Download Iron and zinc intake in children living in rural Uganda

2011
Iron and Zinc Intake in Children
Living in Kibona, Rural Uganda
Marije Willems
Nutrition and Dietetics
University of Amsterdam
Thesis number: 2012126
Version: 1
" To
what extent are iron and zinc deficient in the diet of children
aged 1-5 years living in Kibona, a rural village in Lwengo district,
Uganda?"
Author:
Mw. M.W. Willems
2 Bridge House, Thames Street
Wallingford Oxfordshire OX10 0BH
United Kingdom
[email protected]
Thesis Number:
2012126
Principal:
Mw. R. Nansubuga
Kitovu Hospital, Masaka
Nutrition Ward, Kitovu Hospital
P.O Box 524 Masaka Uganda
[email protected]
Professor:
Mw. A. Doornbos
Hogeschool van Amsterdam
Voeding en Diëtetiek
Dr. Meurerlaan 8
1067 SM Amsterdam
[email protected]
Copyright © 2012. M.W. Willems
© The information, images, and/or data contained in this thesis are copyrighted by
their respective owner and may not be distributed, modified, reproduced in whole or in part without prior
permission of the thesis respective owner.
2
Word of Gratitude
During the period of September through December 2011, I have lived, worked and
researched in the rural area of Masaka, Uganda. As part of my studies in Nutrition and
Dietetics at the University of Amsterdam, I have focused my thesis research in a rural region
of Uganda, called Lwengo District.
My research was focused primarily on the dietary intake of young children in a rural village,
to assess adequacy of iron and zinc intake. I worked together with the Nutrition Ward at
Kitovu Hospital in Masaka.
This research would not have been possible without the time, support and dedication of
many people in Uganda, England and the Netherlands.
I want to say a special thank you to Regis Nansubuga who has dedicated more than 25 years
of her life to help children in this region who have battled with life-threatening effects of
malnutrition and other illnesses in an area where resources are limited. I would also like to
thank Regis for assisting me in the preparation and research required for this thesis.
I couldn't have done this without her help, courage, advice and patience.
I am also grateful for the help of my research team, translators, the doctors and nurses at
the Nutrition Ward at Kitovu Hospital. In all, 22 people played an ongoing role in this
assistance; from medical insights to those who aided me in the 24-hour recall surveys and
everyone else in between that gave their time and effort to assist me in researching a topic
that plays a vital role in overall health and well-being: iron and zinc intakes. I also want to
thank the local health workers in Lwengo District and my partner Mark Carmichael who has
fully supported and encouraged me from the beginning until the end.
I have very much appreciated the guidance of my Academic supervisor Anne Doornbos who
has supported me from the Netherlands. Also a big thank you to the numerous respondents
to the 24-hour recall survey whose anonymity I am bound to respect, but whose
participation, humbleness and happiness I am forever grateful to have experienced.
Marije Willems
December 2011
3
Summary
Background: Worldwide, micronutrient deficiencies of iron and zinc are very common, with
the highest prevalence in less developed countries. There is no known research to date on
iron and zinc intake in the diets of children under five, within a rural village called Kibona in
Lwengo District, Uganda. Due to the high figure of admissions of malnourished children to
the Nutrition Ward in Kitovu Hospital in Masaka, the Kitovu medical team has for several
years, sought to identify iron and zinc intakes of children in the surrounding area. It is
strongly believed that such data and understanding would be crucial for effectively
designing and targeting nutrition intervention measures in the future.
Aim: To assess the dietary intakes of local children between one and five years of age to
identify and measure the extent of inadequate intakes of iron and zinc, living in Kibona, a
rural village in Lwengo District, so that effective nutrition education and food-based
intervention programs can be planned in the future.
Methods: Dietary intake was measured in fifty children between one and five years of age
who were living in Kibona, Lwengo District, Uganda. A 24-hour recall method was used over
a period of three days, with duplicate measurements on a subset of the sample to allow
estimation of usual intake. Breastfeeding and complementary feeding practices were also
surveyed.
Results: Results showed that the mean daily iron intake was 5.1 mg/d for age category 1-3
and 8.2 mg/d for age category 3-6. The mean daily zinc intake was 2.0 mg/d for age category
1-3 and 2.5 mg/d for age category 3-6. Compared to the Recommended Nutrient Intake
(RNI) of iron and zinc by the World Health Organisation, results show that 94% of the total
children had iron deficiency in the diet, and 98% had zinc deficiency in the diet.
Conclusion: The subjects had a predominantly plant-based diet. Foods of animal origin were
consumed rarely. The total daily iron and zinc intake does not meet the daily RNI, due to low
bioavailability of a plant-based diet. The RNI of iron and zinc may not be met in a plantbased diet. Kitovu Nutrition Ward will soon start to implement an educational program for
the families on feeding, to improve the iron and zinc intake in children from Lwengo District
to reduce iron and zinc deficiencies.
Keywords: Zinc; iron; Uganda; Lwengo District; Kibona; micronutrients; 24-hour recall
4
Table of contents
1. Introduction ................................................................................................................. 6
1.1 Nutritional situation in Uganda ........................................................................................ 6
1.2 Iron and zinc deficiencies ................................................................................................. 7
1.3 Rationale for the Study .................................................................................................... 8
2. Subjects and Methods .................................................................................................. 9
2.1 Ethical Consideration ....................................................................................................... 9
2.2 Study Area ........................................................................................................................ 9
2.3 Subjects ............................................................................................................................ 9
2.4 24-hour dietary recall ....................................................................................................... 9
2.5 Data entering and analyses ............................................................................................ 11
3. Results........................................................................................................................ 12
3.1 Results of the 24 hour recall .......................................................................................... 12
3.2 Estimation of energy, iron and zinc intake..................................................................... 14
4. Discussion .................................................................................................................. 16
4.1 Important Results ........................................................................................................... 16
4.2 Strengths and limitations ............................................................................................... 16
4.2 Comparison of energy, iron and zinc measurements to other studies ......................... 17
4.3 Recommendations on improving iron and zinc defiencies compared to other studies 17
4.4 Future investigation ....................................................................................................... 18
5. Recomendations for Kibona Vilage .............................................................................. 19
6. Conclusion .................................................................................................................. 22
References ..................................................................................................................... 48
Appendix I
Appendix II
Appendix III
Appendix IIII
Food list with energy, iron and zinc values
Dietary Data
Mean energy, iron and zinc intake over period of three days
Comparison recommended iron and zinc intake
5
1. Introduction
1.1 Nutritional situation in Uganda
Malnutrition is a very serious health problem around the world and can be grouped as:
 low weight-for-age (underweight);
 low height-for-age (stunting);
 low weight-for-height (wasting);
 micronutrient malnutrition.3
Malnutrition contributes to half of the preventable maternal and child deaths in the world.1
In Uganda alone, malnutrition affects 2 million children under the age of five.
The most recent statistics of Uganda (UDHS) reported that approximately two of five
children under the age of 5 years (38 percent) suffer from chronic malnutrition (stunting). It
was also estimated that 16 percent is underweight, and 6 percent has acute malnutrition
(wasting).2 3
The Uganda Child Survival Strategy estimated that malnutrition directly and indirectly
contributes to up to 60 percent of child mortality, making malnutrition one of the most
significant contributors to childhood mortality in the country. If this status quo is maintained
520,000 children will die as a consequence of underweight alone before 2015.4
Uganda’s most frequent malnutrition problems are high rates of chronic malnutrition and
micronutrient deficiencies. Micronutrient deficiencies are also referred to as the 'Hidden
Hunger'.5 This name was given as even if intake of micronutrients appears adequate in the
diet of children, the amount of micronutrients absorbed in the body can be low, due to low
mineral bioavailability in plant-based diets. Identifying micronutrient malnutrition in
children without regular assessments is difficult.6
The most widespread micronutrient deficiencies are: iron, iodine, vitamin A and zinc7. The
matter has achieved worldwide attention – i.e. that large parts of the developing world are
suffering from these deficiencies and that it poses a serious threat to the well-being of
many. Except for iodine, little progress has been made in controlling micronutrient
deficiencies in sub-Saharan Africa. 8
To support the future health needs of its citizens, Uganda has committed itself to ending
hunger and malnutrition to ensure food and nutrition security for all Ugandans. This
initiative is defined in the Uganda Food and Nutrition Policy (UNFNP). As a result, a range of
international agreements designed to address the matter have been approved and
committed to by the Ugandan government. In support of this, the Uganda Food and
6
Nutrition Policy (UFNP) was adopted in 2003 and specifically recognises the basic human
right to sufficient food for all. 9
However, in the last ten years, the rate of change in instances of underweight has been less
than -0.7 percentage point per year, implying that at this rate, Uganda is not likely to meet
the UN Millennium Development Goal to reduce malnutrition and hunger by 201510 11
1.2 Iron and zinc deficiencies
Iron deficiency is known to be the most common and widespread micronutrient disorder in
the world and affects an estimated 2 billion people. This is approximately 30% of the world's
population. 12 13 It has been estimated by the World Health Organization (WHO) that
around 600–700 million people worldwide suffer from iron deficiency anaemia. 14 The
prevalence of iron deficiency is highest in South East Asia at 57%, with Africa placing 2 nd at
46%. 15
Studies have shown that pregnant woman and young children are at high risk due to
increased iron needs during pregnancy and growth. 16 17 Adequate iron intake is of great
importance for the development of the brain and can otherwise result in irreparable
damage to the brain cells.18 19 It is also important for other tissues such as muscles, which
are differentiated early in life. Severe deficiencies have negative influences to the normal
defence systems against infections and reduces physical working capacity of the body. 20
Iron deficiency carries significant adverse consequences for child development both in the
short and long term. 21 22
The most widespread cause of iron deficiency is inadequate dietary intake that fails to
provide sufficient levels of iron to cover the body's physiological requirements. Other causes
are high disease burdens resulting from malaria, diarrhoeal disease, acute respiratory
infections and hookworms that lead to intestinal blood losses. 23 24
More recently, zinc has also been identified as a major risk factor and global burden of
disease. 25 Worldwide, the prevalence of zinc deficiency has been estimated to be almost
20% 26 Milder and less severe zinc deficiency has been discovered in otherwise healthy
infants and children, in both developed and developing countries.27 A milder form of zinc
deficiency can lead to growth retardation and is much more prevalent than the severe
version. 28
Zinc has an important role in the body for cell division, protein synthesis, and growth.
Severe zinc deficiency can lead to: growth retardation, delayed sexual and bone maturation,
skin lesions, diarrhoea, alopecia, impaired appetite, increased susceptibility to infections
mediated via defects in the immune system and the appearance of behavioural changes.
The effects of marginal or mild zinc deficiency are less clear. A reduced growth rate and
7
impairments of immune defence are so far the only clearly demonstrated signs of mild zinc
deficiency in humans. Other effects, such as impaired taste and wound healing, which have
been claimed to result from a low zinc intake, are less consistently observed. 29
In particular, infants, children, adolescents, and pregnant women on a plant-based diet are
high at risk of an inadequate zinc intake. 30
Both iron and zinc deficiencies contribute to low birth weight, impaired immune
competence, cognitive function, maternal and infant morbidity, growth failure in infancy
and childhood among millions of young children.31 32 33
1.3 Rationale for the Study
To our (Kitovu medical team’s) knowledge, there is no literature that clearly documents the
dietary intake and risk of iron and zinc deficiencies of children under five years of age, living
in Kibona, Lwengo District - a rural part of Uganda. Given the high prevalence of
malnutrition generally, more studies are urgently needed to investigate the micronutrient
content of foods consumed by Ugandan children.
Information of this particular group is essential for the Nutrition Ward at Kitovu Hospital in
Masaka, and necessary for planning and implementing nutrition education programmes and
intervention strategies to reduce the number of children from Lwengo District, admitted to
the Nutrition Ward.
Reducing malnutrition in Uganda is critical to save children’s lives and achieve Millennium
Developing Goal 4 to reduce the mortality rate among children under five. 34 The presented
study was set up to measure adequacy of iron and zinc in the diet of children aged one till
five, living in Kibona, Lwengo district of Uganda.
The research question of this thesis is as follows:
" To what extent are iron and zinc deficient in the diet of children aged 1-5 years living in
Kibona, a rural village in Lwengo district, Uganda?"
Sub questions that are answered throughout the thesis are:
1. What are the health risks of iron and zinc deficiencies for children aged 1-5 years?
2. What is the recommended daily intake of iron and zinc for children aged 1-5 years,
living in Kibona, Lwengo District, Uganda?
3. What is the mean iron and zinc intake in children aged 1-5 years living in Kibona,
Lwengo district?
4. In what foods, sourced locally in rural Uganda, can we find the micronutrients iron
and zinc?
5. Based on the findings of the 24-hour recall surveys and research conducted as part of
this thesis, what recommendations in foods can be given to address any iron and zinc
deficiencies that may be discovered?
8
2. Subjects and Methods
2.1 Ethical Consideration
Ethical approval for this study was obtained from the District Health Office and Lwengo
Health clinic. All respondents who participated in the study were completely voluntary and
based on informed consent. There was no compensation offered for participation.
Measures were taken to assure the respect, dignity, and freedom of each individual
participating in the data collection. All 24-hour recalls were conducted in private. Each
subject was assigned a unique identification code to protect their anonymity.
2.2 Study Area
The field work was carried out in Kibona, Lwengo District, Central Uganda during the period
of 27th-29th November 2011.
Lwengo District is one of the newest districts in Uganda and became functional on the 1st of
July 2010. The climate in the district is equatorial with a bimodal type of rainfall received in
the months of April-May and July-August, increasing southwards. There is a main dry season
from December to February. The majority of the houses in the rural areas are huts made
from mud, or houses made from cement. The vegetation is predominantly savannah, some
forest plantations and riparian vegetation. Generally, the district is rural, with very limited
public services. Subsistence agriculture and livestock farming are the two main economic
activities in Lwengo. There is no clinical hospital in the district and Masaka Hospital and
Kitovu Hospital in Masaka are closest at a distance of approximately 40km.
2.3 Subjects
Fifty children, one till five years of age, who were residing in Kibona, a rural village in
Lwengo District, and who were considered to be at high risk of iron and zinc deficiency,
were randomly assigned for the study. Through Sample Size calculations, the amount of
children was selected with a 90% confidence level and 10% margin of error. It was more
likely to get a correct answer using a minimum amount of subjects for this type of survey. If
the sample size would be too big, there is a higher change that only a small percentage of
the sample responds to the survey.35 Kibona village was selected since most children
admitted to Kitovu Hospital came from this village. The parent or caretaker was asked to
undertake the dietary assessment of the children. For logistical and practical reasons the
home of the subjects in the selected villages were chosen as location of the dietary
assessment.
2.4 24-hour dietary recall
The nutritional assessment was performed using the 24-hour recall method. This method
was recommended by Harvest Plus. Harvest Plus is a joint venture between the
International Centre for Tropical Agriculture (CIAT) and International Food Policy Research
9
Institute (IFPRI) and works with more than 200 scientists, researchers, and other experts
around the world. It has developed practical guidelines and procedures for carrying out a
24-hour recall method that has been especially modified to measure the adequacies of iron
and zinc intake in rural populations in developing countries.36 . The 24-hour recall was
administered by ten local Ugandans who were each trained interviewers.
The interviewers were recruited to match both the languages (English and Luganda, the
native language) and skill needs of the survey. Other selection criteria used in the selection
of the interviewer were the necessity of a reasonable level of education and health
educational background, to ensure their ability to sufficiently grasp and successfully execute
the thorough level of detail.
Each team consisted of two people. In addition to the above mentioned selection criteria,
50% of the interviewers were local village health workers, and the other half were qualified
nurses, midwifes and District Health workers.
An intensive training program was delivered at Makondo Health Clinic, at Lwengo District
and lasted one week to cover the dietary intake studies, including pre-testing and review of
survey instruments. In the training, standardized manuals as produced and provided by
Harvest Plus on relevant topics were used for guidance. All training provided theory as well
as practical application in the form of role plays, presentations, and field testing to minimize
respondent biases, interviewer biases, respondent memory lapses, and incorrect estimation
of portion sizes.
A pre-test was carried out in a rural village similar to the study area. The pre-test
incorporated validation of the interview techniques as well as the use of measurement
equipment and sampling methodology. Once the pre-test had been completed, the survey
teams addressed any points that needed improvement prior to data collection.
The interviews were conducted with the person within the household who was primarily
responsible for food choice of the child and food preparation. The local language 'Luganda'
was chosen to ensure that the parent/caretaker were able to freely express themselves and
to feel comfortable during the interview process.
The 24-hour recall over a period of 3 days was chosen, as the day-to-day variation in intakes
can differ by nutrient from one day to the next. Thus, conducting the 24-hour recall over a
72-hour period provides a more balanced view of the typical dietary intakes of children
targeted in this study. 37
10
The 24-hour recall surveys were structured into four steps to maximize respondent recall of
foods eaten by child.
1. The first step, the ‘quick list’, involved respondents supplying a broad description of
all food and beverage items, including snacks, consumed in the previous day,
commencing with the food or drink taken immediately after the reference child
woke up and ending with the last food or drink taken before going to sleep at night .
2. In the second step, a detailed description of each food or beverage item on the quick
list was ascertained through a series of questions and prompts (generated by
interviewers) which were specific to each item. Respondents were asked to give
information on the ingredients and preparation methods of mixed dishes.
3. The third step was to estimate the amount of each food and beverage and their
ingredients consumed.
4. The final step was to review and check the recall responses to confirm responses
given about the previous day’s intake.
The 24 hour recall method was determined with the Kitovu medical team as the most valid
approach, as it is a more straightforward approach to carry out than other methods such as
blood samples. It is less expensive and less invasive than other methods - thus, compliance
is enhanced. This approach is especially suitable for areas where diets are not very diverse
and are predominantly plant-based following Harvest Plus. 37
In total, 100% of the intended 150 interviews were successfully completed and
subsequently checked by independent team members to ensure integrity of the data
collected. A random sample of 16% of the 50 survey participants (i.e. 8 in total) were then
chosen for follow-up interviews by these team members to review the 24-hour recall results
to ensure accuracy.
2.5 Data entering and analyses
Dietary intake data was entered using Microsoft Excel 2007. A double-entry system was
used to eliminate keying errors. The dietary intake was converted into calorie and
micronutrient amounts of iron and zinc using the nutrient database for standard references
of the US Department of Agriculture. (Appendix I)
The dietary assessment system associated dietary components for 1800 foods consumed in
Egypt, Kenya, Mexico, Senegal, India, and Indonesia. It included a computer program that
calculated energy and nutrient intakes with total bioavailability of iron and zinc. 38 39
All consumed foods were put into a table. (Appendix II) Calorie, iron and zinc intakes were
calculated for prepared food portions as eaten. (Appendix I, Appendix III) To estimate iron
and zinc deficiencies, intake amounts were compared with iron and zinc estimated average
requirements (EARs) for individuals. (Appendix IIII) Adjustments were made to account for
variance in bioavailability according to food source. 40 41 42
11
3. Results
3.1 Results of the 24 hour recall
The 24 hour recall showed that the children typically consumed between two and three
meals per day consisting of breakfast, lunch and dinner.
Breakfast consisted most often of tea with sugar. Some children consumed millet porridge,
leftovers of matooke, (plantain) cassava, sweet potato, or posho (a stiff porridge made of
maize flour) accompanied by the tea. A common lunch for the children included matooke,
cassava or sweet potatoes prepared with onions and tomatoes and occasionally served with
groundnut sauce. Silver fish (small dried local fish) was sporadically included in the meals,
when and where available. For dinner, the meal was often comprised of the same foods that
were prepared for lunch.
The mean energy (kcal) intake of the children per food group is shown in figure 1.
Figure 1 Composition of mean energy (kcal) intake by food group (N=50 children
aged 1-5).
12
Overall, the diet is predominantly plant-based, with the majority of the diet represented in
the consumption of matooke, groundnuts and cereals.
Energy (kcal) intake is broken down as follows:

The majority of calorie intake is derived from plantain (matooke), representing
33.1% of total calories.

17.1% of calorie intake comes from cereals (white bread, millet porridge, maize
porridge, posho)

15.1% comes from groundnuts

11.5% from root or tubers (cassava, sweet potato)

4.8% of the energy is supplied by foods of animal origin like beef or silver fish

4.5% from pulses such as kidney beans and cow peas

4.5% sugar

4.5% fresh cow’s milk

2.9% fruit, mostly jackfruit and sweet banana

0.9% fat (vegetable oil and some local butter)

0.4% vegetables (mostly onion, tomato, spinach, eggplant)

0.2% of spices or other.
13
3.2 Estimation of energy, iron and zinc intake
Total energy intake corresponds with iron and zinc deficiencies. Table 1 shows the mean and
median energy intake of the male and female subjects categorized by age group. One of the
children in the sample has an affinity for high energy groundnut sauce contained in the
meals that are served on a daily basis. This is the most likely explanation for the difference
between the mean and median within the sample.
The mean variance indicates the total calories that are lacking per day.
Table 1. Mean and Median daily energy (kcal) intake of male and female subjects N = 50
specified per age group
Age group
Male
Total N =
17
Mean
Energy
(kcal)
intake
Median
Energy
(kcal)
intake
Recommended
Energy (kcal)
intake
Mean
Variance
Energy
(kcal)
shortage
Total
subjects
deficient
Total Subjects
Deficient in
Percentage
Age 1-2
N=6
765
766
948
-183
4
66.7%
681
528
1,129
-448
3
75.0%
1,008
1,152
1,252
-244
3
60.0%
820
820
1,360
-540
2
100.0%
Age 2-3
N=4
Age 3-4
N=5
Age 4-5
N=2
Total
12
70.6%
Female
N= 33
Age 1-2
N=13
691
670
865
-174
9
69.2%
Age 2-3
N=13
737
734
1,047
-310
12
92.3%
Age 3-4
N=4
711
720
1,156
- 445
4
100.0%
Age 4-5
N=3
1,333
801
1,241
+92
2
66.7%
Total
27
81.8%
14
Looking at the mean measurement, Table 1 shows that 70.6% of the total male subjects did
not consume sufficient energy (kcal) intake and 81.8% of the female subjects had shortage
of energy intake, per day. Table 2 and 3 show the daily iron and zinc intake of the subjects.
Table 2.
Mean and Median Daily Iron intake in children aged 1-5, living in Kibona, Uganda. N = 50
Age
N=50
Mean
Iron
intake
(mg)
Median
Iron
Intake
(mg)
Recommended
Iron intake (mg)
(RNI)
Mean
Variance
Shortage
Iron
Total
subjects
deficient
Total subjects
deficient in
percentage
1-3
N = 36
5.1
mg/d
4.1
mg/d
11.6
mg/d
-6.4
mg/d
35
97.2%
3-6
N = 14
8.2
mg/d
5.1
mg/d
12.6
mg/d
-4.3
mg/d
13
85.7%
Total:
94.0%
Table 3.
Mean and Median Daily Zinc intake in children aged 1-5, living in Kibona, Uganda. N = 50
Age
N=50
Mean
Zinc
intake
(mg)
Median
Zinc
intake
(mg)
Recommended
Zinc intake
(mg) (RDI)
Mean
Variance
Shortage
Zinc
Total
subjects
deficient
Total subjects
deficient in
percentage
1-3
N = 36
2.0
mg/d
1.9
mg/d
6.9
mg/d
-4.8
mg/d
36
100%
3-6
N = 14
2.5
mg/d
1.7
mg/d
8.0
mg/d
-5.4
mg/d
13
92.9%
Total:
98.0%
Comparisons of mean total intakes of iron and zinc with RNI intake shows that 94% of the
total children have an iron deficiency in the diet (table 2), and 98% have zinc deficiency in
the diet. (Table 3). Children were categorized in two age groups: a) 1-3 and b) 3-6 years. The
1-3 year old category showed a mean intake of 5.1 mg/d of iron. Compared to the RNI of
11.6mg/d it shows that 97.2% of the 1-3 age category have iron deficiency in the diet. 85.7%
of the 3-6 year old category were shown to be deficient in the diet, with a mean intake of
8.2 mg/d, compared to the RNI of 12.6mg/d. Table 3 shows that 100% of the 1-3 year olds
have a zinc deficiency in the diet, with the mean intake of 2.0mg/d. 92.9% of the 3-6 year
olds have a iron deficiency in the diet with the mean intake of 2.5mg/d.
15
4. Discussion
4.1 Important Results
The most remarkable outcome of this study is that 94% of the total children in Kibona have
an iron deficiency in the diet and 98% have a zinc deficiency in the diet. This extremely high
prevalence is due to the insufficient calorie intake and low bioavailability in the consumed
plant-based diet.
As a result of the 24-hour recall interviews, the results show that the diet among children in
Kibona contained the staples: matooke, cereals, some groundnuts and legumes. Matooke
was most frequently reported and included 33.1% of the total diet. (Figure 1). An
estimation of 4.8% of the diet reported intake of animal origin. (Figure 1). Dried silver fish
and beef were the most frequently reported foods of animal origin. Groundnuts and
legumes were both common parts of the diet, especially in absence of fish and meat. Leafy
vegetables and fruits were rarely reported as a part of the diet, with 0.4% and 2.9%.
4.2 Strengths and limitations
According Harvest Plus, the 24 hour recall was the most straightforward and best approach
to use for measuring dietary intake in the children in Kibona. The 24 hour recall is especially
appropriate for diets that are plant-based and not very diverse. It is cost-effective, less
invasive than other methods i.e. blood tests, and it is culturally accepted.
The resulting data collected during the 24-hour recall study, is dependent on certain factors
which can affect the overall integrity of such a study. Factors such as memory, ability to
estimate portion sizes, degree of motivation and the persistence of the interviewer can all
affect the overall result. 43 This and the relationship between the subject and interviewer
(parent/caretaker of child and interviewer) might have had an influence on the report of
food intake.
To ensure that any negative effects were minimized, all reasonable precautionary measures
were taken to minimize respondent biases, interviewer biases, respondent memory lapses,
and incorrect estimation of portion sizes. The precautionary measures included a week long
intensive training to each interviewer that covered theory and practical application in the
form of role plays, presentations, and field testing. Specially designed standard data sheets
and protocols were also used for an optimal result of the 24-hour recall.
The day of the week and also other special occasions can give a day-of-the-week effect on
the data in this survey; these potential errors were reduced by carrying out 24-hour recall
interviews for three days44 45 at different weekdays, including a day in the weekend, as
recommended in the literature.46
The compliance to the 24-hour recall was considered to be relatively high due to the
minimal burden imposed on behalf of those participating in the survey. Due to the relatively
16
low number of participants interviewed, the fact that the interviewers experienced positive
interactions with participants and the relatively low variety in food items available in the
area, it is highly likely that the results provide for an acceptable overview of the staple food
consumed by the children.
We believe that the findings presented in this report are of high quality and represent an
accurate description of dietary intake of these children in Kibona, Lwengo District.
4.2 Comparison of energy, iron and zinc measurements to other studies
The estimated energy, iron and zinc intake is lower than the recommended daily energy
requirements and recommended nutrient intake for children at the age of one till five years.
The RNIs referred to are derived from the estimates of average individual dietary
requirements. 44
The bioavailability of diets is usually categorized in three levels, low (5%) moderate (10%)
and high (15%) based on the dietary composition. A low bioavailability of 5% was used for
the children in this study. The high bioavailability of iron is often found in western diets,
which include more vegetables, fruits, meat and fish.47
Due to the high content of phytic acid in the more common foods, the bioavailability levels
of 5% and 10% for iron are considered to be realistic in developing countries44.
The diet of the subjects consists mostly of plantain and cereals that are high in phytic acid
which is considered as the main inhibitor of zinc and iron availability. 48
A similar study in Tanzania used the iron bioavailability of 5%, for children with a similar
diet. 49
4.3 Recommendations on improving iron and zinc defiencies compared to other studies
A study in China looks at the most realistic and cost-effective strategy to prevent and
overcome iron and zinc deficiencies. They conclude that supplementation and fortification
can be used as a short-term strategy for particular groups. Two long-term intervention
strategies for rural areas are dietary diversification and bio fortification with improved
varieties. These are especially realistic and cost-effective for rural populations. 50 Another
study about the control of iron and zinc in developing countries also concludes that
fortification of staple foods is a sustainable and low cost-effective approach. 51
A study in India on intervention strategies for improving iron status of young children and
adolescents concludes that preventive supplementation coupled with nutrition education
may be a good effective strategy associated with better compliance and improvement in
iron status. They also state that long-term, effective approaches should include:
fortification, dietary modification, public health and disease control measures, and income
generation programs. They agree with above studies that food fortification can be a cost-
17
effective intervention strategy if technologically feasible, nutritionally sound, culturally
acceptable and economically viable food vehicles and the right fortification programme can
be identified. 52
The WHO and Food and Agricultural Organization of the United Nations recommend to use
programmes that include food-based strategies such as dietary diversification and food
fortification, as well as nutrition education, public health and food safety measures, and
finally supplementation. 53 54
It depends per local circumstance and local needs on what approaches should be used.
Programmes that deliver micronutrient supplements often provide the fasted improvement
in micronutrient status of individuals or the targeted population groups. Food fortification
tends to have a less immediate, but nevertheless, a much wider and more sustained impact.
55
Although increasing dietary diversity is generally regarded as the most desirable and
sustainable option, it takes the longest to implement.56
In South Africa, fortification of curry powder with Na, Fe, and EDTA produced significant
improvements in blood haemoglobin, ferritin levels and iron stores in women, and in ferritin
levels in men. The prevalence of iron -deficiency anaemia in women fell from 22% to just
5%, in a 2 year study. Unfortunately, well-designed trials of the impact of iron fortification of
flour were lacking at that present time.57
4.4 Future investigation
Fortified foods often fail to reach the poorest segments of the general population who are
at the greatest risk of micronutrient deficiency, like the children in Kibona.
The people in Kibona would have restricted access to fortified foods due to low purchasing
power and an underdeveloped distribution channel. People in rural villages relay on owngrown or locally produced food. Availability, access and consumption of adequate quantities
and a variety of micronutrient-rich foods, such as animal foods and fruits and vegetables, is
limited as shown in the results. Fortification of sugar, seasonings and other condiments may
provide a solution to the deficiencies in Kibona. Most children drink tea with sugar and most
families use seasonings in preparations of meals.
Literature on the topic recommends the usage of different approaches to improve iron and
zinc intake in rural areas, like the village of Kibona. It needs to be taken into consideration
that strategies to improve dietary diversification and bioavailability of iron and zinc may not
be sufficient enough to overcome the deficiencies in most rural areas. Therefore, more
research is needed on the possibilities, costs and effectiveness of fortifying plant-based
foods in Kibona.
18
5. Recommendations for Kibona Village
As mentioned in the discussion, it depends on the local situation and needs what
approaches should be used to improve iron and zinc intake. The most effective strategy for
Kibona village could be to implement by a programme that includes:
 Dietary diversification
 Food fortification; i.e. sugar, spices and seasonings
 Nutrition education
 Public health and food safety education
 Supplementation58 59
Further investigation on the cost and effectiveness on food fortification and
supplementation is needed before implementing this strategy into Kibona.
The recommendations on improving the diet with dietary diversification are following
below.
Dietary diversification to improve iron intake
Dietary diversification can be implemented for the children in Kibona with a nutritional
education and health intervention program.
The absorption of iron in the body depends on the dietary iron. Animal protein promotes
iron nutrition in two ways: it stimulates the absorption of both haem and non-haem iron
and it provides the well absorbed haem iron. Non-haem iron is found in cereals, pulses,
fruits, vegetables and dairy products and comprises the major source of dietary iron. The
absorption of non-haem can vary, depending on enhancing and inhibiting factors. Inhibitor
factors are foods with polyphenols, tannins, phytate, certain forms of protein and some
dietary fibres, like tea, coffee, egg yolk and bran. Absorption in mixed diets can vary from
1–20%. When a diet consisting of animal protein, absorption can increase to 50%. 60
Intake of animal protein has been found to be associated with a lower prevalence of iron
deficiency. Organic acids, such as citric acid, have been found to enhance the absorption of
non-haem iron in some studies.61
It is recommended to improve the iron intake by eating more iron rich foods like animal
protein such as beef, silver fish or chicken, if possible.62 However, due to poverty and high
prices of these products, it is often not possible, or realistic. Therefore, and perhaps more
accordingly, children would benefit from a diet with increased iron rich plant-foods such as
cereals, pulses, fruits, vegetables and dairy products, combined with vitamin C-rich foods
like fruit and vegetables, for a higher absorption. 63
19
Dietary diversification to improve zinc intake
The availability of zinc from the diet can be improved by reducing the phytate content and
including sources of animal protein. 64
Lean red meat, whole-grain cereals (millet and maize porridge), pulses, and legumes (such
as beans, cowpeas and groundnuts) provide the highest concentrations of zinc, and with the
exception of lean red meat, are usually available and inexpensive. Processed cereals with
low extraction rates (such as white rice) and chicken, pork or meat with high fat content
have a moderate zinc content and would therefore benefit diets by increasing their intake.
Fish, roots and tubers (such as cassava, sweet potato), green leafy vegetables (spinach), and
fruits are only modest sources of zinc. Saturated fats and oils and sugar have very little zinc
contents.65
To improve both iron and zinc intake, it is advised to increase whole-grain cereals like millet
and maize porridge, increase pulses and legumes intake such as groundnut sauce, beans and
cowpeas. These products are available throughout the year at all local produce markets, are
easily stored and relatively inexpensive. Certain foods, such as beans, can also be dried and
preserved for more than 6 months. Children's diets should also include more fresh fruit and
vegetables. Throughout the year, more local products can be consumed like: spinach,
eggplants, tomatoes, onion, avocado, jackfruit, mango, banana, pineapple, and papaya. 66
These fruit and vegetables are all locally grown, inexpensive and can help improve the
overall nutrition intake.
An example of a well-balanced, nutritious diet for a child aged 1-5, living in Kibona village, to
increase energy, iron and zinc intake is shown below.
Total Nutritional Values
 Energy (kcal): 1886
 Protein: 331 kcal/ 84.5 g
 Carbohydrates: 771 kcal / 192.7 g
 Fat: 692 kcal/ 76.8 g
 Iron: 14.9 mcg
 Zinc: 8.5 mcg
Breakfast
Midmorning Snack
Lunch
1 cup of millet porridge with milk, water and
1 tsp sugar
1 piece of fruit: jackfruit, pineapple, mango,
banana, papaya
1 cup of tea (with sugar)
100 g cereals: cassava, (sweet) potato,
matooke, rice
2 tsp butter/ vegetable oil
20
Afternoon Snack
Dinner
100 g beans/cowpeas
50 g silver fish/meat/poultry
or 50 g groundnut sauce
100 g vegetables: tomato, onion, pepper,
spinach, eggplant
1 avocado
1 cup of millet porridge with milk, water and
1 tsp sugar
1 piece of cereals: cassava
or vegetable: piece of tomato, avocado.
100 g cereals: cassava, (sweet) potato,
matooke, rice
1 tsp butter/oil
100 g beans/cowpeas
50 g silver fish or 50 g groundnut sauce
100 g vegetables: tomato, onion, pepper,
spinach, eggplant
1 piece of fruit
Implementing the above diet can help to improve the total dietary intake and iron and zinc
deficiencies in the diet of the children in Kibona.
Even with a diet change, dietary diversification may not be enough to overcome iron and
zinc deficiencies in the diet. It is usually regarded as the most desirable and sustainable
option, but it takes the longest to implement, since parents or caretakers may not want to
change their lifestyle, behaviour and habits to make dietary changes. 67
Further nutritional education, public health and food safety education will be developed for
the families in Kibona village to teach the parents on how to feed their families adequately.
More intervention planning is needed to deliver a quality program for Kibona village that
can resolve the many cases of iron and zinc deficiencies.
21
6. Conclusion
In this study it was found that children aged one till five, living in Kibona village, Lwengo
district had a predominantly vegetable based diet, mainly consisting of: matooke (plantain),
groundnuts, cereals and some legumes and pulses.
The consumption of vegetables and fruits in the diet fails to achieve the diversity required to
represent a healthy diet, including sufficient iron and zinc intake and absorption, particularly
considering the low consumption of animal-source foods.68 The Iron and zinc content in the
diet was small due to low bioavailability. The mean intake of both iron and zinc per day was
not adequate according to the Recommended Nutrient Intake by the World Health
Organisation (RNI). 98% of the total subjects had iron deficiency in the diet and 94% had a
zinc deficiency in the diet.
For the prevention of both iron and zinc deficiencies in the diet, not only dietary change is
needed. Other approaches such as supplementation with medical iron and zinc, fortification
of a suitable staple food, spice or seasoning, the control of infection through public health
activities and nutrition education may be needed also.
Dietary changes in Kibona village need to be made to increase iron and zinc intake by
dietary diversification. This can be done by eating more whole-grain cereals like millet and
maize porridge, legumes and pulses such as beans, ground nuts and cowpeas, since the cost
of animal protein is too high.
Given that only Kibona village was used to measure the dietary intake of the children in a
short period of time, caution is warranted with respect to simple generalizations.
Nevertheless, the diet in rural Uganda is known to be similar to other rural areas.
In conclusion, it can be said that most children living in Kibona have iron and zinc
deficiencies in the diet due to a poor, plant-based diet. Armed with the knowledge and
results of this study, Kitovu Nutrition Ward will soon start to implement a nutrition and
educational program for the families on dietary diversification to improve the iron and zinc
intake in the diet of the children in Kibona.
22
Appendix I
Food list with energy, iron and zinc values
Food item per 100 gram
Food
Code
Energy
Kcal
Fe
(mg)
Zn
(mg)
Starches
Bread, White
1
260
0.9
0.5
Cooked banana (matooke)
2
116
0.6
0.1
Chapatti (oil)
3
372.6
0.7
0.4
Chapatti (dry)
4
207.9
0.6
0.4
Potato (English Cooked)
5
93
0.4
0.3
Sweet potato (Cooked)
6
76
0.72
0.2
Cassava (Cooked)
7
138
0.5
0.3
Yam (Raw)
8
97
0.8
0.5
Maize Porridge (no sugar/milk)
9
36.2
0.4
0.2
Maize Porridge (milk/sugar)
10
129.8
0.4
0.4
Millet Porridge with sugar
11
91
0.3
0.1
Posho (maize flour/water)
12
123.8
1.2
0.6
Rice (White boiled)
13
130
1.49
0.42
Pumpkin (Cooked)
14
14
0.1
0.2
Pumpkin Leaves (Cooked)
15
21
3.2
0.2
Kidney Beans Relish (Boiled/water/salt/tomato/no
oil)
16
117.2
1.8
0.7
Kidney bean broth (soup without
oil/(tomato/onion/salt)
17
31
0.7
0.2
Cow peas Relish Dry (with oil)
18
154.7
0
0.2
Cooked Local Dishes
23
Cow peas broth (soup/oil/tomato/onion/salt)
19
46
0.7
0.2
Groundnut sauce
20
616.6
12
3.1
Spinach Relish (tomato/onion/salt/no oil)
21
43.5
2.6
0.3
Beef Stew (beef/tomato/onion/salt/oil)
22
143
0.9
2.1
Fish Relish (dried fish/tomato/onion/oil)
23
253.6
0.9
1.6
Fish Relish (dried fish/tomato/onion/no oil)
24
76.5
0.3
0.4
Tilapia Fish (Cooked)
25
128
0.69
0.41
Tomato (cooked)
26
20
0.2
0.13
Tomato (Raw)
27
11
0.3
0.15
Onion (fried)
28
54
0.3
0.18
Onion (Cooked)
29
20
0.5
0.18
Eggplant (Cooked)
30
16
0.5
0.1
Spinach Boiled (spinach/no oil)
31
23
3.6
0.8
Mushroom
32
27
0.5
0.5
Cabbage (Cooked)
33
14
0.1
0.1
Green Pepper
34
19
0.5
0.2
Vegetable oil
35
862
0
0
Kimbo Fat
36
884
0
0
Cowboy Fat
37
884
0
0
Curry Powder
38
325
29.59
4.05
Salt
39
0
0
0
Sugar
40
380
0
0
41
94
0.6
0.4
Individual vegetables
Oil/Fat/spices
Fruit
Jack Fruit
24
Pineapple
42
50
0.29
0.12
Banana (Ripe)
43
89
0.3
0.2
Avocado
44
190
0.4
0.4
Paw Paw (Ripe Papaya)
45
39
0.1
0.1
Orange Drink (Concentrated)
46
158
0
0
Passion fruit Juice (Fresh pasionfruit juice/sugar)
47
110
0.1
0
Raw Cow Milk
48
71
0
0.31
Water
49
0
0
0
Drinks
25
Appendix II
Dietary Data
Child ID
Child ID: 001
Child ID: 001
Child ID: 001
Child ID: 001
Child ID: 001
Child ID: 001
Child ID: 001
Child ID: 001
Child ID: 001
Child ID: 001
Child ID: 001
Child ID: 001
Child ID: 001
Child ID: 001
Child ID: 002
Child ID: 002
Child ID: 002
Child ID: 002
Child ID: 002
Child ID: 002
Child ID: 002
Child ID: 002
Child ID: 002
Child ID: 002
Child ID: 002
Child ID: 002
Child ID: 002
Child ID: 003
Child ID: 003
Child ID: 003
Child ID: 003
Child ID: 003
Child ID: 003
Child ID: 003
Child ID: 003
Other Information
Category
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Sunday
Weight
(grams)
400
300
100
250
120
3
NO
14.5
16
Female
Food
Code
11
6
41
49
2
Malaria
No
40
20
8
107
Some days
Normal/decrease
30
7
29
15
3
NO
11
13.5
Female
12
2
26
29
49
240
170
20
10
250
abdominal disorder
No
16
6
185
No
Normal
1 year, 8 months
NO
8.7
14
Female
21
43
20
24
11
7
49
40
7
20
2
Malaria
Anti malaria's, painkillers
24
12
Some days
16
Category
Monday
Weight
(grams)
Tuesday
Weight
(grams)
100
125
300
125
550
4
25
20
150
50
120
200
200
160
125
225
60
138
60
60
375
12
35
40
25
60
1
75
25
50
25
25
50
350
150
100
2
150
120
25
26
Child ID: 003
Child ID: 003
Child ID: 003
Child ID: 003
Child ID: 003
Child ID: 004
Child ID: 004
Child ID: 004
Child ID: 004
Child ID: 004
Child ID: 004
Child ID: 004
Child ID: 004
Child ID: 004
Child ID: 004
Child ID: 004
Child ID: 004
Child ID: 004
Child ID: 005
Child ID: 005
Child ID: 005
Child ID: 005
Child ID: 005
Child ID: 005
Child ID: 005
Child ID: 005
Child ID: 005
Child ID: 005
Child ID: 005
Child ID: 005
Child ID: 005
Child ID: 006
Child ID: 006
Child ID: 006
Child ID: 006
Child ID: 006
Child ID: 006
Child ID: 006
Child ID: 006
Child ID: 006
Child ID: 006
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Normal/decrease
11
21
60
30
3
NO
10
12.7
Female
49
40
2
20
7
250
12
200
122
35
OK
No
16
35
60
30
No
Normal
43
24
17
41
450
16
320
350
20
200
122
144
138
80
50
140
4
NO
11.5
15
male
49
40
41
2
20
375
12
100
320
70
OK
No
24
23
50
30
No
Normal
2
NO
12
16.7
Female
7
11
16
17
3
12
7
49
2
31
29
300
125
100
130
30
OK
Herbal
16
17
25
25
No
Normal
40
30
29
375
16
12
320
122
200
30
60
375
25
25
375
50
130
120
30
250
200
45
195
200
15
25
25
4
35
20
1
15
10
27
Child ID: 006
Child ID: 006
Child ID: 006
Child ID: 007
Child ID: 007
Child ID: 007
Child ID: 007
Child ID: 007
Child ID: 007
Child ID: 007
Child ID: 007
Child ID: 007
Child ID: 007
Child ID: 007
Child ID: 007
Child ID: 007
Child ID: 008
Child ID: 008
Child ID: 008
Child ID: 008
Child ID: 008
Child ID: 008
Child ID: 008
Child ID: 008
Child ID: 008
Child ID: 008
Child ID: 008
Child ID: 008
Child ID: 008
Child ID: 009
Child ID: 009
Child ID: 009
Child ID: 009
Child ID: 009
Child ID: 009
Child ID: 009
Child ID: 009
Child ID: 009
Child ID: 009
Child ID: 009
6
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
225
450
400
12
42
1 year, 5 months
Yes
14
17.5
Female
49
48
40
1
2
1000
200
36
42
600
325
600
24
42
500
Fever/flue on 3rd day
Paracetamol, panadols
24
22
80
165
80
Decrease on day 3
Normal
25
26
29
12
16
60
10
10
120
50
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
2 years, 6 months
NO
11
13.7
Female
48
7
2
26
29
200
72
100
10
10
OK
Herbal
49
40
200
12
No
Normal
20
11
31
30
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
2 years, 1 month
NO
10
14.4
Female
7
49
45
2
24
60
250
40
240
60
103
410
105
440
Malaria
Drip with anti malaria's,
painkillers
40
2
4
Some days
Normal/decrease
6
1
36
30
Medicines:
Food
unusual:
Appetite:
24
300
320
150
120
20
10
725
36
480
12
172
200
30
30
240
240
24
160
150
25
10
25
28
Child ID: 009
Child ID: 009
Child ID: 009
Child ID: 009
Child ID: 0010
Child ID: 0010
Child ID: 0010
Child ID: 0010
Child ID: 0010
Child ID: 0010
Child ID: 0010
Child ID: 0010
Child ID: 0010
Child ID: 0010
Child ID: 0010
Child ID: 0010
Child ID: 0010
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0011
Child ID: 0012
Child ID: 0012
Child ID: 0012
Child ID: 0012
Child ID: 0012
Child ID: 0012
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
2 years, 6 months
NO
9
12.9
Female
26
21
35
29
49
7
2
32
26
Malaria
Painkillers, anti malaria's
29
46
No
decrease
31
16
40
24
165
72
120
20
25
10
30
3
10
110
72
120
102
50
10
80
30
25
4
30
4 years and 6 months
NO
14
14.4
Female
49
40
2
20
32
80
2
170
50
20
125
2
100
typhoid fever, malaria
Anti malaria's, painkillers, CAF,
pre dui sane
41
40
26
5
10
No
Decrease
5
10
200
60
20
15
3 years, 5 months
NO
12
14.9
Male
29
24
11
7
16
38
35
13
47
30
8
11
2
26
29
32
200
420
5
5
5
Flue
41
140
40
5
100
125
10
2
5
123
125
10
20
600
180
5
5
5
300
225
29
Child ID: 0012
Child ID: 0012
Child ID: 0012
Child ID: 0012
Child ID: 0012
Child ID: 0012
Child ID: 0012
Child ID: 0012
Child ID: 0012
Child ID: 0013
Child ID: 0013
Child ID: 0013
Child ID: 0013
Child ID: 0013
Child ID: 0013
Child ID: 0013
Child ID: 0013
Child ID: 0013
Child ID: 0013
Child ID: 0013
Child ID: 0013
Child ID: 0013
Child ID: 0013
Child ID: 0014
Child ID: 0014
Child ID: 0014
Child ID: 0014
Child ID: 0014
Child ID: 0014
Child ID: 0014
Child ID: 0014
Child ID: 0014
Child ID: 0014
Child ID: 0014
Child ID: 0014
Child ID: 0014
Child ID: 0015
Child ID: 0015
Child ID: 0015
Child ID: 0015
Child ID: 0015
Child ID: 0015
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines::
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
No
17
105
80
No
Normal
30
49
40
24
7
32
20
8
11
40
2
7
49
40
200
2
15
20
12
100
3
NO
12
15.5
Male
Diarrheal
No
Yes, might have eaten at
neighbour
Normal
125
10
232
4
170
30
125
30
125
2
100
50
6
30
16
520
140
122
125
50
5
50
60
120
120
375
102
150
234
30
30
2
41
20
49
7
Flue, Fever, Malaria
Painkillers, anti malaria's
21
30
30
8
unusual
decrease
6
40
26
29
150
4
7
2
24
49
40
32
300
4
170
125
3
NO
12
14.5
Female
3 years, 5 months
NO
14.5
14.5
Female
OK
72
15
270
5
20
90
120
30
125
4
90
120
50
125
4
10
60
120
200
30
status:
Child ID: 0015
Child ID: 0015
Child ID: 0015
Child ID: 0015
Child ID: 0015
Child ID: 0015
Child ID: 0015
Child ID: 0016
Child ID: 0016
Child ID: 0016
Child ID: 0016
Child ID: 0016
Child ID: 0016
Child ID: 0016
Child ID: 0016
Child ID: 0016
Child ID: 0016
Child ID: 0016
Child ID: 0016
Child ID: 0016
Child ID: 0017
Child ID: 0017
Child ID: 0017
Child ID: 0017
Child ID: 0017
Child ID: 0017
Child ID: 0017
Child ID: 0017
Child ID: 0017
Child ID: 0017
Child ID: 0017
Child ID: 0017
Child ID: 0017
Child ID: 0018
Child ID: 0018
Child ID: 0018
Child ID: 0018
Child ID: 0018
Child ID: 0018
Child ID: 0018
Medicines:
Food
unusual:
Appetite:
No
1
No
Normal
16
30
44
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
2 years, 3 months
NO
11
15.3
Male
7
49
2
23
37
OK
No
29
26
10
10
No
Normal
38
40
16
8
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
1 year, 4 months
Yes
7
12.5
Female
12
49
2
30
31
170
125
120
30
5
50
70
50
Underweight, flue, tumour
flue slap, painkillers
24
23
30
30
50
Yes
decrease
38
7
20
6
18
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
5
50
5
27
30
170
240
60
5
30
60
110
120
320
10
4
50
140
100
2
30
25
2
75
40
5
NO
15
14.7
Male
7
11
40
2
23
60
300
4
200
80
Flue
Painkiller
38
49
2
125
72
102
4
220
8
200
150
400
31
Child ID: 0018
Child ID: 0018
Child ID: 0018
Child ID: 0018
Child ID: 0018
Child ID: 0018
Child ID: 0019
Child ID: 0019
Child ID: 0019
Child ID: 0019
Child ID: 0019
Child ID: 0019
Child ID: 0019
Child ID: 0019
Child ID: 0019
Child ID: 0019
Child ID: 0019
Child ID: 0019
Child ID: 0019
Child ID: 0019
Child ID: 0019
Child ID: 0019
Child ID: 0019
Child ID: 0020
Child ID: 0020
Child ID: 0020
Child ID: 0020
Child ID: 0020
Child ID: 0020
Child ID: 0020
Child ID: 0020
Child ID: 0020
Child ID: 0020
Child ID: 0020
Child ID: 0020
Child ID: 0020
Child ID: 0021
Child ID: 0021
Child ID: 0021
Child ID: 0021
Child ID: 0021
Child ID: 0021
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
Some days
Decrease
12
16
30
41
17
100
100
10
40
50
1 year, 6 months
Yes
10
14.8
Female
7
11
40
2
24
30
80
3
25
15
Little flue
No
1
37
5
15
No
Decrease
4 years and 6 months
NO
17
16
Male
41
26
29
32
45
44
16
49
8
9
2
49
40
6
41
Gets sick every 2 wks
No
22
7
No
Normal
16
24
12
23
1 years, 6 months
NO
9.8
13.5
Female
Cold
49
40
12
6
24
44
60
90
30
4
50
50
40
3
3
5
40
105
27
25
80
40
70
200
425
2
20
220
325
6
150
140
400
2
115
300
345
30
400
80
410
4
50
450
160
83
410
12
820
24
180
32
status:
Child ID: 0021
Child ID: 0021
Child ID: 0021
Child ID: 0021
Child ID: 0021
Child ID: 0021
Child ID: 0021
Child ID: 0022
Child ID: 0022
Child ID: 0022
Child ID: 0022
Child ID: 0022
Child ID: 0022
Child ID: 0022
Child ID: 0022
Child ID: 0022
Child ID: 0022
Child ID: 0022
Child ID: 0022
Child ID: 0022
Child ID: 0022
Child ID: 0023
Child ID: 0023
Child ID: 0023
Child ID: 0023
Child ID: 0023
Child ID: 0023
Child ID: 0023
Child ID: 0023
Child ID: 0023
Child ID: 0023
Child ID: 0023
Child ID: 0023
Child ID: 0023
Child ID: 0024
Child ID: 0024
Child ID: 0024
Child ID: 0024
Child ID: 0024
Child ID: 0024
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
Full Cafe tablets
2
No
Normal/decrease
7
16
1 years, 6 months
NO
9.8
14
Male
49
40
48
2
24
975
20
750
380
30
375
16
750
180
912
42
375
200
Mild Underweight
Anti malaria's, other
supplements
26
10
5
5
29
10
5
Some days
Decreased some days
1 years, 6 months
yes
9.5
14
Female
30
1
41
10
31
16
7
9
40
2
24
31
125
12
80
20
10
Mild cough
No
9
13
125
120
Normal/decrease
Decreased some days
35
26
49
1
16
7
49
40
7
2
16
30
5
5
2 years, 6 months
NO
16
15
Female
Malaria
420
120
247
60
15
25
100
10
375
15
20
50
10
240
160
100
125
125
125
25
500
4
25
150
20
20
30
15
675
8
725
4
15
20
25
100
15
33
status:
Child ID: 0024
Child ID: 0024
Child ID: 0024
Child ID: 0024
Child ID: 0024
Child ID: 0024
Child ID: 0024
Child ID: 0025
Child ID: 0025
Child ID: 0025
Child ID: 0025
Child ID: 0025
Child ID: 0025
Child ID: 0025
Child ID: 0025
Child ID: 0025
Child ID: 0025
Child ID: 0025
Child ID: 0025
Child ID: 0025
Child ID: 0026
Child ID: 0026
Child ID: 0026
Child ID: 0026
Child ID: 0026
Child ID: 0026
Child ID: 0026
Child ID: 0026
Child ID: 0026
Child ID: 0026
Child ID: 0026
Child ID: 0026
Child ID: 0026
Child ID: 0027
Child ID: 0027
Child ID: 0027
Child ID: 0027
Child ID: 0027
Child ID: 0027
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
painkillers, anti malaria's, other
supplements
12
50
Yes
Decreased some days
16
9
24
6
31
50
50
405
20
150
15
3
NO
15
17
Female
49
2
7
20
31
870
520
72
25
25
405
400
1355
400
30
Malaria
Vitamins, anti malaria's
24
48
60
405
No
Normal
12
22
40
21
202
265
115
4
60
2 years, 6 months
NO
13
15.7
male
49
48
40
2
16
2000
400
108
200
115
Previous Typhoid
No
1
7
42
30
No
Normal
9
24
36
10
810
110
5
2
1620
1620
225
30
225
54
225
40
810
1 year, 6 months
NO
9.8
15.4
Male
48
40
49
1
9
225
54
710
17
450
462
54
24
450
360
OK
2
120
120
240
34
Child ID: 0027
Child ID: 0027
Child ID: 0027
Child ID: 0027
Child ID: 0027
Child ID: 0027
Child ID: 0027
Child ID: 0027
Child ID: 0028
Child ID: 0028
Child ID: 0028
Child ID: 0028
Child ID: 0028
Child ID: 0028
Child ID: 0028
Child ID: 0028
Child ID: 0028
Child ID: 0028
Child ID: 0028
Child ID: 0028
Child ID: 0028
Child ID: 0028
Child ID: 029
Child ID: 029
Child ID: 029
Child ID: 029
Child ID: 029
Child ID: 029
Child ID: 029
Child ID: 029
Child ID: 029
Child ID: 029
Child ID: 029
Child ID: 029
Child ID: 029
Child ID: 0030
Child ID: 0030
Child ID: 0030
Child ID: 0030
Child ID: 0030
Child ID: 0030
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
No
7
30
No
100
1 year, 10 months
?
8
13.5
Female
16
24
17
8
33
26
29
49
40
2
22
12
OK
No
16
17
115
95
No
Normal
5
NO
15.5
14.5
Female
26
28
30
7
20
24
6
49
40
2
20
24
OK
No
9
44
No
Normal
27
7
30
16
2
NO
12.5
15.6
Male
2
24
20
49
7
Malaria
40
Normal
30
240
80
375
18
120
115
250
10
10
10
5
375
18
100
750
54
120
250
115
95
5
10
5
405
30
640
720
60
405
18
840
30
195
30
75
405
18
690
244
122
405
83
35
72
25
25
360
80
100
225
120
240
30
60
225
60
1300
300
12
35
Child ID: 0030
Child ID: 0030
Child ID: 0030
Child ID: 0030
Child ID: 0030
Child ID: 0030
Child ID: 0030
Child ID: 0031
Child ID: 0031
Child ID: 0031
Child ID: 0031
Child ID: 0031
Child ID: 0031
Child ID: 0031
Child ID: 0031
Child ID: 0031
Child ID: 0031
Child ID: 0031
Child ID: 0031
Child ID: 0031
Child ID: 0032
Child ID: 0032
Child ID: 0032
Child ID: 0032
Child ID: 0032
Child ID: 0032
Child ID: 0032
Child ID: 0032
Child ID: 0032
Child ID: 0032
Child ID: 0032
Child ID: 0032
Child ID: 0032
Child ID: 0033
Child ID: 0033
Child ID: 0033
Child ID: 0033
Child ID: 0033
Child ID: 0033
Child ID: 0033
Child ID: 0033
Medicines:
Food
unusual:
Appetite:
Anti malaria's, painkillers
16
115
Yes
Decrease
1
30
26
29
17
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
1 year, 9 months
NO
9
17
Female
49
40
7
3
2
810
30
30
62
350
145
125
150
30
320
400
OK
No
16
12
135
100
100
10
No
Normal
24
41
17
20
2
NO
11
15.4
Female
2
16
49
7
20
300
20
125
132
50
220
50
100
73
50
300
50
200
102
OK
No
24
41
40
100
40
20
No
Normal
17
50
50
1 year, 8 months
Yes
10.5
16
Female
6
2
11
24
49
150
120
310
80
310
240
310
30
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
80
20
10
10
80
40
100
150
120
310
OK
No
No
36
unusual:
Child ID: 0033
Child ID: 0033
Child ID: 0033
Child ID: 0033
Child ID: 0033
Child ID: 0034
Child ID: 0034
Child ID: 0034
Child ID: 0034
Child ID: 0034
Child ID: 0034
Child ID: 0034
Child ID: 0034
Child ID: 0034
Child ID: 0034
Child ID: 0034
Child ID: 0034
Child ID: 0034
Child ID: 0035
Child ID: 0035
Child ID: 0035
Child ID: 0035
Child ID: 0035
Child ID: 0035
Child ID: 0035
Child ID: 0035
Child ID: 0035
Child ID: 0035
Child ID: 0035
Child ID: 0035
Child ID: 0035
Child ID: 0036
Child ID: 0036
Child ID: 0036
Child ID: 0036
Child ID: 0036
Child ID: 0036
Child ID: 0036
Child ID: 0036
Child ID: 0036
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Normal
4
NO
13
16
Male
11
2
16
17
30
475
720
235
130
475
200
20
OK
No
15
7
No
Normal
33
4
NO
13
13
Female
49
40
2
43
24
750
12
130
115
30
OK
No
6
30
150
10
No
Normal
37
16
20
11
1
5
3
NO
14.8
19
Female
12
26
2
7
17
220
20
200
102
40
OK
No
16
49
30
290
No
Normal
41
24
100
180
600
280
25
25
50
60
10
375
6
290
115
80
205
4
240
115
80
5
20
20
350
21
300
100
120
155
100
37
Child ID: 0036
Child ID: 0036
Child ID: 0036
Child ID: 0036
Child ID: 0037
Child ID: 0037
Child ID: 0037
Child ID: 0037
Child ID: 0037
Child ID: 0037
Child ID: 0037
Child ID: 0037
Child ID: 0037
Child ID: 0037
Child ID: 0037
Child ID: 0037
Child ID: 0037
Child ID: 0038
Child ID: 0038
Child ID: 0038
Child ID: 0038
Child ID: 0038
Child ID: 0038
Child ID: 0038
Child ID: 0038
Child ID: 0038
Child ID: 0038
Child ID: 0038
Child ID: 0038
Child ID: 0038
Child ID: 0039
Child ID: 0039
Child ID: 0039
Child ID: 0039
Child ID: 0039
Child ID: 0039
Child ID: 0039
Child ID: 0039
Child ID: 0039
Child ID: 0039
Child ID: 0039
11
45
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
340
80
2
NO
8.5
12.9
Male
7
12
2
24
41
30
395
150
100
40
50
120
OK
No
49
16
165
640
22
No
Normal
26
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
1 year, 1 month
NO
10
16
Female
48
2
24
40
21
OK
No
31
26
No
Normal
29
22
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
1 year, 1 month
Yes
7
13.5
Male
10
2
24
49
43
485
65
40
125
56
OK
No
12
16
50
50
No
Normal
40
1
9
48
120
200
80
100
50
425
320
110
8
965
400
80
16
30
805
300
14
30
10
5
165
125
60
40
290
125
25
15
6
62
185
300
2
17
535
38
Child ID: 0039
Child ID: 0039
Child ID: 0040
Child ID: 0040
Child ID: 0040
Child ID: 0040
Child ID: 0040
Child ID: 0040
Child ID: 0040
Child ID: 0040
Child ID: 0040
Child ID: 0040
Child ID: 0040
Child ID: 0040
Child ID: 0040
Child ID: 0041
Child ID: 0041
Child ID: 0041
Child ID: 0041
Child ID: 0041
Child ID: 0041
Child ID: 0041
Child ID: 0041
Child ID: 0041
Child ID: 0041
Child ID: 0041
Child ID: 0041
Child ID: 0041
Child ID: 0041
Child ID: 0042
Child ID: 0042
Child ID: 0042
Child ID: 0042
Child ID: 0042
Child ID: 0042
Child ID: 0042
Child ID: 0042
Child ID: 0042
Child ID: 0042
Child ID: 0042
Child ID: 0042
37
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
5
4
NO
17
17
Male
7
2
20
24
7
30
200
60
40
30
OK
No
6
40
75
No
Normal
49
16
30
3 years, 4 months
NO
20
16.5
Female
49
6
40
2
26
500
75
4
240
25
OK
No
29
36
20
8
No
Normal
25
1 year, 10 months
NO
10.5
15.5
Female
7
9
45
30
35
43
20
49
40
7
9
2
500
8
30
225
300
625
2
90
OK
No
13
22
192
120
123
No
Normal
12
43
16
45
33
50
40
50
50
50
40
35
50
270
330
2
185
50
60
50
250
75
12
400
12
350
20
10
30
250
250
211
5
5
168
50
400
345
400
300
39
Child ID: 0042
Child ID: 0042
Child ID: 0042
Child ID: 0042
Child ID: 0042
Child ID: 0043
Child ID: 0043
Child ID: 0043
Child ID: 0043
Child ID: 0043
Child ID: 0043
Child ID: 0043
Child ID: 0043
Child ID: 0043
Child ID: 0043
Child ID: 0043
Child ID: 0043
Child ID: 0043
Child ID: 0044
Child ID: 0044
Child ID: 0044
Child ID: 0044
Child ID: 0044
Child ID: 0044
Child ID: 0044
Child ID: 0044
Child ID: 0044
Child ID: 0044
Child ID: 0044
Child ID: 0044
Child ID: 0044
Child ID: 0045
Child ID: 0045
Child ID: 0045
Child ID: 0045
Child ID: 0045
Child ID: 0045
Child ID: 0045
Child ID: 0045
Child ID: 0045
Child ID: 0045
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
4
NO
19
17
Female
1
17
29
35
26
49
43
40
11
2
17
50
1000
168
24
400
400
OK
Septic
7
24
30
160
No
Normal
2 years, 9 months
NO
9
15
Female
3
16
34
26
29
17
49
40
7
2
24
750
12
72
120
60
430
8
72
170
30
5
10
55
450
12
60
170
80
OK
No
9
12
250
120
170
120
No
Normal
31
44
26
16
17
30
2 year 6 months
NO
11
15
Male
49
40
7
2
16
1235
24
60
200
50
OK
Septrin
31
12
30
120
No
normal
24
41
18
30
10
5
10
1200
24
400
400
400
150
72
30
115
10
50
30
27
5
25
25
1200
12
60
50
50
550
24
60
50
15
40
80
40
Child ID: 0045
Child ID: 0045
Child ID: 0045
Child ID: 0046
Child ID: 0046
Child ID: 0046
Child ID: 0046
Child ID: 0046
Child ID: 0046
Child ID: 0046
Child ID: 0046
Child ID: 0046
Child ID: 0046
Child ID: 0046
Child ID: 0046
Child ID: 0046
Child ID: 0047
Child ID: 0047
Child ID: 0047
Child ID: 0047
Child ID: 0047
Child ID: 0047
Child ID: 0047
Child ID: 0047
Child ID: 0047
Child ID: 0047
Child ID: 0047
Child ID: 0047
Child ID: 0047
Child ID: 0048
Child ID: 0048
Child ID: 0048
Child ID: 0048
Child ID: 0048
Child ID: 0048
Child ID: 0048
Child ID: 0048
Child ID: 0048
Child ID: 0048
Child ID: 0048
Child ID: 0048
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
5
NO
16
16
Female
7
2
49
43
24
600
780
293
122
OK
No
31
60
650
18
17
50
50
272
300
590
194
300
600
750
18
750
24
No
Normal
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
1 year, 7 months
NO
10.5
14.4
Male
49
40
1
2
16
OK
parasol
7
20
yes
decrease
6
24
9
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
3
NO
14
15.5
Female
9
7
12
16
49
475
72
200
115
250
OK
No
2
24
270
30
No
Normal
17
44
40
31
50
72
122
75
30
750
206
200
50
750
144
100
500
120
50
27
12
15
41
Child ID: 0048
Child ID: 0049
Child ID: 0049
Child ID: 0049
Child ID: 0049
Child ID: 0049
Child ID: 0049
Child ID: 0049
Child ID: 0049
Child ID: 0049
Child ID: 0049
Child ID: 0049
Child ID: 0049
Child ID: 0049
Child ID: 0050
Child ID: 0050
Child ID: 0050
Child ID: 0050
Child ID: 0050
Child ID: 0050
Child ID: 0050
Child ID: 0050
Child ID: 0050
Child ID: 0050
Child ID: 0050
Child ID: 0050
Child ID: 0050
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
Age:
Breastfed:
Weight:
MUAC:
Sex:
Health
status:
Medicines:
Food
unusual:
Appetite:
4
NO
12.5
14.2
Male
2
49
40
20
30
240
250
12
50
15
OK
No
7
24
72
30
No
Normal
6
16
12
22
3
NO
14
15
Female
2
49
40
17
24
flue for 2 days
painkillers
9
7
No
decrease
6
11
50
450
12
120
250
12
72
30
75
50
50
360
345
12
95
30
120
120
240
120
6
30
80
170
72
225
345
42
Appendix III
Mean Energy, Iron and Zinc intake over period of 3 days
Energy (Kcal)
Fe (mg)
Zn (mg)
Child ID: 001
Child ID
956.15
8.17
2.25
Child ID: 002
863.66
7.98
2.63
Child ID: 003
413.30
4.14
1.27
Child ID: 004
1,143.05
12.47
3.50
Child ID: 005
1,362.86
11.93
3.70
Child ID: 006
568.40
6.05
1.66
Child ID: 007
1,125.17
4.17
3.63
Child ID: 008
993.67
9.49
2.87
Child ID: 009
648.43
3.14
1.00
Child ID: 0010
296.34
1.60
0.57
Child ID: 0011
539.54
4.53
1.36
Child ID: 0012
1,431.28
15.01
4.17
Child ID: 0013
607.59
6.34
1.74
Child ID: 0014
798.50
8.22
2.22
Child ID: 0015
322.27
1.58
0.65
Child ID: 0016
447.65
2.85
0.90
Child ID: 0017
363.88
3.36
1.32
Child ID: 0018
659.74
4.15
1.72
Child ID: 0019
249.24
1.06
0.52
Child ID: 0020
979.54
7.07
3.74
Child ID: 0021
670.43
3.58
1.53
Child ID: 0022
1,094.95
2.79
3.07
Child ID: 0023
404.25
2.69
1.04
Child ID: 0024
320.39
2.90
1.05
Child ID: 0025
953.75
6.30
3.03
Child ID: 0026
1,238.76
4.48
3.05
Child ID: 0027
823.00
3.86
2.43
Child ID: 0028
1,059.74
12.93
4.73
Child ID: 029
2,658.08
34.56
9.27
Child ID: 0030
909.42
9.83
2.90
Child ID: 0031
810.68
4.92
1.67
Child ID: 0032
777.87
7.41
2.23
Child ID: 0033
571.75
2.72
0.82
Child ID: 0034
1,152.49
8.00
2.30
Child ID: 0035
675.15
3.56
1.21
Child ID: 0036
734.03
3.95
1.76
Child ID: 0037
504.54
3.80
1.83
Child ID: 0038
1,096.77
3.36
4.13
Child ID: 0039
708.23
3.13
2.33
Child ID: 0040
537.63
5.06
1.32
43
Child ID: 0041
765.14
5.43
1.56
Child ID: 0042
872.28
6.34
2.77
Child ID: 0043
1,083.06
5.17
1.72
Child ID: 0044
589.33
4.37
1.84
Child ID: 0045
430.95
2.47
1.00
Child ID: 0046
800.99
4.31
1.38
Child ID: 0047
549.95
6.76
2.10
Child ID: 0048
717.10
5.67
2.44
Child ID: 0049
555.13
4.67
2.23
Child ID: 0050
562.00
3.03
0.94
44
Appendix IIII
Comparison recommended iron and zinc intake
Recommended Zinc Intake (mg) Low bioavailability 5%
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
3-6 year
3-6 year
1-3 year
Child ID: 001
Child ID: 002
Child ID: 003
Child ID: 004
Child ID: 006
Child ID: 007
Child ID: 008
Child ID: 009
Child ID: 0010
Child ID: 0013
Child ID: 0014
Child ID: 0016
Child ID: 0017
Child ID: 0019
Child ID: 0021
Child ID: 0022
Child ID: 0023
Child ID: 0024
Child ID: 0025
Child ID: 0026
Child ID: 0027
Child ID: 0028
Child ID: 0030
Child ID: 0031
Child ID: 0032
Child ID: 0033
Child ID: 0036
Child ID: 0037
Child ID: 0038
Child ID: 0039
Child ID: 0042
Child ID: 0044
Child ID: 0045
Child ID: 0047
Child ID: 0048
Child ID: 0050
3-6 year
Child ID: 005
Child ID: 0011
Observed
2.25
2.63
1.27
3.50
1.66
3.63
2.87
1.00
0.57
1.74
2.22
0.90
1.32
0.52
1.53
3.07
1.04
1.05
3.03
3.05
2.43
4.73
2.90
1.67
2.23
0.82
1.76
1.83
4.13
2.33
2.77
1.84
1.00
2.10
2.44
0.94
Observed
3.70
1.36
Recommended
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
6.9
Recommended
8
8
Deficient Yes/No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Deficient Yes/No
Yes
Yes
45
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
Child ID: 0012
Child ID: 0015
Child ID: 0018
Child ID: 0020
Child ID: 029
Child ID: 0034
Child ID: 0035
Child ID: 0040
Child ID: 0041
Child ID: 0043
Child ID: 0046
Child ID: 0049
4.17
0.65
1.72
3.74
9.27
2.30
1.21
1.32
1.56
1.72
1.38
2.23
8
8
8
8
8
8
8
8
8
8
8
8
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Recommended Iron intake (mg) Low bioavailability 5%
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
Child ID: 001
Child ID: 002
Child ID: 003
Child ID: 004
Child ID: 006
Child ID: 007
Child ID: 008
Child ID: 009
Child ID: 0010
Child ID: 0013
Child ID: 0014
Child ID: 0016
Child ID: 0017
Child ID: 0019
Child ID: 0021
Child ID: 0022
Child ID: 0023
Child ID: 0024
Child ID: 0025
Child ID: 0026
Child ID: 0027
Child ID: 0028
Child ID: 0030
Child ID: 0031
Child ID: 0032
Child ID: 0033
Child ID: 0036
Child ID: 0037
Child ID: 0038
Observed
8.17
7.98
4.14
12.47
6.05
4.17
9.49
3.14
1.60
6.34
8.22
2.85
3.36
1.06
3.58
2.79
2.69
2.90
6.30
4.48
3.86
12.93
9.83
4.92
7.41
2.72
3.95
3.80
3.36
Recommended
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
11.6
Deficient Yes/No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
46
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
1-3 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
3-6 year
Child ID: 0039
Child ID: 0042
Child ID: 0044
Child ID: 0045
Child ID: 0047
Child ID: 0048
Child ID: 0050
3-6 year
Child ID: 005
Child ID: 0011
Child ID: 0012
Child ID: 0015
Child ID: 0018
Child ID: 0020
Child ID: 029
Child ID: 0034
Child ID: 0035
Child ID: 0040
Child ID: 0041
Child ID: 0043
Child ID: 0046
Child ID: 0049
3.13
6.34
4.37
2.47
6.76
5.67
3.03
Observed
11.93
4.53
15.01
1.58
4.15
7.07
34.56
8.00
3.56
5.06
5.43
5.17
4.31
4.67
11.6
11.6
11.6
11.6
11.6
11.6
11.6
Recommended
12.6
12.6
12.6
12.6
12.6
12.6
12.6
12.6
12.6
12.6
12.6
12.6
12.6
12.6
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Deficient Yes/No
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
47
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