Nutrition Innovation Labs- Africa & Asia Jeffrey K Griffiths - Africa Patrick Webb - Asia Shibani Ghosh – Africa & Asia 21 April 2015 Nutrition Innovation Labs Africa & Asia 1 Uganda, Nepal, Malawi, Egypt, Bangladesh…
Nutrition InnovationLabs-
Africa & AsiaJeffrey K Griffiths - Africa
Patrick Webb - AsiaShibani Ghosh – Africa & Asia
21 April 2015 Nutrition Innovation Labs Africa & Asia 1
Uganda, Nepal, Malawi, Egypt, Bangladesh…
Over-Arching Operational/PolicyResearch Questions
• How do investments in agriculture achieve measurableimpacts in nutrition? Can impact pathways beempirically measured?
• Can nutrition governance (policy processes) be betterunderstood and measured to improve impact onnutrition?
• What neglected biological pathways impedenutrition gains, and how can these be overcome(aflatoxins, water quality/WASH, environmentalenteropathy, etc.)
21 April 2015 Nutrition Innovation Labs Africa & Asia 2
21 April 2015 Nutrition Innovation Labs Africa & Asia 3
1. Operations Research – informing programming. Whatworks and what does not? Why? Focused initially in Ugandaand Nepal, now expanding
2. Capacity-building – support national HICD. Malawi:Dietetics program at BUNDA/LUANAR; nutrition educationand capacity.
3. Support global dialogue – policy analysis, metrics work,frontier research on biological mechanisms.
4. Mission support – specific horticulture, aquaculture,aflatoxin, microbiome, program design questions: Bangladesh,Malawi, Egypt, Nepal, Uganda…
Nutrition Innovation Lab Phase I (2010-2015)
Human and Institutional CapacityBuilding- Malawi
Active collaboration with USAID Malawi, Bunda/LUANAR, and College of Medicine, Univ. of Malawi• Development and implementation of the first Dietetics
program in Malawi• Compilation of a food composition table– Endorsed by Government of Malawi– Work closely with UN FAO
• Bringing nutrition into the College of Medicinecurriculum in Malawi
21 April 2015 Nutrition Innovation Labs Africa & Asia 4
The evidence base on nutrition sensitiveagricultural interventions is small:
§ Most studies review a single intervention. Littledata allowing meaningful, comparativeassessments.
§ No studies compare relative effects on women vs.men.
§ Few studies explain barriers to, incentives for,adoption of new technologies
§ Fewer still shed light on why interventions didor did not improve nutrition despiteproductivity gains21 April 2015 Nutrition Innovation Labs Africa & Asia 5
1
?
?
?
StaplesCommercialization/value chain
Home gardens/Small ruminants
Protein quality,Env. Enteropathy
Nutrient density/Diseases: Malaria
Aflatoxin exposure21 April 2015 Nutrition Innovation Labs Africa & Asia 6
Aquaculture-Horticulture to Nutrition Platform(Nutrition Innovation Lab Asia)
Research Platform/collaboration in Bangladesh– Partners include USAID BFS, USAID Bangladesh,
Nutrition Innovation Lab, Horticulture InnovationLab, Aquafish Innovation Lab, World Fish,USAID Spring, Bangladesh AgriculturalUniversity
– In country Technical Advisory Committee– Working around five USAID programs active in
the FTF Zone of influence
21 April 2015 Nutrition Innovation Labs Africa & Asia 7
Bangladesh Research Questions(Program and Scaling Relevance)
• Population level effect: 0, 1, or 2 or moreinterventions in aquaculture or horticultureand nutrition behaviors, including:
• Implementing new technologies (cool-bots,solar dryers, floating gardens) -
• Outcomes: income, consumption and nutritionof Producer households and Nutrition ofConsumers
• Relationship between public health nutrition,income and consumption outcomes acrossgroups21 April 2015 Nutrition Innovation Labs Africa & Asia 8
21 April 2015 Nutrition Innovation Labs Africa & Asia 10
In 1990s, Mulanje waspoorest District in Malawi.GTZ 1997-2004, integratedprogramming instituted.In 2011, < 10% are poor,and gains sustained.
21 April 2015 Nutrition Innovation Labs Africa & Asia 11
Recent review by British Aid (DFID) of quality of publishedstudies on horticulture/aquaculture
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/292727/Nutrition-evidence-paper.pdf
CommunityConnector
Programme
Maternal/Child Nutrition
Essential Nutriton and HealthActions (ENA, EHA)
Agricultural and postharvest Technologies
Risk management, Micro-creditSavings
ServiceQuality
Income,Health
DietQuality
??
Genderapproaches Sectoral coordination
?
80,000households 15 districts ofUganda
21 April 2015 Nutrition Innovation Labs Africa & Asia 12
MULTIPLEINTERVENTIONS
Kabunga N, Ghosh S, Griffiths JK. Working Paper 2014
Fruit & Vegetable Production in Uganda Leads To: Improved Food Security, Less Anemia
• Surveyed 3,630 households in 6 districts. Ag production, 24 hourfood recall, hemoglobin (Hgb), malaria tests/Rx in women 15-49
• F&V production significantly ↑↑ F&V consumption. (p< 0.01).F&V producing households had less food insecurity, especiallythe most food insecure. (p<0.05)
• Women living in F&V households had higher Hgbs (p< 0.01)and were ~ 15% less likely to be anemic.
This biologically plausible pathway links Fruit and Vegproduction, better food security, and less anemia.
F&V production: effect on maternal anemia (PSM)
0.05.1.15.2.25Density0510152012118hemoglobin (g/dL) Non-producers Producers kernel = epanechnikov, bandwidth = 0.5000
A= severeanemiaB=mod. anemiaC=mild anemia
A
B
C
F&VProducers
Non-producers
Change (producers vs.non-producers)
t-value and significance
Hemoglobin (g/dL) 13.03 12.84 + 0.19 g/dL 3.34, p < 0.01
Maternal anemia (%)Mat. anemia, PSM
21.37% 20.97%
25.47% 24.29%
- 16.1% -13.7%
-2.65, p < 0.01 -1.70, P < 0.10
SEVERE ANEMIA, PSM 0.00% 0.36% -100% -2.19, p < 0.05
Moderate anemia, PSM 7.03% 9.54% -26.3% -1.97, p < 0.05
PSM = Propensity Score Matched
Prevalence of Stunting in children
No Cow's milkCow's Milk No Cow's milk
No Cow's milk
Cow's Milk
Cow's Milk
0102030400
0
10
10
20
20
30
30
40
40
Percent
Percent
• Chi Square Test: p=0.018• Children who consumed cow’s milk were 38%
less likely to be stunted
• While children <2 who received milk were 38% lessstunted - in households with cattle, the children had an20-25% ↑↑ risk of malaria (p< 0.001). Malaria =>death, morbidity, stunting, cognitive defects.
• Yet: owning improved cattle enhances income,nutrition, decrease food insecurity (Kabunga 2014).
• We posit peri-domestic cattle support malariamosquito vectors that do not bite inside households. (Sobednets, household spraying don’t affect them).
Livestock/Malaria Linkage
Data source: USAID Uganda
21 April 2015 Nutrition Innovation Labs Africa & Asia 18
Biologically plausible pathway from Agriculture toNutrition (anemia, stunting) mediated by Malaria
ENVIRONMENTAL ENTEROPATHY (EE)People living in contaminatedenvironments have leaky,chronically inflamed intestinesEE - Short blunted villi, tissue isinfiltrated with inflammatorycells. 15% less protein and 5%less carbohydrate is absorbed.↑ nutritional needs, bacterialeak into body, leads to anemia.Bad bacteria are likely cause.
Korpe & Petri, Trends in MolecularMedicine June 2012, Vol. 18, No. 6
19
MYCOTOXINSIN FOOD
HUMANAND
ANIMALPATHOGENS
UNHEALTHYINTESTINALMICROBIOME
MICRO- ANDMACRO-
NUTRIENTS
PERMEABLE(“LEAKY”)AND INFLAMMED GUT
20
MYCOTOXINSIN FOOD
HUMANAND
ANIMALPATHOGENS
HEALTHY INTESTINALMICROBIOME
MICRO- ANDMACRO-
NUTRIENTS
NORMAL GUT –NOT PERMEABLE
21