Article Text

Download PDFPDF

Making a balanced plate for pregnant women to improve birthweight of infants: a study protocol for a cluster randomised controlled trial in rural Bangladesh
  1. Morseda Chowdhury1,2,
  2. Camille Raynes-Greenow1,
  3. Ashraful Alam1,
  4. Michael J Dibley1
  1. 1 Sydney School of Public Health, The University of Sydney, Sydney, Australia
  2. 2 Health Nutrition and Population Programme, BRAC, Bangladesh
  1. Correspondence to Dr Morseda Chowdhury; morsheda.c{at}


Objectives Low birthweight significantly contributes to neonatal mortality, morbidities and psychosocial debilities throughout the course of life. A large proportion of infants (36–55%) in Bangladesh is born with low birthweight. Nutritional status of women during pregnancy is critical for optimal growth and development of the fetus. Nutrition education has been found to improve maternal nutritional status. Our study aims to determine whether nutrition education with a practical demonstration during pregnancy is an effective intervention for improving the birthweight of infants compared with standard nutrition education only.

Methods and analysis We will conduct a community-based cluster randomised controlled trial in one rural district of Bangladesh. Treatments will be allocated evenly between the study clusters (n=36). Participants in the intervention clusters receive ‘balanced plate nutrition education’ with a practical demonstration from community health workers 4–7 times throughout their entire pregnancy, starting from the first trimester. The control clusters will receive standard nutrition education delivered by public and other healthcare providers as per ongoing antenatal care protocol. Our sample size would be 900 pregnant women to determine 100 g differences in mean birthweight, considering 5% type 1 error, 80% power and an intra-cluster correlation coefficient of 0.03. The primary outcome of the trial is birthweight of the infants and the secondary outcomes include daily caloric intake and dietary diversity score among the pregnant women. Outcomes will be measured at enrolment, third to ninth month of gestation (monthly) and at delivery. Community health workers blinded to the study hypothesis will collect all data.

Ethics and dissemination The study was approved by the James P Grant School of Public Health, BRAC University Ethical Review Committee, Dhaka, Bangladesh. We will communicate the final results to relevant research and public health groups and publish research papers in peer-reviewed journals.

Trial registration number ACTRN12616000080426.

  • low birthweight
  • pregnant women
  • balanced plate

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors MC conceived the overall study and wrote the first draft of the protocol and this manuscript and CRG critically reviewed it. MJD provided critical input regarding study design, sample size calculation, and outcome evaluation and statistical analysis plan. AA provided crucial input on formative research and process evaluation design, and contributed to addressing the reviewers’ comments and revision of the paper. MC and CRG obtained funding for the intervention. All authors critically reviewed and approved the final version of the manuscript and agree to be accountable for all investigations necessary to resolve questions related to accuracy or integrity of all or any part of the work.

  • Competing interests None declared.

  • Ethics approval James P Grant School of Public Health, BRAC University Ethical Review Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.