Nutrition-Sensitive Intervention With Selected African Indigenous Leafy Vegetables Among School-Going Children In Machakos County, Kenya

ABSTRACT

The 2014 Kenya Demographic Health Survey (KDHS) and Micronutrient Survey reportshowed malnutrition among children aged 5-11 years in Kenya. In particular,malnutrition in Machakos County manifested as stunting (26.3 %), wasting (6.3 %),underweight (12.7 %), marginal vitamin A deficiency (VAD) (33.9 %), anemia (16.5%), zinc deficiency (82.5 %) and iron deficiency (9.4 %). African Indigenous Leafy Vegetables (AILVs) such as Vigna unguiculata and Amaranthus cruentus can be usedto fight malnutrition in school-going children, based on their high micronutrient levels,but they need to be made more available to these children. The cultivation of AILVs aswell as their consumption can be optimized through school garden establishments andthe effect of the AILVs’ consumption on the children’s nutrition status accurately determined. This is to generate data to support the recommendation by 2014 KDHS thatfood based intervention through garden establishment can fight malnutrition. However,empirical data to support this recommendation employs determining body mass index,a limited technique as compared to deuterium dilution isotope (DDI) method that measures fat free mass (FFM) and fat mass (FM). The objective of the study was todetermine the effect of consuming school garden-sourced vegetables on nutritionalstatus of school children in Machakos County, Kenya. This was an experimental crossover design study with 4 weeks in between phases, phase I (13 weeks) and II (12weeks). In phase I study subjects (children aged 6-10 years) who met the inclusioncriteria were grouped as experimental (Kangundo, N=66) and control (Kilalani, N=46).The experimental group fed on a recipe of Vigna unguiculata and Amaranthus cruentus grown in school gardens of Kangundo and Kilalani primary, Machakos, with anaccompaniment of a mixture of maize grains and beans once a day, 5 days a week perphase while the control group had only the accompaniment. The baseline informationon dietary practices, morbidity, socio-demographic, economic factors andanthropometry of children were collected using a structured questionnaire. Hemoglobin(HB) was measured by a hemoglobinometer, while levels of Fe and Zn in raw andcooked recipe and in blood samples were determined using AAS procedure. The bodyFFM and FM was determined by DDI method and saliva analyzed by FourierTransform Infrared (FTIR) spectroscopy, while serum retinol and BC were analyzed byHPLC. Baseline results showed poor consumption of indigenous vegetable (< 20 %),high morbidity (> 40 %), low socio-economic status of the parents/guardians (> 95.6 %who earned . The garden sourced vegetable recipe contained sufficient levels (mg/100g)of Fe 55.465 ± 0.419, Zn 3.430 ± 0.054, and BC 4.299 ± 0.010 to meet the RDA for children. At the end line, the study subjects’ body composition as indicated by the FFM and FM as well as the Fe, Zn and BC levels significantly improved (p < 0.001) during both intervention phases. Further, there was a positive micronutrient impact, as shown significantly higher levels of Fe, Zn, BC, Retinol and HB in the experimental group as compared to the control group at end line (p < 0.001) during both phases I and II. Since consumption of AILVs improves the nutritional status of school-going children the study recommends promotion of school gardens and consumption of school-garden sourcedAILVs to improve nutrition of school-going children.