Effectiveness Of Fortified Sunflower Oil On Retinol Status Of Underfive Children And Lactating Mothers In Manyara And Shinyanga Regions, Tanzania

EXTENDED ABSTRACT

Vitamin A Deficiency (VAD) continues to be a public health problem in low income countries including Tanzania. It affects the vulnerable social groups namely women of reproductive age (15-45 years) including pregnant women and lactating mothers; and children below five years. Despite the Government’s efforts to eliminate VAD among the lactating mothers and children below five years, the prevalence is still very high. Vitamin A deficiency in Tanzania accounts for approximately one-third in children below five years, 39% of pregnant women and 35% for lactating mothers. The main underlying cause of VAD is a diet that is chronically insufficient in vitamin A. One intervention to eliminate vitamin A deficiency in this study was fortification of virgin sunflower oil with vitamin A. Despite the fact that utilization of the fortified cooking oil with vitamin A at household level is increasing rapidly in Tanzania, there is little information on the use of fortified cooking oil with vitamin A as the major source for preventing VAD. Therefore, the present study was designed to fill the gap by evaluating the effectiveness of fortifying virgin sunflower oil with vitamin A on the retinol status of children below five years and lactating mothers in Manyara and Shinyanga regions of Tanzania. Each region involved three intervention districts and one control district. Intervention districts were involved in consumption of fortified virgin sunflower oil with vitamin A in the households. The fortification level of vitamin A in the sunflower oil was 30-40 mg/kg as per East African Standards recommendation. No control was made on the amount of oil to be used in the preparation of any meal in the household. Intervention districts were encouraged to buy fortified sunflower oil from the specified shops where the fortified oil was sold at subsidized rate of 2100 Tshs per liter and use it for preparing food. For mothers who were not able to liters (1 L, 3 L, 5 L and 20 L container) there was fortified sunflower oil with vitamin A sold in small quantities known as coops. Through socio-marketing, this group iii was also encouraged to consume vitamin A rich foods and diversify their diets. During intervention period the control groups were not receiving sunflower oil fortified with vitamin A. Instead, they were encouraged to use unfortified sunflower oil for cooking and consume vitamin A rich foods as well as diversifying their diets. During intervention period, mothers were visited at their households by the village health workers and homebased care providers once every week to monitor compliance to the use of the fortified oil. They were encouraged to buy the fortified sunflower oil and use it for food preparation. Control groups started receiving the fortified sunflower oil after the intervention period of 18 months. Assessment of consumption of fortified sunflower oil with vitamin A was carried out in the intervention districts where fortified virgin sunflower oil with vitamin A in the households was practiced. A total of 569 mother-child pair was involved to evaluate the potential use of the fortified virgin sunflower oil in controlling vitamin A deficiency. Retinol in the Dry Blood Samples was determined by Retinol Binding Protein enzyme linked immune assay (ELISA) method while Retinol in the oil was determined by HPLC method. Results revealed that, at baseline about 60% (n=313) of the oil samples from the households had retinol concentration level below 20 mg/kg, out of which majority were from Manyara (n=245, 47%) and only few samples (n=68, 13%) were from Shinyanga. At end-line, majority of households oil samples (89.9%, n=471 of the) had retinol concentration of 20-40 mg/kg, which these values were within the recommendation by East African Standards EAS 269:2017 (TZS 1313:2014) fortified edible oils and fats specification. Baseline mean serum retinol concentrations of the children and lactating mothers in the control districts were 14.63±5.31 and 20.75±7.32 µg/ml, respectively, while in the intervention districts, the mean serum retinol concentrations for the children and lactating mothers were 15.14±5.44 and 20.10 ±7.33 µg/ml, respectively. These values were lower than those recommended by World Health Organization which defines the plasma retinol concentrations of