Caregiver and child acceptability of a provitamin A carotenoid, iron and zinc rich complementary food prepared from common bean and pumpkin in Uganda.

Abstract

Vitamin A deficiency (VAD), iron deficiency (ID), and zinc deficiency (ZnD) are the three leading micronutrient deficiencies causing morbidity and mortality among children under five years in developing countries, including Uganda. A high prevalence of VAD, ID and ZnD among children in developing countries begins during the period of complementary feeding, which is between the ages of six to 24 months. This is the period when children are fed complementary foods (CFs) prepared from vitamin A, iron, and zinc deficient staple tubers and cereals. To combat VAD, ID, and ZnD, the World Health Organization (WHO) recommends that CFs be diversified with vitamin A, iron and zinc rich food sources, such as animal source foods (ASFs), food supplements and commercially fortified foods. However, ASFs, commercially fortified foods and food supplements are either unaffordable or inaccessible to rural Ugandan caregivers. Therefore, the aim of this study was to prepare a complementary food (CF) rich in provitamin A carotenoids (PVACs), iron and zinc using locally available common bean and pumpkin and to test the acceptability of the CF among caregivers and their children in rural Uganda. The study objectives were to: (i) select one common bean landrace superior in iron and zinc, and one pumpkin landrace superior in PVACs from a variety of local landraces available in the local market; (ii) evaluate the effect of home cooking methods on provitamin A carotenoid (PVAC) retention in the selected pumpkin (superior in PVACs), and iron and zinc retention in the selected common bean (superior in iron and zinc); (iii) assess child acceptability of an innovative CF- a common bean pumpkin blend (BPB) prepared with common bean (superior in iron and zinc) and pumpkin (superior in PVACs); (iv) assess caregiver perceptions and acceptability of the innovative CF (BPB). The study was conducted in rural Kyankwanzi district, Uganda, East Africa. Cross-sectional and randomised control trial designs were used in this study for the consumer acceptability investigations; and a controlled laboratory experiment for the nutrient retention investigation. Three pumpkin landraces on the local market of the study area were screened for PVACs, whilst five common bean landraces also on the local market were screened for iron and zinc content. Iron and zinc content were determined by flame atomic absorption spectrometry (FAAS), whilst PVAC content was determined by high performance liquid chromatography (HPLC). True retention of iron, zinc and PVAC was determined after expert caregivers cooked pumpkin by either boiling or steaming, whilst the common bean was cooked by either boiling with or without prior soaking. Caregivers prepared the test CF and the control according to the consistency (thickness or thinness) fit for child consumption based on the child’s age and stage of development. The test CF (BPB) was prepared by mixing and blending two parts of cooked pumpkin and one part of cooked common bean, whilst the control CF, pumpkin puree (PP) was prepared by mashing one part of cooked pumpkin. Seventy children, aged 6 to 24 months participated in the child acceptability randomised crossover study. In the current study, the CFs test food (BPB) and control (PP) were considered acceptable if the child consumed at least 50 g and more of the 100 g of the CF offered. Mean duration for intake of the CFs and vitamin A, iron and zinc intake were calculated. A paired t-test was used to determine whether there were significant differences in the amount, duration, and micronutrient intake between the BPB and PP. Further, 70 caregivers (whose children participated in the child acceptability study) participated in the caregiver acceptability study. A cross-sectional sensory evaluation study design was used to assess caregiver perceptions and acceptability of the study CFs. Sensory attributes (taste, colour, aroma, texture and general acceptability) of the BPB and PP were rated using a five-point facial hedonic scale (1=very bad, 2=bad, 3=neutral, 4=good, 5=very good). Focus group discussions (FGDs) were also conducted to assess caregiver perceptions about using the BPB as a CF. A chi-square (X2) test was used to detect the proportionate difference for each sensory attribute between BPB and PP, whilst focus group discussions (FGDs) data was analysed by thematic analysis. A p value of 0.05 was considered statistically significant. For objective one (first investigation), β-carotene content in Sweet cream (1 704 μg/100 g) was significantly higher compared to Dulu (1 333 μg/100 g) and Sun fish (1041 μg/100 g) (p<0.0001). The α- carotene content of Sweet cream was significantly lower (46 μg/100 g, p<0.0001) compared to Dulu (77.3 μg/100 g) and Sun fish (79.3 μg/100 g). However, the total retinol activity equivalent (RAE) was highest in Sweet cream (143.9 μg/100 g), compared to Dulu (115.4 μg/100 g) and Sun fish (90.1 μg/100 g). Iron content was highest in Obwelu (7.75 mg/100g), compared to Masavu (6.95 mg/100 g), Nambale (6.55 mg/100g), Kanyebwa (7.15 mg/100 g) and Obwayelo (6.5 mg/100 g). Obwelu had significantly higher iron concentrations than Obwayelo (p<0.05). Zinc content was highest in Obwelu (3.05 mg/100 g), but was not significantly different (p >0.05) compared to the other common bean landraces of Masavu (2.95 mg/100 g), Nambale (2.35 mg/100 g), Kanyebwa (2.9 mg/100 g) and Obwayelo (3.0 mg/100 g). The findings of the first investigation suggested that Sweet cream was superior in PVAC content compared to the other pumpkin landraces, whilst Obwelu was superior in iron and zinc content compared to the other common bean landraces. Therefore, Sweet cream and Obwelu were selected for use in the preparation of a CF rich in PVACs, iron and zinc. For objective two (second investigation), β-carotene, α-carotene, and total provitamin A content in raw pumpkin was 1704 μg/100 g, 46 μg/100 g and 1437 μg/100 g, respectively. Either boiling or steaming pumpkin resulted in over 100% retention of PVACs and total provitamin A. Iron and zinc retention in soaked boiled common bean was 92.2% and 91.3%, respectively. Boiling common bean without soaking resulted in 88.4% and 75.6% retention of iron and zinc, respectively. The findings of the second investigation suggested that there was a high retention of PVACs in pumpkin, Sweet cream after boiling or steaming, and a high retention of iron and zinc in common bean, Obwelu after boiling with prior soaking. For objective three (third investigation), the mean amount of BPB (53.9 g) and the control (PP) (54.4 g) consumed by children was high, but not significantly different from each other (p>0.05). The mean duration for child consumption of BPB was 20.6 minutes and 20.3 minutes for the control and the durations for child consumption were not significantly different from each other (p<0.05). The mean child intake of vitamin A was significantly higher (p<0.05) from the control (PP) (152.5 μgRAE) compared to the test food (BPB) (100.9 μgRAE). The mean iron intake was significantly higher (p<0.05) from BPB (1.1 mg) compared to the control (0.3 mg). Furthermore, zinc intake was significantly higher (p<0.00001) from the (0.58 mg), compared to control (0.13 mg). For objective four (fourth investigation), between 64% and 96% of the caregivers rated both BPB and PP as acceptable (good to very good) for all the sensory attributes. There was no significant difference (p>0.05) in caregiver acceptability for all sensory attributes between BPB and PP (p>0.05). Caregivers had positive perceptions about the taste, texture, aroma, and colour of the BPB. Caregivers were keen to know the specific varieties of common bean and pumpkin used to formulate the PVAC, iron and zinc rich BPB. Findings from this study suggest that a complementary food, BPB, rich in PVACs, iron and zinc prepared from locally available common bean, Obwelu and pumpkin, Sweet cream was acceptable to caregivers and their children who were in the age range of complementary feeding in Uganda. To contribute towards combating child VAD, ID and ZnD, policy makers in Uganda, such as the district nutrition coordination teams should support and promote the cultivation and utilisation of common bean, Obwelu and pumpkin, Sweet cream as major ingredients of CFs. The use of BPB as a CF should not replace other existing nutrition interventions such as micronutrient supplementation, commercial fortification, biofortification programmes and the use of ASFs that aim to combat micronutrient deficiencies during the period of complementary feeding. However, the use of BPB as a CF should be a complementary strategy to these existing nutrition interventions. Future studies should investigate the effect of BPB intake on the vitamin A, iron and zinc status of children.