{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T11:35:17Z","timestamp":1770464117437,"version":"3.49.0"},"reference-count":42,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T00:00:00Z","timestamp":1676505600000},"content-version":"unspecified","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UK Medical Research Council (MRC)\/ Newton Fund","award":["MR\/R020485\/1"],"award-info":[{"award-number":["MR\/R020485\/1"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,2,2]]},"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Despite evidence that iron and folic acid (IFA) supplements can improve anaemia in pregnant women, uptake in Nepal is suboptimal. We hypothesised that providing virtual counselling twice in mid-pregnancy, would increase compliance to IFA tablets during the COVID-19 pandemic compared with antenatal care (ANC alone.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>This non-blinded individually randomised controlled trial in the plains of Nepal has two study arms: (1) control: routine ANC; and (2) \u2018Virtual\u2019 antenatal counselling plus routine ANC. Pregnant women are eligible to enrol if they are married, aged 13\u201349 years, able to respond to questions, 12\u201328 weeks\u2019 gestation, and plan to reside in Nepal for the next 5 weeks. The intervention comprises two virtual counselling sessions facilitated by auxiliary nurse midwives at least 2 weeks apart in mid-pregnancy. Virtual counselling uses a dialogical problem-solving approach with pregnant women and their families. We randomised 150 pregnant women to each arm, stratifying by primigravida\/multigravida and IFA consumption at baseline, providing 80% power to detect a 15% absolute difference in primary outcome assuming 67% prevalence in control arm and 10% loss-to-follow-up. Outcomes are measured 49\u201370 days after enrolment, or up to delivery otherwise. Primary outcome: consumption of IFA on at least 80% of the previous 14 days. Secondary outcomes: dietary diversity, consumption of intervention-promoted foods, practicing ways to enhance bioavailability and knowledge of iron-rich foods. Our mixed-methods process evaluation explores acceptability, fidelity, feasibility, coverage (equity and reach), sustainability and pathways to impact. We estimate costs and cost-effectiveness of the intervention from a provider perspective. Primary analysis is by intention-to-treat, using logistic regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>We obtained ethical approval from Nepal Health Research Council (570\/2021) and UCL ethics committee (14301\/001). We will disseminate findings in peer-reviewed journal articles and by engaging policymakers in Nepal.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"ISRCTN17842200\">ISRCTN17842200<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-064709","type":"journal-article","created":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T10:25:13Z","timestamp":1676543113000},"page":"e064709","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Study protocol for a randomised controlled trial of a virtual antenatal intervention for improved diet and iron intake in Kapilvastu district, Nepal: VALID"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"isrctn17842200","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1735-3684","authenticated-orcid":false,"given":"Naomi M","family":"Saville","sequence":"first","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanju","family":"Bhattarai","sequence":"additional","affiliation":[{"name":"HERD International, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"Harris-Fry","sequence":"additional","affiliation":[{"name":"Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santosh","family":"Giri","sequence":"additional","affiliation":[{"name":"HERD International, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shraddha","family":"Manandhar","sequence":"additional","affiliation":[{"name":"HERD International, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna","family":"Morrison","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8968-5963","authenticated-orcid":false,"given":"Andrew","family":"Copas","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bibhu","family":"Thapaliya","sequence":"additional","affiliation":[{"name":"HERD International, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abriti","family":"Arjyal","sequence":"additional","affiliation":[{"name":"HERD International, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6365-2944","authenticated-orcid":false,"given":"Hassan","family":"Haghparast-Bidgoli","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sushil C","family":"Baral","sequence":"additional","affiliation":[{"name":"HERD International, Kathmandu, Nepal"},{"name":"HERD, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Hillman","sequence":"additional","affiliation":[{"name":"Institute for Women's Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,2,16]]},"reference":[{"key":"2025101814363515000_13.2.e064709.1","doi-asserted-by":"crossref","first-page":"e548","DOI":"10.1016\/S2214-109X(18)30078-0","article-title":"Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis","volume":"6","author":"Daru","year":"2018","journal-title":"Lancet Glob Health"},{"key":"2025101814363515000_13.2.e064709.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.f3443","article-title":"Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis","volume":"346","author":"Haider","year":"2013","journal-title":"BMJ"},{"key":"2025101814363515000_13.2.e064709.3","doi-asserted-by":"publisher","DOI":"10.1159\/000354932"},{"key":"2025101814363515000_13.2.e064709.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68397-9"},{"key":"2025101814363515000_13.2.e064709.5","doi-asserted-by":"publisher","DOI":"10.3945\/jn.111.149237"},{"key":"2025101814363515000_13.2.e064709.6","unstructured":"Global Nutrition Report . 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