Vitamin A is an important nutrient in the body and participates in a number of biological roles including vision, growth and reproduction [1] . Good vitamin A status is important for the body to carry out these functions. The dietary needs for vitamin A are normally provided for as preformed retinol and provitamin A carotenoids [1] . In vitamin A deficiency (VAD) therefore, functional disorders are observed. Deficiency in vitamin A during infancy, pregnancy and lactation, has been recognized as a public health problem, contributing significantly to a high rate of maternal and infant mortality [2] . VAD usually results from an inadequate intake amongst other factors. The joint FAO/WHO expert consultation on human vitamin and mineral requirements recommends a daily intake of 800 μg Retinol Equivalence (RE) for pregnant women 19 years and above [1] .

In Cameroon, 18% of pregnant women suffer from VAD, and the situation is even more critical in preschool children (39%) [3] . Recent studies in the town of Ngaoundere, in the Adamawa Region of Cameroon reveal that 37.5% of pregnant women are exposed to acute VAD, with 20% of them at risk for severe VAD [4] . This calls for concern as VAD in the mother can result in malformations in the fetus and predispose the child to VAD [2] . Poor dietary patterns before and during pregnancy have been identified as one of the major causes of malnutrition in women and children [5] , and VA content of human breast milk is strongly affected by maternal nutrition during pregnancy and lactation [6] .

There have been reports showing that food consumption as well as the quantity and quality of the diet composition are influenced by social factors [7] - [8] . Higher socio-economic levels have been associated with healthier dietary patterns whereas poor socio-economic status is linked to poor dietary patterns. In a study conducted in China, it was observed that feeding practices were strongly correlated with malnutrition and anemia in children 0 - 18 months old [9] . Nutritional status therefore, is influenced by our food habits, which in turn are influenced by factors such as cost, income, availability, culture, education, skills (e.g. cooking), beliefs and knowledge about foods [10] - [12] . In an attempt to understand this relationship with regards to vitamin A status, this study sets out to determine the differences in vitamin A intake of pregnant women in Ngaoundere with respect to their geographic origin, socio-professional, anthropometric and demographic factors.

With daily VA intake of 496 ± 23 µg for pregnant women from the Northern Region and 588 ± 24 µg for those of the Southern Region (Table 2), it appears that the intake of vitamin A rich foods in Cameroon is significantly (p < 0.05) influenced by geographic origin and cultural values as opposed to food availability. These results corroborate those of a study conducted in the town of Yaounde by Tabuna and Tanoé who found that there was a relationship between the geographic origin of a household and its food behavior [7] . This difference in vitamin A intake of Northern and Southern women could principally be explained by the food habits in these two regions (Table 3). Dishes consumed by Southern women have higher vitamin A contents, as a consequence of the

¹Gnetum africanum, ²Solanum nigrum, ³Vernonia amygdalina, ⁴Amaranthus hybridus. ⁵Vigna unguiculata, ⁶Adansonia digitata, ⁷Hibiscus sabdarifa, ⁸Corchorus olitorius; ^*Vitamin A Equivalent for 100 g (Dry weight basis).

types of vegetables consumed and culinary practices. Vitamin A activity varies with the type of green leafy vegetable as reported by Djuikwo et al. [15] . Thus, S. nigrum, G. bucholzianum and V. amygdalina mostly consumed by pregnant women from Southern Regions are richer in provitamin A than A. digitata and H. sabdarifa [15] mostly consumed by women of Northern Regions. In addition, women originating from the Southern Regions have the culture of using red palm oil, carrots and tomatoes in their cooking, which are rich sources of β-carotene and other carotenoids [16] , contrary to the women originating from Northern Cameroon who do not have this culture. Southern women use red palm oil for the preparation of dishes like Eru, koki and zom. Furthermore, survey results reveal that women from Northern Regions preferably use smoked fish in their dishes, while women from the Southern Region consume more beef and chicken which contain respectively 25 and 85 µg VA/100 g as opposed to smoked fish which has negligible vitamin A activity [14] . All of these factors contribute to explain the higher vitamin A intake of women of Southern origin compared to those of Northern origin.

VA intake though generally lower in women aged 30 years and above, was only significant in the case of Northern women with intakes of 476 ± 03 µg/day for women aged 30 years and above, compared to 501 ± 17 µg/day for those aged 21 to 29 years. The significant decrease in vitamin A intake of Northern pregnant women 30 years and more (476 ± 03 µg) could be due to the fact that they are mostly in large families with three or more children, which could imply reduced food intake for the mother and the children. Generally, however the variation in food intake with age was not significant, and could be related to the fact that culinary practices are transmitted from one generation to another, from mothers to their daughters, with sometimes light modifications related to the socio-economic and environmental context. This observation is in agreement with that of MOST, USAID Micronutrient Program [17] working on the prevalence of VAD among pregnant women (14 - 43 years) from four districts of Madagascar who reported that there was no statistically significant difference among the various age brackets with respect to VAD.

On the contrary, the general daily vitamin A intake increased significantly (p < 0.05) from 468 ± 12 µg for women who had never gone to school to 608 ± 53 µg for those who reached University. Thus, the more educated a woman is, the better her vitamin A intake irrespective of origin, although the quantities consumed are higher for women from Southern Regions compared to those from Northern Regions. The level of education is thus an important factor to take into consideration when elaborating food policies and education programs. Certainly because of their illiteracy, women with low educational level can neither read nor write, and for some cannot even express themselves in French or English, official languages in Cameroon; they thus do not grasp the messages in the multiple nutritional public awareness campaigns on radio, television, and even in the hospitals and health centers where they go for their prenatal consultations. Added to this, is the fact that they probably do not understand the importance of Nutrition not only during pregnancy, but in their life in general and that of their unborn child. In fact, it has been shown that women who receive even minimal education are generally more aware, than those who have no education, of how to utilize available resources for the improvement of their own nutritional status and that of their families [18] . Education can enable women make correct decisions about food choices, and to have greater access to household resources that are important to nutritional status [19] . A comparative study on maternal malnutrition in ten Sub-Saharan African countries [20] and a study in the Southern Nations, Nationalities and Peoples Region (SNNPR) of Ethiopia [21] showed that the higher the level of education, the lower the proportion of undernourished women in these communities.

These results are different from those of the WHO/FAO study [1] , which found that there was no significant difference in vitamin A intake between women married or single, and whatever their level of education [1] . This could be due to the fact that in a WHO study, there were only women from secondary school and University, compared to this study where approximately 50% of the pregnant women from Northern Region had never gone to school. These results are also different from those found by Tabuna and Tanoe [7] who studied the influence of the level of education on the food behavior of the households in Yaounde town and arrived at the conclusion that there was no relationship between the two. This difference could be due to the difference in the study site given that Tabuna and Tanoe worked in Yaounde, a town located in the Southern part of Cameroon. Statistics of the population in our study showed that pregnant women from Southern Regions were more educated (100% attended at least primary school) than those of Northern origin and this is a reflection of the level of education in these two regions [3] .

The socio-professional status of the women had no significant (p > 0.05) influence on their vitamin A intake, irrespective of origin. This could be explained by the fact that culinary practices were similar among each group of women, and according to the 24 hour dietary recall, the women ate most of their meals at home. Other studies have shown no significant variation in vitamin A intake [1] or food habits in general [7] with socio-professional status. This suggests that food consumption patterns and food habits are more rooted in our cultures than in socio-professional status. Pregnant women having three or more children had lower vitamin A intake (534 ± 60 µg) compared to those having less than three children, but differences are not significant. However, the progressive decrease in vitamin A intake with number of children suggests that mothers with larger families are more at risk for VAD, possibly due to reduced food intake as they have more persons to feed. The vitamin A intake of pregnant women in Ngaoundere town is significantly (p < 0.05) influenced by the age of pregnancy with intake increasing as we move from the first to the third trimester of pregnancy (520 to 571 µg). The increase observed in the vitamin A intake of Northern and Southern women in the third trimester of pregnancy corroborates with increased food intake at this period of increased weight gain to meet up fetal needs and to prepare for lactation [22] . The lower vitamin A intake observed in the first trimester could also be explained by the fact that at this stage of pregnancy, the amounts of cooked foods consumed may be reduced due to bouts of nausea resulting from hormonal changes in the woman’s body [23] .

BMI is a method of assessing nutritional status of individuals, thus linked to food behaviors. Vitamin A intake being influenced by food behaviors, it thus appears important to emphasize the existence or not of a link between BMI and vitamin A intake of the studied population. Vitamin A intake increased with BMI, and the effect is more pronounced in women of Southern origin where significant (p < 0.05) increases were observed in normal and overweight women compared to underweight women. If weight gain is linked to increase food consumption, it follows therefore that vitamin A intake will increase with increase in food consumption and weight gain.

Even though, the average daily vitamin A intake of women from the Northern Regions (496 µg/day) is significantly (p < 0.05) lower than that of women from the Southern Regions (588 µg/day), both consumed less VA than the 800 µg recommended daily. However, with an average daily vitamin A intake of 468 µg, which appears to be the lowest vitamin A consumption in the studied population, pregnant women originating from Northern Cameroon and having no formal education are the most at risk group. Indeed, the quantities of vitamin A found for these women were lower than the threshold critical values of 500 µg/day [4] . It can therefore be suggested that geographic origin and level of education of pregnant women in Ngaoundere town are important factors influencing their vitamin A status. Thus a pregnant woman originating from the Northern part of Cameroon and having no formal education is strongly predisposed to foods low in vitamin A, and consequently presents a higher risk of developing a severe VAD.

In conclusion, this study reveals suboptimal dietary intake of vitamin A (<800 μg), insufficient to cover the needs of pregnant women in Ngaoundere town. Level of education, geographic origin, age of the woman, BMI and age of the pregnancy significantly influenced daily intake of vitamin A. A pregnant woman originating from the Northern part of Cameroon and who has never been to school is strongly exposed to VAD. Thus, nutritional intervention programs designed to reduce the prevalence of VAD should take into consideration these variables. In particular, improving the level of scholarisation of the girl child and culinary practices in the Northern Regions of Cameroon should be one of the priority areas of government action towards fighting VAD.

The authors will like to thank the pregnant women who participated in this study.

Edith N.Fombang,Wilfred DamndjaNgaha,Richard AbaEjoh, (2016) Variability in Vitamin A Intake of Pregnant Women in Ngaoundere-Cameroon with Geographic Origin, Socio-Professional and Demographic Factors. Food and Nutrition Sciences,07,74-82. doi: 10.4236/fns.2016.72009