The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study will test the impact of packages of pregnancy interventions to enhance maternal nutrition and infection management on birth outcomes in rural Ethiopia. ENAT is a pragmatic, open label, 2×2 factorial, randomised clinical effectiveness study implemented in 12 rural health centres in Amhara, Ethiopia. Eligible pregnant women presenting at antenatal care (ANC) visits at <24 weeks gestation are enrolled. ANC quality is strengthened across all centres. Health centres are renadomised to receive an enhanced nutrition package (ENP) or standard nutrition care, and within each health centre, individual women are randomised to receive an enhanced infection management package (EIMP) or standard infection care. At ENP centres, women receive a regular supply of adequately iodised salt and iron-folate (IFA), enhanced nutrition counseling and those with mid-upper arm circumference of <23cm receive a micronutrient fortified balanced energy protein supplement (corn soya blend) until delivery. This study hopes to increase the evidence-base on the role of antenatal infection management on maternal and birth outcomes, and increase the evidence-base on the role of targeted fortified balanced energy protein supplementation on maternal and birth outcomes in a low resource rural setting in sub-Saharan Africa.
