Evaluating the Effectiveness of a Nutrition and Agricultural Linkages Project in Western Kenya: Design of the Mama SASHA Cohort Study of Vitamin A (COVA).

Objectives: The 2013 Lancet Maternal and Child Nutrition series identified rigorous evaluations of nutrition-sensitive agricultural interventions as a research priority. The Mama SASHA study in Western Kenya links delivery of vitamin A (VA) rich orange-flesh sweet potato (OFSP) vines to antenatal care to improve VA and nutritional status of pregnant and lactating women and their children. Methods: In addition to cross-sectional surveys in intervention and control communities at baseline and endline, the evaluation strategy includes a nested longitudinal study that follows women and their infants from pregnancy through 9 months postpartum. VA status of mothers and their infants is assessed during four visits using infection-adjusted plasma retinol binding protein and breast milk retinol (postpartum). Maternal and child iron and anemia status, anthropometry, dietary intakes, agricultural practices, health services uptake, household food security and program uptake are also measured Results: 505 eligible pregnant women, attending ANC at 4 control and 4 intervention facilities, were consented and enrolled. At enrollment overall prevalence of infection adjusted vitamin A deficiency was 21.8%. Women in control and intervention communities did not differ with respect to VA, iron, anemia or anthropometric status; household food security or dietary diversity scores; demographic characteristics; awareness of vitamin A; or consumption of vitamin A rich foods in the past 7 days. Only 10 women had consumed OFSP in the previous 7 days; all in intervention communities. Conclusions: The longitudinal study will contribute to rigorous impact evaluation of the OFSP intervention on maternal and child VA status and allow assessment of program impact pathways.

The Importance of Pregnant Mother Participation in Mama SASHA Pregnant and Lactating Clubs in Communities.

Objectives: Antenatal clinics (ANCs) are critical for improving maternal nutrition and health knowledge. The Mama SASHA project in western Kenya delivers an orange flesh sweet potato intervention (OFSP) through ANC to improve the vitamin A status of women and children less than 2 years. A nested cohort study following women from pregnancy to 9 months postpartum was designed as an evaluation strategy for the Mama SASHA project to assess the impact of the OFSP on the nutritional status and health of the pregnant mothers and their newborns. Methods: A survey was conducted at enrollment among 505 women, 10-24 weeks gestation attending first ANC clinic visit. Results: Of the 505 enrolled women 72% reported they had not yet received counseling from the nurse on exclusive breastfeeding for the first 6 months during the current pregnancy; over 90% reported not yet receiving counseling on when to initiate breast feeding, the importance of colostrum, when to initiate complementary feeding or how long to breast feed. 70 % of participants were multiparas (N=352) of whom 91% attended ANC during their previous pregnancy. Of these only 39% reported receiving information from the health facility on breast feeding during their previous pregnancy, 35% on how to eat during pregnancy, and 44% on how to feed young children. Conclusions: These findings highlight that ANC is lost opportunity in providing nutrition education and counseling. There is significant need to strengthen nutritional counseling both at the ANC as well as through community-based platforms such as pregnant and/or lactating clubs.

Determinants of Vitamin A Status among Pregnant Women Participating in the Mama SASHA Cohort Study of Vitamin A in Western Kenya: Preliminary Findings.

Objectives: Mothers' vitamin A (VA) status during pregnancy and lactation determine infants' VA levels. We estimated VA status during pregnancy and assessed its determinants using data on 505 pregnant women attending first antenatal care visit in Western Kenya. Methods: VA and iron status were assessed using plasma retinol binding protein (RBP), and ferritin and transferrin receptor, respectively, corrected for inflammation as measured by C-reactive protein (CRP>5 mg/L) and alpha-1-acid glycoprotein (>1 g/L)]. Anemia was assessed with Hemocue hemoglobinometer. Results: Only 34% of women had heard of VA, and 26% of them could not specify its importance. School was the most common source of VA information (68%), followed by health facility (19%). Mean (±SD) RBP was 1.44 (±0.35) μmol/l and the prevalence of VA deficiency (VAD) was 21.8%. Prevalence of inflammation (by CRP) was 24%. Anemia, but not iron deficiency, was the only factor associated with VAD (OR (CI): 1.68 (1.05, 2.71). Other potentially modifiable factors, including food insecurity, dietary diversity, awareness of VA, household or maternal consumption of VA rich foods, maternal MUAC and gestational age were not associated with VAD. Conclusions: The prevalence of VAD is high among pregnant women in Western Kenya and associated with anemia but not iron deficiency. Additional research is needed to understand the etiology of VAD in this population.