Modifiable Determinants of Vitamin A Deficiency Among Pregnant Women participating in the MAMA SASHA Cohort Study of Vitamin A in Western Kenya Open Access

Akelo, Victor (2014)

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Mothers' vitamin A (VA) status during pregnancy and lactation determine infants' VA levels. We estimated VA status during pregnancy and assessed its modifiable determinants using data on 505 pregnant women attending first antenatal care visit in Western Kenya. 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 (>5 mg/L) and α-1-acid glycoprotein (>1 g/L)]. Anemia was assessed with Hemocue hemoglobinometer. Mean RBP was 1.44 µmol/l (±0.02) and the prevalence of VA deficiency (VAD) was 21.8%. Prevalence of inflammation was 24%. Only 34% of women had heard of vitamin A, and 26% of them could not specify its importance. School was the most common source of vitamin A information (68%), followed by health facility (19%). Anemia, but not iron deficiency, was the only factor associated with VAD (OR (CI): 1.68 (1.05, 2.71) in the single predictor analysis. In multiple logistic regression analysis, maternal consumption of VA rich food was significantly associated with reduced odds of VAD (AdjOR (CI): 0.53, (0.33, 0.83) but only among women with mid upper arm circumference (MUAC) ≤ 24.5cm. There was no significant association between household (HH) consumption of VA-rich food and VAD (AdjOR 0.96, 95% CI: (0.59, 1.54). The prevalence of VAD is high among pregnant women in Western Kenya and could be associated with anemia but not iron deficiency. Promotion of consumption of Vitamin A rich foods in pregnancy may reduce odds of VAD in pregnancy, especially among women with lower nutritional status. Additional research is needed to understand the etiology of VAD in this population.

Table of Contents

1. Chapter 1: Introduction...9

1.1. Background...9
1.2. Problem Statement...10
1.3. Purpose Statement...10

2. Chapter 2: Review of Literature...12

2.1. Biochemistry of vitamin A...12
2.2. Role of Vitamin A in various physiological systems...13
2.3. Food sources of vitamin A and beta carotene...14
2.4. VAD in Pregnant women and Children...15
2.5. Strategies and Interventions for Preventing VAD...16

3. Chapter 3: Manuscript...19

3.1. Title...19
3.2. Contribution of the Student...19
3.3. Abstract...19
3.4. Background...20
3.5. Methods...21

3.5.1. Overview...21
3.5.2. Study Population...22
3.5.3. Data Collection and Procedures...22
3.5.4. Ethics...24
3.5.5. Statistical Analysis...24

3.6. Results...26
3.7. Discussion...27

3.7.1. Limitations...30
3.7.2. Conclusion...31

3.8. References...32
3.9. Tables and Figures...35

4. Chapter 4: Recommendations and Conclusions...47

4.1. Summary of the Findings...47
4.2. Recommendations...47

4.2.1. Future Research...47
4.2.2. Programming...48
4.2.3. Policy...48

4.3. Conclusion...49

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