Mama Shamba

Agricultural livelihood interventions are a promising and sustainable approach to address the root causes of maternal and infant malnutrition. The Mama Shamba study will test if the provision of agricultural supplies, including a human-powered irrigation pump and training in sustainable agriculture at model farms, can improve pregnancy and infant outcomes.

Background

The scarcity of food is a leading cause of sickness and death in mothers and their newborns in sub-Saharan Africa. Food insecurity and poverty can disempower women and limit their capacity to engage in healthy behaviors. HIV, with the added burdens of stigma and poor health, exacerbates the effects of food insecurity on health.

Formative studies

A prior pediatric study was conducted among 372 children (with their primary caregiver) who resided in the households of adults enrolled in the Adult HIV study. Among children in study households aged 6 to 24 months at enrollment, children in the intervention arm grew an extra 1.2 cm in height (p=0.007) compared to controls.
In the HIV Adult study, pregnant and non-pregnant women similarly benefited in terms of improvement in food security, and empowerment. During in-depth interviews with pregnant intervention participants, women reported improvements in maternal nutrition compared with previous pregnancies which they attributed to the livelihood intervention. They reported improved access to vegetables, increased variety of diet through vegetable sales, and improved nutritional awareness. Intervention participants also reported increased strength and energy throughout pregnancy compared to prior pregnancies.

Study Design

The Mama Shamba study is a randomized control trial that will take place at three health facilities in Migori County, Kenya. 410 pregnant women, half living with HIV, will be enrolled and followed until their infants are 12 months old. Half of the women will be randomized to the intervention arm, and the other half will be randomized to receive the intervention at the end of the study.

Shamba Maisha Intervention

Agricultural Commodities

KickStart “Starter Pump”
Hosing, fertilizer, and seeds.

Agricultural Training

Develop model demonstration farms in the community to deliver training.
Didactic and practical skills training will be offered weekly at the model farm; Topics will be rotated to ensure all participants receive full coverage.

Model farms

Participants will harvest vegetables for home consumption until their individual farms start producing vegetables in 6-8 weeks. Participants will also receive seedlings and compost while training to jump-start their own production at home.

Intervention Adaptations

Based on the prior work, we have adapted the Shamba Maisha intervention:

We will be using a lighter (2.5kg) less expensive, and more transportable water pump as part of the intervention.
The agricultural commodities will be donated to the participants rather than using a loan.
The training sessions will take place on demonstration plots located in the community. They will include video lessons as well as hands-on training.
Participants will receive seedlings, compost, and harvest from the model farms to ensure they can benefit from increased vegetable production as soon as possible, and access to a nutritious diet.

Goals

Determine the impact of the Shamba Maisha Intervention on:
- Pregnancy, infant, and maternal health outcomes among women living with and without HIV and their newborns. The primary outcomes include a reduction in adverse pregnancy outcomes such as pre-term birth and birthweight, and infant length at one year of life.
- Socioeconomic and behavioral empowerment that may influence maternal and infant health.
Identify attitudes, norms, processes, and resources that influence implementation outcomes and effectiveness of the Shamba Maisha Intervention.

Study Team

Principal Investigators

Craig Cohen, MD, MPH is a professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences and director of multiple global health training programs including the GloCal Health Fellowship and the Sustainable Development for HIV Health (SD4H). His research focuses on 1) livelihood interventions, like Shamba Maisha, to improve health outcomes, 2) HIV/AIDS care, support and prevention in low- and middle-income countries, and 3) their intersection with sexual and reproductive health. He is an multiple principle investigator (MPI) for Mama Shamba and a co-investigator on Vijana Shamba.
Pamela Murnane, PhD, MPH, MLIS is an Assistant Professor in the Department of Epidemiology & Biostatistics at UCSF. Her research focuses on biological, behavioral, and structural factors that influence maternal and child health outcomes in the context of HIV in resource-limited settings including livelihood interventions to improve health outcomes. She has expertise in epidemiologic methods, adherence measurement, risk prediction, and implementation science.
Phelgona Otieno, MBChB, MPH, is a pediatrician and epidemiologist with experience conducting research in maternal health, HIV PMTCT, and child health programs, as well as the mentorship of health professionals. At the Kenya Medical Research Institute (KEMRI), she is a principal research officer based at the Center for Clinical Research. Her other research activities include agricultural interventions to promote child health, exploration of immune functions among children with moderate acute malnutrition, and new interventions for moderate acute malnutrition. Her research interests include community interventions that lead to health promotion and alleviation of risks to children and women in Kenya.

Co-Investigators

Lisa Butler, PhD, MPH is a Professor in the Department of Public Health Sciences at Queens University. Her research focuses on the development of appropriate and scalable clinic- and community-based interventions, targeting HIV-affected families to improve healthcare utilization, caregiving behaviors, and maternal, infant, and child physical, mental, and nutritional health outcomes.
Zachary Kwena, PhD, MA is a social scientist based in Kenya with expertise in conducting socio-behavioral qualitative and quantitative research in key and vulnerable populations, including adolescent girls and young women, and pregnant women and their infants. His research interests focus on understanding health risk behaviors, including HIV risk and uptake of interventions for key and priority populations in East Africa, with a focus on HIV prevention in couples, adolescents, and young people.
Sheri Weiser, MD, MPH, MA is a Professor of Medicine and internist at UCSF Division of HIV, Infectious Diseases and Global Medicine at Zuckerberg San Francisco General Hospital. Her research focuses on the impact of food insecurity, extreme weather events, and other social and structural factors on treatment outcomes for HIV and other chronic diseases both domestically and internationally. She also evaluates sustainable food insecurity and livelihood interventions to improve health. She is an MPI for Vijana Shamba and a co-investigator on Mama Shamba.
Elly Weke, MS is the KEMRI Study Manager for both Vijana and Mama Shamba. He is a Doctoral student in Agronomy at Maseno University. His PhD dissertation project is embedded in Vijana and Mama Shamba. Elly has seven years of experience managing Shamba Maisha studies in Kisumu, Migori, and Homa Bay Counties, Kenya.

Staff

Rachel Burger, MHS is the UCSF study manager for both Vijana and Mama Shamba studies. She has seventeen years of experience conducting public health research in East Africa. Her research focus includes mental health, the integration of livelihood interventions to improve health outcomes, and the integration of HIV and sexual and reproductive health services.

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