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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 23-26

Caregivers' knowledge and perception of iron content in common staple foods consumed in Southeastern Nigeria


1 Department of Paediatrics, Enugu State University of Science and Technology, Enugu, Nigeria
2 Child Survival Unit, Medical Research Council, The Gambia Unit, Gambia, UK
3 Department of Pediatrics, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria

Date of Submission17-Aug-2020
Date of Decision01-Sep-2020
Date of Acceptance21-Sep-2020
Date of Web Publication18-Dec-2020

Correspondence Address:
Dr. Chidiebere D. I. Osuorah
Child Survival Unit, Medical Research Council, The Gambia Unit
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJFNS.IJFNS_23_20

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  Abstract 


Background: Iron-deficiency anemia remains a major cause of morbidity and mortality of children in our environment. The knowledge of its function and food-rich sources of iron among mothers and/or caregivers will go a long way to mitigate the growth and developmental consequences of iron deficiency in children.
Methods: Due to the high prevalence of iron-deficiency anemia in our locality, we set out to determine the knowledge of mothers and/or caregivers of the richest source of iron among all staple foods commonly consumed in our locality and their awareness of cooking methods that degrade the dietary iron. This cross-sectional hospital study conducted over an 8-month period recruited and interviewed 407 mothers/caregivers attending the Children's Outpatient Clinic of the Enugu State University Teaching Hospital using illustrated self-administered questionnaires.
Results: A vast majority (90.9%) were aware of dietary iron, but when further questioned about its source and function, almost all respondents (99.2%) considered unripe plantain as the richest food source of iron. None chose cowpea which contains the highest iron content. Likewise, none identified cooking practices that reduce dietary iron availability. Eighteen (4.4%) correctly recognized individuals at the highest risk for iron deficiency, whereas only 5 (2.4%) and 1 (0.3%), respectively, correctly selected all the correct functions of iron and ways it can be lost in the body.
Conclusion: Respondents in our study have absolutely no knowledge of cowpea, the richest and cheapest sources of iron in our environment. There is consequently a need to create a comprehensive nutritional campaign, especially during antenatal and well-child clinic visits, to educate parents/caregivers on local and readily available iron-rich food sources and cooking practices while discouraging cooking practices that could potentially degrade elemental iron in these food sources.

Keywords: Iron, knowledge, Southeastern Nigeria, staple food


How to cite this article:
Ekwochi U, Osuorah CD, Ndu IK, Asinobi IN, Onah SK. Caregivers' knowledge and perception of iron content in common staple foods consumed in Southeastern Nigeria. Int J Food Nutr Sci 2020;9:23-6

How to cite this URL:
Ekwochi U, Osuorah CD, Ndu IK, Asinobi IN, Onah SK. Caregivers' knowledge and perception of iron content in common staple foods consumed in Southeastern Nigeria. Int J Food Nutr Sci [serial online] 2020 [cited 2021 Jan 23];9:23-6. Available from: https://www.ijfans.org/text.asp?2020/9/2/23/303925




  Introduction Top


Iron is an important micronutrient involved in hemoglobin production. It has also been shown to play an essential role in neuronal function and optimal development of the brain. Hence, children with iron deficiency have been shown to have poor school performance. Iron deficiency is a common cause of anemia in children.[1],[2] The major source of iron in humans is nutritional, and the iron content of some Nigerian foods and the effect of their procession modalities on their net iron content have been documented in some studies.[3],[4],[5],[6],[7] The various channels through which iron can be lost from the human system are also available in literatures.[8],[9] Therefore, iron level in an individual will depend on iron content of the individual's foods, how these foods were processed and the rate at which iron has been lost from the individual's system. Based on our personal experience with parents and/or caregivers of children seen in the Pediatric Out- and Inpatient Department of the Enugu State University Teaching Hospital (ESUTH), there is a common and erroneous belief among parents and caregivers that unripe banana is the richest source of elemental iron in diets. This is contrary to documented evidence which shows that cowpea contains 8.27 mg iron per 100 g sample[10] of elemental iron compared to unripe plantain which has 2.53 mg iron per 100 g sample of elemental iron.[11] With high prevalence of micro- and macronutrient deficiency in Nigeria, the knowledge and perception among parents and/or caregivers regarding common foods with the highest iron content, roles of iron in development of the child, how iron can be lost from the body, and food processing techniques that can affect the bioavailability of dietary iron in a child's diet is important. This knowledge we imagine would help in proper preparation and preservation of food with rich iron content needed for proper hematological and neurological development of the child. This cross-sectional study was, therefore, designed to ascertain caregivers' knowledge and perception concerning iron and its availability in common Nigerian foods.


  Methods Top


This is a cross-sectional and descriptive study conducted among the caregivers of children attending the Children's Outpatient Clinic of the ESUTH, Parklane, Southeastern Nigeria. The study was conducted over an 8-month period spanning May–December 2019 using illustrated self-administered questionnaires. The questionnaires were self-administered and trained research assistants were available to provide explanations when required. The first section of the questionnaire obtained the biodemographic profiles of the respondents which were categorized as follows: age which was categorized into the following: 20–24 years, 25–29 years, 30–34 years, 35–39 years, and >40 years; gender of respondents (male or female); highest attained educational level stratified into primary or lower; and completed secondary and postsecondary education. The occupation of respondents was categorized into unemployed, unskilled, semi-skilled, and skilled workers. Other demographic variables obtained included the socioeconomic status of respondents categorized as low, middle, and high and number of children the respondents have nursed in the past 2 years grouped into ≤4 and >4 children.

The second section of the questionnaire surveyed the general knowledge of respondents concerning iron in terms of its function, availability in the common staple foods by asking them to identify the food with the richest source of iron, and the group of people at risk of iron deficiency. To enhance understanding of the concepts, pictures of the common staple foods under study were illustrated in the questionnaires. Other information obtained included the food processing methods that affect the bioavailability of iron and the various ways iron could be lost from the body.

Ethical approval was obtained from the Ethics and Research Committee of the ESUTH, and informed consent was obtained from the caregivers in language they understand. All the data obtained were recorded into Microsoft Excel sheet and analyzed using SPSS version 19 (SPSS Inc., Chicago, IL, USA) software. Continuous variables were reported in percentages. Participants with significant missing data were excluded from the analysis.


  Results Top


Characteristics of study participants

[Table 1] shows the sociodemographics of study participants. In all, 407 respondents were enrolled in the study. Majority (97.6%) were women, with only 7 (2.4%) being male. Seventy-nine (19.6%) were 29 years or younger and 50 (12.4%) were over 40 years of age. Slightly over one-third were in the 30–34 years (30.8%) and 35–40 (37.2%) years' age categories. Respondents with completed secondary education made up 42.8% of the respondents, whereas those with primary education or less and postsecondary education accounted for 9.3% and 47.9%, respectively. Seventy-one (19.8%) of the study participants were skilled and/or senior worker with occupations such as professionals, managers, large-scale businessmen, and contractors. One hundred and twenty-eight (31.4%) were semi-skilled and/or mid-level workers such as intermediate grade civil servants, senior schoolteachers, and nurses, whereas 93 (25.5%) are unskilled and/or junior grade workers such artisans, junior school teachers, drivers, artisans, petty traders, laborers, and messengers. The remaining seventy-two (19.8%) respondents were unemployed. About 1-in-10 of those interviewed had nursed more than 4 children under the age of 5 in the past 2 years, whereas the vast majority, 335 (87.0%), had nursed ≤4 children [Table 1].
Table 1: Sociodemographic characteristics of respondents

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Perception of properties of elemental iron among respondents

[Table 2] and [Table 3] summarize the responses of participants to their knowledge and perception of elemental iron and its properties in group and development of children. A vast majority (90.9%) stated that they have heard of dietary iron, but when further questioned about its properties, they had inadequate knowledge of its source and function. When asked about the function of iron in the child, 194 (24.4%) and 11 (1.4%) stated that it helps in blood formation and brain development, respectively, with only 5 (2.4%) correctly indicating that it aids both in blood formation and brain development. Other incorrect responses are shown in [Table 2]. When questioned on the food type with the highest content of iron, all (99.2%) but three respondents picked unripe plantain. One (0.3%) mentioned maize and 2 (0.5%) soya beans as food source with the highest iron. None mentioned cowpea. On the inquiry about a group of individuals prone to iron deficiency, 281 (29.4%) listed pregnant women, premature babies 136 (14.2%), menstruating females 118 (12.4%), malnourished children 103 (10.8%), infants 313 (32.8%), and 4 (0.4%) stated young males. However, only 18 (4.4%) respondents correctly mentioned all the four categories of people at risk of iron deficiency [Table 3]. Regarding food processing technique that affects the bioavailability of iron in food, over half (55.2%) incorrectly mentioned frying and about one-third (3.7%) had no idea. The remaining incorrectly listed dehausting (1.3%), fermenting (8.8), and drying (4.0%). Finally, 221 (46%) respondents did not know ways iron can be lost from the body. One hundred and twenty-seven (26.5%) mentioned menstrual bleeding, a similar proportion (26.0%) of respondents mentioned nonmenstrual bleeding, whereas 7 (1.5%) mentioned hookworm infestation as a potential route of iron loss. Only one (0.3%) correctly identified the three listed ways through which iron can be lost from the body.
Table 2: Responses to inquiries regarding of dietary iron among respondents

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Table 3: Summary of knowledge and perception of dietary iron among respondents

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  Discussion Top


The finding of this study showed that there was a high recognition of iron in diet but poor knowledge of its food sources and preparation process that reduce its bioavailability. This finding is particularly worrisome as the World Health Organization in 2002 recognized iron deficiency and the associated anemia as one of the most important contributing factors to the global burden of disease.[12] This is because anemia, which is the most consequential effect of iron deficiency, poses an increased risk not only to cognitive and physical development of children but also has a negative effect on physical and work productivity of adults.[13]

Our study revealed that only a small proportion of surveyed participants had complete knowledge of the importance of iron in the body, people prone to iron deficiency, and the various ways elemental iron can be lost from the body. A similar study on 330 women conducted in Gaza strips reported that 84% of the respondents could not tell if a person was anemic, 81.3% of them were not aware of the consequences of iron-deficiency anemia, and 91.6% had no knowledge of the causes of iron-deficiency anemia. This poor knowledge of the importance of iron is troubling because without proper understanding of the value of iron in the development and functioning of the body, many caregivers would not know how to appropriately source for iron rich foods.[14]

It was also noted from our study that none of the study participants knew that cowpea was among the richest source of dietary iron available in our setting or the culinary practices that degrade and/or reduce its bioavailability in food sources. This study finding is worse but comparable to the finding of another study, which reported that 89% of its respondents did not know any iron-rich foods whereas 74.8% did not know which foods reduce iron absorption. The referenced study also noted that 56.5% of the respondents did not consider anemia to be a serious condition.[14] With 83.5 million children under 5 years, 17.2 million pregnant women, and over 69.8 nonpregnant individuals affected by iron-deficiency anemia in Africa,[15] there is an urgent need to intensify nutritional campaign among mothers and caregivers in our setting on the indispensability and importance of iron in the body systems for optimal functionality.


  Conclusion Top


We conducted this hospital-based cross-sectional study because of the high prevalence of iron-deficiency anemia in our center[16] and to ascertain the knowledge of mothers regarding the richest source of dietary iron in our setting. The study has, however, shown that mothers have absolutely no knowledge of cowpea which is one of the richest and cheapest sources of iron in our environment. There is consequently a need to create a comprehensive nutritional campaign, especially during antenatal and well-child clinic visits, to educate mothers and/or parents on local and readily available iron-rich food sources and cooking practices while discouraging cooking practices that could potentially degrade elemental iron in these food sources.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wang M. Iron deficiency and other types of anemia in infants and children. Am Fam Physician 2016;93:270-8.  Back to cited text no. 1
    
2.
Erigene R, Sylvia ON Onesmus M. Prevalence of iron deficiency anaemia and associated factors among children aged six to fifty nine months seen at Kabutare district hospital, Rwanda”. EC Nutr 2019; 14:1-12.  Back to cited text no. 2
    
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Latunde-Dada GO, Chandra Babu S, Chapasuka E. Sources and forms of iron in Nigerian foods and effects of processing on availability. Food and Nutrition Bulletin. 1997;18:1-6.  Back to cited text no. 3
    
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Luis ES. Nutrient composition and feeding value of proso millets, sorghum grains and corn in broiler diets. Poultry Sci 1982;61;311-20.  Back to cited text no. 4
    
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Oguntona T. Nutritional values. Postgrad Dr 1984;6:5-10.  Back to cited text no. 5
    
6.
Oyenuga VA. Nigeria's Food and Feeding Stuff. Ibadan, Nigeria: Ibadan University Press; 1968.  Back to cited text no. 6
    
7.
Platt BS. Tables of representative values of foods commonly used in tropical countries. In: Medical Research Council Special Report Series. London: HMSO; 1962. p. 302.  Back to cited text no. 7
    
8.
Available from: https://www.healthline.com/health/iron-deficiency-anemia. [Last accessed on 2020 Aug 02].  Back to cited text no. 8
    
9.
Azubuike JC, Izuora GI, Obi GO. Anaemia in non-sickling Nigerian children around Enugu. Trop Geogr Med 1977;29:365-8.  Back to cited text no. 9
    
10.
US Department of Agriculture, Agricultural Research Service, Nutrient Data Laboratory. USDA National Nutrient Database for Standard Reference, Release 27 (Slightly Revised). Version Current; May 2015. Available from: http://www.ars.usda.gov/ba/bhnrc/ndl. [Last accessed on 2020 Aug 02].  Back to cited text no. 10
    
11.
Adepoju OT, Sunday BE, Folaranmi OA. Nutrient composition and contribution of plantain (Musa paradisiacea) products to dietary diversity of Nigerian consumers. Afr J Biotechnol. 2012;11:13601-5.  Back to cited text no. 11
    
12.
Available from: http://www.who.int/malaria/docs/TreatmentGuidelines2006.pdf. [Last accessed on 2020 Aug 02].  Back to cited text no. 12
    
13.
Available from: http://www.who.int/wormcontrol/documents/en/Controlling%20 Helminths.pdf. [Last accessed on 2020 Aug 05].  Back to cited text no. 13
    
14.
Jalambo MO, Naser IA, Sharif R, Karim NA. Knowledge, attitude and practices of iron deficient and iron deficient anaemic adolescents in the Gaza strip, Palestine. Asian J Clin Nutr 2017;9:51-6.  Back to cited text no. 14
    
15.
De Benoist B, Cogswell M, Egli I, McLean E. Worldwide prevalence of anaemia 1993-2005; WHO Global Database of anaemia. 2008.  Back to cited text no. 15
    
16.
Ekwochi U, Osuorah DI, Odetunde OI, Egbonu I, Ezechukwu CC. Prevalence of iron deficiency anemia in anemic under-5 children in Enugu South East Nigeria. Niger J Paed 2014;41:129-32.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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