Impact of the Benazir Nashonuma Programme on maternal and child health and nutrition in Pakistan: protocol for a prospective cohort study.

INTRODUCTION: Maternal and child malnutrition continues to pose a considerable public health challenge in Pakistan, leading to increased instances of stunting, low birth weight and micronutrient deficiencies. The Government of Pakistan has instituted the Benazir Nashonuma Programme (BNP), a conditional cash transfer and specialised nutrition effort designed to assist pregnant and lactating mothers as well as young children. This prospective cohort study seeks to assess the effectiveness of the BNP in enhancing maternal and infant health and nutritional outcomes in the high-burden provinces of Sindh and Punjab. METHODS AND ANALYSIS: This longitudinal prospective cohort study will recruit 5446 pregnant women from BNP intervention and control regions and monitor mother-child pairs during pregnancy until 12 months post partum. The principal outcomes are the incidence of low birth weight and stunting in children at 6 and 12 months of age. Secondary outcomes encompass the prevalence of wasting; maternal nutrient intake; utilisation of reproductive health services; anaemia and iron deficiency anaemia in mothers and infants; infant and young child feeding practices; neurodevelopmental outcomes evaluated through the Bayley Scales of Infant and Toddler Development, 4th Edition; and programme-specific indicators such as the receipt and consumption of specialised nutritional food (Maamta and Wawamum). Dietary information will be gathered by 24-hour recalls while anthropometric measures and biospecimen analyses will be performed at regular intervals. Data will be examined using multivariable regression models while adjusting for confounding variables. The findings will provide evidence regarding the effectiveness of food-based and cash transfer interventions in enhancing health outcomes in resource-limited environments. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Aga Khan University Ethics Review and the Pakistan National Bioethics Committee. The cohort study and the associated quasi-experimental evaluation are registered at ClinicalTrials.gov. Written informed consent will be obtained from all participants. Study findings will be disseminated through peer-reviewed publications, policy briefs, stakeholder engagement and conference presentations. TRIAL REGISTRATION NUMBER: NCT05836961, NCT06025786.