Effect of nutrition education and promotion of orange-fleshed sweet potato on vitamin-A intake and nutritional status of children in Kampala

Abstract

Regular consumption of orange-fleshed sweet potato (OFSP) can significantly increase levels of serum retinol, thus reducing the prevalence and severity of vitamin A deficiency (VAD) in children. For two years preceding this study, two cultivars of OFSP, ejumula and kakamega (SPK004/6/6), were promoted along with nutrition education as a means of controlling VAD. This study was designed to determine the change in vitamin A intake and to determine the nutritional status of 2-6 year old children among households that benefited from nutrition education and OFSP production promotion, extended during the OFSP Projects. A cross-sectional study was carried out using a “with and without project” comparison among communities which had benefited from the OFSP projects at selected schools of Kawempe, Rubaga and Nakawa divisions, Kampala District. Nutrition Education had been conducted in Kawempe and Nakawa divisions while Rubaga and Kawempe divisions had benefited from OFSP Production. Households were sampled from each of the participating school communities, including Makindye division as the control division, i.e. had not benefited from either of the interventions. A sample size of 377 households did participate in the study. Data collection was done using the Interactive 24 Hour Recall method and the Helen Keller International Food Frequency Questionnaire (HKI FFQ). The main survey was done during the month of August 2006 while the mini survey was done in October 2006, based on a sub sample of 120 households randomly selected from the original 377 of the main survey. The purpose of the mini/ nested survey was to assess consistency of the household practices. The data were captured using the Census and Survey Processing Program, CSPro 3.2, and exported to SPSS for analysis. In order to determine the general nutritional status of the index child, two body measurements were taken; weight and height, alongside the age. The data were analysed using the WHO Anthropometric Calculator, from which z-scores were generated and tabulated for the following indices: height-for-age, weight-for-age, weight-for-height and body mass index (BMI) for age. The results from both surveys showed a significant difference (p < 0.05) in the frequency of consumption of OFSP between the intervention divisions and the control divisions. The mean number of days for which OFSP was consumed in all the intervention divisions was significantly higher than that in Makindye division. The mean for Kawempe division was 1.783, Rubaga 0.992, while that of Nakawa was 1.33 above that of Makindye division. Children from Kawempe division had the highest mean daily consumption (223.50g) while those from Makindye had the lowest (9.86g). The mean consumptions of Kawempe, Rubaga and Nakawa (223.50, 193.53 and 123.23, respectively) were each significantly above that of Makindye division (9.86). The mean vitamin A intake was within the normal range (500-15,000µgRE). However, results revealed a significant difference (p < 0.05) only for households involved in the nested survey where the mean vitamin A intake for Kawempe (1620.13) was significantly higher than that for Makindye (1002.10), which was significantly lower than that for Nakawa (2582.86). Results of the paired sample test showed no significant difference (p > 0.05) between the vitamin A intakes during the two different study periods for households in Kawempe and Makindye divisions. The mean weight-for-age z-scores (WAZ) and Height-for-age z-scores (HAZ) was below the WHO standard mean for the index children in all the divisions except for Makindye Division. Weight-for-height z-scores (WHZ) of the index children in all the divisions had a mean well beyond the WHO standard mean. Children in Makindye Division were the most hit by wasting, much as children from all divisions appeared to be above the WHO standard mean for wasting. The picture cast by the BMI results still showed that Makindye was most affected by malnutrition. Conclusively, nutrition education aimed at increased consumption of OFSP translated into its increased consumption. However, the synergy of both nutrition education and OFSP production promotion was greater than the effect of each intervention singly. While the intake of vitamin A was generally commendable, it could not be entirely attributed to the project interventions.Wasting and chronic energy deficiency (CED) were more prevalent in the control division than in all the others. In conclusion therefore, both nutrition education and OFSP production promotion were effective in improving the nutritional status of children as reflected in the areas with or without project activities. The prevalence of stunting and underweight still warrant a public health intervention in all the divisions which benefited from the project activities.