Simple Food Group Diversity as a Proxy Indicator for Iron and Vitamin A Status of Rural Primary School Children in Uganda

Abstract

Children in resource poor settings are at a high risk of inadequate iron and vitamin A intake when diets lack diversity and are dominated by staple foods. Yet comparative information on diet quality among school children is scarce. The objective of the study was to assess the potential of simple food group diversity to serve as a proxy indicator of iron and vitamin A status among rural school children in Uganda. A cross sectional correlation model of associations between Food Group Diversity (FGD) and iron and vitamin A status was used. We analyzed 8 schools in Kumi District, Uganda, randomly selected from the 34 schools that participated in the main part of the study. Our sample included primary school children, aged between 9-15 years (n = 172). Food group diversity and food variety (FV) were calculated from both a food frequency questionnaire (FFQ) and a 24-hour dietary recall. The FGD and FVS were tested against iron (as serum ferritin) and vitamin A (as serum retinol) status. The FGD (based on FFQ data) was 9.6 (±1.9). There was a positive correlation between 24-hour recall and FFQ for consumption of cereals (Corr. Coef = 0.28; p < 0.05), which was also the most highly consumed group (98.9% & 86.9% by FFQ and 24-hour recall; respectively). Consistent with other studies, increase in the number of food groups significantly increased serum ferritin and serum retinol measures (p < 0.001). Presence of at least one food item in the roots & tubers; cereals; and pulses/nuts, significantly increased serum ferritin and serum retinol concentrations (p < 0.01). We speculate that simple food group diversity may reflect intake and serve as a simple indicator of iron and vitamin A status among school children. Strategies aimed at increasing dietary diversity in the community may benefit the families of these children and improve their micronutrient status.

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H. Acham, G. Tumuhimbise and J. Kikafunda, "Simple Food Group Diversity as a Proxy Indicator for Iron and Vitamin A Status of Rural Primary School Children in Uganda," Food and Nutrition Sciences, Vol. 4 No. 12, 2013, pp. 1271-1280. doi: 10.4236/fns.2013.412163.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] M. H. N. Golden, “The Nature of Nutritional Deficiency in Relation to Growth Failure and Poverty,” Acta Paediatrica, Vol. 80, No. 374, 1991, pp. 95-110.
[2] G. L. Kennedy, M. R. Pedro, C. Seghieri, G. Nantel and I. Brouwer, “Dietary Diversity Score Is a Useful Indicator of Micronutrient Intake in Non-Breast-Feeding Filipino Children,” Journal of Nutrition, Vol. 137, No. 2, 2007, pp. 472-477.
[3] A. Onyango, K. G Koski and G. Tucker, “Food Diversity versus Breastfeeding Choice in Determining Anthropometric Status in Rural Kenyan Toddlers,” International Journal of Epidemiology, Vol. 27, No. 3, 1998, pp. 484-448. http://dx.doi.org/10.1093/ije/27.3.484
[4] A. W. Onyango, “Dietary Diversity, Child Nutrition and Health in Contemporary African Communities,” Comparative Biochemistry and Physiology Part A: Molecular & Integrative Physiology, Vol. 136, No. 1, 2003, pp. 61-69. http://dx.doi.org/10.1016/S1095-6433(03)00071-0
[5] A. Tarini, S. Bakari and H. Delisle, “The Overall Nutritional Quality of the Diet Is Reflected in the Growth of Nigerian Children,” Santé (Montrouge, France), Vol. 9, No. 1, 1999, p. 23.
[6] A. Hailu and T. Tessema, “Anthropomentric Study of Ethiopians Pre-School Children,” Ethiopian Medical Journal, Vol. 35, No. 4, 1997, pp. 235-244.
[7] M. Faber, V. B. Jogessar and A. J. S. Benadé, “Nutritional Status and Dietary Intakes of Children Aged 2 -5 Years and Their Caregivers in a Rural South African Community,” International Journal of Food Sciences and Nutrition, Vol. 52, No. 5, 2001, pp. 401-411.
http://dx.doi.org/10.1080/09637480120078285
[8] M. Faber, “Dietary Intake of Primary School Children in Relation to Food Production in a Rural Area in KwaZuluNatal, South Africa,” International Journal of Food Sciences and Nutrition, Vol. 50, No. 1, 1999, pp. 57-64.
http://dx.doi.org/10.1080/096374899101427
[9] L. E. Torheim, E. L. Ferguson, K. Penrose and M. Ariomond, “Women in Resource-Poor Settings Are at Risk of Inadequate Intakes of Multiple Micronutrients,” Journal of Nutrition, Vol. 140, No. 11, 2010, pp. 2051S-2058S.
http://dx.doi.org/10.3945/jn.110.123463
[10] J. E. Arsenault, E. A. Yakes, M. M. Islam, M. B. Hossain, T. Ahmed, C. Hotz, B. Lewis, A. S. Rahman, K. M. Jamil and K. H. Brown, “Very Low Adequacy of Micronutrient Intakes by Young Children and Women in Rural Bangladesh Is Primarily Explained by Low Food Intake and Limited Diversity,” The Journal of Nutrition, Vol. 143, No. 2, 2013, pp. 197-203.
http://dx.doi.org/10.3945/jn.112.169524
[11] J. K. Kikafunda, A. F. Walker, D. Collett and J. K. Tumwine, “Risk Factors for Early Childhood Malnutrition in Uganda,” Pediatrics, Vol. 102, No. 4, 1998, p. e45.
http://dx.doi.org/10.1542/peds.102.4.e45
[12] G. Kennedy, A. Berardo, C. Papavero, P. Horjus, T. Ballard, M. C. Dop, J. Delbaere and I. D. Brouwer, “Proxy Measures of Household Food Consumption for Food Security Assessment and Surveillance: Comparison of the Household Dietary Diversity and Food Consumption Scores,” Public Health Nutrition, Vol. 13 No. 12, 2010, pp. 2010-2018.
http://dx.doi.org/10.1017/S136898001000145X
[13] UBOS, “Uganda Demographic and Health Survey (UDHS) Report,” Uganda Bureau of Statistics and Macro International, Inc., Calverton, 2011.
[14] F. M. Turyashemererwa, J. Kikafunda, R. Annan and G. A. Tumuhimbise, “Dietary Patterns, Anthropometric Status, Prevalence and Risk Factors for Anaemia among School Children Aged 5 -11 Years in Central Uganda,” Journal of Human Nutrition and Dietetics, Vol. 26, No. 1, 2013, pp. 73-81. http://dx.doi.org/10.1111/jhn.12069
[15] V. M. Aguayo and S. K. Baker, “Vitamin A Deficiency and Child Survival in Sub-Saharan Africa: A Reappraisal of Challenges and Opportunities,” Food and Nutrition Bulletin, Vol. 26, No. 4, 2005, pp. 348-355.
[16] M. Nishimura, T. Yamano and Y. Sasaoka, “Impacts of the Universal Primary Education Policy on Educational Attainment and Private Costs in Rural Uganda,” International Journal of Educational Development, Vol. 28, No. 2, 2008, pp. 161-175.
http://dx.doi.org/10.1016/j.ijedudev.2006.09.017
[17] A. M. Prentice, K. A Ward, G. R. Goldberg, L. M. Jarjou, S. E. Moore, A. J. Fulford and A. Prentice, “Critical Windows for Nutritional Interventions against Stunting,” American Journal of Clinical Nutrition, Vol. 97, No. 5, 2013, pp. 911-918.
http://dx.doi.org/10.3945/ajcn.112.052332
[18] Kumi District State of the Environment Report, Kumi District local Government, 2008.
http://nema-ug.org/district_reports/kumi_dsoer_2008.pdf
[19] LAKIMO, “Lake Kyoga Management Plan 2004-2007,” Lake Kyoga Integrated Management Organisation, Uganda, 2004.
[20] H. Acham, “Nutrition, Health and Academic Achievement of Primary School Children: A Case of Kumi District Eastern Uganda,” Makarere University, Kampala, 2010.
[21] H. Acham, J. K. Kikafunda, T. Tylleskar and M. K. Malde, “Nutritional and Health Status of Primary Schoolchildren in Rural Uganda,” African Journal of Agriculture Nutrition and Development, Vol. 12, No. 2, 2012, pp. 5862-5880
[22] WHO/UNICEF/UNU, “Iron Deficiency Anaemia Assessment, Prevention, and Control: A Guide for Programme Managers,” Geneva, 2001.
[23] G. M. Addison, M. R. Beamish, C. N. Hales, M. Hodgkins, A. Jacobs and P. Lewellin, “An Immunoradiometric Assay for Ferritin in the Serum of Normal Subjects and Patients with Iron Deficiency and Iron Overload,” Journal of Clinical Patholology, Vol. 25, No. 4, 1972, pp. 326-329.
[24] J. G. Bieri, T. J. Tolliver and G. L. Catignani, “Simultaneous Determination of Alpha Tocopherol and Retinol in Plasma or Red Cells by High Pressure Liquid Chromatography,” American Journal of Clinical Nutrition, Vol. 32, No. 4, 1979, p. 2143.
[25] WHO, “Indicators of Vitamin A Deficiency and Their Application in Monitoring and Evaluating Intervention Programmes,” WHO/NUT/96.10, World Health Organization, Geneva, 1996.
[26] J. Coates, B. Colaiezzi, J. Fiedler, J. Wirth, K. Lividini and B. Rogers, “Applying Dietary Assessment Methods for Food Fortification and Other Nutrition Programs,” Global Alliance for Improved Nutrition (GAIN), Geneva, 2012.
[27] R. Gibson, “Principles of Nutrition Assessment,” Oxford University Press, New York, 1990.
[28] I. Tidemann-Andersen, H. Acham, A. Maage and M. K. Malde, “Iron and Zinc Content of Selected Foods in the Diet of Schoolchildren in Kumi District, East of Uganda: A Cross-Sectional Study,” Nutrition Journal, Vol. 10, No. 81, 2011.
[29] WHO/CDC, “Assessing the Iron Status of Populations,” Report of a Joint World Health Organization/Centres for Disease Control and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level, Geneva, 2005.
[30] A. W. Onyango, O. Receveur and S. A Esrey, “The Contribution of Breast Milk to Toddler Diets in Western Kenya,” Bulletin of the World Health Organization, Vol. 80, No. 4, 2002, pp. 292-299.
[31] M. G. Courcy, H. R. Hosking and L. J. A Loewenthal, “An Investigation into Health and Agriculture in Teso, Uganda,” Nutrition Report No. 1, Teso, Government Printer, Entebbe, 1937.
[32] WFP, “Comprehensive Food Security & Vulnerability Analysis (CFSVA),” World Food Programme, Uganda Country Office, 2009.

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