A Community-Based Integrated Agriculture and Nutrition Program is Associated with Improved Vitamin A Status of Lactating Women but not their Infants in Western Kenya Open Access

Deneen, Michelle Elizabeth (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/5999n3545?locale=en


Background. Vitamin A deficiency is a significant public health problem in Western Kenya. Agricultural household food production interventions using biofortified crops such as orange-fleshed sweet potato (OFSP) show potential for addressing vitamin A deficiency.

Objective. The objective of this study is to determine whether an integrated agriculture, antenatal care, and nutrition program is associated with maternal and infant retinol binding protein (RBP) and anemia at nine months postpartum.

Methods. This is a nested cohort study within a larger study in which 8 health facilities and their catchment areas were randomized to control or intervention. The intervention included nutrition education during antenatal care, nutrition training for community health workers, monthly women's clubs, and OFSP voucher distribution at antenatal care visits, redeemable at local vine farmers. Sociodemographic and biochemical data were collected from women at enrollment in early pregnancy and again from women and infants at four and nine months postpartum. Mixed modeling was used to test associations of program participation with low RBP (women <1.05 µmol/L, infants <0.83 µmol/L) and anemia at nine months, controlling for clustering by sublocation, baseline differences, and key sociodemographic factors.

Results. The odds of low RBP were decreased for intervention mothers compared to control mothers (OR=0.42, 95%CI: 0.19-0.95). Maternal anemia, infant low RBP, and infant anemia at nine months did not differ by intervention.

Conclusions: This integrative program improved the vitamin A status of women but not infants. Further research is needed to understand which aspects of the intervention contributed to improved maternal vitamin A status.

Table of Contents

Chapter 1: Introduction 1

Chapter 2: Literature Review 3

2.1 Burden and Physiologic Effects of Vitamin A Deficiency 3

2.2 Dietary Sources of Vitamin A and Bioavailability 4

2.3 Factors Associated with Vitamin A Deficiency 5

2.4 Strategies for Addressing Vitamin A Deficiency 6

2.4.1 Supplementation 6 2.4.2 Fortification 8 2.4.3 Agricultural Interventions 9

2.5 The Mama SASHA Project 10

Chapter 3: Manuscript 12

3.1 Title 12

3.2 Contribution of the Student 12

3.3 Abstract 12

3.4 Background 13

3.5 Methods 16

3.5.1 Overview 16 3.5.2 Study Population and Recruitment 16 3.5.3 Intervention and Control 17 3.5.4 Collection of Biochemical Data 18 3.5.5 Variable Specification 19 3.5.6 Data Analysis 20 3.5.7 Ethics 22

3.6 Results 23

3.7 Discussion 25

3.8 References 29

3.9 Tables and Figures 36

Chapter 4: Recommendations and Conclusions 44

4.1 Summary of Key Findings 44

4.2 Public Health Implications and Recommendations 45

4.2.1 Future Research 45 4.2.2 Programs 46 4.2.3 Policies 47 Appendix: Supplementary Analysis 49

Loss to Follow-up Analysis 50

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