JiVitA Bangladesh

Establishing the site

• Established in 1998 in Gaibandha, Bangladesh, the JiVitA project grew out of a groundbreaking Vitamin A supplementation trail led by Hopkins faculty in neighboring Nepal.  Researchers were eager to see whether they could replicate the substantial reductions in maternal deaths that had resulted from Vitamin A supplementation in pregnant  Nepali women.
• The name JiVitA (pronounced "ji-vee-ta") is based on the Bangla word jibheetoh, which means “alive."
• The site was chosen due to its alignment with the 25th percentile of many demographic, health, nutritional, economic and development indicators in Bangladesh, with the goal that research findings from the site would be generalizable to similar populations in Bangladesh and South Asia.

• Multiple activities were key to the project’s establishment, including its recognition as a research component of the National Integrated Population and Health Program (NIPHP), a joint activity of the Governments of Bangladesh (Ministry of Health and Family Welfare) and the United States (USAID); development of a network of local, national and international collaborating institutions; and regular connections with the regional, district and local communities, where the team periodically provides emergency services.  
• The project has also recruited and trained over 850 staff, 90 percent of whom are local women. These staff occupy field-level logistical, administrative, technical and professional positions.
• The JiVitA study area has been extensively mapped, and GPS location data are maintained for over 160,000 households and 90,000 relevant landmarks (e.g. ponds, tubewells, markets, health care providers). These data have been used to partition the study area into 596 “sectors,” each comprised of approximately 250 homes, that serve as clusters of randomization.
• The program also operates field offices, a field management station, a biospecimen processing laboratory, and a project headquarters with administrative, data management, storage, and GIS facilities.

Research list and links

• Since JiVitA's establishment, Hopkins-affiliated teams have investigated the effect of nutritional supplements and products on maternal infant and child health. 
  • In JiVitA-1, JHU researchers demonstrated that, unlike in Nepal, neither weekly vitamin A nor beta carotene in pregnant women in Bangladesh, compared with placebo, reduced all-cause maternal, fetal, or infant mortality.  [LINK]
  • JiVitA-2 was a double-masked, cluster-randomized, 20,000-infant trial that was nested within JiVitA-1. It demonstrated that newborn supplementation with 50,000 IU of vitamin A reduced infant mortality by 15 percent through six months of age.  [LINK]
  •  JiVitA-3 aimed to assess the effects of antenatal multiple micronutrient vs. iron-folic acid supplementation on six-month infant mortality and adverse birth outcomes.   The trial demonstrated that multiple micronutrient supplements did not reduce all-cause infant mortality to age six months but resulted in a non-statistically significant reduction in stillbirths and significant reductions in preterm births and low birth weight. [LINK]
  • JiVitA-4 examined whether supplementing infants six months to 18 months old with different fortified complementary food products could reduce stunting and improve weight-for-length.  Two of the products tested (Plumpy'doz, an Mq-LNS product, and a local chickpea preparation) were effective at achieving both outcomes; an additional product (a local rice-lentil preparation) helped to prevent stunting.  The fortified blended food product WSB++ affected neither outcome.  [LINK]
  • JiVitA-5 findings are not-yet published, but the trial investigated  the role of peri-conceptional MMS on low birthweight [LINK]
• More recent trials have built on this historical legacy, both by incorporating new directions (gut health) as well as following-up on the health and nutrition of the children of previous trial participants.
  • While findings from JiVitA-6 are also not yet published, the trial examined whether linear growth in infants 6-12 months of age would be affected by daily feeding of protein-rich foods (either a blended food product or an egg) combined with periodic treatment with azithromycin for enteric pathogens.  [LINK]
  • The J1CFU trial followed-up the children of JiVitA-1 participants. Findings included a description of the children's cognitive development, noting that children who had received both antenatal and postnatal Vitamin A supplementation had better executive function and scholastic achievement in reading, spelling, and math; there were no differences in overall intelligence, memory, or motor function between the children of study participants and non-participants, however. [LINK]

Micronutrient Dose Response (MiNDR) Study

PI: Dr. Parul Christian

Duration: August 2023 - October 2026

• Objectives: This study aims to determine the level of vitamins and minerals that will optimize birth outcomes among pregnant women in Bangladesh.  Current antenatal supplements such as Multiple Micronutrient Supplements (MMS) are formulated using the Dietary Reference Intake  levels of vitamins and minerals, and while MMS improves pregnancy outcomes and maternal and young child nutritional status, it does not to fully resolve nutritional deficiencies.  Participants in MiNDR will receive from one to three times the DRI levels of different vitamins and minerals, and the study will characterize the dose-response and (to the extent possible) the pharmacokinetics of the different micronutrients at each level.
• Participants: 350 pregnant women, 18-35 years old
• Donor: Bill and Melinda Gates Foundation
• Collaborators: International Centre for Diarrhoeal Disease Research, Bangladesh

Balanced Energy Protein Supplementation Research (Target BEP)

PI: Dr. Parul Christian

Duration: October 2022 - March 2025

• Objectives: Pre-pregnancy BMI is a risk factor for adverse birth outcomes, and provision of Balanced Energy Protein (BEP) supplements (supplements where less than 25 percent of calories are from protein) to underweight pregnant women has been shown to improve pregnancy outcomes.  WHO currently recommends BEP use in contexts where 20 percent or more of women of reproductive age are underweight, but targeting delivery of BEP to underweight women may be more effective and feasible for settings where regional variations in underweight exist. The objective of this study is to evaluate the effect of BEP supplementation without targeting and with targeting (by low pre-pregnancy BMI and inadequate gestational weight gain) on birthweight. (Trial Registration)
• Participants: 3,750 pregnant women, 18-35 years old
• Donor:  Bill and Melinda Gates Foundation
• Collaborators: BRAC University James P. Grant School of Public Health

Parul Christian, Site Custodian

Daniel Erchick 
Alain Labrique
Amanda Palmer
Towfida Siddiqua
Keith West Jr.