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.
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