A systematic review was conducted to evaluate the status and intake of iron, vitamin A, iodine, folate and zinc in women of reproductive age (WRA) (≥15–49 years) and pregnant women (PW) in Ethiopia, Kenya, Nigeria and South Africa. National and subnational data published between 2005 and 2015 were searched via Medline, Scopus and national public health websites. Per micronutrient, relevant data were pooled into an average prevalence of deficiency, weighted by sample size (WAVG). Inadequate intakes were estimated from mean (SD) intakes. This review included 65 surveys and studies from Ethiopia (21), Kenya (11), Nigeria (21) and South Africa (12). In WRA, WAVG prevalence of anaemia ranged from 18–51%, iron deficiency 9–18%, and iron deficiency anaemia at 10%. In PW, the prevalence was higher, and ranged from 32–62%, 19–61%, and 9–47%, respectively. In WRA, prevalence of vitamin A, iodine, zinc and folate deficiencies ranged from 4–22%, 22–55%, 34% and 46%, while in PW these ranged from 21–48%, 87%, 46–76% and 3–12% respectively. Inadequate intakes of these micronutrients are high and corresponded with the prevalence figures. Our findings indicate that nationally representative data are needed to guide the development of nutrition interventions and public health programs, such as dietary diversification, micronutrient fortification and supplementation.

Background: Maize-meal porridge is used for infant feeding in many African countries, including South Africa. A low-cost, finely milled, maize-meal porridge was fortified with β-carotene, iron, and zinc (100% of recommended dietary allowance), as well as ascorbic acid, copper, selenium, riboflavin, vitamin B-6, vitamin B-12, and vitamin E. Objective: We assessed whether the fortified porridge could reduce anemia and improve the micronutrient status and motor development of infants. Design: Infants aged 6–12 mo (n = 361) were randomly assigned to receive either the fortified or unfortified porridge for 6 mo. Primary outcomes were hemoglobin and serum retinol, zinc, and ferritin concentrations and motor development. Growth was assessed as a secondary outcome. Primary and secondary outcomes were assessed at baseline and 6 mo. Results: Two hundred ninety-two infants completed the study. The fortified-porridge group had an intervention effect of 9.4 μg/L (95% CI: 3.6, 15.1 μg/L) for serum ferritin and 9 g/L (95% CI: 6, 12 g/L) for hemoglobin concentrations. The proportion of infants with anemia decreased from 45% to 17% in the fortified-porridge group, whereas it remained >40% in the control group. The fortified-porridge group achieved on average 15.5 of the 25 motor development score items, whereas the control group achieved 14.4 items (P = 0.007). Serum retinol concentration showed an inconsistent effect, and no intervention effect was observed for serum zinc concentrations. Conclusions: This low-cost fortified porridge can potentially have a significant effect in reducing anemia and improving iron status and motor development of infants in poor settings. The formulation needs some adjustment in terms of zinc fortification.

Objective: To perform a systematic review to evaluate iron, vitamin A, zinc, and iodine status and intakes in children and adolescents (0-19 years) in Ethiopia, Kenya, Nigeria, and South Africa. Method: Both national and subnational data published from the year 2005 to 2015 were searched via MEDLINE, Scopus, and national public health websites. For each micronutrient and country, status data from relevant studies and surveys were combined into an average prevalence and weighted by sample size (WAVG). Inadequate intakes were estimated from mean (SD) intakes. Results: This review included 55 surveys and studies, 17 from Ethiopia, 11 from Kenya, 12 from Nigeria, and 16 from South Africa. The WAVG prevalence of anemia ranged from 25% to 53%, iron deficiency from 12% to 29%, vitamin A deficiency (VAD) from 14% to 42%, zinc deficiency from 32% to 63%, and iodine deficiency from 15% to 86% in children aged 0 to 19 years from 4 countries. Generally, children 15 ppm) salt ranged from 2% in Kenya to 96% in Ethiopia. Conclusion: With large variation within the 4 African countries, our data indicate that anemia and vitamin A, zinc, and iodine deficiencies are problems of public health significance. Effective public health strategies such as dietary diversification and food fortification are needed to improve micronutrient intake in both younger and older children.

Background: Production of yellow and dark-green leafy vegetables at the household level may provide economically deprived households with direct access to provitamin A–rich foods. Objective: The aim of the study was to determine whether the dietary intake of yellow and dark-green leafy vegetables and the serum retinol concentrations of children improve with a home-gardening program. Design: A home-gardening program was integrated with a community-based growth-monitoring system in a rural village. Cross-sectional data were collected at baseline and 20 mo after implementation of the program. The dietary intake, serum retinol concentrations, and growth of 2–5-y-old children and maternal knowledge regarding vitamin A were determined. A neighboring village served as a control village. Results: In the experimental village, 126 home gardens were established, representing approximately one-third of the households. Serum retinol concentrations in the experimental village increased significantly (P = 0.0078), whereas those in the control village decreased significantly (P = 0.0148). At follow-up, children from the experimental village consumed yellow and dark-green leafy vegetables more often and had significantly higher (P = 0.005) serum retinol concentrations (0.81 ± 0.22 μmol/L; n = 110) than did children from the control village (0.73 ± 0.19 μmol/L; n = 111). Maternal knowledge regarding vitamin A improved significantly in the experimental village (P = 0.001). Conclusion: A home-gardening program that was integrated with a primary health care activity, linked to nutrition education, and focused on the production of yellow and dark-green leafy vegetables significantly improved the vitamin A status of 2–5-y-old children in a rural village in South Africa.

Objectives: The objectives of this study were to determine the availability of, access to and nutrition-related uses of African leafy vegetables in rural and urban households; and to determine the β-carotene content of the dominant African leafy vegetable. Design: The study consisted of a qualitative explorative phase (field walks, semi-structured interviews with key informants, focus group discussions) at two rural sites; and a quantitative household survey (questionnaire) at two rural and one urban site. Amaranth leaves were analysed for β-carotene content. Setting and subjects: The household survey included households at a rural site in Limpopo province (n = 100); and a rural (n = 101) and urban (n = 391) site in KwaZulu-Natal province, South Africa. Results: A variety of edible plants were identified during field walks at the two rural sites. Focus group discussions narrowed this down to ten plants at the rural Limpopo site and six at the rural KwaZulu-Natal site. The most popular leaves were amaranth (Amaranthus spp), spider plant (Cleome gynandra), wild watermelon (Citrullus lanatus) and blackjack (Bidens spinosa), consumed individually or mixed with other leaves. Rural households procured leaves mostly from the wild whereas urban households relied more on informal markets. In Limpopo, leaves were dried and stored for consumption during winter. KwaZulu-Natal households considered African leafy vegetables food for the poor. Leaves were boiled in salted water, or steamed and then fried in oil. Fried and boiled amaranth leaves contained 627 and 429 µg retinol activity equivalents/100 g respectively. Conclusions: Availability of, access to and nutrition-related uses of African leafy vegetables are context-specific, with inter- and intraprovincial rural/urban differences. Information collected during small studies within a specific area can therefore not be generalised for the overall South-African population. Amaranth can potentially contribute significantly to vitamin A requirements of nutritionally vulnerable communities.