Impact of Lunch Provision on the Nutritional and Health Status of Garment Workers in Cambodia
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Beschreibung
Although concerns about the nutritional and health status of Cambodian garment workers do exist, data are still sparse. The establishment of staff canteens in garment factories serving free lunch has been proposed as a suitable intervention to improve nutrition and health of workers. However, trials that verify this hypothesis are missing and information is lacking on exemplary meals, their nutritive value, and their costs.
The objectives of the present thesis are: 1) to examine the nutritional, hemoglobin (Hb), and micronutrient status of female workers employed by a garment factory in Phnom Penh, Cambodia; 2) to assess the nutritive value of low-price model lunch sets provided to garment workers within the Lunch Provision in Garment Factories study (LUPROGAR); 3) to compare food intake between garment workers with and without access to LUPROGAR’s model lunch provision; and 4) to determine the impact of LUPROGAR’s model lunch provision on anthropometry, Hb, and micronutrient status of female Cambodian garment workers.
The LUPROGAR study was an exploratory randomized controlled trial implemented at a garment factory in Phnom Penh, Cambodia. Female workers (nulliparous, non-pregnant) were recruited and randomly allocated into an intervention arm (six-month free model lunch provision through a newly established canteen during workdays) and a control arm. Exemplary low-price lunch sets (~700 kcal on average, biweekly menu) included diverse local dishes prepared by an established local caterer. At baseline and after five months of lunch provision, anthropometric measurements (body mass index (BMI), weight, triceps skinfold thickness (TSF), and mid-upper arm circumference (MUAMC)) were performed and blood samples were taken to obtain results on Hb, serum ferritin (FER) and soluble transferrin receptor (sTfR), serum retinol binding protein (RBP), serum folate, and serum vitamin B12 (VitB12) concentrations. Dietary intake on workdays was assessed at baseline and at two follow-up interviews during the lunch provision period (first follow-up at two and a half months and second follow-up at five months) using the Food and Agricultural Organization (FAO) guideline on recording individual dietary diversity. At the canteen, dish samples were collected repeatedly to examine mean serving sizes of individual ingredients. Food composition tables and NutriSurvey software were used to assess mean amounts and contributions to recommended dietary allowances (RDAs) or adequate intake of energy, macronutrients, dietary fiber, vitamin C (VitC), iron, vitamin A (VitA), folate, and VitB12.
223 women were recruited (n=112 control and n=111 intervention). 172 (n=86 in each arm) completed the study. Baseline prevalence of underweight, anemia, depleted iron stores, and marginal iron stores, were 31%, 27%, 22%, and 47%, respectively. Subjects were not affected by frank VitA, folate, or VitB12 deficiency, whereas ~30% showed a marginal folate status. On average, LUPROGAR’s model lunch sets provided roughly one third of RDA or adequate intake of energy, carbohydrates, fat, and dietary fiber. Contribution to RDA of protein was high (46% RDA). Lunches contained a high mean share of VitC (159% RDA), VitA (66% RDA), and folate (44% RDA), but were rather low in VitB12 (29% RDA) and iron (20% RDA). Intervention subjects on average visited the canteen on 85% of the intervention days. Lunch provision resulted in a more frequent consumption of dark green leafy vegetables, VitA-rich fruits, other fruits, and oils and fats during lunch breaks. In contrast, flesh meats, legumes, nuts and seeds, as well as sweets, were eaten at a lower frequency. Except for a higher consumption rate of VitA-rich fruits and a lower intake frequency of sweets, lunch provision had a less clear impact on total 24-h intake from different food groups and was not associated with a higher women’s dietary diversity score. Overall, mean changes in anthropometric variables, Hb, and serum RBP were marginal and not significant among intervention subjects. Mean serum folate concentration increased by +1.1 ng/mL (-0.02, 2.2) (p=0.054), representing a marginally significant positive intervention effect. On the other hand, mean serum FER decreased by -6.6 µg/L (-11.9, -1.3) (p=0.015). A secondary subgroup analysis prompts that effects are differently pronounced according to the baseline status of workers.
Young female garment workers in Cambodia are identified as a group with an elevated risk for nutritional deficiencies. Therefore, strategies need to be developed for improving their nutritional, Hb, micronutrient, and health status. LUPROGAR’s exemplary low-price lunch sets for garment workers matched recommendations regarding their contribution to RDA’s of caloric content and macronutrient composition for sources of energy intake. Future model lunch sets for this group of women could incorporate some organ meats to increase the provision of iron. On the other hand, it is considered that LUPROGAR’s model lunch sets contained beneficial and adequate amounts of VitC, VitA, folate and VitB12, on average. Consequently, meal provision via staff canteens is expected to bear the potential to improve food security of workers, approximately at costs of less than 1 USD/person/day (at large scale). A more gap-oriented design of the lunch sets taking into account underutilized foods and the nutritional status of the workers is recommended for increasing their dietary diversity. Moreover, skipping of meals in workers with access to a staff canteen should be closely monitored in order to avoid unfavorable dietary changes. Distinct positive effects from lunch provision on anthropometry, Hb, and micronutrient status, can solely be expected in malnourished individuals. It is suggested that similar but larger trials, which include lunch sets adapted to the concrete needs of workers affected by underweight, anemia, and/or definite micronutrient deficiencies, should be performed. The overall findings from this study should have practical implications for the design and implementation of subsequent studies, lunch programs, and further strategies aiming at the improvement of the nutritional and health status of female garment workers in Cambodia.
Autor*in
Jan Makurat