Effectiveness and Acceptability of Weekly Iron Folic Acid Supplementation With Conditional Cash Transfer (WIFASCCT) Among Adolescent Girls in Four Districts of Pakistan in Low Income Setting

NCT06733844 | Completed

• 1 other identifier: WIFAS - CCT Study
• Study Type: interventional
• Target: 2,131
• Locations: 1 country
• Sites: 1

Brief Summary

In Pakistan, adolescent girls aged 15-19 years are particularly vulnerable to anemia and malnutrition, with over half (54.7%) being anemic. Many of these girls, especially those out of school, are often excluded from health interventions. Approximately 2.1 million adolescent girls (9%) are out of school. To address malnutrition among this group, the Government of Pakistan has prioritized adolescent girls and women under the Benazir Income Support Programme (BISP) through the Nashonuma conditional cash transfer (CCT) intervention. A new pilot program linked to the CCT is being implemented in six flood-affected districts across Pakistan. The intervention focuses on delivering nutrition interventions to adolescent daughters of Kafalat beneficiaries. This effectiveness study using a mixed-methods evaluation approach will assess the program's impact on reducing anemia, improving nutrition, and enhancing equity in access to nutrition services

Conditions

Anemia

Keywords

Adolescents; anemia; weekly iron folic acid supplementations; conditional cash transfer; Pakistan

Outcome Measures

Primary Outcomes (1)

• Anemia prevalence rate among adolescent girls

  At 18 months

Secondary Outcomes (4)

• Effectiveness of delivery

  At 18 months

• Knowledge, Attitudes, and Practices (KAP) to adolescent nutrition and anemia

  At 18 months

• Impact of the conditional Cash Transfer (CCT) program on Women's Empowerment

  At 18 months

• Proportion of School-Attending and Out-of-School Adolescents Reached by the CCT Program

  At 18 months

Study Arms (2)

Intervention pilot districts

EXPERIMENTAL

Consisted of 4 districts from four provinces of Pakistan

Dietary Supplement: Weekly iron folic acid supplementations

Control districts

NO INTERVENTION

For each intervention district within every province, a corresponding control district was selected. The control districts were identified and selected based on being the closest match to the intervention district in terms of prevalence of anemia and nutritional status (BMI) among adolescent girls as reported in the National Nutritional Survey 2018. The rate of anemia and iron folic acid intake in last pregnancy (an indicator of nutrition services being accessed) between the intervention and control districts was also comparable for the women of reproductive age (15-49 years). Comparison districts were selected for not having an ongoing WIFAS or adolescent nutrition program for adolescents.

Interventions

Weekly iron folic acid supplementations DIETARY_SUPPLEMENT

In the intervention arm, adolescent girls will receive weekly iron and folic acid supplements (WIFAS), nutrition education, and group counseling sessions. WIFAS will be delivered quarterly, with each girl consuming one supplement at the facilitation center and the remaining 12 at home, once a week. The supplements contain 60mg of iron and 2.8mg of folic acid. A quarterly cash transfer of PKR 1,000 will be given to the mother, conditional on the girl's WIFAS consumption and attendance at the quarterly education and counseling sessions. The girl will report her supplement intake at each visit and receive 13 more supplements. The intervention will last 18 months.

Intervention pilot districts

Eligibility Criteria

• Age: 15 Years - 19 Years
• Gender Eligibility Details: Adolescent girls
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Adolescent girls 15-19 years of age
• Currently living in households in the intervention communities
• Their mothers are current recipients of the BISP UCCT amount
• Their mothers are current recipients of Additional CCT amount for having an adolescent daughter participate
• Receiving WIFAS for herself and for her adolescent daughter
• Participate in adolescent nutrition education sessions.
• Mothers of adolescent girls
• Fathers of adolescent girls
• BISP facility providers
• Lady Health workers
• Community influencers

You may not qualify if:

• Adolescent girls (aged 15-19 years) who are not currently living in households in the intervention communities
• Are not recipients of the current BISP UCCT amount, and additional CCT amount for having an adolescent daughter.

Sponsors & Collaborators

• Aga Khan University: lead
• Nutrition International: collaborator
• World Food Programme (WFP): collaborator

Study Sites (1)

Aga Khan University

Karachi, Sindh, 74800, Pakistan

Location

MeSH Terms

Conditions

Anemia

Condition Hierarchy (Ancestors)

Hematologic Diseases; Hemic and Lymphatic Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: November 22, 2024
• First Posted: December 13, 2024
• Study Start: November 6, 2023
• Primary Completion: December 30, 2025
• Study Completion: December 30, 2025
• Last Updated: January 27, 2026

Record last verified: 2026-01

Locations

PA (1)