Whole cowpea meal fortified with NaFeEDTA reduces iron deficiency among Ghanaian school children in a malaria endemic area

Nutritional and toxicological assessment of Piliostigma thonnigii leaves and Tubaani food samples: a preliminary investigation

Tubaani is a local delicacy prepared with Piliostigma thonningii leaves. The leaves may contain trace/heavy metals and important phytonutrients that could impact consumers' health. Concerns over the nutritional and toxicological implications of Piliostigma thonningii leaves are critical. Tubaani food and Piliostigma thonningii leaf samples were investigated using Neutron Activation Analysis (NAA) and Spectrophotometry technique. The health risk of Tubaani was also assessed by calculating the target hazard quotient (THQ) and hazard index (HI) of potentially toxic elements. Fifteen trace elements were detected at non-toxicological concentrations in the samples analyzed. No significant difference (p > 0.05) was observed between the samples' mean concentrations. The phenolic content in leaf extracts was higher as compared to the flavonoids. However, the flavonoids in the leaves had an effect on the food samples, unlike the phenols. The THQ and HI of the elements were below 1.0. There is no reason to be concerned about the current dietary intake of the potentially toxic elements in the routine consumption of Tubaani as portrayed in data obtained in this investigation by NAA, THQ, and HI.

Effects of Iron-Fortified Foods on the Nutritional Status of Children Residing in Regions Vulnerable to Parasitic Diseases: A Systematic Review

Parasitic infections (PIs) remain a public health concern among school-age children living in areas of greater socioeconomic vulnerability, especially in Brazil, Russia, India, China, and South Africa. PIs can promote nutritional deficiencies, increasing the risk of anemia and impaired physical and cognitive development. Thus, fortified foods have been considered as a promising strategy for improving the nutritional status of children and preventing PI complications. This systematic review aimed to present the effects of iron-fortified foods for deworming and improving blood parameters in schoolchildren residing in areas that are vulnerable to PIs. This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines of randomized clinical trials addressing the use of fortified foods and micronutrients in children living in areas endemic for PIs. The PubMed, LILACS, Scopus, and Cochrane databases were searched to identify articles published between 2000 and 2020. A total of 153 records were retrieved from the databases, 10 of which were considered eligible for this study. On the basis of our analysis, most of the selected studies showed that the inclusion of fortified foods in the diet improved blood and infectious parameters. Therefore, fortified foods can be used as an important tool for controlling the adverse outcomes of PIs among children living in areas of greater vulnerability. However, more studies on this topic are needed to provide more evidence and consolidate strategies using iron-fortified food.

Determinants of dietary patterns of Ghanaian mother-child dyads: A Demographic and Health Survey

Having a comprehensive understanding of a population's dietary patterns is a key component of any effective strategy for preventing malnutrition, planning, and putting nutrition interventions and policies into place. It's interesting to note that information on dietary patterns of Ghana's vulnerable subpopulations of women and children is lacking. The purpose of this study is to characterize the dietary patterns of women (15-49 years old) and their young children (0-3 years old), as well as to investigate into the socioeconomic and demographic factors influencing the characterized dietary patterns. The sociodemographic information and food consumption of mother-child dyads (n = 1,548) were collected for this nationally representative cross-sectional study. Principal component analysis and multiple variable logistic regression were used, respectively, to determine the dietary patterns of dyads and the determinants of the identified dietary patterns. For women and children, respectively, four dietary patterns ('Beverage & sugary based', 'Meat based', 'Indigenous- tuber based' and 'Indigenous- grain based') and two ('Indigenous' and 'Milk, Meat, & cereal based') emerged. Ethnicity, wealth quintiles, parity, seasonality, dyad's age, body mass index, education, residency, marital status, and household size were the socioeconomic / demographic determinants of the dietary patterns. To sum up for women and children, meat based and indigenous staple based dietary patterns were identified, with several important socioeconomic and demographic variables acting as predictors of the dietary patterns. The identified dietary patterns and their determinants may serve as a basis for nutrition intervention and policies for women and children in Ghana.

Poor iron store recovery in voluntary blood donors in the northern zone of Ghana; a five-month three-centre cohort study

OBJECTIVE

In Ghana, although iron deficiency is endemic, post blood donation iron supplementation is not routine. We sought to determine whether at five months post-donation of a single unit of whole blood, donors were able to recover iron stores.

MATERIALS AND METHODS

This three-centre cohort study recruited 164 blood donors at the Lawra, Nandom, and Bimbila communities in the northern zone of Ghana. Venous blood samples were drawn at baseline to estimate full blood count (FBC), haemoglobin variants, qualitative G6PD status, and serum ferritin. Five months post-donation, venous blood samples were drawn for a repeat measurement of FBC and serum ferritin. Data were analysed using SPSS and GraphPad prism to assess recovery of iron stores.

RESULTS

Whereas 26.8 % had inherited haemoglobin variants, 18.9 % of the donors had qualitative G6PD deficiency. Overall, mean difference between pre-donation and five months post donation iron stores significantly differed from zero (p < 0.001; one sample t-test). After five months post donation, 76.8 % of the blood donors could not achieve pre-donation iron stores. Whereas 6.1 % and 8.5 % blood donors had depleted iron stores and iron deficient erythropoiesis at baseline, these increased to 9.8 % and 21.3 % respectively at five-month post donation. Moreover, at five months post donation, 11 % of these blood donors would have been disqualified per haemoglobin screening cut off of 12.5 g/dl.

CONCLUSION

Reliance on food intake to replenish iron store lost per blood donation may not adequately assure donor health in the study area; iron supplementation should be considered.

Can Improved Legume Varieties Optimize Iron Status in Low- and Middle-Income Countries? A Systematic Review

Iron and zinc deficiencies are some of the most widespread micronutrient deficiencies in low- and middle-income countries (LMIC). Dietary diversification, food fortification, nutrition education, and supplementation can be used to control micronutrient deficiencies. Legumes are important staple foods in most households in LMIC. Legumes are highly nutritious (good sources of essential minerals, fiber, and low glycemic index) and offer potential benefits in addressing nutrition insecurity in LMIC. Several efforts have been made to increase micronutrient intake by use of improved legumes. Improved legumes have a higher nutrient bioavailability, lower phytate, or reduced hard-to-cook (HTC) defect. We hypothesize that consumption of improved legumes leads to optimization of zinc and iron status and associated health outcomes. Therefore, the objective of this review is to examine the evidence on the efficacy of interventions using improved legumes. Nine relevant studies are included in the review. Consumption of improved legumes resulted in a ≥1.5-fold increase in iron intake. Several studies noted modest improvements in biomarkers of iron status [hemoglobin (Hb), serum ferritin (SF), and transferrin receptor] associated with consumption of improved legumes. Currently, no efficacy studies assessing the relation between consumption of improved legumes and zinc status are available in the literature. Evidence shows that, in addition to repletion of biomarkers of iron status, consumption of improved legumes is associated with both clinical and functional outcomes. The prevalence of iron deficiency (ID) decreases with consumption of improved legumes, with increases of ≤3.0 g/L in Hb concentrations. Improvement in cognition and brain function in women has been reported as well. However, further research is necessary in more at-risk groups and also to show if the reported improvements in status markers translate to improved health outcomes. Evidence from the included studies shows potential from consumption of improved legumes suggesting them to be a sustainable solution to improve iron status.

Food-based indicators are related to iron and iodine deficiencies of mother-toddler dyads during the lean season in northern Ghana

Fe and iodine deficiencies are among the common forms of nutritional deficiencies globally and cause detrimental effects on mother and child. In developing countries, strategies to address these problems rarely use preventative dietary approaches. This cross-sectional study aims to ascertain whether dietary diversity score (DDS) and dietary patterns (DP) can predict the associated risk (AR) of Fe and iodine deficiencies in mother-toddler dyads during the dry/lean season in northern Ghana. Data were collected from women (15-49 years; n 118) and their toddlers (6-23 months, n 121). Dyads DDS and DP were calculated from their food intake recall. Multivariable logistic regression models were used to examine whether DDS, DP and socio-demographic factors predict higher odds of Fe and iodine deficiencies in dyads. DDS and DP predicted Fe and iodine deficiencies AR. Compared with DDS ≥4, women with DDS <4 have higher odds of Fe deficiency (ID) (adjusted OR (AOR) 1·82, 95 % CI 1·03, 3·21) and iodine deficiency (AOR 9·73, 95 % CI 3·19, 29·67). Two DP emerged in principal component analyses, 'rural elites diet' predicted ID risk in mothers (AOR 8·65, 95 % CI 1·76, 42·39), while 'indigenous diet' predicted iodine deficiency risk (AOR 11·41, 95 % CI 1·36, 95·97) in mothers only. The AR of Fe and iodine deficiencies in vulnerable populations may be predicted by diet-based measures in northern Ghana. We recommend further research into DDS and DP to predict Fe and iodine status of mother-toddler dyads in Ghana.

Hibiscus sabdariffa Meal Improves Iron Status of Childbearing Age Women and Prevents Stunting in Their Toddlers in Northern Ghana

Globally, iron deficiency (ID) is the most common form of nutritional deficiency, particularly in young children and childbearing age women. ID can lead to stunting and impaired cognitive development in children, as well as adverse maternal health and birth outcomes. In this study, the efficacy of an alternative food-to-food fortification utilizing indigenous iron-rich food sources was investigated in a quasi-experimental study. Childbearing age women (15–49 years, intervention-Kassena Nankana West district: n = 60; control-Builsa North district: n = 60) and their toddlers (6–24 months) consumed Hibiscus sabdariffa leaf meals (HSM, 1.71 mg Fe/100 g meal) three times a week for 12 weeks during the dry/lean season in Northern Ghana. We found that feeding the HSM (1.9 kg/day) improved iron status of women of childbearing age with time (p = 0.011), and protected stunting among toddlers during the dry/lean season (p = 0.024), which is the period with the worst food and nutrition insecurity. Compared with the control group, the number of stunted toddlers declined in the intervention group.

Clinically Relevant Herb-Micronutrient Interactions: When Botanicals, Minerals, and Vitamins Collide

The ability of certain foods to impair or augment the absorption of various vitamins and minerals has been recognized for many years. However, the contribution of botanical dietary supplements (BDSs) to altered micronutrient disposition has received little attention. Almost half of the US population uses some type of dietary supplement on a regular basis, with vitamin and mineral supplements constituting the majority of these products. BDS usage has also risen considerably over the last 2 decades, and a number of clinically relevant herb-drug interactions have been identified during this time. BDSs are formulated as concentrated plant extracts containing a plethora of unique phytochemicals not commonly found in the normal diet. Many of these uncommon phytochemicals can modulate various xenobiotic enzymes and transporters present in both the intestine and liver. Therefore, it is likely that the mechanisms underlying many herb-drug interactions can also affect micronutrient absorption, distribution, metabolism, and excretion. To date, very few prospective studies have attempted to characterize the prevalence and clinical relevance of herb-micronutrient interactions. Current research indicates that certain BDSs can reduce iron, folate, and ascorbate absorption, and others contribute to heavy metal intoxication. Researchers in the field of nutrition may not appreciate many of the idiosyncrasies of BDSs regarding product quality and dosage form performance. Failure to account for these eccentricities can adversely affect the outcome and interpretation of any prospective herb-micronutrient interaction study. This review highlights several clinically relevant herb-micronutrient interactions and describes several common pitfalls that often beset clinical research with BDSs.

Effect of green leafy vegetables powder on anaemia and vitamin-A status of Ghanaian school children

Background

Nutritional anaemia and vitamin-A deficiency are public health issues confronting Ghanaian children. Their adverse effects are likely pronounced during the dry season when green leafy vegetables, rich-sources of iron and provitamin-A are scarce. This study assessed the effect of dried green leafy vegetables on anaemia and vitamin-A status of Ghanaian school children.

Method

This was 3 months pretest, posttest nutrition intervention study. Children 4–9 years were randomized to receive or not receive supplement. High Performance Liquid Chromatography and Haemocue hemoglobinometer were used to determine vitamin-A and haemoglobin concentrations respectively. Malaria-parasitaemia and helminthes were examined by Giemsa-staining and Kato-Katz respectively. Nutritional status was assessed by anthropometry. Student’s t-test was used to establish significant differences between groups.

Results

At baseline, the mean haemoglobin concentrations of control and supplemental were 116.9 ± 9.9 g/l and 117.6 ± 12.7 g/l respectively. At end-line, it was 121.9 ± 13.5 g/l for supplemental and 113.4 ± 8.5 g/l for control, significant at p = 0.001. At baseline prevalence of anaemia was 37.3 and 41.5% in control and supplemental respectively. At end-line it was 33.3% in supplemental against 57.5% in control, significant at p = 0.024. At baseline mean retinol concentrations were 16.79 ± 8.74 μg/dl and 16.97 ± 7.74 μg/dl for control and supplemental respectively. Mean retinol concentrations for control and supplemental were 24.35 ± 5.50 μg/dl and 26.96 ± 6.86 μg/dl respectively at end-line. At end-line 60% of control against 64.0% of supplemental had low vitamin-A status. At end-line, anaemic-control had mean retinol concentration of 23.78 ± 5.23 μg/dl and anaemic-supplemental had 27.46 ± 7.28 μg/dl. Prevalence of low vitamin-A status was 64.3 and 84.2% in anaemic-control and anaemic-supplemental respectively at baseline but it became 23.1 and 21.1% respectively, at end-line. The mean haemoglobin concentrations of anaemic-control and supplemental were 105.7 ± 7.5 g/l and 113.6 ± 13.6 g/l respectively at end-line. The change in prevalence of anaemia between the anaemic groups was 12.2%, significant at p = 0.042.

Conclusion

Consumption of green leafy vegetables powder increased mean haemoglobin and retinol concentrations of the study participants. It had the potential to minimize prevalence of anaemia and low vitamin-A status of study participants.

A free lunch or a walk back home? The school food environment and dietary behaviours among children and adolescents in Ghana

Food environments can play an important roles in shaping nutrition and health outcomes. One such environment that has potential to affect youth is the school food environment. In contrast to higher-income countries, however, there is a critical evidence gap on the role of school food environments on children and adolescents in low- and middle-income countries. This mixed-methods study contributes to filling this gap by investigating the role of school food environments on dietary behaviours of children and adolescents in Ghana. It draws on data from household and school questionnaires as well as focus group discussions collected as part of the baseline for an impact evaluation of the Ghana School Feeding Programme (GSFP). Multi-level regression models were fitted with random intercepts at the individual, household and community levels. Excerpts from the focus group discussions provided a deeper understanding of quantitative findings. Children and adolescents who received free school meals provided by the GSFP or who lived further away from school were less likely to go home for lunch. More than half of sampled schools reported offering foods for sale by independent vendors, the most common being meals followed by confectionery, fruit and sugar-sweetened beverages. Predictors of bringing money to school to buy food included non-receipt of free school meals, adolescence, greater commuting distance from home, household asset score, and urban location. Policy efforts focusing on the school food environment may contribute to healthy dietary behaviours for children and adolescents with positive impacts over the lifecourse.

Seasonality affects dietary diversity of school-age children in northern Ghana

BACKGROUND AND OBJECTIVES

Dietary diversity score (DDS) is relatively easy to measure and is shown to be a very useful indicator of the probability of adequate micronutrient intake. Dietary diversity, however, is usually assessed during a single period and little is known about the effect of seasonality on it. This study investigates whether dietary diversity is influenced by seasonality.

METHODS

Two cross-sectional surveys were conducted in two different seasons-dry season (October 2010) and rainy season (May 2011) among the same school-age children (SAC) in two rural schools in northern Ghana. The study population consisted of 228 school-age children. A qualitative 24-hour dietary recall was conducted in both seasons. Based on 13 food groups, a score of 1 was given if a child consumed a food item belonging to a particular food group, else 0. Individual scores were aggregated into DDS for each child. Differences in mean DDS between seasons were compared using linear mixed model analysis.

RESULTS

The dietary pattern of the SAC was commonly plant foods with poor consumption of animal source foods. The mean DDS was significantly higher (P < 0.001) in the rainy season (6.95 ± 0.55) compared to the dry season (6.44 ± 0.55) after adjusting for potential confounders such as age, sex, occupation (household head and mother) and education of household head. The difference in mean DDS between dry and rainy seasons was mainly due to the difference in the consumption of Vitamin A-rich fruits and vegetables between the seasons. While vitamin A-rich fruits (64.0% vs. 0.9%; P < 0.0001) and vitamin A rich dark green leafy vegetables (52.6% vs. 23.3%, P < .0001) were consumed more during the rainy season than the dry season, more children consumed vitamin A-rich deep yellow, orange and red vegetables during the dry season than during the rainy season (73.7% vs. 36.4%, P <0.001).

CONCLUSION

Seasonality has an effect on DDS and may affect the quality of dietary intake of SAC; in such a context, it would be useful to measure DDS in different seasons. Since DDS is a proxy indicator of micronutrient intake, the difference in DDS may reflect in seasonal differences in dietary adequacy and further studies are needed to establish this.

Subclinical inflammation influences the association between vitamin A- and iron status among schoolchildren in Ghana

BACKGROUND AND OBJECTIVE

In resource-poor settings, micronutrient deficiencies such as vitamin A deficiency may co-exist with iron-deficiency. In this study we assessed the iron and vitamin A status of schoolchildren and the association between vitamin A and iron status.

METHODS

A cross-sectional design using the baseline data of a dietary intervention trial conducted among randomly selected 5-12 years old schoolchildren (n = 224) from 2 rural schools in northern Ghana. Hemoglobin (Hb), serum ferritin (SF) and serum transferrin receptor (sTfR) concentrations were used as measures of iron status. Retinol binding protein (RBP) was used as a measure of vitamin A status. Subclinical inflammation (SCI) was measured using C-reactive protein (CRP) and α1-acid glycoprotein (AGP) concentrations. We examined the cross-sectional association between vitamin A and iron status biomarkers with multiple linear regressions.

RESULTS

The proportions of schoolchildren with anemia (WHO criteria), iron-deficiency (ID, SF <15μg/l and/or sTfR >8.5mg/l) and iron-deficiency anemia (IDA, concurrent anemia and ID) were 63.8%, 68.3% and 46.4% respectively. Low or marginal vitamin A status (0.70 μmol/l ≤ RBP < 1.05μmol/l) was present in 48.2% while 37.5% of the schoolchildren had vitamin A deficiency (VAD, RBP <0.70 μmol/l). The prevalence of SCI as well as concurrent VAD and ID were 48.7% and 25% respectively. RBP was associated with Hb (β = 7.2, P = 0.05) but not SF (β = 20.7, P = 0.33) and sTfR concentration (β = 12.0, P = 0.63). In the presence of SCI, RBP was not associated with hemoglobin status but a significant positive association was observed among children without SCI.

CONCLUSIONS

The study shows that RBP is significantly associated with Hb concentration but not with SF and sTfR. The observed relationship between RBP and Hb is only significant in the absence of SCI.

Impact of Cowpea-Based Food Containing Fish Meal Served With Vitamin C-Rich Drink on Iron Stores and Hemoglobin Concentrations in Ghanaian Schoolchildren in a Malaria Endemic Area

BACKGROUND

Nutritional anemia is a public health problem among Ghanaian schoolchildren. There is need to employ dietary modification strategies to solve this problem through school and household feeding programs.

OBJECTIVE

To evaluate the effectiveness of cowpea-based food containing fish meal served with vitamin C-rich drink to improve iron stores and hemoglobin concentrations in Ghanaian schoolchildren.

METHODS

The study involved cross-sectional baseline and nutrition intervention phases. There were 150 participants of age 6 to 12 years. They were randomly assigned to 3 groups, fish meal -vitamin C (n = 50), vitamin C (n = 50), and control (n = 50), and given different cowpea-based diets for a 6-month period. Height and weight measurements were done according to the standard procedures, dietary data were obtained by 24-hour recall and food frequency questionnaire, hemoglobin concentrations were determined by Hemocue Hemoglobinometer, and serum ferritin and complement-reactive protein (CRP) were determined by enzyme-linked immunosorbent assay. Participants' blood samples were examined for malaria parasitemia and stools for helminthes using Giemsa stain and Kato-Katz techniques, respectively.

RESULTS

Mean ferritin concentration was not significantly different among groups. End line mean or change in hemoglobin concentrations between fish meal-vitamin C group (128.4 ± 7.2/8.3 ± 10.6 g/L) and control (123.1 ± 6.6/4.2 ± 10.4 g/L) were different, P < .05. Change in prevalence of anemia in fish meal-vitamin C group (19.5%) was different compared to those of vitamin C group (9.3%) and the control (12.2%). Levels of malaria parasitemia and high CRP among study participants at baseline and end line were 58% and 80% then 55% and 79%, respectively. Level of hookworm infestation was 13%.

CONCLUSION

Cowpea-based food containing 3% fish meal and served with vitamin C-rich drink improved hemoglobin concentration and minimized the prevalence of anemia among the study participants.

School feeding contributes to micronutrient adequacy of Ghanaian schoolchildren

Without gains in nutritional outcomes, it is unlikely that school feeding programmes (SFP) could improve cognition and academic performance of schoolchildren despite the improvements in school enrolment. We compared the nutrient intake adequacy and Fe and nutritional status of SFP and non-SFP participants in a cross-sectional survey involving 383 schoolchildren (aged 5-13 years). Quantitative 24 h recalls and weighed food records, repeated in 20% subsample, were used to estimate energy and nutrient intakes adjusted for day-to-day variations. The probability of adequacy (PA) was calculated for selected micronutrients and the mean of all PA (MPA) was calculated. The concentrations of Hb, serum ferritin, and soluble transferrin receptor (sTfR) and anthropometric measurements were used to determine Fe and nutritional status. Energy and nutrient intakes and their adequacies were significantly higher among SFP participants (P<0·001). The MPA of micronutrients was significantly higher among SFP participants (0·61 v. 0·18; P<0·001), and the multiple-micronutrient-fortified corn soya blend was a key contributor to micronutrient adequacy. In SFP participants, 6 g/l higher Hb concentrations (P<0·001) and about 10% points lower anaemia prevalence (P=0·06) were observed. The concentration of sTfR was significantly lower among SFP participants (11·2 v. 124 mg/l; P=0·04); however, there was no difference in the prevalence of Fe deficiency and Fe-deficiency anaemia between SFP and non-SFP participants. There was also no significant difference in the prevalence of thinness, underweight and stunting. In conclusion, the present results indicate that school feeding is associated with higher intakes and adequacies of energy and nutrients, but not with the prevalence of Fe and nutritional status indicators. The results also indicate an important role for micronutrient-dense foods in the achievement of micronutrient adequacy within SFP.

Meeting iron needs for infants and children

PURPOSE OF REVIEW

Iron deficiency early in life is associated with impaired neurological development. This study reviews the latest research on how to best meet iron requirements in infants and children.

RECENT FINDINGS

There is concurrent evidence that delayed cord clamping is well tolerated and improves infant iron stores. Iron supplements or enriched complementary foods starting before 6 months of life do not reduce iron deficiency prevalence in low-risk populations. However, for low birth weight infants, iron supplements before 6 months of life have long-term benefits. Iron deficiency anaemia (IDA) during the second half year of life is rare in countries with high compliance to iron-rich complementary foods, but remains a major problem globally. In high-risk populations, iron supplementation reduces IDA and possibly improves growth. However, increased risk of infections is a concern and optimal preventive strategies have not yet been determined. Finally, there is concurrent evidence that iron supplementation of anaemic school-aged children reduces IDA and possibly improves neuropsychological outcomes.

SUMMARY

Interventions for prevention of iron deficiency should be prioritized in risk groups. However, the unclear long-term benefits and possible risk of adverse effects, particularly increased infections in developing countries, prompt further large-scale, double-blinded trials.

Reasons for raising the maximum acceptable daily intake of EDTA and the benefits for iron fortification of foods for children 6-24 months of age

The current maximum acceptable daily intake (ADI) of ethylenediaminetetraacetic acid (EDTA) of 1.9 mg day⁻¹ per kilogram bodyweight (mg day⁻¹ kgbw⁻¹) limits the daily intake of iron as iron EDTA [ferric sodium EDTA; sodium iron(III) EDTA] to approximately 2–2.5 mg day⁻¹ for children 6–24 months of age. This limit was defined by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) in 1973 based on data from an animal‐feed study published in 1963. Other animal studies indicate that this limit can be raised to 4.4 or possibly up to 21.7 mg day⁻¹ kgbw⁻¹, which is 2.3–11.4 times higher than the current value. For nearly 50 years, iron EDTA has been used in France in medicinal syrup for infants 1–6 months of age. The maximum recommended dosage of this drug is 37 times higher than the maximum ADI of EDTA. No adverse health effects have been reported as a result of this medicinal consumption of iron EDTA. Raising the maximum ADI of EDTA to only 4.4 mg day⁻¹ kgbw⁻¹ would enable iron EDTA, an iron fortificant with proven bioavailability in phytate‐rich meals, to be added in adequate amounts to cereal‐based meals for children 6–24 months of age, who are at risk of iron deficiency.

Anaemia among school children older than five years in the Volta Region of Ghana

INTRODUCTION

Anaemia among children is a public health issue in Ghana. The Ghana School Feeding Programme (GSFP) was instituted on pilot basis in an effort to provide nutritious lunch to school children. Evidence on the nutritional status of pupils is needed to inform the expansion of GSFP. This study sought to assess anaemia among Ghanaian pupils.

METHODS

This cross-sectional study involved a random sample of 143 pupils aged 6 to 12 years. Blood samples were collected and analysed for serum-ferritin (SF), C-reactive protein (CRP), haemoglobin and malaria-parasitaemia (MP). Stool samples were examined for soil-transmitted helminths. Dietary data were collected using the 24 hour-recall method on three non-consecutive days and a food frequency questionnaire. The Student's t-test was used to compare mean values between sexes. Binary logistic regression was performed to identify factors associated with anaemia. Statistical significance was set at p < 0.05.

RESULTS

SF and haemoglobin concentrations were 23.9 ± 15 ng/ml and 120 ± 11 g/L respectively. The prevalence of anaemia was 30.8%. More females (41.5%) than males (21.8%) had anaemia (p < 0.005). Seventy-one percent of pupils had low SF levels. MP prevalence was 67.8%. Hookworm infestation was only observed in males (18.0%). Dietary iron and vitamin C intakes were 18.98 ± 8.8 mg and 23.7 ± 6.7 mg, respectively. Child's sex, SF and MP were associated with anaemia. Males had a lower likelihood of being anaemic (OR = 0.2, CI 0.1-0.5, p = 0.002).

CONCLUSION

The study findings underscore the need for multi-pronged approaches that address both malaria control and nutrition in order to reduce anaemia among pupils.

Micronutrient fortification of food and its impact on woman and child health: a systematic review

BACKGROUND

Vitamins and minerals are essential for growth and metabolism. The World Health Organization estimates that more than 2 billion people are deficient in key vitamins and minerals. Groups most vulnerable to these micronutrient deficiencies are pregnant and lactating women and young children, given their increased demands. Food fortification is one of the strategies that has been used safely and effectively to prevent vitamin and mineral deficiencies.

METHODS

A comprehensive search was done to identify all available evidence for the impact of fortification interventions. Studies were included if food was fortified with a single, dual or multiple micronutrients and impact of fortification was analyzed on the health outcomes and relevant biochemical indicators of women and children. We performed a meta-analysis of outcomes using Review Manager Software version 5.1.

RESULTS

Our systematic review identified 201 studies that we reviewed for outcomes of relevance. Fortification for children showed significant impacts on increasing serum micronutrient concentrations. Hematologic markers also improved, including hemoglobin concentrations, which showed a significant rise when food was fortified with vitamin A, iron and multiple micronutrients. Fortification with zinc had no significant adverse impact on hemoglobin levels. Multiple micronutrient fortification showed non-significant impacts on height for age, weight for age and weight for height Z-scores, although they showed positive trends. The results for fortification in women showed that calcium and vitamin D fortification had significant impacts in the post-menopausal age group. Iron fortification led to a significant increase in serum ferritin and hemoglobin levels in women of reproductive age and pregnant women. Folate fortification significantly reduced the incidence of congenital abnormalities like neural tube defects without increasing the incidence of twinning. The number of studies pooled for zinc and multiple micronutrients for women were few, though the evidence suggested benefit. There was a dearth of evidence for the impact of fortification strategies on morbidity and mortality outcomes in women and children.

CONCLUSION

Fortification is potentially an effective strategy but evidence from the developing world is scarce. Programs need to assess the direct impact of fortification on morbidity and mortality.

Cowpeas in Northern Ghana and the factors that predict caregivers' intention to give them to schoolchildren

BACKGROUND

Cowpeas are important staple legumes among the rural poor in northern Ghana. Our objectives were to assess the iron and zinc content of cowpea landraces and identify factors that predict the intention of mothers/caregivers to give cowpeas to their schoolchildren.

METHODS AND FINDINGS

We performed biochemical analysis on 14 landraces of cowpeas and assessed the opinion of 120 caregiver-child pairs on constructs based on the combined model of the Theory of Planned Behaviour and Health Belief Model. We used correlations and multiple regressions to measure simple associations between constructs and identify predictive constructs. Cowpea landraces contained iron and zinc in the range of 4.9-8.2 mg/100 g d.w and 2.7-4.1 mg/100 g d.w respectively. The landraces also contained high amounts of phytate (477-1110 mg/100 g d.w) and polyphenol (327-1055 mg/100 g d.w). Intention of mothers was strongly associated (rs = 0.72, P<0.001) with and predicted (β = 0.63, P<0.001) behaviour. The constructs, barriers (β = -0.42, P = 0.001) and attitudes towards behaviour (β = 0.25, P<0.028), significantly predicted intention albeit the predictive ability of the model was weak.

CONCLUSIONS

We conclude that some cowpea landraces from northern Ghana have appreciable amounts of iron and zinc but probably with poor bioavailability. Attitudes towards giving cowpeas and perception of barriers are important predictors of caregivers' intention to give cowpeas to their schoolchildren. Finally our results suggest that increasing knowledge on nutritional benefits of cowpeas may increase health values caregivers hold for their children in support of giving cowpeas to schoolchildren.