Improving the iron status of children in Kisumu county Kenya using porridge flour enriched with bovine blood
There is a high prevalence of iron deficiency and anaemia in Kenya with young children and mothers bearing the greatest burden. Bovine blood is acceptable food in Kenya but it largely goes to waste. It therefore could be used to improve local diets as a strategy for preventing anaemia. This study evaluated the effect of consumption of bovine blood enriched porridge, on the iron status of anaemic preschool children in a malaria endemic region of Kenya. A rapid assessment was conducted to determine knowledge, attitudes and practices related to anaemia and bovine blood use in East sub-countyof Kisumu County. This involved four key informant interviews, four focus group discussions, free listing and observations of slaughter houses. This was followed by biochemical screening of 270 children for haemoglobin status. A total of 140 children were tested and out of these a sample of 102 children were selected for the household survey and the intervention. A structured questionnaire was used in the baseline householdsurvey to collect background data on socio-demographic and socio-economic characteristics, food consumption, anthropometric measurements and morbidity characteristics of the children. Iron status was also assessed. Based on the knowledge from the rapid assessment, porridge flour was developed from sorghum, millet and cassava flours and enriched with bovine blood powder. The flours and bovine blood powder were analysed for proximate composition and specific mineral contents. Using the results, Nutri-survey modelling was used to formulate the composite porridge flours to provide approximately 50% of the iron RDA for young children. Sensory evaluation was performed to determine the most acceptable porridge flour. The most acceptable flour was then subjected to shelf life evaluation tests. During the intervention phase of the study, children were randomly allocated to two feeding groups. One group was fed with the porridge containing the blood (intervention group) and the other with the porridge without blood (placebo group). The feeding period lasted six weeks, after which the children were re-evaluated for haemoglobin and iron status. Qualitative and quantitative data were analysed with the help of ATLAS ti, Nutrisurvey and IBM SPSS Statistics Base, version 22 respectively. Summary statistics for age, sex, socio-demographics, anthropometry, and biochemical indicators at baseline were determined to describe the study population. Analysis of covariance was used to determine any differences between treatment groups, and group-specific effect sizes calculated and P < 0.05 was considered significant. Results of the rapid assessment indicated that the community was aware of anaemia and its main causes. Bovine blood is well-accepted as food and traditional methods exist for it’s preparation for consumption and preservation. The most acceptable porridge mix contained sorghum: finger millet: cassava: blood powder in the ratios of 6:14:10:0.5 respectively, andprovided 54% of the recommended daily intake of iron for 1-3 year old children, when consummed as one cup of porridge daily. The mix had a better shelf life when stored at 35ºC for up to three months. Out of 270 children screened, 51.86% were anaemic and 34.7% suffered from iron deficiency anaemia. There were no significant differences in the baseline characteristics, morbidity status and nutritional status of children in both feeding groups (p>0.05). The dietary recall indicated that most children (88.9%) were receiving less than the RDA foriron. The prevalence rates of stunting, wasting and underweight were 24.5% and 10.8% and 16.7% respectively. After six weeks of intervention 52.6% of the children achieved normal haemoglobin levels, mostly from the intervention groupwhich had significantly(p= 0.000) higher levels compared to the placebo group.There was also a significant (p< 0.05) difference in soluble transferrin receptor levels between the two groups. However, the mean change in serum ferritin between the groups was not significant (p = 0.080). The study concludes that porridge flour formulated from sorghum, millet, cassava and bovine blood can be effectively used to improve the iron status of anaemic children living in malaria endemicregions of Kenya.