Local Food Resources to Fight Children Malnutrition and Infectious Diseases in Mozambique

Damiano Pizzol¹, Francesco Di Gennaro^2*, Angela De Palma³, Guillermo Marquez⁴, Laura Monno², Annalisa Saracino², Michela Romanelli⁵, Giovanni Putoto⁶ and Alessandro Bertoldo⁷

¹Operative Research Unit, Doctors with Africa CUAMM, Beira, Mozambique

²Department of Clinical Infectious Diseases, University of Bari “Aldo Moro”, Bari, Italy

³Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”; Bari, Italy

⁴Unicef, Mozambique

⁵Operative Research Unit, Doctors with Africa CUAMM, Maputo, Mozambique

⁶Operative Research Unit, Doctors with Africa CUAMM, Padova, Italy

⁷Reproductive Medicine Center, Zerouno Procreazione, Venice, Italy

*Corresponding Author:

Francesco Di Gennaro
Department of Clinical Infectious Diseases
University of Bari “Aldo Moro”
Bari, Italy
Tel: +393924804707
Fax: +39080547833
E-mail: cicciodigennaro@yahoo.it

Received date: July 13, 2016; Accepted date: August 11, 2016; Published date: August 22, 2016

Citation: Pizzol D, Di Gennaro F, De Palma A, Marquez G, Monno L, et al. (2016) Local Food Resources to Fight Children Malnutrition and Infectious Diseases in Mozambique. J Emerg Infect Dis 1:111. doi:10.4172/2472-4998.1000111

Copyright: © 2016 Pizzol D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Objective: To develop sustainable recipes, using local food resources, as a possible solution to manage children malnutrition and nutritional lack in Mozambique, thus preventing infectious diseases.

Methods: Our work was based on the Dietary Reference Intake (DRI) reports for children aged 4-8 years old. After having listed more than 60 commonly consumed local foods in Mozambique, we developed some recipes, indicating composition, energy and nutrients values. Information on nutrients concentrations was taken from the National Nutrient Database for Standard References, the Food Composition Tables for Mozambique and the Research Center for Aliments and Nutrition. In the recipes, the traditional way of listing ingredients was reported, which were then turned into international, standardized values.

Results: We elaborated some different local food recipes, easy to prepare, at low cost and useful in a systematic approach in order to fight malnutrition in Sofala Province, Mozambique. Each recipe included functions and daily Recommended Dietary Allowance (RDA) of: water, proteins, lipids, carbohydrates, fibers, sodium, potassium, iron, calcium, phosphorus and vitamins. We suggested recipes richer in vitamins and micro/macro nutrients for breakfast, while those providing high caloric intake were more indicated for the main meal. The resulting recipes have been made understandable, for both local and international population, thanks to the coexistence of traditional and international description of ingredients.

Conclusion: Local recipes approach is a possible promising tool among the most cost-effective/high impact interventions against child malnutrition and mortality from infectious diseases in Mozambique.

Keywords

Malnutrition; Infectious diseases; Children; Local food resources; Mozambique; Doctors with Africa

Introduction and Objective

Pediatric malnutrition is defined by the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition as “an imbalance between nutrient requirements and intake that results in cumulative deficits of energy, protein or micronutrients that may negatively affect growth, development and other relevant outcomes” [1]. It represents a serious public health issue linked to an increased mortality and morbidity risk and children under 5 years old have a higher risk due to growth speed and brain development [2].

The World Health Organization (WHO) reports that the annual infant mortality rate is about 6.3 million and 42% of these takes place in the African region. Just six causes are considered responsible of 73% of deaths in children under the age of five: respiratory infections (19%), diarrhea (18%), malaria (8%), pneumonia and neonatal sepsis (10%), pre-term birth (10%) and birth asphyxia (8%) [3-5]. Malnutrition is obviously an additional risk for all of these conditions, worsening the course of the infectious diseases and slowing the healing, and it is considered the underlying cause of 53% of pediatric deaths up to 5 years [6]. In fact, an inadequate diet leads to weight loss, decrease of the immune response and damage of the mucosa, allowing invasion of pathogens, which finally worsens the overall nutritional status. In addition, these conditions lead to decreased efficacy of vaccines and increased exposure to infectious agents [7,8].

An important role in child health and development is also played by the nutritional and educational status of the mother [9,10].

In developing countries about 200 million children - one in three - between 0 and 5 years suffer from some form of malnutrition and those with a severe form have a nine times greater risk of death compared to well-fed children [11,12].

In Mozambique, children constitute 52% of the national population and malnutrition in childhood is a serious concern: 16.9% of babies are born with low birth-weight; 5.9% children under 5 years suffer from acute malnutrition (moderate or severe) and 42.6% are chronically malnourished [13-15]. The problem is particularly heavy in rural areas, where the quality of the diet is extremely low and the consumption of food and dietary diversification are inadequate in more than 31% of households, in spite of a general improvement in food production and availability of food [16]. Different and various strategies have been adopted to fight the malnutrition problem and the food-based approach in prevention and control of micronutrient deficiencies as well as nutrition, is fully recognized by the Food and Agriculture Organization of the United Nations [10,17].

There are also a wide range of specialized foods ranging from Fortified Blended Foods (FBFs) and micronutrient powders to Readyto- Use Foods and High-Energy Biscuits (HEBs) such as Plumpy’Net, with which it is possible to obtain good results [18,19].

In Mozambique, Government programs concerning malnutrition, child care and health education are active, including: nutritional supplementation interventions, school health programs and agriculture, community preventions campaigns, nutrition and food security plans [20].

Nevertheless, there is a gap of knowledge on the use of local food resources as a possible, simple, low cost solution to fight malnutrition and prevent infectious diseases in Mozambique. In fact, even if many Authors suggest that malnutrition and diseases are strongly related [7,21], worsening the prognosis of infectious diseases like tuberculosis, HIV and malaria, no study have yet been published concerning the power and the potential good effect of local food resources on these aspects. A major issue in countries with limited resources is the sustainability of the program itself.

Thus, this study seeks to illustrate some sustainable recipes, made with local food resources, as a possible solution to fight child malnutrition and reduce the risk of infectious diseases (mainly tuberculosis, HIV and malaria), in Mozambique.

Methods

In this study project, we adopted the Dietary Reference Intake (DRI) for children aged 4-8 years old from the DRI reports [22] and the function and the Recommended Dietary Allowance (RDA) of main nutrients were considered. Moreover, we obtained a list of local food resources in order to select and propose local recipes as a possible, innovative, simple and rapid approach to fight children malnutrition and infectious diseases in a lowincome country as Mozambique [7,21,23,24]. The research was made in cooperation with the Provincial Health Department of Sofala and the local association “Grupo das Mães Kuplumussana”.

Dietary reference intake

The DRI represents the most current scientific knowledge on nutrient needs of healthy populations. We adopted the DRI for children aged 4-8 years old from the DRI reports [22]. Main nutrients were listed and for each one the function and the RDA were indicated. RDA is used as a goal for individual intake and in this study was set to meet the needs of almost all (97 to 98 percent) individuals in the mentioned age group.

Food list

The list of foods commonly consumed in Mozambique, in particularly in the Province of Sofala, was made consulting the Food Composition Tables for Mozambique [25], the Health Provincial Direction (DPS) of Sofala and searching in local markets, shops and supermarkets.

Information on nutrient concentrations in foods was taken from the USDA National Nutrient Database for Standard References [26], the Food Composition Tables for Mozambique [25] and the Research Center for Aliments and Nutrition [27].

Recipes elaboration

The recipes were developed by the joint work of the DPS, the non-governmental organization “Doctors with Africa” and a local association named “Grupo das Mães Kuplumussana”, taking also cue from the manual “Oficina culinarias praticas de Mocambique”.

The recipes have been firstly collected reporting traditional way of listing ingredients and then, based on the DRI and the food list, turned into international, standardized values.

Results

The DRI for 4-8 years old children is reported in Table 1, where functions and daily RDA are listed in term of: water, proteins, lipids, carbohydrates, fibers, sodium (Na), potassium (K), iron (Fe), calcium (Ca), phosphorus (P) and vitamins (thiamin or vitamin B1, riboflavin or vitamin B2, niacin or vitamin B3, vitamin A, vitamin C and vitamin E).

Table 1: Dietary Reference Intakes (DRIs) for 4-8 years old children.

In Table 2 we reported sixty foods commonly used in Mozambique, indicating for each one the composition and the energetic value.

Table 2: List of foods commonly consumed in Mozambique.

From all the collected recipes we chose six of them, two characterized by the presence of vitamins and micro/macro nutrients, therefore more indicated for breakfast, and four with high caloric intake, suggested for the main meal. Here we report the recipes described by the amount of traditional ingredients.

1. Mush of Baobab seeds: a cup of Baobab seeds, half tablespoon of corn flour, four tablespoon of sugar, a cup of milk;

2. Pap of Moringa leaves: four tablespoons of corn flour, four tablespoons of sesame, two tablespoons of beans, a tablespoon of peanuts, a handful of Moringa leaves;

3. Curry of Mandioca leaves: two coffee cups of cashews, a bunch of Mandioca leaves, half cup of shrimps, a cup of coconut milk, a onion, two tomatoes, rice flour;

4. Curry of peanuts with pumpkin leaves: a tea cup of chopped peanuts, four bunch of pumpkin leaves, two tomatoes, an onion, corn flour;

5. Curry of beans: two cups of beans, two tomatoes, three tablespoons of chopped onion, two garlic cloves, a tablespoon of corn oil, a cup of corn flour;

6. Curry of peanuts with cabbage: a cup of coffee of peanuts, a cabbage, two bunches of cabbage leaves, two tomatoes, half onion, a cup of rice flour.

The selected recipes are reported in Tables 3-8, with the ingredients in international, standardized values, and for each ingredient the nutritional content, energy intake and RDA are described.

Table 3: Mush of Baobab seeds.

Table 4: Pap of Moringa leaves.

Table 5: Curry of Mandioca leaves.

Table 6: Curry of peanuts with pumpkin leaves.