Nutrition News for Africa
Abstract - September 30, 2006
A study entitled “The positive impact of red palm
oil in school meals on vitamin Astatus: study in Burkina Faso”
was published in Nutrition Journal 2006, 5:1
Background: Vitamin A deficiency (VAD) is
a public health problem that affects approximately 40% of
the population worldwide. In Burkina Faso, 84.5% of under-fives
and 61.8% of their mothers were found to be vitamin A deficient
in a study conducted in 1999 in the north-central part of
the country. Other sahelian countries are similarly affected.
Dietary diversification is one approach to deal with this
problem, which can be sustainable in the long-term. Red palm
oil (RPO) is the highest plant source of provitamin A carotenoids
and is highly bioavailable because of its fat milieu and the
absence of a plant matrix. A pilot study in Burkina Faso revealed
that it was possible through social marketing to increase
RPO consumption in women and children who were unaccustomed
to it. Following the pilot study a larger project was implemented
with one of its components focusing on the fortification of
school meals with RPO.
Methods: The intervention consisted of adding
15 ml of RPO to individual meals 3 times a week in selected
primary schools in Kaya department in the north-central part
of Burkina Faso, and in Bogande District in the eastern part
of the country. Serum retinol was measured by HPLC at baseline
and 12 months later to take into account seasonal changes.
In Kaya, a simple pre- post-test design was used. A total
of 239 pupils aged 84 to 144 months were randomly selected
from a total of 15 schools and serum retinol samples were
taken before the intervention started in March 2003 and after
it ended in March 2004. In Bogande, all 24 schools with an
active lunch program in the District were included in a randomized
controlled trial. Eight served as negative controls (G1),
receiving only the school lunch, 8 served as positive controls
(G2) where the children also received one vitamin A capsule
(VAC) at the end of the 2003-2004 school year, and the remaining
8 schools received the lunch with RPO from November 2003 till
June 2004. Serum retinol was measured in random sample of
128 pupils in each school group in November 2003 and again
in the same pupils one year later.
Results: In Kaya pupils, the rate of low
serum retinol declined from 47.2% at baseline to 13.1% in
the second survey (p<0.001). Also, 15% of pupils had very
low serum retinol at baseline but none had it one year later.
At baseline there was no difference between boys and girls,
but one year later serum retinol was significantly higher
in girls than in boys. Children with low serum retinol improved
the most. In Bogande, serum retinol did not change in the
negative control group G1, but there was a significant increase
in both the VAC G2 and the RPO G3 groups. As was the case
in Kaya, a higher serum retinol increase was observed in the
subjects who were deficient at baseline.
Discussion: One of the findings of this
study is that VAD at school age is a serious public health
problem in Kaya and Bogande. In the 15 RPO schools in Kaya
and the 8 RPO schools in Bogande, low serum retinol rates
decreased to 13% and 15% respectively, rendering the severe
public health problem a moderate one, after an average of
28 and 51 RPO meals in Kaya and Bogande respectively over
one year. An interesting finding was that the RPO and single
VAC had a nearly equivalent impact on serum retinol in Bogande
pupils. In both study sites, a relatively high rate of low
serum retinol remained after the intervention, whether in
the VAC or RPO groups, which shows that the dosage used sustains
normal vitamin A status for less than 6 months. The high residual
rate could also be due to underlying infections and other
concurrent nutritional deficiencies.
Conclusion: The study finding on high rates
of VAD in school children in Burkina Faso is important as
they are usually not part of the target groups for VAD control.
The study confirmed the effectiveness of RPO as a food supplement
for VA in primary school children. The authors support the
development of RPO and its distribution at a regional level
to reach other countries.
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