Iron Status of Reproductive Age Women in Northern Ghana is Improved by Indigenous Hibiscus Sabdariffa Meal

Abstract

In northern Ghana, iron deficiency anemia (IDA) is prevalent and severe among reproductive age women. Anemia is detrimental to women's health and pregnancy outcomes. Efficacy of supplementation and fortification have been tested to counter the problem, while little efforts have been reported with improving food systems utilizing native food sources to improve iron status in Ghana. Inhabitants are largely of low socioeconomic status, and consume monotonous diets consisting of staple cereals, legumes and vegetables with little or no animal products. Hibiscus Sabdariffa is a native plant high in iron concentration that is widely consumed in northern Ghana during wet seasons. We aimed to investigate the efficacy of standardized native Hibiscus Sabdariffa leaves meal (HSM) containing dry fish in improving iron status of reproductive age women through a 12‐wk community‐based feeding intervention during lean season. Reproductive age women (15–49 yrs, n=118) with children (6–23 mo) were recruited from five rural communities in two districts of Upper East region between May‐September, 2016. Study participants were assigned by district to either treatment (n=58 dyads) or control group (n=60 dyads). At baseline, sociodemographic characteristics, health information including malaria and ill health status were obtained from the participants using a questionnaire. The treatment group received 3 HSM/wk made from Hibiscus Sabdariffa leaves, groundnut, dawadawa, dried fish, iodied salt and water on feeding days by the women in their respective community health centers, whereas the control group received no interventions. HSM contained 25.7 mg of iron and 98.7 mg of protein/meal and the amount of consumption was determined by each subject. Hemoglobin (Hb) levels were measured on the field at baseline, midpoint (6 wk) and endpoint (12 wk) using Hemocue HB 201 analyzer. Women were mostly peasant farmers. Mean Hb values at baseline did not differ between the groups. Mean Hb values increased from baseline to endpoint in the intervention group (mean Δ=0.19g/dl, p trend=0.029) but not in the control group (mean Δ=0.05g/dl, p trend=0.660). The velocity of changes in Hb values were prominent between the midpoint to the endpoint between the two groups (p=0.046) after adjustment for malaria status, household wealth index, marital status, sex of household head, mother's age, and child's age. The HSM is efficacious in improving Hb levels in the treatment group. Future studies may be planned for longer than 12 weeks feeding trials including bioavailability, and multiple doses to determine the dose responses in a larger scale during a full spectrum of dry season.Support or Funding InformationThis study has been conducted with financial support from Borlaug Higher Education for Agricultural Research and Development (BHEARD) and Borlaug Leadership Enhancement in Agriculture Program (LEAP).