Issue of June 2014

AFRICAN NUTRITION MATTERS

JUNE 2014 - VOLUME 2 No. 2

Global intiatives to improve nutrition

Thematic SUN movement in the post 2015 agenda (p. 3)

Interviews Francis Zotor, president of the ANS (p. 5) LOC president (p. 7) Scope on the SUN movement Engaging stakeholders to tackle malnutrition (p.8) Strengthening capacities in West Africa (p.9) Experiences of CSO-SUN in Zambia (p.10)

The era of MOOCs Malnutrition e-learning course (p. 3)

Regional news MI Forum in Addis Ababa (p.15) Nutrition research in North Africa (p.16) West Africa regional instabilities (p.17) mHealth and Nutrition (p. 18)

AFRICAN NUTRITION SOCIETY T H E N E W S L E T T E R

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Editorial Dear Reader, Welcome to the third edition of African Nutrition Matters!

It is indeed with great excitement that this third issue is released to coincide with the 6th African Nutrition Epidemiology Conference (ANEC) to be held in Accra, Ghana, 21-25 July 2014.

The ANEC conference the only one of its kind dedicated to scientific discourse of the African Nutrition Agenda, is this year hosted by the African Nutrition Society and the Ghana Nutrition Society and brings together global leaders in the nutrition science, research and public health, non-governmental organizations and industry to this biennial event.

Indeed this conference is symbolic, as it marks the official launch of African Nutrition Matters the official newsletter of the African Nutrition Society on African soil. In a symposium to be held on Monday 21st July 2014, African Nutrition Matters readership can interact with the editorial team, get copies of this issue and view previously published issues, participate in discussions of how this newsletter comes together and contribute through suggestions for the newsletters growth.

The theme for this issue of ANM “Global initiatives to improve nutrition” opens the discussion on the current movements globally and their impacts and effects on nutrition in African countries. Of particular interest and focus in this issue is the Scaling up Nutrition (SUN) movement which has been adopted by several African countries. The SUN movement, initiated in response to the need to scale up efforts of several countries who lagged behind in meeting the Millennium Development Goals (MDG) and in particularly MDG 1: Eradicate extreme poverty and hunger. The SUN

movement aims to improve nutrition through encouraging policy development and change, program development with collaboration between governments and other partners with shared nutrition goals, and mobilizing resources to effectively scale up nutrition, with a core focus on empowering women. An article by the SUN secretariat describes the technical application of the SUN movements’ roadmap.

Several African countries have signed up and committed to scaling up nutrition. However, while some countries have made important progresses in implementing the SUN roadmap to reduce child malnutrition, some are still struggling in operationalization of the SUN initiatives because there is a great variability in African countries readiness and ability to take on the SUN initiatives. Our thematic article by Dr. Habiba HassanWassef from Egypt National Research Center takes a critical look at the readiness of African countries realistic ability to meet the SUN initiatives goals. Dr. David Nabarro, the SUN Movement Coordinator gives further and new insights into the SUN multistakeholder engagements in the News section.

researchers which features young Zimbabwean researcher Wisdom Dube.

On this occasion of the 6th ANEC, we interviewed the African Nutrition Society president Dr Francis Zotor and the Chair of local organizing committee Professor Stiener-Asiedu who both highlight the importance of ANEC and ANS to the West African Region, the African continent and its Global impact.

We wish you happy reading, and look forward to meeting you at the African Nutrition Matters symposium on Monday 21st July 2014.

Dr Nonsikelelo Mathe Co-editor in Chief

Dr Dia Sanou Co-editor in Chief

AFRICAN NUTRITION MATTERS Official bulletin of the African Nutrition Society.

VOLUME 2 No. 2; JUNE 2014.

Our regional news section articles discuss health in Southern Africa, Nutrition research in North Africa and West African regional instabilities: Consequences for food security. The partners section includes information on the Malnutrition eLearning course by Dr T. Pickup and Dr S. Choi; strengthening institutional and human capacities is critical to the implementation of the nutrition roadmap in West Africa- Roger Sodjinou-UNICEF/WAHO West Africa Nutrition Capacity Development Initiative and a report on the Micronutrient Global Forum Addis Ababa. We continue in this issue to highlight the work of young researchers in Spotlight on young African

Editors-in-Chief: Dia Sanou (Burkina Faso), Nonsikelelo Mathe (Zimbabwe) Editorial Board: Mawuli H. Avedzi (Ghana), Robert Fungo (Uganda), Ali Jafri (Morocco), Hanane Labraimi (Morocco), Muniirah Mbabazi (Uganda), Folake Samuel (Nigeria) Technical Advisory Board: Paul Amuna (Ghana), Francis Zotor (Ghana), Habiba Hassan Wassef (Egypt) Layout: Ali Jafri P. O. Box K18, Korle Bu, Accra, Ghana. Phone:+233-244186867; +233-244872410. Fax:+233-2151394 All correspondence should be addressed to the editors by email: newsletter@answeb.org

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Repositioning the SUN Movement in the post 2015 Agenda for Development Habiba Hassan-Wassef, MD National Research Center, Cairo, Egypt

The SUN Movement in Africa Launched in September 2010 to help countries which are lagging behind in making progress towards the achievement of the MDG1 (Hunger and Poverty) the SUN (Scaling Up Nutrition) Movement[1] soon gained momentum.

To-date thirty five 35[WU1] African countries have joined the movement and their national food and nutrition and food security programmes are benefiting from the support of development partners and the United Nations system. Review of the manner in which the countries translated the SUN Framework for Action into programmes to accelerate the achievement of food and nutrition goals yielded a rich and varied set of approaches.

The richness is attributed to the fact that the SUN initiative provides a guiding framework that supports national nutrition plans and programmes conceived in respect to a particular context for each respective country. The variety in the nature of problems and of the capacity to deal with them, the manner in which available resources were utilized, among other local particularities, have given rise to a varied range of approaches to improve the nutritional status of a given population. It may be opportune at this point in time to follow up on the expression, made by some countries, of the wish to share their successes and failures with the other SUN Movement adherents and to learn from their SUN experience.

While most of the components of the SUN initiative appear to be addressed in the country programmes, as for example the establishment of efficient coordination mechanisms and a strengthened interface between national food security and nutrition programmes; there was little reference to the interface with the agro-food industry in its capacity as a stakeholder in the food value chain.

Continued relevance of the focus on early childhood Scientific evidence of the impact of undernutrition on infant and child mortality and its long-term effects on health and on cognitive and physical development served as the foundation for the SUN Initiative Framework for Action. Much was drawn from the Lancet [2] 2008 special series on maternal and child undernutrition which highlighted the critical importance of the first 1000 Days of Life (9 months of pregnancy and the first twenty four months of life).

The Cost of Hunger in Africa Study [3] (COHA) provides additional evidence to justify the importance of addressing nutrition problems during the critical early formative stages of an individual’s life. Results from the investigated countries (Egypt, Ethiopia, Mauritania, Swaziland, and Uganda) demonstrate how the negative consequences of early undernutrition follow a child in his/her entire life and gravely affect the national economy. The focus on pregnancy and early childhood continued through the post 2015 debate.

In a revealing and challenging paper, Mary Young [4] presents the current convergence of findings in developmental neurobiology and psychology, population health, social science and economics which have contributed to a phenomenal advance in understanding the long reach of early childhood development (ECD). She reports the recent work of the scientists who have shown without doubt that events in early life link with the development of the brain’s circuitry; dynamic gene-environment interactions; programming of the body’s immune, neurological and endocrine systems; life trajectories of human development; and occurrence of chronic diseases in adulthood. Key findings demonstrate that coping abilities, cognitive and noncognitive competencies, health and the process of skill formation are strongly influenced by dynamic interactions between genes and early life environments and experiences. Also, that cognitive, social, emotional and language competencies are interdependent and all contribute to the formation of lifelong capabilities and that these competencies are developed during early childhood and are influenced by good parenting and nurturing practices.

The SUN Movement can thus put a break to the progressive depreciation in the quality of the human capital through an updated framework that translating the recent scientific knowledge into practice while waiting for the appropriate institutional and policy reforms.

This is of particular importance in the case of deprived children living in underserved and poor

JUNE 2014 VOLUME 2 No. 2 communities. A new version of the SUN initiative may thus need to give more attention to good parenting and positive care-giving (Bornstein and Putnick) [5]. According to Young, efforts will need to be made for creating the building blocks for universal Early Childhood Programmes. These include – inter alia - establishing a populationbased outcome measure; training of practitioners and caregivers; and targeted and expanded programmes that recognize the additive synergistic effects of combining nutrition and stimulation.

The post 2015 SUN Framework for Action may thus need to include innovative approaches that integrate ECD services and expand them beyond traditional boundaries.

its strategies accordingly.

Importance of investing in Early Childhood Development

The present list of 17 proposed Sustainable Development Goals to be attained by 2030[6] places “ending hunger, improving nutrition and promoting of sustainable agriculture” as the second goal, with “End poverty everywhere” taking first place. The nutrition targets[7] proposed by the United Nations Food and Agriculture Organization (FAO), the International Fund for Agricultural Development (IFAD) and the World Food Programme (WFP) for the post 2015 Agenda for Development maintain the focus on early childhood. The Rio+20 Outcome Document: “The future we want “[8], represents its contribution to the 2015 debate. Nutrition, under the title of “Food security and nutrition and sustainable agriculture” follows Poverty Eradication in its list of “Thematic areas and cross-sectoral issues”. Water and sanitation closely follow. The document reaffirms the importance of a comprehensive vision and the coherence of integrated multi-sectoral and multipartner programmes.

The first few years of a child's life have a multiplier effect for society. Children who are well nurtured during this period tend to do better in school and stand a greater chance of developing the skills to compete in the global economy.

Investing in young children is thus an integral part of human and economic development. Mary Young explains that the current understanding of the neurobiology of early childhood is that the development of the brain’s architecture and function in early life continues to affect health, learning and behavior all through the life cycle. This means that what is done or not done in early childhood has long-term ramifications for both individuals and societies. Thus, investing in young children is regarded as an integral part of human and economic development and is a key strategy for the post 2015 sustainable human and economic development. As the post 2015 Agenda debate advances, the importance of the quality of “human capital” justified by economic evidence and arguments, is gaining ground. The SUN Movement, which has the advantage of a head start in this direction, will need to incorporate the new evidence and adjust

and

approaches

Nutrition in the post Development Agenda debate

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to be attained by this initiative, which is expected to remain operational beyond d 2015.

2015

Building on the successes of the MDGs, Member States participating in the global debate led by the UN High Level Political Forum on Sustainable Development are creating the foundation for a new global sustainable development agenda. An agenda that will address any unfinished business of the 2015 MDGs as well as the new challenges and complexities facing the world, with sustainable development at its core and poverty eradication as its highest priority.

Launched by the UN Secretary General at the Rio+20 Summit last June 2012, “The Zero Hunger Challenge” calls for stepping up efforts to end hunger.“Zero stunted children under 2 years, no more malnutrition in pregnancy and early childhood” is the second of 5 objectives

Aligning with global and continental initiatives The SUN Movement calls on countries to align with and seek critical synergies from global, regional and local initiatives. Such initiatives could be outside the health domain, such as in the social, agriculture, or education domains. The most critical of such programmes is the national poverty reduction strategy.

The health professionals will need to be able to identify the benefits and synergies that can be sought from a given activity or programme of another sector, especially for those that are outside the health domain. The creation of a joint intersectoral planning group at the level of the national planning authority in one of the SUN countries made it possible to guarantee such alignment at the planning level.

The SUN country programmes must be capable of identifying ways to draw benefits and seek synergies from the global mobilization for eradication of poverty and sustainable development.

Transparency and the willingness to share information are some of the conditions that can facilitate the sharing of mutual benefits. Alignment with global programmes such as those for prevention and control of HIV/AIDS; chronic non-communicable diseases and obesity; reduction of maternal and neonatal mortality; and the integrated management of childhood illnesses may appear to be an obvious rational choice.

However, difficulties may arise when funding sources and supporting UN system agencies are different. Hence the importance of the SUN Framework for Action recommendation for explicit clear reference to nutrition related actions/activities in the Country UNDAF (UN Development Action Framework) planning document that details the partners (government, UN

system, as well as development partner) that will be working together and/or contributing to the achievement of a given nutrition target.

The designation of “2014 Year of Agriculture and Food Security” by the 23rd African Union Summit meeting held in Malabo last June reinforces the mobilization of continental efforts towards achieving the agriculture and food and nutrition security goals. A number of the adopted Summit Declarations are of direct relevance to food and nutrition security. There is scope for seeking potential synergies from some of the agricultural initiatives and programmes that could be of direct benefit to food and nutrition security at the family level.

Conclusion With the reaffirmed focus on the importance of the formative period of early human the SUN Movement is right on track for Agenda 2015. The lessons learned and the experience gained through implementing the SUN framework of Action represents valuable material for fine-tuning the Framework for Action.

The review of the reports published online on the country plans and activities, revealed a wide variation, in particular in the programme organization modalities, in the interface with other sectors, and in the budgetary arrangements for financing multi-sectoral, multipartner nutrition activities. The issue of qualified human resources, the research capacity, and the generation and management of information are some of the areas that were identified to be in need of support. It may be useful at this stage to assess some of the innovative activities that were introduced by some SUN countries, such as the analysis of nutrition in public policies or the formulation of joint (inter-sectoral) indicators.

The overall progress to date made by the majority of the SUN countries can only be commended. Now that we are approaching the new 20152030 Development Agenda it may be opportune to respond to the wish expressed by a number of SUN countries and provide the SUN countries with the occasion to share experiences, success stories and lessons learned.

The outcome represents valuable material that an updated version of the Framework for Action can build on.

References 1. Scaling Up Nutrition, A Framework for Action, 2011 2. The Lancet, “Maternal and Child Undernutrition,” Special Series, January 2008.

3. AUC and UNECA 2012, “The Cost of Hunger in Africa: Social and economic impact of child undernutrition”. Report of the Seventh meeting of the Committee of Experts, AU/ECAMEF/EXP/22(VII) 4. Young, Mary 2014, “Addressing and Mitigating Vulnerability Across the Life Cycle: The Case for Investing in Early Childhood”. UNDP Human Development Report 2014 Occasional Paper 5. Bornstein, M. H., and D. Putnick. 2012.

“Cognitive and Socio-emotional Caregiving in Developing Countries.” Society for Research in Child Development 83 (Jan/Feb) (1): 46–61, (cited in Young, M).

6. sustainabledevelopment.un.org/focussdgs.ht ml 7. www.fao.org/news/story/en/item/219078/ico de 8. http://www.un.org/en/sustainablefuture/

interviews Interview with Dr. Francis Zotor, president of the African Nutrition Society Why was the African Nutrition Society created?

Since its inception in 2008, the African Nutrition society (ANS) is a registered scientific professional body that unifies African nutrition professionals to provide a continental professional scientific forum, promote training, research, and capacity building for nutrition as well as contributing to

workforce development to meet Africa's nutrition and health policy agenda. Our ultimate goal is to provide a home for nutritional scientists and other allied professionals; contribute to programmes and projects aimed at improving nutrition in Africa and reducing the burden of disease. Through our efforts we hope to promote collegiality and bring together individuals across Africa

and other parts of the world to work together towards building and promoting the nutrition profession and practice in Africa.

What is unique contribution of ANS in the continent and in the global scene?

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The ANS in its establishment as an umbrella organisation has among others come to be seen as an organisation that has actively been at the forefront of developing and promoting the nutrition profession in Africa. Through its conference, the African Nutritional Epidemiology Conference (ANEC) nutritionists across Africa and beyond the confines of Africa have come to see the ANS as the organisation to be associated with. Over the past six years since the ANS was formed, the leadership has been in the forefront of working with sister organisations such as the Federation of African Nutrition Societies (FANUS), the International Union of Nutritional Sciences (IUNS), the Nutrition Society of Great Britain and Ireland and the American Society of Nutrition to work collectively to promote the ideals of food and nutritional science on the continent. The ANS has provided a continental professional scientific forum (through its conferences), promoted training (in partnership with the British Nutrition Society), capacity building (with assistance from Unilever, the Nevin Scrimshaw International Nutrition Foundation, the IUNS and the Nestle Foundation) in nutrition and continues to contribute to workforce development to meet Africa’s nutrition and health policy agenda.

us as a continent. African nutritionists need to be more visible and work together, (as well as share examples of good practice across sub regions) to finding solutions to the nutritional challenges within their own communities. The ANS is an association dedicated towards Africa’s nutrition agenda. We encourage all nutritionists and those allied to nutrition to enter into membership with the ANS so that together we can provide a voice for nutrition and work together to address the challenges that confront us as a continent. The ANS has a number of projects the organization would like to initiate amongst other nutritionists across sub-regions of Africa, however a key constraint is seed funding to initiate these projects. It is the Society’s hope that partnership with some key multilateral and bilateral organisations working in Africa would go a long way to working in sync to address Africa’s challenges.

What are the priorities for the next 5 years?

What challenges is ANS facing as an organization?

The ANS is due to launch at ANEC VI a consortium with the British Nutrition Society, the American Society for Nutrition, IUNS, and FANUS through a multi-year investment into an eNutrition Academy initiative. Nutrition training and capacity building remain a major challenge in Africa to provide a competent workforce to support national and regional efforts to combat malnutrition in all its forms. The continent also requires the necessary intellectual drive for nutrition research, policy and practice in countries lacking in readiness for nutrition actions to improve the health their people. The ANS hopes to work in partnership with its members and its associated collaborations to advance these set priorities in the next five years.

The foremost challenge the ANS has found is galvanizing the many nutritionists of African descent to proactively work together to find innovative ways of addressing the numerous nutritional challenges facing

Please, comment on the Nairobi declaration that was made four years at ANEC IV in Nairobi? How has ANS worked towards fulfilling the promises in the declaration?

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The ANS in its 2010 declaration in Nairobi, Kenya vowed amongst its rank and file of nutritionists as part of the health workforce to ensure that training in nutrition was adequate to meet standard academic and professional benchmarks required for competencies in professional practice. A step in the right direction certain key members of the ANS leadership were central in working within the core group that brought about the successful initiation and development of the UN’s Scaling Up Nutrition (SUN).

ANS representation has been central within the SUN Civil Society Network group ever since. To this end in the ANEC V declaration in South Africa, African nutritionist urged African leaders to make scaling up nutrition a priority for the continent, by joining the Scaling Up Nutrition Movement and to lead the way in the fight against hunger and undernutrition in the continent with the support of international institutions and donors countries.

A challenge that remains though to address in the ANEC IV declaration relates to skills and professional competencies that needs to be acquired in dissemination of research outcomes to policy and decision makers. This is a commitment the ANS still has in its sight.

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Interview with Professor Matilda Steiner-Asiedu, LOC chair of the ANEC VI Who are the members of the LOC?

What are the expectations at the end of the conference?

The members of the LOC are the executive committee members and members of the Nutrition and Dietetic Association in Ghana, as well as people in Nutrition related fields who have the responsibility of finding out and solving nutrition problems. The LOC has been in the media throughout last month informing and sharing ideas on nutrition issues that confront Ghanaians in connection with the upcoming conference. We thank all our media partners who have given us the opportunity to do this.

At the end of the conference, there should be the acquisition and transfer of knowledge regarding some solutions to nutrition issues pertinent to the continent. Experiences will be shared and programmes that have yielded results elsewhere will be transferred; in other words “if the wheel has been invented already why waste time trying to invent it again”. Participants should be able to identify and solve some nutrition problems. Through workshops, symposia and seminars various nutrition professional groups will share their new ideas and innovations to tackle the food and nutrition security issues confronting the world. It also is an opportune stage for young scientists and students to build their capacity in scientific reporting and presentation skills (research).

What is the specific theme for ANEC and why this was preferred?

The theme for this year’s ANEC is “Food & Nutrition Security in Africa: New Challenges and Opportunities for Sustainability”. This theme was chosen because nutrition is a national tool for building a strong economy and development since healthy people makes a healthy nation. How do we get people to be healthy? It is through eating the right foods in the right amounts all year round. This borders on Food and Nutrition security. We are looking forward to a time when Africa will be self-sufficient in all food and nutrition needs. This is where sustainability comes in. This forum therefore serves as a good platform to challenge Africans from all walks of life to act rather than only talk. Nutrition is multifaceted; It concerns itself with issues such as how to get the food from farm to the table, socio-cultural contextual factors, eating behaviours and disease outcomes. All these topics will be discussed at ANEC.

What are feature activities of the programme?

Feature activities include the Debate on Genetically Modified foods / Genetically Modified Organisms (GM foods/GMOs)- (Sunday, 20th July, 2014 at 3:00 pm), Workshop on Scientific Writing and publication- (Friday, 25th July, 2014 at 7:30am -10:00am), various symposia on nutrition issues, as well as Exhibitions- (21st to 25th July, 2014) and the presentation of awards to individuals who have a record of distinguished services in nutrition.

There will also be the launch of the electronic Nutrition Academy (eNA), it is believed that this platform will enhance training of nutrition professionals in Africa and dissemination of latest best practices in nutrition.

What is the significance to the Ghanaian nutrition community of hosting ANEC VI? ANEC VI means a lot to the Ghanaian nutrition community because it paves the way to showcase nutrition in Ghana and makes it possible for the general public to know where to get authentic information on nutrition and diet related disorders. The meeting also creates the platform to share knowledge about Nutrition issues in Africa and to find common grounds and solutions to similar problems without reinventing the wheel especially in this present time that Africa is facing financial challenges. Furthermore, since this meeting is attracting international audiences and nutritionists across the globe it provides the right environ to network with professionals and other stakeholders in the field of nutrition, agriculture, food technologist, nongovernmental organizations and the food industry. Ghana also stands to benefit since this also enhances our tourist attraction for those who will be visiting Ghana.

Professor Matilda Steiner-Asiedu

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Scaling Up Nutrition Movement: Engaging and inspiring multiple stakeholders to find new ways of investing together, to tackle malnutrition in all its forms.

David Nabarro Special Representative of the UN Secretary-General for Food Security and Nutrition and SUN Movement Coordinator.

Scientific articles in the international medical journal Lancet during 2008 published reviews which confirmed that women’s and children’s nutrition could be improved by increasing accesses to a series of specific services. An editorial in the journal stated that “nutrition is a desperately neglected aspect of maternal, newborn, and child health.

Leadership (for nutrition) is absent, resources are too few, capacity is fragile, and emergency response systems are fragmentary.”

The world’s political leaders increasingly understood that good nutrition is a vital driver of equitable development – of families, societies and nations.

Reflecting this growing interest, nutrition professionals from more than 100 organizations came together during 2009 and 2010 to develop a Framework for action to Scale Up Nutrition. This was released in Washington DC in April 2010: a Road Map for implementing the Framework, with a focus on the 1000 days between the start of pregnancy and a child’s second birthday, was presented at the UN General Assembly in September 2010. This event triggered the thousand days partnership – advocating for action to improve the nutrition of women and young children – and the Movement for Scaling Up Nutrition (SUN). The Movement focused on scaling up of efforts to improve nutrition with an approach spanning across four strategic processes*. In Africa, the Movement began with the Minister of Health in Zambia, who committed Zambia as the first African country to join the SUN

Movement in December of 2010.

Today, Scaling Up Nutrition in Africa has grown to become a movement of 34 African countries with thousands of supporters globally, many of which are arranged across four networks – the UN system, civil society, business and donors. King Letsie III is the African Union’s Champion for Nutrition supporting African Nations to commit resources to their nutrition plans to allow them to reap the benefits of investment in nutrition. An additional 19 countries contribute to the Movement from Asia and Latin America.

Whilst there are still over 50 million stunted children in Africa, there is a sense of optimism across the continent.

SUN countries recognize that malnutrition poses obstacles to the development of communities and economies. As experiences are shared

by SUN countries, it is clear there is national level leadership coordinating national, regional and international efforts.

The leadership at national level has in many cases ensured that priorities and programs are designed and implemented to meet the needs of those in the country. There is increasing alignment of financial and technical support to implement country plans. Governments, development agencies, foundations, civil society groups, businesses and the research community are coming together to prioritize nutrition – as a health, education, development, and economic issue.

Many of these countries are already starting to show significant improvements in their levels of undernutrition through a combination of specific nutrition interventions combined with policies and programs which are better focused on nutrition outcomes, i.e. “nutrition sensitive development”.

As the second International Conference of Nutrition (ICN2) in Rome, during November 2014 approaches, countries are preparing to make the case for nutrition. The outcome of the conference will be important. It will include the policies, institutional arrangements, investment priorities and monitoring mechanisms being put in place by national governments at both local and national levels. ICN2 is conveniently timed as the African Regional Nutrition Strategy (2015 – 2025) is being developed and the deceleration of African Year of Agriculture and Food Security.

With two thirds of African states in the SUN Movement, they are coming together with supporters. Political engagement is increasing. Ways of working for nutrition are being transformed. Attention is on the future to ensure that every child receives proper nourishment so they can grow up to be healthy and productive and family, communities and countries can prosper. *Scaling Up Nutrition (SUN) Movement Strategy (2012 – 2015).

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Strengthening institutional and human capacities is critical to the implementation of the nutrition roadmap in West Africa Roger Sodjinou, PhD West African Nutrition Capacity Development Initiative

Great efforts have been made over the past few years to raise the profile of nutrition to a high priority in West Africa(1). There is now strong momentum to scale up nutrition interventions and accelerate progress towards improved nutrition outcomes in the region. The nutrition landscape in West Africa has been evolving since 2010 as a result of the launch of new initiatives aimed at enhancing food and nutrition security. With the exception of Cape-Verde, all countries in the West Africa region are now members of the Scaling Up Nutrition (SUN) movement (2). This provides a unique opportunity for countries in the region to scale-up nutrition interventions, improve coordination of nutrition activities, mobilize resources for nutrition actions and improve accountability as well as overall nutrition governance (2). The Renewed Efforts Against Child Hunger and undernutrition (REACH), a global initiative that helps governments to organize partners around a unified vision and a common framework for action to reduce undernutrition (3), has also gained momentum in five countries in the region (Ghana, Mali, Mauritania, Niger and Sierra-Leone). In an attempt to build resilience to the cyclical food and nutrition crises in the Sahel belt region, the European Union and its partners have also launched the Global Alliance for Resilience Initiative (AGIR).

Other nutrition-focused initiatives are also being rolled out to accelerate progress toward reducing undernutrition. All these positive developments are likely to provide the necessary conditions and accelerate

progress toward the achievement of nutrition-related goals in the region.

The success and sustainability of these efforts depend however, on a number of country-specific factors (4). Adequate institutional and human capacity to deliver and scale up nutrition interventions is one of the factors that are critical for the advancement of nutrition (4). There is indeed robust evidence that lack of capacity is hindering West African countries from making progress in nutrition. Our recent capacity needs assessment has indeed revealed important gaps in the current capacity to act in nutrition in West Africa (5-7). In general, nutrition programs in West Africa are characterized by a critical shortage of skilled human resources, high dependency on donor resources as a result of low government investments, weak logistic and infrastructure systems, and lack of supervision as well as coordination of nutrition activities at lower levels. There is also very little incentive for nutrition service providers to stay in service and a lack of clarity in their roles and responsibilities. Other challenges include the limited training capacity to support the expansion of the nutrition workforce, as a result of a lack of nutrition training programs. There is also a lack of harmonization of existing nutrition curricula and a critical shortage of nutrition faculty.

Addressing these unmet needs is a critical step in the implementation of the regional nutrition roadmap. Under the auspices of the West African Health Organization (WAHO), the West Africa

Nutrition Capacity Development Initiative (WANCDI) has been launched to bridge the nutrition capacity gap in the West Africa region. The overall objective of the initiative is to address institutional, organizational and human capacity gaps and provide the needed support to accelerate progress for nutrition in West Africa. The key actions of the initiative include: Contributing to the development and expansion of an appropriately skilled nutrition workforce; Strengthening capacity at organizational and systemic levels; Strengthening existing nutrition training programs and creating a network of nutrition training institutions; Development of curricula that can serve as prototype for preservice and in-service nutrition training and; Creating an enabling environment for nutrition capacity development.

References 1.

2.

3.

4.

5.

Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, Ezzati M, Grantham-McGregor S, Katz J, Martorell R, Uauy R; Maternal and Child Nutrition Study Group. Maternal and child undernutrition and overweight in low-income and middleincome countries.

Lancet 2013; 382(9890):427-51.

The Scaling Up Nutrition website. Available from : URL http://scalingupnutrition.org/about [Accessed May 2014].

The REACH website. Available from: URLhttp://www.reachpartnership.org/home UNICEF. Improving child nutrition: the achievable imperative for global progress.

New York: UNICEF; 2013.

Sodjinou R, Fanou N, Deart L, Tchibindat F, Baker S, Bosu W, Pepping F, Delisle H. Region-wide assessment of the capacity for human nutrition training in West Africa:

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current situation, challenges, and way forward. Glob Health Action 2014; 7: 23247.

Sodjinou R, Fanou N, Deart L, Kupka R, Tchibindat F, Baker S. Nutrition training in medical and other health professional schools in West Africa: the need to improve current approaches and enhance training effectiveness (In press, Global Health Action).

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Sodjinou R, Fanou N, Deart L, Kupka R, Tchibindat F, Baker S. A systematic assessment of the current capacity to act in nutrition in West Africa: cross-country similarities and differences (In press, Global Health Action).

Experiences of the Zambia Civil Society Scaling Up Nutrition Alliance (CSO-SUN) in the Scaling Up Nutrition (SUN) movement to advance health and Development in Zambia William Chilufya SUN Country Coordinator, Zambia

Introduction Malnutrition, especially undernutrition, remains a serious public health concern and fundamental threat to the sustainable economic development for Zambia. A 2007 Demographic Health Survey report showed that 45% of children below five years are stunted, 28% are underweight and 5% are wasted; while a 2008 national report showed these proportions as 47%, 28% and 5% respectively. This means almost every second child or more than one million pre-school age children are stunted in Zambia. The proportion of exclusive breastfeeding in children below six months is 51%. Inadequate dietary intake is reflected in the fact that 37% of children aged 6-23 months consume a diet of minimal diversity (4 or less food groups). Underlying causes of malnutrition include inadequate access to a diverse range of foods, inadequate care for young children and mothers, unhealthy environment and insufficient health services. In addition, high adult illiteracy (36%) and poverty (64%) contribute to malnutrition.

Malnutrition is the underlying factor in the country’s high under-five and infant mortality rates. The under-five mortality rate of 119 and infant mortality of 70 per 1000 live births1 are indicative of Zambia’s developmental challenges.

The 2008 National Nutrition Surveillance System (NNSS) report highlighted Zambia’s highest malnutrition case fatality (40%) in the Southern Africa Development Community (SADC) region. In spite of these high figures, it is just recently that the profile of nutrition has begun to rise With the Zambian government’s joining of the Scaling Up Nutrition (SUN) Movement in early 2011. Before Zambia joined the SUN Movement, fight against malnutrition was perceived in many spheres to be the domain of the government and quasi government institutions, mainly Ministry of Health (MOH) and Ministry of Agriculture and Cooperatives (MACO). With Zambia in the SUN Movement a solid foundation to advance the nutrition agenda in the country has been developed through Multisectoral and Multistakeholder approaches We are witnessing Government Sector Ministries come

together such as Community Development, Water and Sanitation, Agriculture, Commerce and Trade, Education, Health and Agriculture. In addition, stakeholders such as the Government, Civil Society, Donors and Private Sector, all implement their specific roles in support of nutrition.

The CSO-SUN Alliance The Zambia CSO-SUN Alliance, established in October 2012, is a movement of civil society organizations working to influence policy, financial and political commitment to raise the profile of nutrition for national development. The Alliance mobilizes, coordinates and builds the capacity of civil societies to influence national efforts through constructive dialogue as well as advocacy with stakeholders including the government, donors and the private sector. The Alliance is also focused on advocacy and raising awareness so as to improve the profile of nutrition among policy makers and households.

The Alliance’s area of focus is the 1000 most critical day’s period. This is the window of opportunity from conception

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until a child’s second birthday, during which time nutrition has the greatest impact on saving the lives of children and mothers. Our vision is to have a Zambia where every mother and child is assured of adequate nutrition.

Ten Key Recommendations to address undernutrition in Zambia

The alliance works to support the new Nutrition Bachelor of Science and Masters of Science degrees and further supports the University of Zambia to establish a fully functional Nutrition Department as a crucial element of any strategy to address human resource gaps in nutrition

Increase spending to address the nutrition crisis Civil Society is advocating for increased spending to nutrition in order to effectively implement nutrition interventions. As at now Nutrition is not prioritized in terms of funding in lines Ministries.

In order to achieve our advocacy objectives we have adopted 10 key recommendations refereed to as ‘10 key Asks’ to addressing undernutrition in Zambia. These recommendations were developed in consultation with Government, the Donor Community and Civil Society.

The recommendations are improving current nutrition plans and accelerating progress towards a Zambia where all children can achieve their right to adequate nutrition, and full life potential, fulfilled. The 10 key recommendations include:

Reform existing programs to increase their effect on nutrition In Zambia, there is a heavy reliance on maize for food resulting in a mono-diet; high in calories but poor in other nutrients.

In order to reduce malnutrition rates (and in particular stunting), a deliberate policy that supports diversification of agriculture is necessary; but what is more critical, is to have a deliberate policy that provides incentives for livestock production to allow for promoting increased per capita animal protein intake in Zambia.

The Alliance advocating for reforming the Farmer Input Support Programme (FISP) and the Food Reserve Agency (FRA) so that they impact more positively on nutrition.

Engage civil society as a partner in the fight against under-nutrition.

Civil Society has the potential to make Malnutrition problems visible and improve the scope and quality of service delivery through research and advocacy.

Civil Society Organizations in Zambia are influencing and shaping nutrition policies more effectively because they directly engage political parties, government ministers and local governments, to turn nutrition campaigns into government policies.

Therefore the Alliance is open to other stakeholders who wish to use our platform to raise nutrition awareness provided they fall under our area of concern. It is for these reasons that CSO-SUN Zambia is becoming a credible source of nutrition information in Zambia.

To build political will to tackle undernutrition Cross-country studies of the Governance on Nutrition have highlighted that political will given to tackling malnutrition is one of the most critical factors for success in these efforts. The Alliance has engaged members of parliament (MPs) to advocate for effective programs to tackle under nutrition. Today, Members of Parliament (MPs) have become champions for nutrition working with the Alliance to raise awareness among our leaders through advocacy.

To address the serious gaps to ensure adequate human resources at all levels It is not realistic to expect to address the crisis of under-nutrition without urgently increasing the availability of qualified nutritionists. The crisis of malnutrition is complex. Addressing it requires technical competence across sectors. Presently, Zambia has limited numbers of trained nutritionists and dieticians to provide the necessary guidance in addressing the challenge, both at policy and program levels (preventive or curative interventions).

Ensure effective high-level national coordination Malnutrition is a multi-faceted problem, it requires coordinated action from multiple sectors of Government, including Ministry of Health (for curing those with acute malnutrition), the Ministry of Community Development, Mother and Child Health (for promoting healthy behaviours), the Ministry of Agriculture (for food security and production of nutritious foods), the Ministry of Local Government and Housing (for ensuring adequate water and sanitation services, to avoid frequent illnesses that reduce children’s abilities to absorb nutrients), not to mention the Ministry of Finance and Planning (to ensure adequate funding of nutrition programmes) and the Disaster Mitigation and Management Unit in the Vice-President’s office (to ensure planning for and mitigation of the impact of emergencies on food and nutritional security).

Champions of Nutrition As part of our advocacy efforts, the Alliance has identified Champions for Nutrition among the Members of Parliament (MPs). The MPs have undergone training in order to further understand civil society’s issues around of Nutrition in Zambia. The MPs now advocate for nutrition in their parliamentary activities especially in the House and Committees of Parliament.

Drawing on the success of Nutrition Champions MPs, the Alliance has taken strides to identify other traditional leaders and influential members of the community as nutrition champions.

Sensitization efforts As a way of raising the understanding and appreciation of the 1000 Most Critical Days Programme, the Alliance has taken strides to build the capacity of the media by holding media trainings.

Journalists from both print and

JUNE 2014 VOLUME 2 No. 2 electronic have been orientated. Since the training, we have received an overwhelming response from the media as evidenced in the wide coverage of our activities.

Furthermore, we have partnered with media houses to do joint media works on nutrition in Zambia, for example the Zambia National Broadcasting Corporation (ZNBC) in producing and publishing a documentary on malnutrition, the case for Mumbwa district. The documentary, entitled “A Silent Story”, premiered on 12th December 2013 at the primetime of 18:20hrs on the corporation’s main television station. The documentary has since been re-aired cost free on numerous occasions. Furthermore, “A Silent Story” has been converted for online viewing and is available on our You tube channel. We also partnered with Millennium Radio among others to do a six month Nutrition Talk radio series at no cost to the Alliance.

Through the Nutrition Talks a platform was created for communities to ask questions on nutrition by way of phoning in.

Lessons learned To advance health and development in Zambia through improved nutrition, it is very important that we speak with one voice and involve multiple stakeholders in the fight against malnutrition.

Through these efforts the Alliance has also seen that it is almost impossible to bring various stakeholders together without the active participation of the media. To effectively engage various stakeholders in the fight against malnutrition, the Alliance extensively involves the media through – radio talk

shows, news headlines, newspaper cuttings, twitter, facebook to mention a few, thus gaining popularity among community members and national leaders. For example, the Alliance, in collaboration with the Zambia National Broadcasting Cooperation (ZNBC), developed a documentary on Malnutrition, the case of Mumbwa District central province of Zambia.

This documentary showcases the extents of malnutrition in the country, and is continuing to receive attention by various national leaders and civil society.

Conclusion The CSO-SUN Alliance though is a year old has contributed in a special way to improving the nutrition situation in the country through awareness raising. The problem of malnutrition is yet to be resolved in Zambia, this entails stakeholders to continue working together and recognizing the importance of each role player. The Alliance’s diverse means of sensitization and awareness raising is key to driving the Scaling Up Nutrition Movement to advance health and development. It is critical for Zambia and African countries in general to note that the launch of the SUN First 1000 Most Critical Days Programme will not remain open indefinitely.

The responsibility falls on all stakeholders to capitalise on this crucial momentum and urgently seize upon this opportunity, before it is lost.

References 1. Grantham-McGregor, S. et al (2007), ‘Child Development in Developing Countries: Developing

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Potential in the First 5 Years for Children in Developing Countries’, The Lancet, Vol. 369, No. 9555: 6070.

2. Hoddinott et al., 2008, Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults. Lancet 2008; 371: 411–16.

3. National Food and Nutrition Commission (NFNC). Food and Nutrition Report, 2008, and Central Statistical Office, 2009 4. Mejía Acosta, A. and Fanzo, J., 2012. Fighting Maternal and Child Malnutrition: Analysing the political and institutional determinants of delivering a national multisectoral response in six countries, IDS/DFID

Further reading: http://www.ids.ac.uk/files/dmfile/DFID _ANG_Synthesis_April2012.pdf Regarding the Zambia study that was part of the IDS research mentioned above: http://www.ids.ac.uk/idspublication/ana lysing-nutrition-governance-zambiacountry-report

CONTACT Website: www.csosun.org Facebook: facebook.com/CSOSUN Twitter: @CSOSUN

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Malnutrition eLearning course Trevor Pickup Global eHealth International Partnership Lead, Faculty of Medicine, University of Southampton, UK.

Sunhea Choi Global eHealth Education Lead, Faculty of Medicine, University of Southampton, Southampton, UK.

MOOCs and Malnutrition eLearning The last few years have seen fast growth of eLearning with the internet becoming globally accessible and its potential for training being realised.

There is now a wide range of educational materials available on the internet, ranging from short videos on YouTube to certified eLearning courses.

The most recent trend in this area is Massive Open Online Courses (MOOCs), which are offered from higher education institutions to increase educational opportunities globally. A large number of people are taking an advantage of the offered opportunity by enrolling on these courses. The malnutrition eLearning course, developed by the University of Southampton (UoS) UK in collaboration with the International Malnutrition Task Force (IMTF) to support health professionals’ capacity building in the management of malnutrition, is one of such courses.

Development and field test Childhood malnutrition continues to be a major global issue both in terms of mortality and the developmental and stunting issues that many experience.

While great progress has been made in some countries such as Ethiopia, others are still not seeing the change required to really impact on this issue. One of the main reasons is the lack of health professionals’ capacity in caring for

children with malnutrition. Successful treatment of children with malnutrition requires specialist training, but it is not sufficiently covered in medical training at most medical schools both in Europe and across the world. Training for public health professionals, i.e. nutritionists, nurses and NGO staff, is also not easy to access.

In response to this the UoS and IMTF developed an eLearning course called, “Caring for infants and children with severe acute malnutrition”, which can be freely accessed via the internet. To evaluate the effectiveness of the course and the appropriateness of its delivery in a target context, in December 2010 a pilot study was conducted in Kampala, Uganda with 86 in-service and preservice health professionals. The results showed that the participants’ knowledge of and understanding about malnutrition and its management using WHO 10 steps improved significantly (1). After revising the course based on the pilot study participants’ feedback, it was launched in summer 2011.

Course dissemination using Social Media One of the challenges for eLearning is the difficulty of bringing the target user into contact with a particular material online. The difficulty increases when the target user is a subset of a global population and eLearning is not developed as part of a particular training

programme. Due to the challenge many high quality eLearning materials, developed to support education/training globally, have not become widely accessed.

Introducing the Malnutrition eLearning course to the relevant health professionals in the field, for example policy makers, educators/trainers, health workers and students in Africa and Asia, has proven to be challenging.

Initially, the course had been introduced to healthcare communities, agencies and professional bodies through presentations, exhibitions and Masterclasses at international events, but bringing it to the potential users was slow. From October 2012 and in response to this challenge, the project team initiated a Social Media campaign to directly disseminate the information about the course to the health professionals who may benefit from it but are not possible to reach through international events. A mixture of email, LinkedIn, Facebook, newsletters and YouTube were used for the course promotion. Messages within LinkedIn Public Health groups reached a large number of target user and resulted in a significant increase in enrolments on the course. Facebook was used by a different population but it has also been effective in making contact with potential users of the course.

Newsletters were produced regularly and sent out using a mailing list. People

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who have used the course and found it helpful passed on the details to their colleagues.

Enrolments on the course increased from 31 people in the 3 months from July to September 2012, to 896 in the following quarter. A user survey, conducted in spring 2012, showed that LinkedIn was the most effective social media marketing tool, which has led the largest number and highest proportion of the exposed audience to course enrolment (2, 3). Google Analytics, used to analyse the sources of referrals, supported this result.

Course use to date and user feedback To date (May 2014), over 7,000 people from 130 countries have used the course. The users include individual inservice health professionals who care for children with malnutrition; teachers and trainers using the course for their own knowledge gain or teaching; preservice health professionals studying health science programmes, and field workers from NGOs. The course is also being used by a number of institutions as part of their undergraduate or postgraduate health science programs.

These include institutions from Ghana (KNUST, the Catholic University and Kintampo), Nigeria (Michael Okpara University of Agriculture), Kenya (Masinde Muliro University of Science and Technology and University of Nairobi), Guatemala (Universidad Rafael Landivar), Columbia (Universidad Nacional De Colombia) and Sri Lanka (University of Columbo).

The user experience with the course has been very positive, with many being very pleased with the course design and content (for more user feedback, go to www.som.soton.ac.uk/learn/test/nutritio n/testimonials/). A few selected comments as follows.

“The course is excellent. I highly recommend it to those working in child survival areas. Kudos to the team to have come up with such an comprehensive coursework and

brilliantly presented which makes it completely user friendly” “Asking if I enjoyed the course is an understatement. I was impacted and it has given me new insight and a new vigour for my career path: malnutrition and cognitive development in under 5 children.”

“I am so happy with the material and am confident enough that the course is very helpful for anyone who has been engaged in humanitarian programs as well as all form of nutrition programming throughout the world!!!”

“Sir I am happy to inform you that I have finally completed the course and it’s been confirmed in the My learning. I am very glad and I know it will help me a lot in discharging my duties especially where the survival of the child is concerned. Thank you and thank you to all who planned for this very course. I am grateful.”

Conclusion MOOCs offer the opportunity for people around the world to access high quality training that is relevant to their situation. When combined with effective dissemination methods, they have potential for global capacity building.

An example is the Malnutrition eLearning course that has been developed for global capacity building in malnutrition management and disseminated using social media and award schemes. The project is still at an early stage, but it has demonstrated potential of MOOCs and social media as means for global malnutrition management capacity building. These methods should be tested, and when proven effective, be followed by the nutrition education community to support the much needed nutrition capacity building globally.

Info about the course access via Nutrition Portal The course is available at: http://www.som.soton.ac.uk/learn/test/n utrition and takes about 6-8 hours to complete. It is appropriate for in-service

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and pre-service health professionals, studying medicine, nursing, nutrition and allied subjects.

Project team Chief investigator: Professor Alan Jackson Project lead and instructional designer: Dr Sunhea Choi Author: Dr. Reginald Annan Technical advisor and editor: Professor Ann Ashworth Hill Project dissemination: Trevor Pickup Design and development: Faculty of Medicine eLearning team (Matthew Hammerton, Elizabeth Ault and George Ke)

References 1.Choi, S., Annan, R.A. and Jackson, A.A. eLearning as a solution to train doctors and nurses to manage malnutrition in children. In: CAPGAN Conference 2011, 22-23 July 2011, London, UK. 2011.

2.Choi, S., Annan, R. and Pickup, T. Malnutrition eLearning and Social Media joined forces to build global malnutrition management capacity.

In: AMEE Conference 2013, 24 - 28 August 2013. Prague, Czech Republic.

2013.

3.Pickup, T., Annan, R. and Choi, S. Malnutrition capacity building enabled by eLearning and social media. In: IUNS 20th International Congress of Nutrition, 15 20 September 2013. Granada, Spain.

2013.

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Highlight on the Micronutrient Global Forum, Addis Ababa, Ethiopia 2014 Aglago Kouassivi Elom, PhD Unité Mixte de Recherche en Nutrition et Alimentation, URAC 39, Rabat, Morocco. aglagoelom@gmail.com

The micronutrient (MN) Forum, created since 2006 has been an effective global meeting where research, innovative initiatives, and policy for the tackling of MN deficiencies have been discussed.

After Istanbul in 2007 and Beijing in 2009, the MN Forum chose the African continent for its third destination. The 2014 meeting took place in Addis Ababa, Ethiopia from 1st to 6th June.

The choice of Ethiopia remains symbolic as the country has struggled with malnutrition over decades.

However, the country set a strong example to the world by signing a nutrition strategy in 2011 which gathered about 10 ministers of health who committed to put nutrition at the top of their respective agenda.

The MN Forum 2014 themed ‘Building bridges’ was declared opened by the First Lady of Ethiopia, in the presence of the Minister of Health and Lynnette Neufeld, the chair of MN Forum.

Presentations were discussed in plenary and in thematic sessions. The causes and consequences of MN deficiencies, and solutions and strategies to improve micronutrients status worldwide were covered: iron, iodine, zinc and vitamins.

Life cycle nutrition was also considered during the Forum, with a paramount spot on children and pregnant women, highlighting the importance of the window of opportunity. It was revealed from oral presentations and communications that supplementation and food fortification was effective in decreasing MN deficiencies, especially in developing countries. The session on Scaling Up Nutrition (SUN) movement demonstrated the success of the

initiative in many countries, amongst them Ethiopia. It has been grounded that commitment from the highest level of leadership of one’s country is not only important, but the unique way to improve sustainable micronutrient status of a population of a country.

Kenneth Brown from Bill & Melinda Gates Foundation presented an innovative tool to optimize the costeffectiveness of national micronutrients deficiency control. Even if the cost of supplementation and food fortification are low compared to the advantages, field workers and logistics, especially regarding remote areas are still a challenge to overcome and it is necessary to consider financial optimisation issues when setting programs.

The MN Forum also was a platform to debate agriculture and food-based interventions. Often neglected, it is important to always underline that food security must be prior to MN debates, and binding the right to food security with MN interventions is important for decisive outcomes. Therefore, success of corn-soya blend in Cambodia, orange sweet potato in Africa and increased intake of animal source foods in some populations should be a hand push to combat MN deficiencies. Laboratory and field approaches for the analysis of MN, such as dietary assessment and choice of right biomarkers were debated. Exclusively, some countries’ specificity, Guatemala as an example, demonstrated that MN interventions are becoming alarming because of supplementation, added to the mandatory fortification and multiple

voluntary fortifications by the industries which need the supervision and control of experts in order to prevent overconsumption in some cases.

Finally, innovative solutions like portable kits and the use of geolocalization to follow the distribution scheme of supplements and fortified foods have been presented. During a session on leadership development, it came out that many countries need strong leadership at all levels to back MN interventions. As a very influential nutritionist and a leader, Anna Lartey, the current president of International Union of Nutritional Sciences (IUNS) and Director of Nutrition Division at FAO, shared at the closing ceremony the keynote address. Invitation was sent to meet up in Mexico in 2016 for the next MN Forum and forward the agenda.

*The author would like to thank his PhD supervisor Pr Hassan Aguenaou.

He is also delighted to thank the International Life Sciences Institute (ILSI) and Dr Geoffy Smith, for the award presented to him at the MN Forum.

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Nutrition research in North Africa Ali Jafri, PhD Ben M’sik Faculty of Sciences , University Hassan II Mohammedia Casablanca ali.jafri@univh2m.ac.ma

How do we picture the ultimate and perfect outcome of nutrition research?

Probably eradicating hunger, feeding the world, winning the fight against malnutrition, etc.

Those aren’t unreachable perspectives since nutrition research has literally allowed mankind to reach for the stars (1). It is no surprise that research holds an important place in nutrition strategies.

The world had come to realize -a bit late perhaps- that if we were to succeed in our struggle against chronic diseases, this success is most likely to come through nutrition.

If we compare nutrition research in North African countries based on their scientific production, we would find that most of them are in relatively low positions in agricultural and biological sciences (Egypt: 42, Tunisia: 48, Morocco: 64, Algeria: 77, Sudan: 82, Libya: 136, Mauritania: 161) though three of them are in the Top 10 of scientific production on the continental level (data source: Scopus).

Comparing the evolution of the annual scientific production in these countries (figure 1) we notice that in 2003-2004 research in Egypt and Tunisia witnessed a weakening in the nutrition-related fields, scientific production has nearly tripled in Egypt and quadrupled in Tunisia between 2004 and 2011, but even before, data shows that more papers were already being published from Egypt, which might be due to the fact that there substantially more scientific journals published in English than there is in French -assuming the fact that scholars from the Maghreb

Figure 1. Scientific production in four countries from North Africa (in number of scientific papers per year). Data source: Scopus.

region tend to publish in francophone journals- but, that doesn't explain the scientific surge in Tunisia following 2004.

The fact is that nutrition trainings and research in both Egypt and Tunisia are much more developed and were long organized in order to meet the requirements and challenges these countries are facing. For the complexity of the epidemiologic situation in North Africa (2) is in need of thorough understanding that can only be brought through organized research. Most (if not all) North African countries didn't have a proper nutrition strategy until a few years ago (3).

Now, the region is headed towards meeting the objectives of the World Health Organization’s regional nutrition strategy (3) which aims to improve the nutritional status of the populations mainly by focusing on the political

engagement in setting up policies which would ensure decreasing undernutrition, NCDs and food insecurities. This strategy requires an important governmental commitment in order to meet these objectives and have the expected success, unfortunately, the unstable political situation in a number of the region countries has added an extra challenge to the picture. We can only hope that they recover quickly from that setback.

References 1. Lane HW, Bourland C, Barrett A, Heer M, Smith SM. The role of nutritional research in the success of human space flight. Adv Nutr.

2013 Jan 1;4(5):521–3.

2. Labraimi H, Jafri A. Nutrition challenges in North African countries. African Nutrition Matters. Accra; 2013 Sep;16–7.

3.

WHO-EMRO. Document technique EM/RC57/4: Stratégie régionale sur la nutrition 2010-2019. Cairo; 2010.

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West Africa regional instabilities: Consequences for food security Hayford Mawuli Avedzi University of Alberta, Canada

Folake Samuel, PhD Department of Human Nutrition, University of Ibadan, Nigeria

Food security is said to exist when all people at all times have physical and economic access to sufficient, safe and nutritious food for a healthy and active life. Thus when there is food and nutrition security people’s diets are adequate in both quality and quantity, providing the required amounts of energy, macronutrients (carbohydrates, protein, fats) and micronutrients (vitamins, minerals, electrolytes) and the nutritional needs of special groups such as infants and young children are met. However, instabilities including armed conflicts, one-sided violence, draught, epidemics, and economic crisis, which affect the “physical and economic access” to food impact heavily on food and nutrition security.

This has profound effects on people's nutritional health and lives by increasing acute malnutrition, morbidity and mortality.

Between 1990 and 2003, major armed conflicts occurred in 17 African countries. While West Africa has taken important steps to consolidate peace and democratic governance after these conflicts, the gains are increasingly being endangered by new threats and challenges. In recent times, thousands of defenceless Nigerian citizens, particularly in the northern part of the country have been killed, maimed and displaced due to growing insurgency and sectarian violence by the group

known as Boko Haram. The continuous spate of bombings and killings of innocent citizens, which began in 2009, has resulted in a state of civil insecurity in Nigeria coupled with political and socioeconomic crises that bedevil the oil and human resource rich nation.

Between February and March 2014, three West African nations: Guinea, Liberia and Sierra Leone witnessed the world's biggest Ebola Virus Disease (EVD) outbreak that killed hundreds of people and threatens regional and global public health security. In addition to the loss of lives, the EVD outbreak, which is characterized by an intense community spread, is having negative economic effect on the affected nations as foreign workers are leaving, flights are being cancelled and businesses are recording low sales. EVD, which remains the deadliest outbreak to date, has no cure spreads through contact with an infected person's bodily fluids.

Corruption, poor political leadership and economic policies have culminated in free-fall of the Ghanaian Cedi in addition to increasing inflation.

Consequently, food and nutrition security of low-income households is endangered as food prices have risen up to levels that they can barely afford due to higher costs of living. This situation is not too different in most of the West African nations where corruption, poor governance is commonplace.

Draughts, floods and pests due to changes in the world's climate is affecting many West Africa nations leading to major shifts in food production, and availability. The subregion is extremely vulnerable to climate change because its agriculture is essentially rain-fed. Almost every country in the region has experienced a year-by-year reduction in rainfall.

Displacement of farmers from the land due to civil insecurity and collapse of public safety; disruption of the agricultural cycle and destruction of food stocks and harvests by environmental factors such as draughts, floods or fire; and the interference in the food market caused by poor governance and economic crisis within the territory of a country culminate in the disruption and total collapse of food supply networks and marketing systems of affected populations. Disruption or collapse of food supply ultimately result shortages that drive prices up to levels which low-income households cannot afford.

Provision of emergency food aid to populations experiencing these instabilities and food insecurity is an important short-term response to ameliorate the plights of affected populations. However, the sub-region, and most of Africa must come together to find lasting solutions to these challenges.

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References An Introduction to the Basic Concepts of Food Security. http://www.fao.org/docrep/013/al936e/a l936e00.pdf Declaration on the political situation in West Africa, Abuja, 8th August 2012, West African Civil Society Forum (WACSOF). http://www.responsibilitytoprotect.org/P osition%20Statement%20by%20WACS OF.pdf

West Africa, United Nations Department of Political Affairs http://www.un.org/wcm/content/site/un dpa/main/activities_by_region/africa/we st_africa Special Ministerial Meeting on Ebola Virus Disease in West Africa Accra, Ghana, 2 - 3 July 2014 http://www.afro.who.int/en/clusters-aprogrammes/dpc/epidemic-a-pandemicalert-and-response/epr-highlights/4187special-ministerial-meeting-ebola-accra2-3-july-2014.html

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Outbreak of Ebola in Guinea, Liberia, and Sierra Leone: http://www.cdc.gov/vhf/ebola/outbreaks /guinea/ Climate change in West Africa - the risk to food security and biodiversity.OFEDI and GRAIN, 2009. http://www.grain.org/article/entries/775 -climate-change-in-west-africa-the-riskto-food-security-and-biodiversity

mHealth and Nutrition: opportunities for health promotion and nutrition messaging in Southern Africa Nonsikelelo Mathe, PhD University of Alberta, Canada

There are more mobile phone subscriptions in Sub Saharan African (SSA) than in the USA or the European Union. It is anticipated that by 2017 there will be approximately 1.12 billion mobile phone subscribers in SSA [1].

The penetration of mobile phones, in SSA, is estimated to be 63% in 2013 and may reach more than 70% by 2015[2]. These figures imply that people living in SSA countries are more connected than ever before, and potentially have greater access to information through mobile phones and other mobile devices. Moreover, the wide penetration of mobile phones has the potential to reach large numbers of people living in resource-limited settings.

Mobile health or mHealth describes the use of mobile devices to support public health and medicine. This includes the use of short messaging service (SMS), wireless data transmission, voice calling, and smartphone applications to transmit health-related information [3].

The Global Observatory for eHealth (GOe) defined mHealth as “Medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices�. mHealth has the potential to offer solutions to healthcare workers including nutritionists and dietitians, to maximize their impact and efficiency, especially where access to healthcare

personnel is limited, as in most rural areas in SSA [4]. Mobile phones have been used in health education interventions using text messaging to address risk factors for noncommunicable diseases in developed countries [5]. Although most research in mHealth has been in high income countries with advanced mobile information infrastructure, increasingly a number of mHealth interventions are being developed and applied to disease prevention and control in more resource-limited contexts [4]. Two examples from Southern African countries include:

In a study in Zambia, a system operated by nurses in a public sector cervical cancer prevention program was used. After taking photographs of a suspicious cervical lesion with a mobile phone, nurses in remote settings sent images electronically to an expert consultant for review as well as an SMS message notifying Although there is a paucity of information on the application of mobile phones and technology in the context of nutrition in Africa, elsewhere, mHealth initiatives that include nutrition have been used in for health promotion, nutrition messaging and surveillance. Indeed, there remains some skepticism and myths about mHealth [8] and more research in the context of mHealth in Africa is needed. However, the potential influence and impact of mobile technologies in nutrition surveillance, monitoring and evaluation, data gathering and nutrition interventions is immense.

the consultant to review the images.

The consultant and nurse were able to communicate via mobile phone while viewing the images simultaneously [6].

A South African study involved peer support for adult women living with diabetes via mHealth. A series of

References 1. International Technology Union (2013) The World in 2013: ICT Facts and Figures, World Health Organization. Geneva 2. Deloitte, Sub-Saharan Africa Mobile Observatory 2012, 2012.

3. World Health Organization (2011), mHealth: new horizons for health through mobile technologies, 2011, World Health Organization.

Geneva 4. Betjeman, T.J., S.E. Soghoian, and M.P. Foran, (2013) mHealth in SubSaharan Africa. Int J Telemed Appl p. 482324.

educational group sessions addressing lifestyle improvements were offered to women living with diabetes and each was assigned a “text message buddy” to assist with lifestyle changes via SMS. After the sessions, the women were asked health questions via daily text messages [7].

5. Cole-Lewis, H. and T. Kershaw, (2010) Text messaging as a tool for behavior change in disease prevention and management.

Epidemiol Rev, 32(1): p. 56-69.

6. Parham, G.P., et al., (2010) eC3--a modern telecommunications matrix for cervical cancer prevention in Zambia. J Low Genit Tract Dis, 14(3): p. 167-73.

7. Rotheram-Borus, M.J., et al., (2012) Diabetes buddies: peer support through a mobile phone buddy system. Diabetes Educ, 38(3): p. 357-65.

8. Biesdorf, S., Niedermann, F., (2014) Healthcare’s digital future, in Mckinsey and Company Insights and Publications, Mckinsey and Company.

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Spotlight on Wisdom G. Dube What are your thoughts about global movements “such as the Scaling Up Nutrition” and its relevance to young nutrition researchers such as yourself?

Where are you based?

Centre of Excellence for Nutrition, Potchefstroom, North-West University, SA Where are you from?

Zimbabwe What area of research are you working in?

I have a growing interest in infant and young child nutrition research. My interest is particularly in the area of “Implementation research”. I would define my area of research as the “Bridge linking programming and research for communities”.

Tell us a little bit about the projects you are involved in currently?

I am currently the Principal Investigator for the UNICEF funded project “Infant and young child feeding training in Zimbabwe: Analysis and Recommendations”. This resulted in the following publication: Wisdom G. Dube, Thokozile Ncube (2012). Frontline experiences of Community Infant and Young Child Feeding in Zimbabwe.

Field Exchange, Issue No 43, July 2012. p95. http://fex.ennonline.net/43/frontline Another project I have been involved in is “The Functioning and Sustainability of a School Health Programme in Binga District, Matabeleland North” in Zimbabwe, where I work as the project co-ordinator.

I would like to comment on the efforts of the SUNRAY (Sustainable Nutrition Research for Africa in years to come) project. This project initiated an agenda for prioritization of Nutrition research particularly in Africa. The project was one of the awarded projects by the European Commission with the aim of helping establish research priorities, strengthening commitment, and identifying resource needs, synergies and co-ordinated research efforts on a European and global level towards tackling malnutrition (http://sunrayafrica.co.za).

I was nominated to contribute to the consultative effort of the SUNRAY in 2012 and this nomination came due to my active nutrition-research contributions in Zimbabwe also coupled by my previous participation in the ANLP (African Nutrition Leadership Program, http://www.africanutritionleadership.org / ). l would like to emphasize on the importance of this growing movement to any young nutrition researcher. In a nutshell the project has identified a number of factors which are particularly relevant to nutrition research. The factors include improved interaction and problem-driven research, capacity building priority, cross-African collaborations. Further information about this important movement can be found on the website: http://sunrayafrica.co.za In relation to the SUN movement, in 2010, l attended a high level meeting on “Lessons for the Scaling up Nutrition (SUN) movement”. The purpose of this meeting was to exchange and learn lessons from African and Asian countries, particularly to set an

exchange platform for the SUN movement approaches from the different countries, a detailed report is found on: (http://www.ennonline.net/pool/files/ife/ cmam-conference-report.pdf).

I was invited to attend the meeting and represent the government of Zimbabwe and this came due to my contributions to nutrition frontline work, l was doing with the Ministry of Health, Nutrition department of Zimbabwe. It might have been a long time since lessons have been learnt on the SUN, l still believe as young nutrition researchers there is need for continued learning from the experiences of this great advocacy movement for nutrition action. As a lesson from the meeting and a challenge, l look back to a comment made by David Nabarro about the SUN saying “The way-forward(in 2010) was rather not clear and required skilful approach towards achieving change”. I also leave this challenge to all young nutrition-researchers particularly in Africa to apply ourselves skillfully and tactfully towards achieving change and positive nutrition outcomes among the communities.

References Email: vadubewg@gmail.com Linkedin: za.linkedin.com/pub/wisdomdube/31/5a7/169/ Recent achievement (publication of paper, abstract accepted, conference attendance, awards, etc.)

Recent Publications: 1.Dube WG, Makoni T, Nyadzayo T.K, Covic M.N., A strategy to scale-up Vitamin A supplementation in a remote rural region in Zimbabwe, SouthAfrican Journal of Child-

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Health(SAJCH),Vol 8.No 2, 2014. http://sajch.org.za/index.php/SAJCH/art icle/view/618/520 2. Dube WG. Nutrition and Economic growth in South Africa: A cointegration approach model, Journal of Economic studies (JES) (Accepted &

Forthcoming), 2014. http://mpra.ub.unimuenchen.de/id/eprint/52950 Abstracts Accepted: 1. "Progress in elimination of iodine deficiency disorders in Zimbabwe- A program coverage".

Micronutrient Forum, Ethiopia, 2014.

2. "Weight-for-age charts and Z-scores developed for 10-15 year old adolescents in north-west province South Africa: the HIV/AIDS context": 20th International AIDS conference Melbourne Australia, 2014.

Announcements African Nutrition Matters Symposium: processes, challenges, opportunities and the way forward 21 July 2014 – Accra, Ghana (Parallel symposium at ANEC VI. Venue: Osei Tutu) 1:00-2:00 PM.

Building Healthy Global Food Systems: A New imperative for Public Health: Ground-breaking Food Policy Conference.

September 8-9, 2014 – Oxford, UK. http://www.wphna.org/Oxford2014/

25th Congress of the Nutrition Society of South Africa and the13th Congress of the Association for Dietetics in South Africa.

September 16-19, 2014 - Boksburg, South Africa. http://www.nutritioncongress.co.za/index.php/component/content/category/2-uncategorised

Third World Congress of Public Health Nutrition 9-12 November 2014 - Las Palmas de Gran, Spain. http://www.nutrition2014.org/

International Nutrition Conference (ICN2) organized by FAO and WHO 19 – 21 November 2014 – Rome, Italy. http://www.fao.org/about/meetings/icn2/en/

African Nutrition Matters is the official bulletin of the African Nutrition Society.