Background - Food and nutrition insecurity severely compromises the quality of life in farm communities in South Africa. Although food‐based approaches are more sustainable strategies to address malnutrition, most other strategies only target the alleviation of single micronutrients. Synergies between nutrients demand a wider scope; food‐based strategies need to focus on improving both overall diet quality and the well‐being of rural and urban populations. Agricultural biodiversity is crucial in such strategies to improve food security and health. This thesis aims to investigate the effect of African leafy vegetables (ALVs) on the alleviation of micronutrient deficiencies in school children residing in the North West Province of South Africa. Methods - Four focus group discussions assessed primary caregivers’ (n=29) knowledge, perceptions and use of indigenous and traditional plants. Thereafter, the research focused on the leaves of Amaranthus cruentus (amaranth), Cleome gynandra (spiderplant), Cucurbita maxima (pumpkin) and Vigna unguiculata (cowpea). Sensory acceptability to children of selected ALV dishes, prepared in a traditional way (n=98) and prepared with gravy, was assessed (n=80). The nutrient composition and the bio‐accessibility of iron and zinc in these ALVs were determined. A randomised controlled trial to investigate the effect of consumption of these ALVs on the iron, vitamin A en zinc status of primary school children (grade R – grade 4) followed. Children of two rural farm schools were randomly allocated per grade and school to receive either daily (five days/week) 300 gram cooked ALVs with the school meal starch (N=86) or the normal school meal (N=81) for three months. Results - Caregivers were positive about using ALVs, transferring knowledge from generation to generation. Children found dishes made with ALVs, prepared in the traditional way as well as with gravy, acceptable in terms of colour, smell and taste. ALVs contributed 11.6 ‐ 15.8 mg iron and 1.4 ‐ 3.7 mg zinc per meal. Amaranth‐and‐spiderplant has the highest amount of bio‐accessible iron (0.42 mg iron). All dishes contain 0.3 mg bio‐accessible zinc. At baseline, intervention and control children were deficient for Hb <11.5 g/dL (16.0% and 10.5%), serum ferritin <15 μg/L (16.3% and 18.5%), serum retinol <20 μg/dL (7.0% and 2.5%) and serum zinc <65 μg/dL (75.6% and 75.3%). No significant estimated intervention effect was found. Conclusion - Caregivers possessed knowledge of ALVs and were positive about their use. Based on dialyzable iron and zinc, the contribution of the ALV dishes towards dietary requirements is more substantial for iron than zinc. The randomised controlled trial showed that ALVs unable to improve serum retinol, serum ferritin or hemoglobin in mildly deficient children or those with low status zinc. Furthermore, despite the low zinc status in our population, ALV consumption did not improve serum zinc concentrations. Based on the more theoretical and indirect study results, including both caregivers’ and children’ positive image of ALVs, and the nutrient composition and iron and zinc bio‐accessibility of the ALVs, these selected vegetables do have the potential to contribute to the micronutrient intake of school children. However, the importance of ALVs might not necessary be to serve as a strategy for micronutrient deficiency alleviation, but rather in the diversification of the diet in resource‐poor settings and thereby contribute to the micronutrient intake. / PhD (Nutrition), North-West University, Potchefstroom Campus, 2014

Background - Food and nutrition insecurity severely compromises the quality of life in farm communities in South Africa. Although food‐based approaches are more sustainable strategies to address malnutrition, most other strategies only target the alleviation of single micronutrients. Synergies between nutrients demand a wider scope; food‐based strategies need to focus on improving both overall diet quality and the well‐being of rural and urban populations. Agricultural biodiversity is crucial in such strategies to improve food security and health. This thesis aims to investigate the effect of African leafy vegetables (ALVs) on the alleviation of micronutrient deficiencies in school children residing in the North West Province of South Africa. Methods - Four focus group discussions assessed primary caregivers’ (n=29) knowledge, perceptions and use of indigenous and traditional plants. Thereafter, the research focused on the leaves of Amaranthus cruentus (amaranth), Cleome gynandra (spiderplant), Cucurbita maxima (pumpkin) and Vigna unguiculata (cowpea). Sensory acceptability to children of selected ALV dishes, prepared in a traditional way (n=98) and prepared with gravy, was assessed (n=80). The nutrient composition and the bio‐accessibility of iron and zinc in these ALVs were determined. A randomised controlled trial to investigate the effect of consumption of these ALVs on the iron, vitamin A en zinc status of primary school children (grade R – grade 4) followed. Children of two rural farm schools were randomly allocated per grade and school to receive either daily (five days/week) 300 gram cooked ALVs with the school meal starch (N=86) or the normal school meal (N=81) for three months. Results - Caregivers were positive about using ALVs, transferring knowledge from generation to generation. Children found dishes made with ALVs, prepared in the traditional way as well as with gravy, acceptable in terms of colour, smell and taste. ALVs contributed 11.6 ‐ 15.8 mg iron and 1.4 ‐ 3.7 mg zinc per meal. Amaranth‐and‐spiderplant has the highest amount of bio‐accessible iron (0.42 mg iron). All dishes contain 0.3 mg bio‐accessible zinc. At baseline, intervention and control children were deficient for Hb <11.5 g/dL (16.0% and 10.5%), serum ferritin <15 μg/L (16.3% and 18.5%), serum retinol <20 μg/dL (7.0% and 2.5%) and serum zinc <65 μg/dL (75.6% and 75.3%). No significant estimated intervention effect was found. Conclusion - Caregivers possessed knowledge of ALVs and were positive about their use. Based on dialyzable iron and zinc, the contribution of the ALV dishes towards dietary requirements is more substantial for iron than zinc. The randomised controlled trial showed that ALVs unable to improve serum retinol, serum ferritin or hemoglobin in mildly deficient children or those with low status zinc. Furthermore, despite the low zinc status in our population, ALV consumption did not improve serum zinc concentrations. Based on the more theoretical and indirect study results, including both caregivers’ and children’ positive image of ALVs, and the nutrient composition and iron and zinc bio‐accessibility of the ALVs, these selected vegetables do have the potential to contribute to the micronutrient intake of school children. However, the importance of ALVs might not necessary be to serve as a strategy for micronutrient deficiency alleviation, but rather in the diversification of the diet in resource‐poor settings and thereby contribute to the micronutrient intake. / PhD (Nutrition), North-West University, Potchefstroom Campus, 2014

This parallel randomized control trial study assessed the effect of food-based strategies in improving the haemoglobin level; decreasing anaemia and thus the iron status of pregnant women. The study randomized 195 anaemic women enrolled from four randomly selected health centres in Dire Dawa while attending ANC into two intervention groups and control; and followed for 12weeks. The study intervened diet-based supplementation of 90mg/day vitamin C divided and consumed in three doses; combined with nutrition education intervention in intervention group 1; while only nutrition education intervention in group 2. Dietary diversity was assessed using past 24-hours and 7-days dietary recall approaches and haemoglobin levels were determined at baseline and end-line and compared to analyse treatment effects. By end of the study, intervention group 1 and 2 had significantly increased mean haemoglobin by 0.77 ± 0.11gm/dl and 0.398 ± 0.073gm/dl respectively; however, the control had significant decrease by -0.193 ± 0.05gm/dl. Anaemia prevalence also significantly decreased by 29% and 19.7% in intervention group 1 and 2 respectively. However, all women in the control were anaemic. Intervention group 1 and 2 also had significantly higher dietary diversity, consumption of vitamin C-rich fruits and vegetables, nutritional knowledge and modification practices. The researcher thus concludes that diet-based vitamin C supplementation integrated with nutrition education has a significant effect in improving haemoglobin, decreasing anaemia and thus improving the iron status of pregnant women in Dire Dawa. Based on the findings, the researcher developed a framework for an integrated food-based strategy for improving the iron status of pregnant women in Ethiopia. / Health Studies / D. Litt. et Phil. (Health Studies)