Girard Amy Webb, Grant Frederick, Watkinson Michelle, Okuku Haile Selassie, Wanjala Rose, Cole Donald, Levin Carol, Low Jan
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA;
International Potato Center, Nairobi, Kenya.
J Nutr. 2017 May;147(5):955-963. doi: 10.3945/jn.116.236406. Epub 2017 Apr 12.
Orange-fleshed sweet potato (OFSP) improves vitamin A (VA) status of young children; research with pregnant and lactating women is limited. We examined the effectiveness of the Mama SASHA (Sweetpotato Action for Security and Health in Africa) program to improve nutrition knowledge, diets, and nutritional status of pregnant and lactating women (PLW) in Western Kenya. Eight health facilities were allocated to the Mama SASHA intervention or comparison arms. PLW in intervention facilities received enhanced nutrition counseling at health clinics, were linked with community-based maternal support groups, and received vouchers for OFSP vine cuttings. Control PLW received clinic-based nutrition counseling only. A total of 505 women in early and midpregnancy, attending their first antenatal care visit, and with no previous engagement in project activities were enrolled from the 8 facilities. Nutrition and health-seeking knowledge, food security, dietary patterns, and anthropometric measurements were collected at 4 time points at ≤9 mo postpartum. VA intakes were assessed with multipass 24-h recalls in a subsample of 206 mothers at 8-10 mo postpartum. VA status was assessed by using serum retinol-binding protein (RBP). Impacts were estimated with multilevel mixed models adjusted for clustering and differences at enrollment. At enrollment, 22.9% of women had RBP <1.17 μmol/L. By 9 mo postpartum, intervention women had significantly higher intakes of VA [adjusted difference = 297.0 retinol activity equivalent (RAE) units; 95% CI: 82, 513 RAE units; = 0.01; = 206], greater consumption of VA-rich fruit and vegetables in the previous 7 d (difference-in-difference estimate: 0.40 d; 95% CI: 0.23, 0.56 d; < 0.01), and a 45% reduction in the odds of RBP <1.17 μmol/L (OR: 0.55; 95% CI: 0.33, 0.92; = 0.01). Promotion of OFSP to PLW through health services is a feasible strategy to improve women's nutrition knowledge, VA intakes, and maternal RBP.
橙色果肉甘薯（OFSP）可改善幼儿的维生素A（VA）状况；针对孕妇和哺乳期妇女的研究有限。我们考察了“妈妈萨沙”（非洲安全与健康甘薯行动）项目在改善肯尼亚西部孕妇和哺乳期妇女（PLW）的营养知识、饮食及营养状况方面的效果。八家卫生机构被分配至“妈妈萨沙”干预组或对照组。干预组的孕妇和哺乳期妇女在健康诊所接受强化营养咨询，与社区孕产妇支持小组建立联系，并获得橙色果肉甘薯插条代金券。对照组的孕妇和哺乳期妇女仅接受基于诊所的营养咨询。从这8家机构中总共招募了505名处于孕早期和孕中期、首次进行产前检查且此前未参与过项目活动的妇女。在产后≤9个月的4个时间点收集营养和寻求健康知识、粮食安全、饮食模式及人体测量数据。在产后8 - 10个月时，对206名母亲的子样本通过多次24小时回顾法评估VA摄入量。通过使用血清视黄醇结合蛋白（RBP）评估VA状况。采用针对聚类和入组时差异进行调整的多水平混合模型估计影响。入组时，22.9%的妇女RBP<1.17μmol/L。到产后9个月时，干预组妇女的VA摄入量显著更高[调整差异=297.0视黄醇活性当量（RAE）单位；95%CI：82，513 RAE单位；P=0.01；n=206]，在过去7天中富含VA的水果和蔬菜的消费量更大（差异-差异估计：0.40天；95%CI：0.23，0.56天；P<0.01），且RBP<1.17μmol/L的几率降低了45%（OR：0.55；95%CI：0.33，0.92；P=0.01）。通过卫生服务向孕妇和哺乳期妇女推广橙色果肉甘薯是改善妇女营养知识、VA摄入量和母体RBP的可行策略。
