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Low delivery vit a


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Low delivery vit a

  1. 1. 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
  2. 2. The Situation: Decline in Vitamin A Deficiency among Children 6-60 months of age not on track in SSA except for North Africa Number Rate (Millions) 1990-2007 1990 2007 2007 ppts/yr 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 Rate required to meet MDG Prevalence (serum retinol <20 ug/dl) 30 African countries >30% prevalence low serum retinol UNSCN, 6th Report on World Nutrition Situation (2010), p. 16
  3. 3. 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 UNSCN, 6th Report on World Nutrition Situation (2010), pp. 90 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. 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.
  4. 4. The Potential Contribution of Orange-fleshed Sweetpotato 1. Marginal change ... VAD 2. Increased area, yields, marketing ... Food security
  5. 5. 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
  6. 6. Overcoming the Conventional Wisdom : African and Asians will not eat orange- fleshed sweetpotatoes  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 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.
  7. 7. 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 Eat OrangeKARI/CIP/CARE collaboration funded by ICRW/OMNI/USAID
  8. 8. Bosbok Resisto 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 Retention & efficacy studies established that OFSP is a rich and bioavailable source of vitamin A Source: van Jaarsveld et al. 2005 and 2006, MRC-South Africa
  9. 9. #1 Access to Beta-Carotene- Rich Sweetpotato Vines Buy more Vitamin-A-Rich Foods & Health Services INTEGRATED DELIVERY SYSTEM Increase Young Child Feeding Frequency & Diet Diversity #2 Demand Creation & Empowerment Through Knowledge Substitute white-fleshed with orange fleshed, beta-carotene rich varieties Earn income from sales of roots & processed products Produce more Energy & Beta-Carotene per hectare Improved agronomic & storage practices to assure availabilityBEHAVIORAL CHANGE Work with caregivers to improve feeding practices AWARENESS Media campaign to increase demand #3 Ensure Sustained Adoption & Use through Market Development Sustainably Improve Young Child Intake of Vitamin A & Energy Improved Vitamin A Status Increase area to meet demand
  10. 10. Delivery at the Community Level (TSNI) in Rural MozambiqueCentral Mozambique Zambézia Province 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 Funded by the Micronutrient Initiative, Rockefeller Foundation, USAID, & HarvestPlus
  11. 11. 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) 426 1414 56 1226 0 200 400 600 800 1000 1200 1400 1600 Vitamin A (μg RAE) P-value=0.00 Energy (kcal) P-value=0.00 AmountofNutrient Intervention (n=465) Control (n=234) Low et al., Journal of Nutrition 137: 1320-1327, 2007
  12. 12. 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
  13. 13. 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
  14. 14. Pathway #2: Demand Creation campaign essential and the orange color is an asset COMMUNITY THEATER MARKET-BASED PROMOTIONS & RADIO COOKING DEMOS
  15. 15. 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?
  16. 16. 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 Pathway #3: Marketing
  17. 17. 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?