Enhancing Haemoglobin Status of Anaemic School Girls Using Cooked Vegetables Enriched With Baobab Powder in Kilifi County- Kenya

Abstract

Anaemia and especially iron deficiency anaemia remain one of the most significant nutritional deficiency in the world affecting approximately 30% of the population. This is more so in countries like Kenya being developing countries. Women of child bearing age and adolescents bear the largest burden. Previous studies have identified inadequate dietary intake and poor absorption of iron as the main causes of anaemia. The study evaluated the effect of consuming cooked vegetables enriched with baobab powder, on haemoglobin status of anaemic adolescent girls in Kilifi, Kenya. A rapid assessment was conducted to determine knowledge attitude and prevalence of anaemia in Kilifi County through four key informant interviews. A structure questionnaire was used to collect socio-demographic and socio-economic data, morbidity data and food consumption habits of adolescent girls. Analyses were carried out to determine the iron content of the vegetables Amaranth and Solanum nigram and the vitamin C content of the baobab grown at the study site. The iron content of raw Solanum nigrum was 5.5mg/100g and of amaranths at 4.4mg/100g. However, the iron content of cooked vegetables in the serving of 225g was 6.2mg and 4.5mg respectively. The vitamin C content of baobab powder was 106mg/100g. Each serving of the mixed vegetable (225g) was enriched with 10g of baobab powder containing 10.6mg of vitamin C. Systematic random sampling was used to select 112 adolescent girls from the entire school population using the class registers. From the sampled girls 101 were screened for haemoglobin level, after obtaining parental consent during the baseline testing. Reagent less method using a HemoCue machine was used to assess the haemoglobin level of each of the girls. 32 out of the 101 girls had a haemoglobin of < 11.9 g/dl and hence were recruited into the feeding trial. During the intervention, the 32 anaemic adolescent girls were allocated into two feeding groups consisting of 16 girls in each group. One group was served with mixed vegetables enriched with 10g of baobab powder in each serving of (225g) and the other group with vegetables without baobab powder (placebo) during the scheduled school lunch. The feeding xiii period lasted 30days, after which 31 adolescent girls who completed the feeding trial were re- evaluated for haemoglobin level. Data analysis was done using SPSS version 23. Descriptive statistics (frequencies, mean and percentile) were used to describe the study population. Bivariate and multivariable logistic regression were used to determine associated factors (diet consumption habits, age of participant with the haemoglobin level) and T-test was used to compare means of the two feeding groups. The result show that the prevalence of anaemia among the sampled population at baseline was 31.7%, out of which 9.4% had severe anaemia (<8.0g/dl), 40.6% had moderate anaemia (8.0-10.9g/dl) and 50% mild anaemia (11.0-11.9g/dl). A comparison between the two feeding groups indicated the mean baseline haemoglobin were lower in the intervention group (10.5g/dl) compared to the control group (11.2g/dl). Although the difference was not significant (P=0.052). After the 30 days of feeding trial 14 girls representing 45.2% of the adolescent girls achieved normal Hb (>11.9g/dl). The mean final haemoglobin concentration for the intervention group was 11.6g/dl and for control at 11.8g/dl with a mean change of 1.1g/dl and 0.6g/dl respectively. This was significant at (P=0.045). In conclusion, indigenous green leafy vegetables are a good source of iron and are availability all year round in the study area. Baobab being a rich source of vitamin C with a shelf life of up to 3 months can be used concurrently with the vegetables to enhance the absorption of iron and hence improve anaemia significantly. Almost half of the adolescent girls who completed the feeding trial 14 out of the 31 achieved normal Hb of >11.9 with an average rate of increase of 1.0g/dl mostly from the intervention group, thus can be concluded that cooked vegetables enriched with baobab powder can effectively improve haemoglobin level of anaemic adolescent girls