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

Abstract

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.