The potential of Moringa oleifera (Lam.) leaves for use in complementary foods to combat child food and nutrition insecurity among South African rural and peri-urban communities.

Abstract

The inadequate nutritional quality of complementary foods is a major public health problem in developing countries such as South Africa, and contributes towards the reported high rates of child malnutrition. Consequently, there is an urgent need to investigate interventions aimed at improving the nutritional quality of complementary foods. The aim of this study was to assess the potential of Moringa oleifera (Lam.) leaves for use in complementary foods to combat food and nutrition insecurity amongst children in South African communities. Mothers from Lebowakgomo village in Limpopo province (n=106) and Hammanskraal Township in Gauteng province (n=106), were recruited on a voluntary basis to participate in the survey which assessed the food and nutrition security status of their children, aged 7-12 months old. Additionally, six focus group discussions were conducted per study area to assess mothers’ perceptions about children’s food access and to further establish a recipe for a popular traditional cereal-based complementary food. The Children’s Food Insecurity Access Scale (CFIAS) was used to assess the food security status (access) of the children. The Individual Dietary Diversity Score (IDDS) together with the unquantified food consumption frequency survey were used as a proxy measure of the nutritional quality of the children’s diets. The age and weight of the children were obtained from the children’s clinic health cards and were used to calculate Weight-for-Age Z scores (WAZ). These values were interpreted to determine the prevalence of underweight children. The popular cereal-based traditional complementary food recipe (white maize soft porridge) used by mothers from the studied communities was modified by substituting maize meal with MLP at 1, 2 and 3% (w/w) levels. The nutritional, phytochemical and antioxidant analysis of the popular traditional complementary soft porridge (control) and Moringa-added porridges (test samples) were determined using standard methods. The sensory acceptability of the porridges was evaluated by the mothers who were recruited on a voluntary basis (n= 60 per study area) and six focus group discussions were conducted per study area to assess mothers’ perceptions on the inclusion of Moringa in complementary foods. The findings of the survey showed that a large percentage of children were severely food-insecure, 87% and 78%, at Lebowakgomo and Hammanskraal, respectively. Additionally, children from Lebowakgomo (23.6%) and Hammanskraal (17.9%) were severely underweight. Overall, children’s diets in both study areas were characterized by nutrient-deficient complementary foods. Cheaper foods with a higher satiety value such as white maize meal (WMM) and sugar were the most commonly purchased and used. Hence, the children consumed very limited amounts of foods rich in proteins, minerals, and vitamins, which significantly increased the risk of malnutrition. As the MLP was increased from 0 to 3% in the Lebowakgomo white maize soft porridge, a corresponding significant increase in nutrient content was observed: ash (from 0.52 to 0.87 g/100 g), calcium (0.01 to 0.09 mg/100 g), potassium (0.10 to 0.14 mg/100 g), protein (8.70 to 9.68 g/100 g), threonine (0.14 to 0.66 g/100 g), glutamine (1.28 to 1.56 g/100 g), provitamin A (0.81-1.16 μg/g), lutein (0.04-0.30 μg/g), zeaxanthin (0.21-2.18 μg/g), β-cryptoxanthin (0.11-0.14 μg/g), β-carotene (0.25-0.50 μg/g) and 9-cis-β-cryptoxanthin (0.25-0.31 μg/g). Increasing the MLP from 0 to 3% in the soft porridge at Hammanskraal, caused a significant increase in the levels of iron (from 52.50 to 101.0 mg/100 g), manganese (1.00 to 4.00 mg/100 g), phenylalanine (0.35 to 0.47 g/100 g), provitamin A (0.87-1.01 μg/g), lutein (0.05-0.22 μg/g), zeaxanthin (0.22-1.29 μg/g) and β-carotene (0.27-0.39 μg/g). Additionally, the antioxidant activity, total phenolic and flavonoid contents of Hammanskraal and Lebowakgomo white maize soft porridges increased as the concentration of MLP was increased. The sensory evaluation results showed that the acceptance of each of the two traditional complementary foods decreased as the level of MLP increased. Mother’s indicated in the focus group discussions that Moringa-added soft porridges had a bitter taste, which would not be suitable for children. Only the Moringa-added soft porridge from Lebowakgomo containing 1% of Moringa was rated similar in overall acceptability as the corresponding white maize soft porridge (control). Nevertheless, all mothers expressed willingness to use Moringa in complementary foods if they would be trained on how to process it into foods suitable for children. There is a need to vary product formulation and processing methods, which may contribute to increased acceptance of Moringa-based foods. Additionally, the safety of using MLP in complementary foods should be investigated.