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Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT06223854
Other study ID # 2078626-1
Secondary ID
Status Active, not recruiting
Phase N/A
First received
Last updated
Start date April 25, 2024
Est. completion date September 30, 2025

Study information

Verified date April 2024
Source University of California, Davis
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The overarching objective of this two-phase project is to assess the effects of fortifying iodized salt with folic acid on improving women's folate status. Folate insufficiency is the primary risk factor for neural tube defects (NTDs), which are highly prevalent in Ethiopia. The purposes of Phase 2 of the project, described herein, are to complete a community-based, randomized, dose-response intervention trial of edible salt fortified with just iodine or iodine and one of two levels of folic acid among non-pregnant women of reproductive age (WRA), We will assess the effects of the intervention on women's discretionary salt intakes, markers of folate and iodine status, and incidence of any adverse events.


Description:

Potentially eligible women of reproductive age (WRA) in two rural and two semi-urban communities (kebeles) in the Oromia Region of Ethiopia will be identified from existing census records. A convenience sample of 360 eligible, consenting women will be recruited following an initial screening interview at the women's homes. Before the screening interview, the data collector will read a disclosure statement concerning the purpose and the contents of the interview, and the data collector will then request verbal consent to obtain descriptive information on the women's age, general health status, pregnancy status, use of contraceptives, address, cell phone number (if available), and potential willingness to participate in the subsequent intervention trial. After reviewing the women's health history and pregnancy status, measured blood pressure, and current use of contraceptives, the data collector will determine the women's potential eligibility for the trial. The data collector will describe the purposes of the trial, the study procedures and related risks and benefits, the confidentiality of results, and the fact that participation is voluntary. Women who are interested in participating in the study will be encouraged to ask any questions to the research team and consult with family members before providing their signed consent (in the presence of a neutral witness) to participate in the trial. Additional questions then will be asked of consenting women regarding their marital status, ethnicity, religion, educational level, and employment; and their housing characteristics (housing construction, water source, sanitary facilities, access to electricity and cell phone service), and selected household (HH) assets; and the women will be invited to attend the local health facility to complete additional interviews to assess their birth history, household food insecurity, and additional eligibility criteria, including anthropometrics, a pregnancy test, and fasting blood collection for anemia screening and other baseline measurements. Eligible, consenting women then will be randomly assigned to one of three study arms using a block randomization procedure with block size of six. The fasting blood samples obtained for anemia screening will also be used for measurement of red blood cell and serum folate, unmetabolized folic acid, homocysteine, vitamin B12, holo-transcobalamin, methyl malonic acid, other B vitamins, genetic polymorphisms that affect folate metabolism, thyroglobulin, glucose, insulin, retinol binding protein (RBP), ferritin, soluble transferrin receptor, C-reactive protein, and alpha-1 acid glycoprotein, and a malaria rapid diagnostic test (RDT). Following enrollment, the study participants will be scheduled for a 24-hour urine collection to measure baseline sodium and iodine excretion, after which they will begin receiving the assigned study salt every two weeks. The women will be counseled to use the study salt for all food preparation and seasoning for a total of 26 weeks. Additional data collection during the course of the intervention will include: one or two full-day observed food records to measure discretionary salt intake and folate intake; one or two repeat 24-hour urine collections to measure sodium and iodine excretion; and bi-weekly home assessments of salt acceptability, continued contraceptive use, and any adverse events. At the time of these bi-weekly home visits, unused salt will be collected and a new allotment of salt will be delivered. Fasting blood samples will be collected again at a randomly assigned intermediate time point and at end line. - Page 2 of 5 -


Recruitment information / eligibility

Status Active, not recruiting
Enrollment 360
Est. completion date September 30, 2025
Est. primary completion date December 1, 2024
Accepts healthy volunteers Accepts Healthy Volunteers
Gender Female
Age group 18 Years to 49 Years
Eligibility Inclusion Criteria: - Non-pregnant - Using long-acting contraceptive - Intending to remain in study community for at least six months - Willing to use study salt for all household food preparation and seasoning - Signed, informed consent Exclusion Criteria: - Pregnant - Not using long-acting contraceptive - Acute or chronic disease that affects dietary intake or folate metabolism - Hypertension - Medications that potentially interfere with folate metabolism - Folic acid-containing vitamin supplements - Macrocytic anemia or moderate/severe non-macrocytic anemia. - Mid-upper arm circumference <23 cm and breast feeding an infant <6 months of age

Study Design


Intervention

Dietary Supplement:
Iodized salt
Masked, individually labeled 500-g containers of the study salts will be delivered to the participants' homes bi-weekly by field workers who will collect previously delivered salt containers during the same visit. Participants will be counseled to use the study salt for all food preparation and meal-time seasoning for all members of the household and not to share the salt with others or use it for non-food consumption purposes.
Experimental: Iodized salt with lower-dose folic acid fortification
Masked, individually labeled 500-g containers of the study salts will be delivered to the participants' homes bi-weekly by field workers who will collect previously delivered salt containers during the same visit. Participants will be counseled to use the study salt for all food preparation and meal-time seasoning for all members of the household and not to share the salt with others or use it for non-food consumption purposes.
Experimental: Iodized salt with higher-dose folic acid fortification
Masked, individually labeled 500-g containers of the study salts will be delivered to the participants' homes bi-weekly by field workers who will collect previously delivered salt containers during the same visit. Participants will be counseled to use the study salt for all food preparation and meal-time seasoning for all members of the household and not to share the salt with others or use it for non-food consumption purposes.

Locations

Country Name City State
Ethiopia Ethiopian Public Health Institute Addis Ababa

Sponsors (5)

Lead Sponsor Collaborator
University of California, Davis Ethiopian Public Health Institute, Nutrition International, University of California, San Francisco, University of Rhode Island

Country where clinical trial is conducted

Ethiopia, 

Outcome

Type Measure Description Time frame Safety issue
Other Blood pressure Resting systolic and diastolic blood pressure will be measured at baseline and at the time of subsequent blood drawings. Baseline (pre-intervention), intermediate time point (between 4-20 weeks), and end line (24-26 weeks)
Primary Red blood cell folate Red blood cell (RBC) folate concentration will be measured on three occasions in each participant: 1) before the start of the intervention, 2) at a randomly assigned mid-point between 4 and 20 weeks after the start of the intervention, and 3) between 24-26 weeks after the start of the intervention. RBC folate concentration will be will be determined by using a microbiological assay. Baseline (pre-intervention), intermediate time point (between 4-20 weeks), and end line (24-26 weeks)
Primary Serum folate Serum folate concentration will be measured on three occasions in each participant: 1) before the start of the intervention, 2) at a randomly assigned mid-point between 4 and 20 weeks after the start of the intervention, and 3) between 24-26 weeks after the start of the intervention, by using a microbiological assay. Baseline (pre-intervention), intermediate time point (between 4-20 weeks), and end line (24-26 weeks)
Primary Serum homocysteine Serum homocysteine concentration will be measured on three occasions in each participant: 1) before the start of the intervention, 2) at a randomly assigned mid-point between 4 and 20 weeks after the start of the intervention, and 3) between 24-26 weeks after the start of the intervention. Baseline (pre-intervention), intermediate time point (between 4-20 weeks), and end line (24-26 weeks)
Primary Serum thyroglobulin Serum thyroglobulin concentration will be measured on three occasions in each participant: 1) before the start of the intervention, 2) at a randomly assigned mid-point between 4 and 20 weeks after the start of the intervention, and 3) between 24-26 weeks after the start of the intervention. Baseline (pre-intervention), intermediate time point (between 4-20 weeks), and end line (24-26 weeks)
Primary 24-hour urinary iodine excretion 24-hour urinary iodine excretion will be measured prior to the start of the intervention and at a second time time at least 4 weeks after the start of the intervention. Before and during the intervention
Primary Serious adverse events Serious adverse events requiring an overnight stay in a clinical facility or resulting in disability, or death will be recorded during each bi-weekly home visit. Throughout the course of the intervention, total of 26 weeks
Secondary Hemoglobin concentration Hemoglobin concentration in venous blood will be measured at three time points, using an automated hematology analyzer. Baseline (pre-intervention), intermediate time point (between 4-20 weeks), and end line (24-26 weeks)
Secondary Serum B12 Serum concentration of cyanocobalamin will be measured at three time points. Baseline (pre-intervention), intermediate time point (between 4-20 weeks), and end line (24-26 weeks)
Secondary Serum transcobalamin Serum concentration of transcobalamin will be measured at three time points. Baseline (pre-intervention), intermediate time point (between 4-20 weeks), and end line (24-26 weeks)
Secondary Serum methyl malonic acid Serum concentration of methyl malonic acid will be measured at three time points. Baseline (pre-intervention), intermediate time point (between 4-20 weeks), and end line (24-26 weeks)
Secondary Serum unmetabolized folic acid Unmetabolized folic acid will be measured in serum at three time points. Baseline (pre-intervention), intermediate time point (between 4-20 weeks), and end line (24-26 weeks)
Secondary Serum glucose Fasting serum glucose concentration will be measured at three time points. Baseline (pre-intervention), intermediate time point (between 4-20 weeks), and end line (24-26 weeks)
Secondary Serum insulin Fasting serum insulin concentration will be measured at three time points. Baseline (pre-intervention), intermediate time point (between 4-20 weeks), and end line (24-26 weeks)
Secondary Discretionary salt intake Discretionary salt intake will be measured by full-day, in-home weighed dietary records at one or two time points after the start of the intervention After the start of the intervention, between 4-20 weeks
Secondary Urinary sodium excretion 24-hour urinary sodium excretion will be measured prior to the start of the intervention and at a second time time at least 4 weeks after the start of the intervention. Before and between 4-20 weeks after the start of the intervention
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