| dc.description.abstract | Introduction: Chinsaga (Gynandropsis gynandra (L.)) is a leafy vegetable
indigenous to Africa, and is an important component of the traditional diet
of the people of western Kenya such as the Abagusii, who refer to it as
Chinsaga. The Abagusii believed Chinsaga has powerful blood restorative
properties, and is recommended for pregnant and lactating women as a
hematinic and immunostimulant.
Objective: This study sought to provide scientific validation for the
traditional use of Gynandropsis gynandra (L.) among the Kisii community
(Abagusii) in promoting maternal and child nutrition. This was done by
assessing the impact of Gynandropsis gynandra (Chinsaga) consumption on
the hematological profile and selected iron metabolism biomarkers among
lactating women at Kenyatta National Hospital as indicators of nutritional
status. The study also aimed at documenting the socioeconomic value of
Chinsaga and chromatographic characterization of the plant sourced from
Kilgoris and Kisii.
Methodology: A cross-sectional survey was undertaken to examine the
socioeconomic value and trade of Chinsaga in Kisii and Kilgoris followed by
plant collection and processing to provide material for a clinical study. A
sample of the processed material was subjected to chromatographic
characterization using Thin Layer (TLC) and High Performance Liquid
(HPLC) Chromatography.
The study was reviewed and granted ethics approval by the Kenyatta
National Hospital – University of Nairobi Ethics and Research Committee
(KNH-UoN ERC), reference number: KNH-ERC/01/3757. A randomized
triple blind controlled study was carried out at Kenyatta National Hospital
Maternal Child Health Clinic 17. The study enrolled 119 women below 35
years of age, with a maximum of 4 live births and between their first and
second month after delivery. The two arm study evaluated the effects of
Chinsaga consumption on hematological profile and on selected markers of
iron metabolism. The comparator intervention was dietary supplementation
with processed kale (Brassica carinata). Participants were followed for 28
days and anthropometrics, demographics, blood and milk specimens were
collected. The pre and post treatment hematological laboratory parameters
tested included; ferritin, transferritin and lactoferrin as biomarkers of iron
metabolism.
Results: Chinsaga trade has a well structured supply chain with:
producers; collectors; wholesalers; retailers and consumers in a variety of
combinations. The highest demand is in urban areas. Commercial
agriculture of Chinsaga has good prospects; however farm sizes are
declining.
The plant undergoes three stages of maturation as described by farmers:
Omonyenye (germination to four weeks); Amasabore (week 4 to 8) and
Ekegoko, (mature stage). The Amasabore and Ekegoko are recommended for
lactating mothers. A chromatographic fingerprint of Chinsaga was
developed using ethyl acetate: methanol: water (50:20:10) on thin layer
chromatography (TLC) and greater resolution achieved using gradient
elution on HPLC-UV with acetonitrile, propan-2-ol, water and formic acid
(0.4%) in the ratios 85:35:25, adjusted to pH 2.3 as mobile phase on a C18
column.
In the clinical study involving lactating mothers, Chinsaga supplementation
was associated with significantly higher values of Red Blood Cell Counts
(RBC) in the 2nd visit (median 4.79 Interquatile Range (IQR) 4.51 – 5.05,
p=0.03) and 3rd visit (median 4.85, (IQR 4.46 – 5.18, p=0.03) compared to
the control arm. Similar differences across arms were observed with
changes in mean corpuscular volume; (median 27.3, IQR 25.5 – 29, p=0.03)
and hemoglobin concentration (median 27.5, IQR 25.85 – 28.85, p=0.05).
However there were no statistically significant differences across arms for
hemotocrit, (median 39.2, IQR 33.9 – 40.3, p=0.31) and hemoglobulin
(median 13.3, IQR 11.7 – 13.85, p=0.42).
On stratified data analysis, the effects of Chinsaga are dependent on patient
reported duration of iron intake. The effects of Chinsaga on RBC count were
most prominent in patients who had taken iron supplements for at least 1
month. On bivariable generalized linear regression modeling, the other
variables that were positively associated with RBC counts and with p< 0.05
were; duration of stay at the current residence, age of husband, Njahe,
Ugali and Cocoa. However, on adjusting for confounding, only cocoa
consumption had a statistically negative effect on RBC counts (adjusted β 6.735
± 1.827 P=0.00).
At a molecular level, there was progressive increase in transferrin gene
expression during the three clinic visits. The highest mean was observed in
the third visit (2.3, 95% C I (4.49 , 0.170).
Conclusion and recommendations: This study confirms the cultural value
of Chinsaga and its socioeconomic benefit to the community of the Kisii by
providing scientific data supporting the folklore use of Chinsaga by
breastfeeding mothers for blood restoration as evidenced by the
improvement of the hematological profile and effects on markers of iron
metabolism. Chinsaga is a viable commercial crop that should be exploited
for the socioeconomic benefit of Kenyans. Studies are needed to examine
the effect of Chinsaga diet on enhancing breast milk quantity. This study
exposes a gap in the knowledge and the need to conduct similar studies on
traditional vegetables and foods consumed by various communities in
Kenya. Such action will help preserve what is known and promote the
incorporation of the traditional vegetables into the diet for the benefit of
mankind. In addition, this study has demonstrated feasibility and provided
a model for the design and conduct similar studies. | en_US |
| dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
