Dietary intake of vitamin a, household food security and Prevalence of undernutrition among lactating Mothers in Sinai Slum, Nairobi County, Kenya

Abstract

Background Vitamin A deficiency is a problem of public health significance among all the family members including the lactating mothers. In Africa, about 20% of the women of child bearing age are undernourished. In Kenya, 12% of the women 15-49 years are considered thin with a body mass index (BMI) of < 18.5. During the period of lactation, nutrient needs of the lactating mother increase to cater for her needs and the breastfeeding child. Low dietary intake of vitamin A during lactation has been found to result in inadequate concentration in breast. Due to this, undernutrition is common among lactating mothers. Objectives: The objective of this study was to determine the adequacy of dietary intake of vitamin A, prevalence of undernutrition and household food security among lactating mothers aged 16-45 years in Sinai slum, Nairobi County, Kenya. The specific objectives were to determine i) adequacy of dietary intake of vitamin A ii) prevalence of undernutrition iii) Household food security. Methods: A cross sectional study method was employed with participants identified through consecutive sampling. A total of 384 lactating mothers from Sinai slum attending Lunga Lunga health centre participated in the study from March to April 2011. A 24-hour dietary recall and a Food Frequency Questionnaire (FFQ) were used to assess dietary adequacy of vitamin A intake. Prevalence of undernutrition was determined through anthropometric measurements; Body Mass Index and Mid Upper Arm Circumference (MUAC). Household food security was determined using food insecurity access scale and dietary diversity questionnaires. Statistical analysis was done using Microsoft excel and SPSS Version 23.0. Descriptive analysis was used to display participant characteristic while Chi-square test was used to test for associations between inadequate intake of vitamin A, maternal undernutrition, household food security, and sociodemographic factors. Logistic regression was used to determine actual predictors of adequate dietary intake of vitamin A, maternal undernutrition and household food security. Results: A total of 225 (58.6%) lactating mothers had inadequate dietary intake of vitamin A while 120 (31.3%) had low MUAC<220mm and 53(13.8%) had low Body Mass Index (BMI). Low protein intakes correlated with inadequate vitamin A intakes and low MUAC (p=0.043, p=0.035). Energy intake had a statistically significant association with dietary intake of vitamin A and low MUAC (p<0.001). Food insecurity had a statistically significant association with inadequate dietary intakes of Vitamin A, low MUAC and low BMI. Food insecure households were 2 times more likely to have inadequate Vitamin A intakes (p<0.001), low MUAC (p=0.002 and low BMI (p=0.042). The Household Dietary Diversity Score HDDS score was 5.2(SD=2.15). Dietary diversity correlated with inadequate Vitamin A intakes (p=0.003). Length of breastfeeding also correlated with low MUAC (p=0.027). Conclusion: Lactating women in Sinai slums have low dietary intake of vitamin A. Additionally, they are under nourished with characteristic low protein and energy intakes as well as BMI and MUAC. Food insecurity alongside limited purchasing power compromise positive nutritional outcomes for the mothers hence at risk of these multiple micronutrient deficiencies. Recommendations: There is need for well-designed nutrition intervention programs focusing on nutrient intake of affordable foods to increase dietary diversity and food variety of lactating women in this low socio-economic setting. Concurrent nutrition sensitization, distribution of nutritional supplements and empowerment programs through income generating activities, developing policies and comprehensive approaches, integrating foodbased strategies by the government to address the high prevalence of undernutrition among lactating mothers. Such interventions would improve their nutritional status as well ultimately reduce vitamin A deficiencies. vi