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Five-year follow-up of a food-based vitamin A intervention in Tanzania

Published online by Cambridge University Press:  02 January 2007

Diana Kidala ,
Ted Greiner  and
Mehari Gebre-Medhin
Diana Kidala
Affiliation:
Tanzania Food and Nutrition Centre, Dar-es-Salaam, Tanzania
Ted Greiner
Affiliation:
Department of Women's and Children's Health, Section for International Maternal and Child Health, Uppsala University, S-751 85 Uppsala, Sweden
Mehari Gebre-Medhin*
Affiliation:
Department of Women's and Children's Health, Section for International Maternal and Child Health, Uppsala University, S-751 85 Uppsala, Sweden
*
*Corresponding author: Email Mehari,Gebre-Medhin@kbh.uu.se
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Abstract

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Objective

To evaluate the long-term effects of a horticultural and nutrition education intervention in rural Tanzania.

Design

A quasi-experimental post-test design was used.

Setting

The research was carried out in 10 villages in Singida region, Tanzania.

Subjects

Mothers and their children aged 6–71 months (n = 236) from an experimental (Ilongero) and control (Ihanja) area were interviewed regarding knowledge and practices related to vitamin A nutrition. Intake of vitamin A-rich foods by the children during the 7 days prior to the interview was recorded. Stools were examined for helminths and serum samples were analysed for retinol and C-reactive protein (CRP) (n = 146) for the children aged 12–71 months.

Results

Knowledge and practices were more favourable to vitamin A intake in the experimental area than in the control area, and an increased frequency of intake of green leaves was associated with higher serum retinol values. The experimental area had lower mean serum retinol levels (13.7 μg dl−1, n = 75) than the control area (19.3 μg dl−1, n = 71). One likely confounder was the higher helminth infestation in the experimental area (n = 75, 79%) than in the control area (n = 71, 49%) (P > 0.001). Children with helminths (n = 94) had a lower mean serum retinol level than those without (n = 52) (12.3 ± 5 vs. 24 ± 10 μg dl−1; P = 0.001).

Conclusions

Food-based vitamin A programmes can make sustainable improvements in knowledge and dietary practices but these may not necessarily be reflected in increases in serum retinol. Programme implementation and evaluation should take confounders into consideration as, in this case, helminth infestation.

Keywords

Nutrition educationVitamin AHelminthsChildrenNutrition interventionFoodSerum retinolTanzania
Type
Research Article
Information
Public Health Nutrition , Volume 3 , Issue 4 , December 2000 , pp. 425 - 431
Copyright
Copyright © CABI Publishing 2000

References

1Kavishe, FP. Nutrition–relevant Actions in Tanzania. Geneva: ACC/SCN, 1993.Google Scholar
2TFNC. An overview of Singida Horticultural Potential in Relation to Promotion of Production and Consumption of Vitamin A Rich Fruits and Vegetables. Dar-es-Salaam: Tanzania Food and Nutrition Centre, 1991.Google Scholar
3TFNC. TFNC's 20th Anniversary 1973–1993. Dar-es-Salaam: Tanzania Food and Nutrition Centre, 1993.Google Scholar
4Rahmathulla, L, Underwood, B, Thulasiraj, R, et al. Reduced mortality among children in southern India receiving a small weekly dose of vitamin A. New Engl. J. Med. 1990; 323: 929–35.CrossRefGoogle Scholar
5Ghana VAST Study Team. Vitamin A supplementation in northern Ghana. Effects on clinical attendance, hospital admissions, and child mortality. Lancet 1993; 342: 7–12.CrossRefGoogle Scholar
6Beaton, GH, Martorell, R, Aronson, KJ, et al. Effectiveness of Vitamin A Supplementation in the Control of Young Child Morbidity and Mortality in Developing Countries. Geneva: ACC/SCN, 1993.Google Scholar
7Mele, L, West, KPJ, Kusdiono, Z, and the Aceh Study Group. Nutritional and household risk factors for xerophthalmia in Aceh, Indonesia: a case-control study. Am. J. Clin. Nutr. 1991; 53: 1460–5.CrossRefGoogle ScholarPubMed
8Hussain, A, Kvåle, G, Ali, K, Bhuyan, AH. Determinants of night blindness in Bangladesh. Int. J. Epidemiol. 1993; 22: 1119–26.CrossRefGoogle ScholarPubMed
9Shanker, AV, Gittelsohn, J, West, KPJ, Stallings, R, Gnywali, T, Faruque, F.Eating from a shared plate affects consumption in vitamin A deficient Nepali children. J. Nutr. 1998; 1127–33.CrossRefGoogle Scholar
10Friis, H, Mwaniki, D, Omondi, B, et al. Serum retinol concentrations and Schistosoma mansoni, intestinal helminths, and malarial parasitemia: a cross–sectional study in Kenyan preschool and primary school children. Am. J. Clin. Nutr. 1997; 66: 665–71.CrossRefGoogle ScholarPubMed
11Atukorala, TMS, Lanerolle, P.Soil–transmitted helminthic infection and its effect on nutritional status of adolescent school girls of low socioeconomic status in Sri Lanka. J. Trop. Pediatr. 1999; 45: 18–22.CrossRefGoogle Scholar
12Reddy, V, Vijayaraghavan, K, Mathur, KK. Effect of deworming and vitamin A administration on serum vitamin A levels in preschool children. J. Trop. Pediatr. 1986; 32: 196–9.CrossRefGoogle ScholarPubMed
13Ahmed, F, Mohiduzzaman, M, Jackson, AA. Vitamin A absorption in children with ascariasis. Br. J. Nutr. 1993; 69: 817–25.CrossRefGoogle ScholarPubMed
14Mbago, MCY, Namfua, PP. Some determinants of nutritional status of one–to–four year–old children in low income urban areas in Tanzania. J. Trop. Pediatr. 1992; 38: 299–306.CrossRefGoogle ScholarPubMed
15Zeitlin, MF, Megawangi, R, Kramer, EM, Armstrong, HC. Mother's and children's intakes of vitamin A in rural Bangladesh. Am. J. Clin. Nutr. 1992; 56: 136–47.CrossRefGoogle ScholarPubMed
16Rahman, MM, Islam, MA, Mahalanabis, D, Chowdhury, S, Biswas, E.Impact of health education on the feeding of green leafy vegetables at home to children of the urban poor mothers of Bangladesh. Public Health 1994; 108: 211–8.CrossRefGoogle ScholarPubMed
17Greiner, T, Mitra, SN. Evaluation of the impact of a food–based approach to solving vitamin A deficiency in Bangladesh. Food Nutr. Bull. 1995; 16: 193–205.CrossRefGoogle Scholar
18Vijayaraghavan, K, Nayak, MU, Bamji, MS, Ramana, GNV, Reddy, V.Home gardening for combatting vitamin A deficiency in rural India. Food Nutr. Bull. 1997; 18: 337–43.Google Scholar
19Hussain, A, Kvåle, G.Sustainability of a nutrition education programme to prevent night-blindness in Bangladesh. Trop. Med. Int. Health. 1996; 1: 43–51.CrossRefGoogle ScholarPubMed
20Smitasiri, S, Sa-ngobwarchar, K, Kongpunya, P, et al. Sustaining behaviour change to enhance micronutrient status through community– and women-based interventions in north-east Thailand: vitamin A. Food Nutr. Bull. 1999; 20: 243–51.CrossRefGoogle Scholar
21Bloem, MW, Huq, N, Gorstein, J, et al. Production of fruits and vegetables at the homestead is an important source of vitamin A among women in rural Bangladesh. Eur. J. Clin. Nutr. 1996; 50: S62–7.Google ScholarPubMed
22De Pee, S, Bloem, MW, Gorstein, J, et al. Reappraisal of the role of vegetables in the vitamin A status of mothers in central Java, Indonesia. Am. J. Clin. Nutr. 1998; 68: 1068–74.CrossRefGoogle ScholarPubMed
23Solomons, NW, Bulux, J.Identification and production of local carotene-rich foods to combat vitamin A malnutrition. Eur. J. Clin. Nutr. 1997; 51: 39–45.Google ScholarPubMed
24Brown, LV, Zeitlin, MF, Weld, LH, et al. Evaluation of the impact of messages to improve the diets of lactating rural Bangladesh women on their dietary practices and the growth of their breast fed infants. Food Nutr. Bull. 1994; 15: 320–33.CrossRefGoogle Scholar
25Kennedy, ET, Oniango, R.Household and preschooler vitamin A consumption in southwestern Kenya. J. Nutr. 1993; 123: 841–6.CrossRefGoogle ScholarPubMed
26Guptill, KS, Esrey, SA, Oni, GA, Brown, KH. Evaluation of a face-to-face weaning food intervention in Kwara state, Nigeria: knowledge, trial and adoption of a home-prepared weaning food. Soc. Sci. Med. 1993; 36: 665–72.CrossRefGoogle ScholarPubMed
27Parlato, M, Gottert, P. Promoting vitamin A in rural Niger: strategies for adverse conditions. In: Seidel, RE, ed. Strategies for Promoting Vitamin A. Production, Consumption and Supplementation. Washington, DC: Academy for Educational Development, 1996; 8–25.Google Scholar
28TFNC. Report on the Baseline Survey on Vitamin A Deficiency in Ilongero and Ihanja Divisions, Singida. Dar-es-Salaam: Tanzania Food and Nutrition Centre, 1992.Google Scholar
29Hansson, L. C-reactive protein in clinical practice: with special regard to infectious diseases. PhD thesis, Karolinska Institute, Sweden, 1996.Google Scholar
30Speek, AJ. Microdetermination of vitamin A in human plasma using high performance liquid chromatography with fluorescence detection. Chromatogr. Biomed. Applic. 1986; 382: 284–9.CrossRefGoogle ScholarPubMed
31Smitasiri, S, Attig, AG, Valyasevi, A, Dhanamitta, S, Tontisirin, K, Social Marketing Vitamin A-Rich Foods in Thailand, 2nd edn.Bangkok: Institute of Nutrition, Mahidol University, 1993.Google Scholar
32Kuhnlein, HV, Burgess, S.Improved retinol, carotene, ferritin, and folate status in Nuxalk teenagers and adults after a health promotion programme. Food Nutr. Bull. 1997; 18: 202–10.CrossRefGoogle Scholar
33Marinho, HA, Shrimpton, R, Giugliano, R, Burini, RC. Influence of enteral parasites on the blood vitamin A levels in preschool children orally supplemented with retinol and/or zinc. Eur. J. Clin. Nutr. 1991; 45: 539–44.Google ScholarPubMed
34Curtale, F, Vaidya, Y, Muhilal, , Tilden, RL. Ascariasis, hookworm infection and serum retinol amongst children in Nepal. Panminerva Med. 1994; 36: 19–21.Google ScholarPubMed
35Stoltzfus, R, Albonico, M, Chwaya, HM, Tielsch, J, Savioli, L. Virtual Elimination of Vitamin A Deficiency: Obstacles and Solutions for the Year 2000. Guatemala: International Life Sciences Institute, 1996.Google Scholar
36WHO. Indicators for Assessing Vitamin A Deficiency and their Application in Monitoring and Evaluating Intervention Programmes. Geneva: WHO, 1996.Google Scholar