We are moving on from single nutritional interventions to complex interventions in order to address multiple dimensions affecting long-term health. Our group is involved in the Healthy Life Trajectories Initiative (HeLTI), developed in partnership with national funders from Canada, India, China and South Africa and in collaboration with the World Health Organization. There are four separate but harmonized intervention studies implemented in Mysore, Shanghai, Johannesburg and three provinces in Canada. The HeLTI-India study will deliver an integrated package of interventions starting pre-pregnancy and at appropriate points during pregnancy, infancy and childhood. The goal is to reduce childhood adiposity, and improve child health and neurodevelopment. It is a community-based randomised trial set in rural Mysore, South India with three arms (pre-conception, pregnancy and controls) (Figure). Women of reproductive age will receive a multi-faceted intervention delivered by community health workers comprising of: a) multiple micronutrients; b) a group parenting program to address maternal depression and improve child development; c) hygiene and infection prevention measures; and d) reduction of environmental pollution exposure. Interventions will be underpinned by a lifestyle behavior change strategy.
The study will track a host of intermediate and process outcomes, as well as the efficacy, cost-effectiveness, and acceptability of the intervention package, compared with standard care. The study will also report on the relative costs and benefits of commencing the intervention in early pregnancy compared with the preconception period.
At present we are undertaking formative work in 3 representative villages. We will engage with community leaders, women’s self-help groups, and local community health workers. Objectives will be to understand perceptions about pregnancy and aspirations for children, and discuss existing mother-child care provision and the acceptability of our proposed intervention package. Through survey work and group discussions we will obtain information on socioeconomic circumstances, diet, environmental toxin exposure, water and sanitation facilities, and hygiene practices, to inform the development of engagement materials for the main study.