Nutritional status of children (6 To 13 Years) in Tubu and Shorobe molapo farming households, Ngamiland, Botswana

Abstract

Background: The size of floods in the Okavango Delta (OD), Botswana varies annually and seasonally over long periods (decadal). This influences crop production, food security, health and nutritional status of dependent farming households and especially of vulnerable populations such as children. Unlike the under-fives, school age children (SAC) and especially those living in rural, farming and resource poor households have been neglected in health research and not much is known about their nutritional status. Objective: To determine the nutritional status of children (6 to 13 years) in farming households of Tubu and Shorobe villages over the lean and plenty seasons. Methods: Using a cross sectional study design, samples of 84 and 134 children (6 to 13 years) were assessed during the lean and plenty seasons for nutritional status indicators of growth (stunting, underweight, thinness and overweight and obesity), meal patterns, serum iron and zinc status, prevalence of soil transmitted helminthes (STH), relationship between STH and iron status, household food security status and factors influencing nutritional status. Results: Double burden of malnutrition was evident in the study children. Prevalence of underweight, stunting, thinness and overweight/obesity during the lean season was 12.3%, 6%, 11.9% and 4.8% respectively, whereas in the plenty season they were 6.3%, 5.2%, 7.4% and 4.4% respectively. Regardless of season, age, and/or farming system, the bulk (>60%) of the children’s diets were predominately starchy foods such as cereals (>91%), sugar/honey (>84%), miscellaneous foodstuffs (condiments, beverages such as tea and coffee) (>78%) and meat/poultry/offal (>61%). Overall, no more than 27% of all children had representation of roots and tubers, vegetables, fruits, eggs, fish and seafood and pulses/legumes/nuts in their diets in the previous day. Unexpectedly, there was a higher prevalence of anemia at 34% (n=18/53) during the plenty season compared to 17.4% (n=4/23) in the lean season. One girl child, aged 6 years and from a molapo farming household was zinc deficient, with levels below 9.9umol/L. There was a low (0.75%) prevalence of STH but increased intestinal polyparasitism (lean: 7.1%; plenty: 11.2%) associated with poor food handling and preparation- as well as hygiene and sanitation practices. Food insecurity was common amongst households in both lean (95.7%) and plenty (88.7%) seasons. Over 67% of households in both seasons experienced worry over food supply for the previous month, and consumed food of low quality and quantity. Significant differences were only observed when comparing mean WAZ by season (lean: 0.8±0.9 and plenty: 0.5±1.0, t (133) = -2.144, p<0.05) and mean BAZ by age (6 to 9 years: 0.8±0.8 and 10 to 13 years: 1.0±0.9, t (208) = 2.341, p<0.05). Child age significantly influenced thinness. Household income, the plenty season and Tubu village were negatively associated with meal patterns (dietary diversity). On the contrary, farming system was positively associated with dietary diversity. Household income negatively influenced household food security. Conclusion: Although the study SAC seemed to have poor nutritional status, generally, they fared better than the under-fives in the nation. Nonetheless, significant health concerns that must be quickly addressed in the studied communities included undernutrition (underweight and thinness), limited dietary diversity, poor food handling and preparation practices and poor hygiene and sanitation practices, and pervasive household food insecurity. Nutritional status of SAC deteriorated more during the plenty season. Loss of crops to floods, which is an indicator of climate change majorly affected SAC nutritional status, household food security and dietary diversity. Molapo farming is a promising system towards improving dietary diversity.