Assessing the Preliminary Effects of a Multisectoral Agricultural Intervention on Adolescent Girls' Health
Condition: Adolescent Behavior; Sexual Behavior; Reproductive Behavior
Study type: Interventional

Summary: 
      The goal of this study is to understand how the Shamba Maisha household agricultural and
      economic intervention impacts the sexual, reproductive, and nutritional health of adolescent
      girls. The intervention includes: a) a human-powered water pump and other required farm
      commodities, b) a micro-finance loan (~$75) to purchase the pump and agricultural implements,
      and c) education in sustainable farming practices.
    

Detailed description: 
      Food insecurity (FI) and poverty are important drivers of HIV vulnerability among adolescent
      girls, and contribute to worse sexual and reproductive health (SRH) outcomes. While most
      approaches to improving adolescent SRH outcomes have focused on individual-centered
      approaches alone, integrated family-level interventions that address the underlying context
      for risk behaviors such as poverty and FI may be more effective in reducing adverse SRH
      outcomes. A household-level multisectoral agricultural and finance intervention in Nyanza
      Region, Kenya called Shamba Maisha (SM) designed to mitigate household FI and improve health
      in HIV-affected households has been successfully developed and piloted. In mid-2016, a large
      cluster-randomized controlled trial (RCT) of SM was launched, targeting 704 adults and 352
      young children to test the effectiveness of this intervention. This pilot study leverages the
      SM RCT infrastructure to recruit up to 240 adolescent girls residing in SM households and
      assess the impact of the SM intervention at the household level on adolescent girls' SRH
      outcomes at study endline. The central hypothesis is that improvements in household FI and
      wealth will contribute to reduced sexually transmitted infections (STIs), HIV, and unintended
      pregnancies among adolescent girls. To test this hypothesis, demographic, behavioral,
      clinical, and biological data from adolescent girls and their caregivers living in
      intervention and control SM households will be collected. The primary outcomes are food
      security, depressive symptoms, and sexual risk behaviors in the adolescent girls. The
      secondary outcomes are pregnancy/unintended pregnancy, HIV, herpes simplex virus 2 (HSV-2),
      and nutritional status in the adolescent girl.

      The ultimate goal is to develop an intervention tailored specifically to the needs of
      adolescent girls to help reverse the cycle of FI, poverty, low empowerment, and poor SRH
      outcomes among adolescent girls. If proven efficacious, the proposed intervention may: 1)
      halt or slow down the cycle of incident HIV, other STIs, and unintended pregnancies to
      improve the lives of adolescent girls in similar settings, and 2) help achieve several top
      Sustainable Development Goals (SDG) including SDG 1 (zero poverty), SDG 2 (zero hunger), SDG
      3 (good health and wellbeing), and SDG 5 (gender equality).
    

Intervention name(s): Multi-sectoral agricultural intervention
Intervention type(s): Other
Intervention description(s): Adult participants in the intervention arm receive a loan (~$175) from a well-established Kenyan bank used to get a human-powered water pump, seeds, fertilizers and, pesticides, and education in financial management and sustainable farming practices.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: adolescent health; sexual health; reproductive health; food security