Nepal Nutrition Intervention Project - Sarlahi (NNIPS)

Establishing the site

• The NNIPS field site was established in 1989 as a collaboration between the Johns Hopkins University (JHU) Bloomberg School of Public Health and the Nepal Netra Jyoti Sangh, the national program for control of childhood blindness in Nepal.
• During the 1990s, severe vitamin A deficiency affected up to eight percent of preschool-aged children in Nepal; even more children had moderate and/or sub-clinical deficiencies.  All levels of vitamin A deficiency are associated with health and mortality risks.
• The initial vitamin A studies at NNIPS demonstrated that periodic, high-dose vitamin A supplementation could significantly reduce child morality-- results which were  soon replicated at multiple sites globally, and which led the Government of Nepal to launch the Nepal National Vitamin A Program in 1993.
• The close partnerships between NNIPS and the Government of Nepal continue to this day and have helped translate multiple research findings -- including, in 2011, the role of chlorhexidine and safe umbilical cord care in reducing neonatal mortality -- into national policies and programs.

Research list and links

• NNIPS initial work built the evidence base for Vitamin A supplementation in forty different countries globally. 
  • NNIPS1 was a double-blind, placebo-controlled, cluster randomised trial that evaluated the effect of supplementation with high-potency vitamin A every four months on pre-school child mortality. The study demonstrated a thirty-percent reduction in child mortality, leading to substantial changes in both Nepali and other government's Vitamin A programs. [LINK]
  • NNIPS2 was, similarly, a double-blind, placebo-controlled, cluster randomised trial that compared maternal mortality between women receiving pre-formed vitamin A, those receiving vitamin A as beta-carotene supplement, and those receiving a placebo. The pre-formed vitamin A reduced maternal mortality during and following delivery by 40 percent, while the beta-carotene reduced mortality by 49 percent. [LINK]
• NNIPS then expanded its scope to examine the role of multiple micronutrient and iron and zinc supplementation on maternal and child health.
  • In NNIPS3, the team set out to examine if its previous findings, which had linked multiple micronutrient supplementation (MMS) with a reduction in low birth weight, could be extended to prevention of fetal loss/infant mortality.  The double-blind, cluster-randomized, placebo controlled trial compared vitamin A supplementation (placebo) to MMS, Iron supplementation, Iron and folic acid supplementation, and iron, folic acid and zinc supplementation.  Findings demonstrated that maternal supplementation with MMS did not reduce overall fetal loss or early infant mortality. Among preterm infants, folic acid alone or with iron reduced mortality at three months of age.  [LINK]
  • NNIPS4 evaluated the efficacy of zinc, iron, and folic acid prophylaxis on morbidity, mortality, and growth in children 1-36 months of age.  Children received either iron, folic acid, or iron, folic acid, and zinc, or a placebo.  None of the arms demonstrated impact on diarrheal disease, acute lower respiratory infections or mortality. [LINK] [LINK]

Balanced Protein Energy Supplements During Pregnancy and Post-Partum (MINT Phase III)

PIs: Dr. Parul Christian, Dr. Joanne Katz, Dr. Daniel Erchick

• Objectives: This community-based, randomized controlled trial builds on two previous formative research trials that have identified the most acceptable BEP formulations for the local population.  The current trial will examine the effect of these BEP supplements (provided daily during pregnancy and/or daily during the six-month period following delivery) on a variety of perinatal, infant, and maternal outcomes, including small-for-gestational-age and infant length-for-age growth during the first year of life.
• Participants: 1,800 pregnant women and their infants
• Donors: Bill and Melinda Gates Foundation, Thrasher Research Foundation, National Institutes of Health
• Collaborators: George Washington University

Parul Christian, Site Custodian

Daniel Erchick 
Joanne Katz
Tsering Lama