Dietary intake, forest foods, and anemia in Southwest Cameroon

PLoS One. 2019 Apr 12;14(4):e0215281. doi: 10.1371/journal.pone.0215281. eCollection 2019.


Background: 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.

Methodology: 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.

Results: 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.

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Anemia / blood
  • Anemia / epidemiology*
  • Animals
  • Cameroon / epidemiology
  • Cross-Sectional Studies
  • Diet*
  • Ecosystem
  • Female
  • Forests*
  • Fruit
  • Gnetum
  • Hemoglobins / metabolism
  • Humans
  • Nutritional Status
  • Prevalence
  • Rainforest
  • Rural Population
  • Vegetables
  • Young Adult


  • Hemoglobins

Grants and funding

This research was supported with funding from the Department for International Development, UK Government (DfID) to CYT, BP, and AI. and United States Agency for International Development's Forest and Biodiversity Office (USAID) to CYT and AI as well as the Consortium of International Agricultural Research Centers (CGIAR) research program on Forest, Trees and Livelihoods to CYT and AI. Idea Wild also donated instruments for the research.