title: Cultural and environmental barriers to adequate iron intake among northern Kenyan schoolchildren.
abstract: The purpose of this study was to examine the context of iron deficiency and feeding patterns of iron-rich foods among northern Kenyan school-aged children. A nutrition survey was conducted among 300 subjects in two Rendille communities, Korr and Karare. The objectives were to determine the prevalence of iron deficiency as it relates to parasitic infection, dietary intake, and sociodemographic factors, as well as cultural food proscriptions influencing child feeding. Sociodemographic and qualitative data on food beliefs and child-feeding practices were obtained from the primary caretaker of each subject. From pediatric subjects, 24-hour dietary recall data were obtained with the help of the primary caretaker, and capillary blood from a fingerstick was used to detect iron deficiency based on measures of hemoglobin, the zinc protoporphyrin-to-heme ratio, C-reactive protein, and transferrin receptor. With an overall prevalence of 31.2%, iron deficiency was found to be associated with dietary iron intakes constrained by diverse economic, cultural, and environmental factors among Rendille children. In Karare, where children's iron intake approached recommended levels, iron deficiency was found to be attributable to low bioavailability of iron (only 4.3% of total iron intake), rather than low dietary intake per se. By contrast, in Korr the average daily iron intake was estimated at only 65% of recommended allowances, indicating that iron deficiency was the outcome not merely of low bioavailability, but rather of overall inadequate iron intake. Sociodemographic analysis showed a significant interaction between sex and economic status, revealing that girls in economically sufficient households were 2.4 times as likely to have iron deficiency as boys. This difference in risk parallels culturally defined gender-based proscriptions for child feeding: girls are believed to benefit from "soft foods," including rice, maize porridge, and tea, whereas boys benefitfrom "hard foods," including meat, blood, and beans. Consequently, in households economically able to purchase iron-rich foods, these foods are being preferentially fed to boys. Economic development may result in improved iron status for boys, but it will be unlikely to benefit girls in the absence of a dietary modification intervention. A modification of culturally acceptable "soft foods" to include iron-rich foods may provide a sustainable approach to controlling and preventing iron deficiency in this population.
authors.affiliation: Department of Anthropology, University of Washington, Seattle, Washington 98195-3100, USA. bsd@u.washington.edu
authors.forename: Bettina
authors.initials: B
authors.lastname: Shell-Duncan
authors.forename: Thomas
authors.initials: T
authors.lastname: McDade
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000453:epidemiology* / Q000209:etiology; D001682:Biological Availability; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D004034:Diet Surveys; D005260:Female; D006801:Humans; D000090463:Iron Deficiencies; D019266:Iron, Dietary / Q000008:administration & dosage* / Q000493:pharmacokinetics; D007630:Kenya; D008297:Male; D011939:Mental Recall; D009753:Nutritive Value; D010272:Parasitic Diseases / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class
chemical_list: D019266:Iron, Dietary