• Christoffersen-Deb, Astrid


    Investigator, BC Children's Hospital
    Clinical Associate Professor, Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia
    Medical Director, Gynecology, Sexual Health and Specialized Program, BC Women's Hospital & Health Centre

    Degrees / Designations
    Primary Area of Research
    Healthy Starts
    Secondary Area(s) of Research
    Lab Phone
    Maria Adamo
    Assistant Phone
    Mailing Address

    Room D-213
    4500 Oak Street
    Vancouver, BC V6H 3N1

    Affiliate Websites
    Research Areas
    • Population Health
    • Strategies to interrupt inter-generational poverty
    • Community-based programs to improve MNCH
    • Peer support in pregnancy and infancy
    • Cervical cancer screening and treatment in low-resource setting
    • Gestational diabetes and pre-eclampsia in low-resource setting
    • Medical anthropology of the beginnings of life
    My research focus has very much been defined by my concern in (1) addressing inequities in care, (2) engaging young people in the process of addressing these, (3) and mentoring a research team in design-thinking principles. To carry this out, I co-founded the AMPATH MNCH Innovations Team in 2014 at Moi University in Kenya. Together, we are a multidisciplinary and multinational group of 30 people, drawing from the fields of OB/GYN, Anthropology, Midwifery, Nursing, Data Science, Pharmacy, Public Health and Business Management. AMPATH is a unique collaboration in global health, committed to developing excellence and leadership capacity in research, education and care in Kenya. In ‘Leading with Care’, our focus has been to layer research onto care initiatives. Broadly, our research projects focus on Access to Care, Maternal/Infant Mortality, Diagnostics and Community Engagement.  
    Current Projects

    1. Chamas for Change: a Cluster RCT in Trans-Nzoia county, Kenya to validate community-based peer support mechanisms during pregnancy and early childhood

    Improving access to care and encouraging health seeking behavior through peer support groups and financial empowerment can improve the outcomes related to pregnancy and childbirth. Chama cha MamaToto (chamas) is a peer-support model that groups together pregnant women in the same community. Translated from kiswahili as ‘groups’, chamas have a longstanding presence in East Africa. Using this existing cultural script, we have developed chamas tailored to the needs of pregnant women. Central to our approach is the integration of health, social and financial literacy education with a savings/loans program. The objective of the study is to demonstrate that chamas are an effective service-delivery platform for improving women’s and children’s health, women’s sense of peer support, women’s empowerment and women’s financial well-being  in western Kenya.

    To assess impact, a cluster randomized control trial of the intervention is taking place in 37 community units and 40 community units for control in 2018-19.

    2. STRIDE – STratification of Risk of Diabetes in Early Pregnancy in India and Kenya

    The prevalence of diabetes mellitus (DM) is increasing worldwide and even more so in developing countries such as Kenya. The aim of the study is to determine the prevalence of GDM in a rural and urban Kenyan population, develop an accurate clinical risk scoring tool based on easily obtainable risk factors to stratify women at risk of GDM in this population, and determine if a selective screening strategy would be cost-effective in Kenya.

    Launched in May 2016, we are carrying out a prospective cohort study recruiting eligible pregnant women who are <20 weeks gestation attending antenatal care at health care facilities within Uasin Gishu county. Through early identification, we hope to reduce the risk of the development of GDM and related maternal complications, the risk of adverse fetal programming due to hyperglycaemia, and ultimately reduce the future metabolic risk of the mother and offspring.

    3. Malezi Mema: Building Adult Capabilities to Safeguard Children's Developmental Potential 

    Worldwide, women and children in poor and rural communities face the challenges of pregnancy and infancy without supportive relationships in the home or community. Children growing up in these environments often face the toxic stresses of Maternal Death and Disability, Poverty, Violence and Neglect. These stresses have been shown to stunt child growth and development and place children and adolescents at risk of further social and economic disparities. These toxic stresses also present numerous challenges to parents who may rely on harsh punishment to parent their children. These conditions help to sustain the vertical transmission of poverty, unmet potential and poor health from one generation to another.

    To disrupt this intergenerational cycle, we integrated a parenting curriculum into the already existing Chamas (women’s groups), which are peer support groups that we have shown to be very successful in improving medical, social and financial health of pregnant women. Building on this success, we partnered with the South African based Sinovuyo Caring Families Programme to adapt a positive parenting programme. We named it MaleziMema, which means ‘Good Parenting. The program targets parents of children under 5 years who are at risk. In 2015, we delivered this parenting programme to 613 mothers and their children living in poor and rural communities in Western Kenya.

    We found that chamas can be used as a platform to build adult parenting capabilities and to safeguard children’s developmental potential in communities where they are otherwise at risk of not meeting their potential. In addition to improving health services utilization, financial literacy, income generation and decreasing childhood illness, we found that children of mothers attending the program were 30% less likely to be punished harshly. In addition, attitudes towards punishment differed between those in the program and those not. Furthermore, we showed that women attending the program had reduced parental stress by 22%. We know that these are all intermediate measures that can lead to increasing toxic stress within homes and negatively affecting child development. We are currently in the process of planning a cluster RCT of this intervention.

    Selected Publications

    Tim Mercer, Adrian Gardner, Benjamin Andama, Cleophas Chesoli, Astrid Christoffersen-Deb, Jonathan Dick, Robert Einterz, Nick Gray, Jemima Kamano, Sylvester Kimaiyo, Beryl Maritim, Kirk Morehead, Sonak Pastakia, Julia Songok, Jeremiah Laktabai (2017). Leveraging the Power of Partnerships: Spreading the Vision for a Population Health Care Delivery Model in Western Kenya, Globalization and Health, (in press).

    Sonak Pastakia, Benson Njuguna, Beryl A Onyango, Sierra Washington, Astrid Christoffersen-Deb, Wycliffe Kosgei, Saravanan Ponnusamy (2017). Prevalence of gestational diabetes mellitus based on various screening strategies in western Kenya: a prospective comparison of point of care diagnostic methods, BMC Pregnancy and Childbirth (in press). Coauthor

    Omenge Orang’o, Tao Liu, Astrid Christoffersen-Deb, Peter Itsura, John Oguda, Sierra Washington, David Chumba, Latha Pisharodi, Susan Cu-Uvin, Anne F. Rositch.(2017) Use of VIA, Pap smear, or HR-HPV testing in women living with HIV/AIDS for post-treatment screening: same tests, different priorities, AIDS 2017 Jan 14;31(2):233-240.

    Christoffersen-Deb A, Ruhl L, Elung’at J, Atieno M, Snelgrove J, Songok J. Chamas for change: An integrated community-based strategy of peer support in pregnancy and infancy in Kenya. The Lancet Global Health 2015;3(Supplement 1):22.

    Spitzer RF, Taleski SJ, Caloia, D, Thorne J, Bocking A, Christoffersen-Deb A, Aaron Yarmoshuk A, Maina L, Sitters, J, Chemwolo B, Omenge E. (2014) One Year Evaluation of the Impact of an Emergency Obstetric and Neonatal Care (EmONC) Training Program in Western Kenya, Int J Gynaecol Obstet, Nov;127(2):189-93.

    Christoffersen-Deb, A. (2012) “Viability: a Cultural Calculus of Personhood at the Beginnings of Life”, Medical Anthropology Quarterly, Vol 26:4; 575-594.


    2016 - 2018 Principal Investigator. Chamas for Change: Validating an integrated community-based strategy of peer support in pregnancy and infancy, Grand Challenges Canada. 250,000 CAD. [Grants] $250 000 over 24months.

    2015 - 2018  Co-Investigator. STRIDE – STratification of Risk of Diabetes in Early Pregnancy in India and Kenya, MRC Newton Fund. Collaborator(s): S Pastakia, W. Kosgei. (£600,567 over 3 years)

    2015 - 2016 Principal Investigator. Chamas for Change: Building Adult Capabilities to Safeguard Children’s Developmental Potential through Mother-Child Clubs in Kenya, Grand Challenges Canada. Collaborator(s): SL. Ruhl, L ($250,000 over 18 months)

    2014 - 2016 Co-Investigator.  LEEPing Ahead:  See and LEEP Training for Primary Care Providers in Kenya, CFAR supplement. Collaborator(s): Cu-Uvin, S. Omenge, E. (500 000 $ over 24 months)

    2011 - 2013 Co-Investigator See and Treat management of precancerous lesions of the cervix, CFAR supplement. Collaborator(s): Cu-Uvin, S. Omenge, E. (250 000$ over 24 months)

    2011 - 2013 Principal Investigator.  Addressing the Fourth Delay: community-based mechanisms to improve accountability in maternal and newborn health. Saving Lives at Birth/Grand Challenges Canada.  Collaborator(s): Christoffersen-Deb, Fazen, L. Ruhl, L. 250,000 CAD. [Grants] $250 000 over 24months.

    2011 - 2013 Principal Investigator. Health for Maternal and Newborn Health: Clinical decision-support for community health workers in Westerm Kenya. Grand Challenges Canada. Collaborator(s): Chemwolo, B. Fazen, L. Ruhl, L. 100,000 CAD. [Grants] $100 000 over 27 months.

    Honours & Awards
    2011 Rising Star in Global Health, Grand Challenges Canada
    Research Group Members