Complex intervention to optimise adolescent BMI pre-conception to address the double burden of malnutrition: A RCT in rural and urban South Africa
Medical Research Council
Wits Health Consortium
South Africa faces a complex health burden with rising non-communicable disease against a background of prevalent infection. Malnutrition, undernutrition alongside overweight/obesity, is widely prevalent, imposing risks along the life course especially among adolescent girls. We propose an intervention to optimise adolescent BMI pre-conception to address the double burden of malnutrition, using established research sites: rural Agincourt and Soweto. We hypothesise that, by optimising change in BMI of adolescent girls at-risk, we can realise a triple return on investment: improved nutrition, reduced metabolic risk, and moderated peri-conceptional exposures to offset transgenerational risk for metabolic conditions. We ask: 1. In high-risk nulliparous adolescent girls, can a community health worker-delivered intervention of nutrition (multi-micronutrient supplementation) and lifestyle change, with a conditional-cash transfer (i) achieve directionally-appropriate changes in BMI?, (ii) improve micronutrient status?, and (iii) influence individual behaviours? 2. Will these changes impact individual metabolic disease risk? 3. In those adolescent women who become pregnant, will reductions in variance of BMI from improved BMI status during the peri-conceptional period impact maternal glucose during pregnancy and new-born birth weight and adiposity? Further: is the intervention package cost-effective; can findings contribute to strategies to tackle the adolescent double burden of malnutrition and reduce trans-generational risk for metabolic disease? We will enrol 1248 underweight or overweight/obese girls 14-19y using age-/sex-appropriate cut-offs. After baseline assessment/randomisation, participants will be reassessed after 18-24 months follow-up. If a participant becomes pregnant, a reassessment will be conducted in pregnancy (<18weeks) and further measures collected during pregnancy and birth. We include both process and economic evaluations.
3.1 Primary prevention interventions to modify behaviours or promote well-being / Research Grant