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    Low delivery vit a Low delivery vit a Presentation Transcript

    • Developing Effective Delivery Systems for Biofortified Crops: Some Thoughts on the Integrated Delivery of Orange-fleshed Sweetpotato in Sub-Saharan Africa Jan Low International Potato Center 9 November 2010
    • The Situation: Decline in Vitamin A Deficiency among Children 6-60 months of age not on track in SSA except for North Africa Rate Prevalence Number Rate required (serum retinol <20 ug/dl) (Millions) 1990-2007 to meet 1990 2007 2007 ppts/yr MDG East Africa 43.7 37.5 17,825 -0.36 -0.87 Central Africa 40.8 42.5 9,259 0.10 -0.82 North Africa 32.6 22.4 4,942 -0.60 -0.65 Southern Africa 37.2 25.0 1,530 -0.20 -0.74 West Africa 45.0 40.4 19,163 -0.27 -0.90 Total for Africa 41.4 36.4 52,718 -0.29 -0.83 30 African countries >30% prevalence low serum retinol UNSCN, 6th Report on World Nutrition Situation (2010), p. 16
    • The Situation, cont.: 1 in 3 persons in SSA (265 million people) not getting enough to eat daily 19 SSA countries moving in the right direction 14 SSA countries worse hunger than in 1990  Trends in underweight (children under 5 yrs) not improving Projects and programmes that aim to improve food and nutrition security through increased yields will be most successful if they are implemented in tandem with efforts to improve crop and dietary diversity. UNSCN, 6th Report on World Nutrition Situation (2010), pp. 90 Those agriculture interventions that invested broadly in different types of capital (physical, natural, financial, human and social) were more likely to improve nutrition outcomes. Berti, et al. Public Health Nutrition (2004) 7(5), 599-609.
    • The Potential Contribution of Orange-fleshed Sweetpotato 1. Marginal change ... VAD 2. Increased area, yields, marketing ... Food security
    • A Few Sweetpotato Facts  Grows from sea level to 2300 meters  Produces on marginal soils (3-12 t/ha)  Yet responds dramatically to favorable conditions (40-60 t/ha)  Women dominant producers in SSA  Flexible harvesting and planting times  Dual purpose use: roots & vines  Vegetatively propagated  Easy farmer-to-farmer sharing  Limited "seed" commercialization
    • Overcoming the Conventional Wisdom : African and Asians will not eat orange- fleshed sweetpotatoes Sweet potato cultivars with deep yellow or orange-fleshed roots are unfortunately rejected in many developing countries in favor of white or cream-fleshed types having little or no provitamin A activity. The Sweet Potato: an Untapped Food Resource. Jennifer Wolfe 1992.  Attempts by AVRDC to introduce them in Asia had failed  Failure to understand that rejection was due to texture, not color  Pilot work in Kenya (1995-97) among 20 women's groups
    • Key Lessons From Pilot Work in Western Kenya:  Nutrition education component essential for increased frequency of consumption of vitamin A rich foods by young children  Orange color accepted, but preferences differed --Adults: high dry matter --Children: low dry matter  Yellow-fleshed variety had inadequate beta-carotene KARI/CIP/CARE collaboration funded Eat Orange by ICRW/OMNI/USAID
    • Retention & efficacy studies established that OFSP is a rich and bioavailable source of vitamin A Resisto Bosbok Efficacy studies  Almost all carotenoids trans-beta-carotene with high retention when boiled (70-92%)  120 grams (small root) fed to school children for 5 days a week for 3 months significantly improved amounts of Vitamin A stored in the liver Source: van Jaarsveld et al. 2005 and 2006, MRC-South Africa
    • INTEGRATED DELIVERY SYSTEM #1 Access to Beta-Carotene- #2 Demand Rich Sweetpotato Vines Creation & #3 Ensure Empowerment Sustained Substitute white-fleshed with Through orange fleshed, beta-carotene Adoption & Knowledge rich varieties Use through Market Improved agronomic & storage Development BEHAVIORAL practices to assure availability CHANGE Work with Produce more Energy & Earn caregivers to Beta-Carotene per hectare income from improve feeding sales practices AWARENESS Increase area of roots & Media processed Increase Young Child campaign to meet demand products Feeding Frequency & to increase demand Buy more Vitamin-A-Rich Diet Diversity Foods & Health Services Sustainably Improve Young Child Intake of Vitamin A Improved & Energy Vitamin A Status
    • Delivery at the Community Level (TSNI) Central Mozambique in Rural Mozambique Design:  2 yr quasi-experimental design  Agriculture & nutrition extensionists based in target areas  2 Intervention groups: 498 hhs More intensive: group + home visits Less intensive: group sessions only  1 Control group: 243 hhs  data collection: Jan 2003-Mar 2005  90% completed study Zambézia Province Funded by the Micronutrient Initiative, Rockefeller Foundation, USAID, & HarvestPlus
    • Did the Intervention Impact the Young Child?  Median intake vitamin A almost 8 times higher (24 h recall)  Group sessions sufficient to achieve improved intake  15% decline in low serum retinol (VAD) due to intervention Median nutrient intakes yesterday: non-breastfed children (mean 32 months old) 1600 1414 1400 1226 Amount of Nutrient 1200 Intervention (n=465) 1000 800 Control (n=234) 600 426 400 200 56 0 Vitamin A (μg RAE) Energy (kcal) P-value=0.00 P-value=0.00 Low et al., Journal of Nutrition 137: 1320-1327, 2007
    • How can we reach larger number of households cost effectively? Reaching End Users Project (2006-2009) in Uganda & Mozambique (HarvestPlus)  TSNI used direct extensionist to farmer contact: relatively expensive  Can the cost be reduced through use of village level promoters for agriculture & nutrition without compromising adoption and vitamin A intake rates?  How long do we need the community level nutrition intervention? More intensive Model: 2 years Less intensive Model: 1 year  Short Answer: Yes, can reduce significantly & have good adoption and intakes with less intensive model
    • What have we learned about the Integrated Approach? Pathway #1: Agriculture  Agronomically competitive, tasty varieties essential  Consumer preferences can vary within/between countries  In areas with short dry seasons (2-3 months), single massive distributions sufficient for widespread adoption  In areas with longer dry seasons (4-6 months), need to establish reliable supply of vines, preferably at decentralized level  Trained farmer multipliers with access to water  Willingness-to-pay exists, but extent depends on market demand for roots & purchasing power in the community
    • Pathway #2: Demand Creation campaign COOKING essential and the DEMOS orange color is an asset MARKET-BASED PROMOTIONS & RADIO COMMUNITY THEATER
    • Pathway #2: Demand Creation at the Community Level  Group sessions on nutrition effective for many messages  Utilization of OFSP, and knowledge of its benefits  Increase in young child feeding frequency  Use of other locally available plant sources of vitamin A  Difficult behaviors to change  Health-related practices: boiling water  Addition of small amounts of fat, purchasing practices  Using promoters results in adoption and use of OFSP, but fewer additional practices than direct extension contact  How minimal can we go on the community level intervention?  How effective is integrating OFSP into broader interventions?
    • Pathway #3: Marketing Marketing component is longer-term investment  Need 3-5 years to develop, but most projects are 2-3 yrs  Invest in educating traders and building consumer demand  Where significant sweetpotato markets already exist  Must "break-into" the market against strong existing preference  Where sweetpotato markets are not well-developed  Links between farmers and traders need to be facilitated/subsidized  Processed products liked, but requires sustained supply  Need to invest in training on fresh storage  Boiled and mashed superior to dried chips/flour
    • Next Step: Building the Evidence for Linking Agriculture & Nutrition with Health to Maximize Impact  Need to minimize loss of vitamin A after intake  Need for greater investment in women's well-being  Launched 5 year study in Western Kenya (2009) [CIP, PATH, CREADIS, ARDAP, Ministries of Health/Ag]  Can linking OFSP access and nutritional training to existing health services for pregnant women provide: 1) an incentive to pregnant women to increase health service utilization? 2) lead to increases in consumption of OFSP and other vitamin A rich foods by the women and their young infants in a cost- effective manner?