Factors contributing to the adequate vitamin A status and poor anthropometric status of 24-59-month-old children from an impoverished Northern Cape community

Nel, Jana (2013-03)

Thesis (MNutr)--Stellenbosch University, 2013.

Thesis

ENGLISH ABSTRACT: Objective: To examine the factors that may influence the vitamin A and anthropometric status of 24-59-month-old children from an impoverished community with a very high prevalence of stunting, but virtually no vitamin A deficiency. Design: Cross sectional, descriptive study with analytical components. Setting: Calvinia West, Northern Cape Province, South Africa Subjects: Biological mothers (n=150) and their children aged 24-59 months (n=150) living in Calvinia West from 6 months of age or younger. Methods: A general interviewer-administered questionnaire comprising of socio-demographic information, a 24-hour recall and an adjusted food frequency questionnaire, focussing on liver intake, were used in the data collection process. Anthropometric measurements (weight and height) were also performed. Results: Results showed that liver consumption alone contributed to more than 100% of the Estimated Average Requirement (EAR) for vitamin A of the pre-school children in this community. Liver was eaten by 84.7% (n=127) of the children and 68% (n=102) of them ate liver at least once per month. The average portion size of the children who consumed liver was 66g at a time. The national food fortification programme contributed to a further 80 μg Retinol Equivalents (RE) and the national supplementation programme 122μg RE of vitamin A per day. There was a significant (p=0.028) inverse association between the amount of liver intake and household income. Liver intake was also significantly (p=0.016) higher in the children whose mothers were unskilled as opposed to those with skilled mothers. According to the World Health Organization (WHO) growth standards 36.9% (n=55) of the children were stunted (low height for age), 25.5% (n=38) were underweight for age and 12.1% (n=18) were wasted (low weight for height). The mean birth weight of the children (n=141) was 2826g (SD=592). Of these children, 27.7% (n=39) had a low birth weight (<2500g). There was a significant positive correlation (r=0.250; p=0.003) between the birth weight of the child and the child's current height for age. The height of the mother, as well as several indicators of socio-economic status, also correlated significantly with the height for age of the child. Conclusion: In this impoverished community the anthropometric status of the children was poor, but vitamin A deficiency was largely addressed through the regular intake of liver. Poor anthropometric status is therefore not always an indicator of micronutrient deficiencies and blanket supplementation approaches are not necessarily the solution in a country with diverse cultures and eating habits. Apart from the immediate risks and consequences of underweight, stunting and wasting in a community, stunting may also lead to overweight and obesity in the long term. This may result in diseases of lifestyle in later life, adding a further burden to an already weakened community. Appropriate evidence-based interventions aimed at the first thousand days of life should be a priority in this community.

AFRIKAANSE OPSOMMING: Doel: Om die faktore wat kan bydrae tot die vitamien A en die antropometriese status van kinders 24-59-maande in 'n arm gemeenskap met 'n baie hoë voorkoms van dwerggroei, maar byna geen vitamien A gebrek, te ondersoek. Ontwerp: Beskrywende, deursnit studie met analitiese komponente Omgewing: Calvinia Wes, Nood Kaap provinsie, Suid-Afrika Deelnemers: Biologiese moeders (n=150) en hul kinders in die ouderdomsgroep, 24-59-maande (n=150) woonagtig in Calvinia Wes sedert 6 maande van ouderdom of jonger. Metodes: 'n Vraelys bestaande uit sosio-demografiese inligting, 'n 24-uur herroep en 'n aangepaste voedsel frekwensie vraelys gefokus op die inname van lewer, was gebruik om data in te samel en voltooi deur die onderhoudvoerder. Antropometriese metings (gewig en lengte) was ook geneem. Resultate: Resultate het getoon dat lewer inname bygedra het tot meer as 100% van die geskatte gemiddelde behoefte van vitamien A vir die voorskoolse kind in hierdie gemeenskap. Lewer was deur 84.7% (n=127) van die kinders ingeneem en 68% (n=102) het dit ten minste een keer per maand geëet. Die gemiddelde porsie grootte van die kinders wat lewer ingeneem het, was 66g op 'n keer. Die nasionale voedsel fortifisering program het 'n verdere 80 μg Retinol Ekwivalente (RE) en die nasionale supplementasie program 122μg RE vitamin A per dag bygedra. Daar was 'n betekenisvolle (p=0.028) omgekeerde korrelasie tussen die die hoeveelheid lewer wat deur die kinders ingeneem is en die huishoudelike inkomste. Lewer inname was ook betekenisvol (p=0.016) meer in kinders wie se moeders ongeskool was teenoor die met geskoolde moeders. Volgens die Wêreld Gesondheid Organisasie se groeistandaarde het 36.9% (n=55) van die kinders dwerggroei getoon (te kort vir hul ouderdom), 25.5% (n=38) was ondergewig vir hul ouderdom en 12.1% (n=18) uitgeteer (ondergewig vir hul lengte). Die gemiddelde geboortegewig van die kinders (n=141) was 2826g (SA=592). Van hierdie kinders het 27.7% (n=39) 'n lae geboortegewig (<2500g) gehad. Daar was 'n betekenisvolle positiewe korrelasie (r=0.250; p=0.003) tussen die geboortegewig van die kind en die huidige lengte vir ouderdom. Die lengte van die moeder, sowel as ander sosio-ekonomiese status aanwysers het ook betekenisvol gekorreleer met die lengte vir ouderdom van die kind. Samevatting: In hierdie arm gemeenskap was die antropometriese status van die kinders swak, maar vitamien A gebrek was grootliks aangespreek deur die gereelde inname van lewer. 'n Swak antropometriese status is dus nie altyd 'n aanduiding van mikronutriënt tekorte nie en 'n oorkoepelende aanslag van supplementasie is nie noodwendig 'n oplossing in 'n land met diverse kultuur en eetgewoontes nie. Behalwe vir die onmiddelike gevare van ondergewig, dwerggroei en uittering in 'n gemeenskap, het kinders met dwerggroei 'n groter risiko om oorgewig en vetsugtig te word in die langtermyn. Dit kan lewensstyl siektes veroorsaak in latere lewe en 'n verdere las op 'n reeds verswakte gemeenskap plaas. Toepaslike intervensies, gemik op die eerste duisend dae van lewe, behoort 'n prioriteit te wees in hierdie gemeenskap.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/80297
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