Moringa Oleifera leaf supplementation on vitamin A status of children in Ada-East district of Ghana

Abstract

Globally over 195 million pre-school children are vitamin A deficient, whilst in Ghana, it was estimated that 72 % of pre-school children are vitamin A deficient. Periodic administration of high dose vitamin A capsules is currently used as a prevention strategy, but this requires appropriate healthcare infrastructure and is donor dependent, hence may not be sustainable if donor support is withdrawn. Inadequate dietary intake of vitamin A-rich foods is a major etiological factor in vitamin A deficiency, so one other prevention strategy could be to promote the consumption of these foods. Plant-based foods such as orange-fleshed roots and tubers, fruits and dark green leafy vegetables like Moringa oleifera (M. oleifera) leaves are rich sources of pro-vitamin A carotenoids that could be beneficial to vulnerable populations in low socio-economic households who mostly derive their nutrition from plant sources. M. oleifera leaves have been reported to improve retinol levels in rats. However, there are only anecdotal reports on the ability of M. oleifera leaves to improve retinol levels in humans. There is the need therefore to conduct evidence-based research to assess the effect of M. oleifera leaves on retinol levels in humans. The objective of the study was to assess the efficacy of M. oleifera leaf supplementation to improve the vitamin A status of children in Ada-East district of Ghana. The interventional study was preceded by an assessment of dietary uses of M. oleifera leaves in Ada-East district through a community survey of mothers/caregivers aged 19 years and above, and an acceptability test of M. oleifera leaf-fortified dishes by children in Ada-East district. Thereafter,children aged 5-12 years were randomized to either receive or not receive dried M. oleifera leaves for 9 weeks in three local dishes. The Intervention group (n = 85) consumed M. oleifera leaf-fortified dishes at 0.2 g/kg body weight, three times a week, whilst the Control group (n = 85) consumed the same food without M. oleifera leaves. Vitamin A, haemoglobin, haematocrit, erythrocytes, mean corpuscular volume, kidney and liver chemistry, and infections were assessed at the beginning and end of study. Vitamin A was assessed by high performance liquid chromatography (HPLC). Red blood indices were assessed on EDTA whole blood samples in the laboratory using Sysmex KX - 21N, an automated haematology analyser. Kidney and liver chemistry were assessed with EliTech clinical systems kits. One hundred and eighty (79.7 %) of respondents use M. oleifera leaves as a food ingredient in the district, but on an irregular basis, while two hundred and twelve (93.8 %) said they would feed their children when requested to do so, because they learned the leaves would make the children strong. M. oleifera leaf-fortified dishes were also highly acceptable to the children. Leaf supplementation improved retinol levels in the Intervention group significantly (P < 0.05). Those with marginal vitamin A status (serum retinol < 0.7 μmol/l) at baseline showed significant increases at end of study. There was a significant positive association between vitamin A and haemoglobin in the Intervention group (P < 0.05), but not in the Control group. All markers of kidney and liver safety did not show any significant changes at end of study. M. oleifera leaf supplementation was efficacious to improve the vitamin A status of children in Ada-East district of Ghana