Serum Vitamin A and Nutritional Status of Children Fed Gari and Beans Stew

Abstract

Introduction: Vitamin A deficiency (VAD) is endemic among children in low income countries. Food-based strategies have been identified globally as more sustainable in addressing micronutrient deficiencies in populations. However, there is paucity of knowledge on the effect of food based interventions in combating vitamin A deficiency in Ghana. The objective of the present study was to determine the serum vitamin A and nutritional status of children fed gari and beans stew prepared with red palm oil. Methodology: The study was a 6 month one-group longitudinal pre - and - post - test design. A convenient sample of 142 school children (6 to 12 years) randomly selected at Kodzobi Basic School (Primary-JHS) in the Volta Region of Ghana participated in the study. A survey was conducted to determine the vitamin-rich foods in the community. A 24 hour dietary recall and food frequency questionnaire instruments were employed to obtain information on the diet of the participants. The nutritional composition of the intervention diet was determined using a standard method. The β-carotene content of the diet and the serum retinol level of the participants were determined using High Performance Liquid Chromatographic (HPLC). The weight and height of the children were measured to determine weight-for-age z-scores, height-for-age z-scores and body mass index-for-age z-scores. Differences in means before and after the intervention period were determined using the paired t-test. Chi-squared test was used to examine the association between serum retinol and some categorical variables. Logistic regression models were used to explore the relationship between serum retinol and the background characteristics of study participants. Results: The survey revealed seasonal availability and accessibility of vitamin A-rich foods in the community. HPLC analysis of the intervention diet showed that it contained high vitamin A (823.56μg RE). Based on the 24 hour dietary recall the macronutrient intakes between the pre and post interventions were significantly different. Carbohydrate intake pre-intervention was 357.76±56.50 g while the post intervention intake was 411.36±58.99 g; pre-intervention protein intake was 31.86±8.43 g whereas the post intervention intake was 45.64±9.20 g. Fat intake pre-intervention was 33.52±7.20 g as against post intervention intake of 35.04±7.44 g. Median vitamin A intake increased from 3.84 (0.0, 1392.14) μg RE to 4.61 (0.0, 1681.79) μg RE. None of the reported socio- demographic variable showed a significant association with vitamin A status. The mean serum retinol level (12.13 μg/dL) of participants at pre-intervention was significantly different from the mean serum retinol of (16.11 μg/dL) at the post-intervention period, p <0.001. The prevalence of vitamin A deficiency (serum retinol concentrations < 20 μg/dL) among the participants decreased from 95.1% in pre-intervention to 77.5% in post- intervention. Comparisons between the pre and post-intervention nutritional status showed a significant difference in height-for-age z-scores (p<0.001). However, there were no statistical differences between the pre and post intervention weight-for-age and BMI-for- age z-scores (-2SD). Mean malaria parasite density for the pre intervention was 2923.42±5667.09/μL and this was significantly different from the post intervention parasite density of 865.16±1312.12/μL. Conclusion: VAD is a public health challenge among the participants. The intake of vitamin A rich foods was poor due to seasonality and accessibility. There was high level of wasting and underweight among the participants. The intervention diet, gari and beans stew made with red palm oil served three times per week did improve serum retinol levels of the children and this may be a sustainable strategy in combating VAD.