intake (kcal) [(611±155) to (987±224), p<0.001)], weight (kg) [(17.5±2.83) to (18.1±3.24), p< 0.001], mid-upper arm circumference (cm) [(14.8±0.91) to (15.1±0.84), p=0.005)] and BMI (kg/m2) [(12.9±0.33) to (13.3±0.45), p=0.002] was significantly improved in the LNS group compared to Placebo. A significant increase in hemoglobin (g/ml) [(12.2±1.14) to (13.7±1.69), p<0.01] and iron levels (µg/dl) [(0.36±0.09) to (0.67±0.20), p<0.001] were observed in the LNS group. No significant differences were detected in the copper and zinc levels. Conclusion: Lipid-based nutritional supplement is effective in improving energy intake, nutritional outcomes and iron but not copper and zinc. The trial was registered at www.isrctn.com under reference: ISRCTN147181521.