Date Published: April 12, 2019
Publisher: Public Library of Science
Author(s): Caleb Yengo Tata, Amy Ickowitz, Bronwen Powell, Esi K. Colecraft, Mary Glover-Amengor.
Forest cover has been associated with higher dietary diversity and better diet quality in Africa. Anemia prevalence among women of reproductive age in sub-Saharan Africa is very high and diet is one known contributor of a high prevalence rate. We investigated whether living in communities with high forest cover was associated with better diet quality and lower anemia prevalence among women of reproductive age in Southwest Cameroon.
We conducted a cross-sectional survey of 247 women of reproductive age from four forest-based villages (n = 126) and four non-forest villages (n = 121). We assessed the Hemoglobin (Hb) levels, anthropometric status, and diet (by 24-hour recall), as well as anemia-related morbidity and socio-demographic characteristics. Differences between groups were assessed with Pearson’s chi-square and independent T-tests. We used a number of multivariate regression models to estimate the impacts of forest proximity on adjusted hemoglobin status of women of reproductive age, as well as to identify the most likely pathway through which forest proximity was important.
We found that women living in forest communities had higher adjusted hemoglobin levels (mean hemoglobin concentration 11.10±1.53 g/dl vs.10.68±1.55g/dl; p = 0.03 for women forest and non-forest communities respectively). Moderate to severe anemia prevalence was significantly higher in women living in the non-forest villages compared to women in forest villages (forest 63% vs. 73%; p = 0.04). Compared with women from non-forest villages, women from forest-based villages had consumed significantly more vitamin A rich fruits and vegetables and animal source foods, and more of these came from the forest (as opposed to the farm or purchased sources). We found that the consumption of Gnetum africanum (Eru), a leafy green vegetable that grows in forests of the Congo Basis, was best able to account for the higher levels of adjusted hemoglobin in women in forest communities.
This study contributes to the growing evidence that in some circumstances, forests make important contributions to diet quality and nutrition. The results of this study suggest that plant foods from the forest may make important contributions to iron intake and reduce the risk of anemia in women. Efforts to prevent forest loss and maintain ecosystem services are warranted to enhance nutrition and health of forest-based communities.
While hunger has declined globally, rates of micronutrient deficiency have remained stubbornly high, especially in Africa [1, 2]. Iron deficiency anemia remains a major public health problem worldwide  and significantly increases the risk of maternal mortality, low birth weight and infant mortality [3–5]. Although global anemia prevalence declined between 1990 to 2010, nearly one-third (32.9%) of the world’s population is anemic, with women and children most affected and iron deficiency the main cause of anemia world-wide . Countries in Africa have some of the highest prevalence of anemia [2, 5]. In Cameroon, the prevalence of anemia among women of reproductive age is 38.8%, higher for rural than urban women .
The present study aimed at investigating the relationship between forest cover, dietary intake and anemia prevalence among women of reproductive ages. The nutritional status of a woman has important implications, not only for her health, but also for that of her children [2, 3]. Anemia in women of reproductive age is one of the most pressing and challenging global public health problems, and an impediment to development in developing countries, including Cameroon. Anemia is known to be especially prevalent in women living in poor and rural areas [3–5]. Studies have shown that iron deficiency may occur where there is low animal source food intake, when the majority of calories / energy in the diet comes from staple foods and especially when people are exposed to infections associated with blood loss or destruction of red blood cells . The results of this study demonstrate that forests, and specifically forest foods may be protective against anemia. While several studies have previously demonstrated the importance of wild foods and forests for diet quality, this is one of the first studies to demonstrate a relationship between forest proximity, forest foods and biochemical measures of nutrition [22, 38–41].
Our study showed a very high prevalence of anemia—75.3%—among women around the Takamanda National Park. Women from forest communities had a higher mean hemoglobin concentration and a lower prevalence of moderate to severe anemia than women living farther from forests. In regression models, consumption of Gnetum africanum (eru, a common leafy vegetable from the forest) was the only variable to explain the differences in anemia between women from forest and non-forest communities. Although we have speculated on some possible reasons for these results, additional research to understand the pathways through which consumption of this plant affects hemoglobin is needed.