Jan Low (CIP) - Delivering Nutrition through Orange-Fleshed Sweetpotato: The Growing Evidence Base
Delivering Nutrition throughOrange-Fleshed Sweetpotato: The Growing Evidence Base Food Nutrition in Eastern & Southern Africa Nairobi, Kenya 10 September 2012 Jan Low, CIP-SSA
An estimated 32% of Africa’sThe Problem children under five years of age are vitamin A deficient. Vitamin A deficiency can limit growth, weaken immunity, cause xeropthalmia leading to blindness, and increased risk of mortality VAD is caused by inadequate intakes and loss due to illness Food-based approaches to combat VAD address one of the major underlying causes but criticized for lack of evidence
Orange-fleshed Sweetpotato: A Potential Contribution to the Solution Most varieties in SSA white-fleshed: marginal change The Challenge: Will OFSP yield as well as the local variety? Will consumers like the taste? What is needed to impact VAD? Will initial adoption be sustained?
Answering these questions took more than a decade…: 1st pilot study in Western Kenya (1995-97) Nutrition education component essential Preferences differed --Adults: high dry matter --Children: low dry matter Yellow-fleshed lack sufficient pro-vitamin A, focus on orange Easy to incorporate sweetpotato weaning foods into young child diet &KARI/CIP/CARE collaborationfunded by ICRW/OMNI/USAID improve feeding frequency
Efficacy Study Among School Children in South Africa ResistoBosbok Efficacy studies 1. Completed in South Africa in 2004 Potential of OFSP 2. Modified relative dose response method in combating VAD 3. 120 gm. fed to school children for 5 days a week for 3 months significantly improved amounts of Vitamin A stored in the liver van Jaarsveld et al., AJCN 81, 1080-87, 2005.
AGRICULTURE NUTRITION MARKETING Demand Creation Introduce new source of and Market Development Vitamin A and Energy: Empowerment for OFSP Roots and Biofortified OFSP through Processed Products Knowledge Mechanisms 1. Create awareness of Vitamin A problem 1. Link to markets to1. Substitute white with orange earn income2. Improve agronomic practices 2. Create awareness of Vitamin A-rich foods 2. Diversify use through3. Improve storage practices 3. Empower caregivers development of to change practices OFSP products Outcomes 1. Knowledge in local 1. Increased supply of beta- carotene & energy community 1. Increased household 2. Sustained yields 2. Increased demand for income for growers 3. Increased supply in Vitamin A-rich foods 2. Sustained OFSP off-season 3. Increased intake cultivation over time Vitamin A & energy Increased Serum Retinol Levels
Integrated (agriculture-nutrition-market)Intervention at Community Level in Mozambique Median intake vitamin A almost 8 times higher (24 h recall) OFSP contributed 35% vitamin A intake, 6% of energy intake 15% decline in prevalence of low serum retinol status attributable to the intervention Median nutrient intakes yesterday: non-breastfed children (mean 32 months old) 1600 1414 1400 1226 1200 Amount of Nutrient 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, JW et al., Journal of Nutrition 137: 1320-1327, 2007
Building the Orange Brand:Radio programs and market advertising to increase awareness of Vitamin A richfoods & increase demand & combat myths
Learned that higher root yielding OFSP hasinsufficient vine vigor for drought-prone areas CANASUMANA RESISTO: -- Hardier vines, more drought resistant -- Has β-Carotene --Alternating not agglomerated --More consistent medium storage roots root size desired in commercial market
Sought funding for a major investment to Breed inAfrica for Africa & to improve the “seed” system... Breeder Maria Andrade (on 15 new drought-tolerant right) focused on vine vigor, OFSP varieties were drought tolerance, and taste… released in February 2011 better yield alone is not sufficient
Reaching End Users (REU): 2007-2009Mozambique: 14,400 households 144 groups Uganda: 10,292 Households 392 Groups Wolfgang H PFEIFFER
High adoption rates (>60%) & positive outcomes on vitamin A intake among children and their mothers (intent to treat figures, include non- adopters)Wolfgang H PFEIFFER (Impact Study led by IFPRI) Estimated Average Requirements (EAR): satisfy 50% of needs of age group
Understanding the costs of using the integrated approach Less intensive (M2) model 30% cheaper to implement No significant difference in 2 models on key metrics Mozambique (secondary staple): Average cost for direct beneficiary: $86 Marginal cost for direct beneficiary: $36 Marginal cost if indirect beneficiaries included: $19 Uganda (staple crop): Average cost for direct beneficiary: $56 Marginal cost for direct beneficiary: $22 Marginal cost if indirect beneficiaries included: $12 $15-20 USD for disability life year (DALY) saved
Would linking more explicitly to a health interventionsubstantially improve Vitamin A status? 0.4 0.35 0.3 Change in 0.25 serum retinol 0.2 0.15 0.1 0.05 0 Baseline Fat + Deworming OFSP OFSP + Fat + Deworming Treatment group Mean (± SEM) changes in serum retinol after supplementation Source: Fasli Jalal et al., Am J Clin Nutr 1998; 68:623-9.
Can linking an agricultural intervention and nutritionaltraining to existing ante-natal care services in Western Kenya provide an incentive to pregnant women to: 1) increase health service utilization 2) increase consumption of OFSP and other vitamin A rich foods by themselves and their children than existing health services alone? 3) Will there be a positive impact on vitamin A status?
Conclusions OFSP root consumption can significantly contribute to improved vitamin A intake & status More research needed on impact of other nutrients Still much to learn on: --effective delivery systems, how to cost- effectively reach large numbers of households & HIV/AIDS affected households & communities (SUN Initiative may provide opportunities) --storage, extended shelf life, processed product development (new markets; reach urban consumers)
SPHI is a multi- partner, multi-donor initiative that seeks to reduce child undernutrition and improve smallholder incomes in 10 million African families by 2020 through the effective production and expanded use of sweetpotato. 16 Target Countries SASHA in 8 countriesOther projects in additional 4 Countries