Florina is a mountainous, landlocked county in northern
Greece with a population of ‘ı53 000 and -ı-700 births per
year. The principal occupations are small farming and animal
husbandry.
Primary health care for the population is provided by 20 rural
clinics located throughout the county. Each clinic serves
four villages, on average, and each is usually staffed by a newly
qualified general practitioner (serving a compulsory year in the
provinces) and a nurse qualified in midwifery. These clinics
come under the jurisdiction of a local health officer who is accountable
to the Minister ofHealth, and are essentially similar
in terms ofstructure, size, funding, equipment, and personnel
qualifications.
Randomization by clinic was adopted in preference to randomization
by study subject to minimize the possible contamination
effects of the educational program in that women from
the same village or neighborhood attending the same clinic
would be enrolled in the same group. Accordingly, the county’s
20 clinics were randomly divided into an intervention and a
control group. An intensive training course in nutrition counseling
was established for the 10 nurses employed at the intervention
group clinics. Some exploration of variability among
these nurse counselors was undertaken in the preprogram perio-
I (at the beginning and the end of the training course) by
means ofa questionnaire designed to evaluate their knowledge
of nutrition. No significant differences were found between individuals
for the standards achieved.
A total of568 pregnant women residing in the market towns
and villages of Flonna were enrolled in the ICH program; 300
by the 10 nurses employed at the 10 intervention group clinics
(intervention group) and 268 by the 10 nurses employed at the
10 clinics assigned to the control group (control group). Two
hundred forty-nine women (83%) in the intervention group
and 19 1 (80%) in the control group were enrolled before the
2 1 St week of pregnancy; the remainder were enrolled between
the 2 1st and 27th weeks oftheir pregnancies. The mean gestational
ages at enrollment were 16.48 ± 0.25 and 16.99 ± 0.35
wk for the intervention and control groups, respectively. The
difference is not significant (p ı 0.20). Baseline biosocial data
and anthropometric measurements were collated for each subject
and each subject was given a standardized clinical examination.
The study was conducted according to protocol approved
by the Ethics Subcommittee ofthe Scientific Council of
the ICI-I.
Maternal physical, obstetric, and social characteristics are
summarized in Table I . As indicated, apart from a small but
statistically significant difference in maternal height, there were
no significant differences between the groups in maternal age,
prepregnancy weight, and Quetelet index. Obstetric histories
were also similar insofar as there were no significant differences
between the groups in age at first pregnancy, parity, average
interpregnancy interval, the reported rate of abortions (induced
and spontaneous), premature births, and infant deaths.
The only differences ofnote were in the rates ofstillbirth (5.5%
in the intervention group vs 2.7% in the control group) and in
the proportions ofwomen who had previously given birth to a
low-birth-weight infant (ie, < 2500 g) (1 1 .5% in the intervention
group vs 6.7% in the control group). None ofthese differences,
however, were statistically significant.
Socioeconomic status (SES) scores, compiled on the basis of
occupation and education of the head of the household, mdicated
that the majority ofwomen in each group (70-73%) came
from low socioeconomic backgrounds. SES were compiled as
follows: SES 1 , university graduates in professional occupations;
SES 2, those with > 6 y education (including secondary
school and technical college graduates) in skilled trade or
white-collar occupations; and SES 3, those with < 6 y education
and engaged in manual trades or peasant farming. There
were notable differences in the relative proportions of women
coming from both the highest and lowest socioeconomic categories
but these differences were not statistically significant (p
ı 0.083). Approximately halfthe women in each group continued
to work outside the home during their pregnancies.