Education and Human Sciences, College of (CEHS)


First Advisor

Mary S. Willis

Date of this Version


Document Type



A THESIS Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Master of Science, Major: Nutrition and Health Sciences, Under the Supervision of Professor Mary S. Willis. Lincoln, Nebraska: August 2022

Copyright (c) 2022 Topacio A. Ortiz


Vitamin A deficiency (VAD) is one of the most common micronutrient deficiencies in Sub-Saharan Africa. Zambians face high VAD rates, despite a mandate for fortified sugar and crops. Limited data have been collected from the most vulnerable segments of Zambia’s population; hence this study was designed as an initiatory study for future research to be conducted with primary school children and pregnant women in Zambian communities.

Once IRB approvals were obtained from the University of Nebraska-Lincoln (UNL) and the Copperbelt University School of Medicine, data were collected in Zambia’s Copperbelt Province, in the cities of Ndola and Luanshya, during May and June of 2018. Four open-air (OAM) markets were inventoried, 1,212 primary school students were interviewed, and women of reproductive age from four clinics participated in focus groups and attended food demonstrations, to gather data related to vitamin A, VAD, and general nutrition education.

Three categories of vitamin-A rich foods were found in the local open-air markets. Generally, children reported high rates of consumption for vitamin A-rich foods, including fortified sugar, although some foods were consumed more than others and favorites were often seasonal. Women attending education and food demonstration sessions at health clinics often understood the value of vitamin A foods but lacked a comprehensive knowledge about crop and livestock species and how each could be prepared to maximize the uptake of vitamin A. Household observations reinforced the fact that although vitamin A-rich foods are available, they are not necessarily accessible, utilizable, or sustainable.

Despite the fact that vitamin A sources could be obtained in the OAMS, and that primary school children reported high consumption rates for most foods, VAD rates remain high in Zambia. Fortified sugar is consumed by all population segments and yet, increased sugar consumption does not seem to be reducing VAD. In communities of the Copperbelt, food security in terms of vitamin A has not been achieved. Factors such as seasonal access to vitamin-A rich foods, diarrheal disease, limited knowledge about the best sources for vitamin A, and a lack of understanding about the importance of fat consumption to facilitate absorption might be responsible for low vitamin A stores. More community-level work in each of Zambia’s provinces should be conducted to determine effective approaches in each region, community and ethnic group.

Advisor: Mary S. Willis