Low delivery vit a

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

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

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.

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

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.

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

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

#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

Delivery at the Community Level (TSNI)

in Rural Mozambique Central 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

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

Am

ou

nt

of

Nu

trie

nt

Intervention (n=465)

Control (n=234)

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

essential and the

orange color

is an asset

COMMUNITY THEATER

MARKET-BASED

PROMOTIONS & RADIO

COOKING

DEMOS

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?

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

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?