AFRICAN NUTRITION MATTERS Volume 3 No. 4 | Summer 2015
AFRICA N NUT RIT IO N SO CIE T Y T H E
N E W S L E T T E R
AFRICAN NUTRITION MATTERS
Contents 5
Editorial
11
Enhancing infant and young child nutrition through agriculture
7
Scaling Up Nutrition Leadership Development in Africa
14
Malawi Floods
8
Commentary: Nutrition in the post 2015 development agenda
19
Improvement in the nutrition related MDG through integrated Health Centers in Niger
10
Proposed Sustainable Development Goals (SDG) by 2030
21
Social responsibility of food industries
13
Diet and the Millennium Development Goals
24
Review: Can Moringa adoption and utilization combat under-nutrition?
AFRICAN NUTRITION MATTERS Volume 3 No. 4 – Summer 2015 African Nutrition Matters is a publication by the African Nutrition Society. ISSN: 2412-3757. This publication is distributed under the terms of a Creative Commons Attribution-ShareAlike 4.0 International License.
Lead Editors: Dia Sanou (University of Ottawa, Canada), Nonsikelelo Mathe (University of Alberta, Canada). Sections editors: Ali Jafri (University of Hassan II Casablanca, Morocco), Brenda Ariba Zarhari Abu (University of the Free State, South Africa), Elom K. Aglago (Ibn Tofail University, Morocco), Keiron Audain (University of Zambia), Muniirah Mbabazi (University of Nottingham, UK). Editorial Assistants: Theodora Amuna, Tolu Eyinla.
All correspondence should be addressed to the lead editors, at: newsletter@answeb.org Cover photo: Flickr / Ali Jafri: BY-NC-SA 2.0 https://flic.kr/p/cPCqFC
7th Africa Nutrition Epidemiology Conference 10-15 October 2016 Marrakesh, Morocco
The seventh African Nutrition Epidemiology Conference will be hosted in the ancient Moroccan city of Marrakesh in 2016.
Flickr / teosaurio: BY-SA 2.0 https://flic.kr/p/8XofK7
Editorial
What role for the African Nutrition Society?
By Nonsikelelo Mathe, Francis Zotor & Dia Sanou The African Nutrition Society’s (ANS) role remains central to The 2000 Millennium Development Goals (MDGs) called for
the multisectorial emphasis in nutrition intervention and other
halving the proportion of people living in hunger. Important
conditions. Through its representation on several global
progress has been made and the goal of ending hunger and
nutrition committees such as the SUN Civil Society Network,
malnutrition rose higher on the agenda of governments and
the International Union of Nutritional Sciences (IUNS)
global development agencies.With just half year to go until the
presidency, the Federation of African Nutrition Societies
MDGs
The
(FANUS), etc., the ANM will advocate and put voice behind
proportion of underweight children in developing countries
the nutrition agenda in Africa. The ANS will harness the
has fallen; and, some progress has been made in reducing
continent’s vast natural and human resources to alleviate
mortality in children under five.
hunger and poverty, and advancing the overall effectiveness of
expire,
let’s
celebrate
accomplishments.
nutritional issues across Africa. Most importantly, the ANS Despite these successes, progress remains uneven around the
recognizes the need for stronger leadership and capacity
world. Many African countries have taken advantage of the
development. This was most recently articulated in a
winds of change, but many are still struggling particularly
publication in the Proceedings of the Nutrition Society (Ellahi
with stunting. Data suggest that the least progress in reducing
et al 2015). In this paper, the ANS leadership discusses the
child undernutrition has been made in sub-Saharan Africa. The
need for systematic capacity development in nutrition in
2014 Global nutrition report suggested that many countries are
Africa. At FANUS’s recent conference in Arusha, Tanzania
simultaneously facing a rapid increase in both number of
during which ANS played a leading role, deliberations
stunted children and those affected by obesity.
emphasis was placed on the need for African nutritionists to strengthen South-South collaborations that will bring together
MDGs have created a great momentum for nutrition and an
partners with distinct and complementary strengths, foster the
increased recognition for nutrition as central to development.
promotion of
This was especially so with the advent of the Scaling Up
amongst each other, share best practices and build
Nutrition (SUN) in the last four years of the MDGs. These
partnerships.
closer technical and economic cooperation
commitments need to be sustained and innovative strategies are required to translate momentum into actions and results.
Africa’ nutrition matters (ANM) is calling for reflection on
The international community has therefore appointed a high
innovative actions to support the global efforts to ending
level panel to propose a framework for the post-2015
hunger and malnutrition in Africa. As the voice of ANS and
development agenda.
The draft framework that could be
heartbeat of ANS on nutrition matters across the continent of
adopted in September 2015 contains 17 goals as compared to
Africa, ANM is committed to sharing knowledge and
eight time-bound goals in the 2000 MDG. An important
information relevant for actions and connect researchers,
development for nutrition is the agreement to define a stand-
policy makers, implementers and beneficiaries. ANM will also
alone goal for hunger and nutrition.
be disseminating good practices from the field and giving
AFRICAN NUTRITION MATTERS
Summer 2015
5
voice to those professionals in remote areas who do not always have opportunity to be heard in mainstream media. Implementation of ANM commitments for the post-2015 nutrition agenda starts in the current issue with an introductory commentary from ANM Chief-Editors on the 17 Sustainable Development Goals (SDG) proposed by the Open Working Group and the Priority nutrition indicators for the Post-2015 SDGs prepared by the United Nations Sub-Committee for Nutrition (UNSCN). In the sub-section “Testimonies from the Field”, ANM sub-Editor Elom Kouassivi Aglago interviews M. Amjed Achour, Director of the Foundation for Child Nutrition in Morocco. We continue with reflections from subeditor Keiron Audain who discusses the changes in diet trends in the years of the MDGs. Dr Audain further reflects on the effect of floods in Malawi. In line with highlighting new innovations within nutrition, Natalie Gyenes and Mary Grimanis discuss the valorization of the Moringa plant for combating under-nutrition. In addition, we explore the work of the international potato center (CIP) who enhance infant and young and child nutrition through agriculture for the reduction of vitamin A deficiency in rural communities. We hope you find the articles in this reflective issue thought provoking and action inspiring. Reference B. Ellahi, R. Annan, S.Sarkar, P.Amuna, A.A. Jackson (2015) Building systematic capacity for nutrition: towards a professionalised workforece for Africa. Conference on “Food and nutrition security in Africa: new challenges and opportunities for sustainability”. Proceedings of the Nutrition Society : African Nutritional Epidemiology Conference (ANEC VI) 15 pp1-9
AFRICAN NUTRITION MATTERS
Summer 2015
6
Scaling Up Nutrition Leadership Development in Africa (SUNLEAD)
3) The way forward for SUNLEAD (Johann Jerling). The workshop was facilitated through a range of interactive activities including role play, discussions, individual and
From the 26th May- 4th June 2015, Scaling Up Nutrition
group assignments. Participants were introduced to key
Leadership Development in Africa (SUNLEAD) workshop
concepts in change management, Polarity management,
2015 was held in at North West University in Potchesftroom,
managing resistance to change, developing values and more.
South Africa. SUNLEAD is an advanced leadership program,
A key fourth pillar was the peer-to-peer feedback and
whose purpose is to develop leadership capacity among
feedback from facilitators and mentors. Participants gave each
nutrition
academics,
other feedback on how they could improve their leadership
government, industry and NGO workers who had previously
capacity. Each participant had the opportunity to observe at
participated in the African Nutrition Leadership Program
least two of their peers who they later gave positive and
(ANLP). All ANLP alumni since 2001, were eligible to apply
constructive feedback on what they could do to improve their
for this program. After a competitive process, eighteen Alumni
leadership style. As with ANLP, reflection was a very
were selected to participate.
important component. Participants were encouraged to reflect
The SUNLEAD initiative aimed to support the different
each evening and document their reflections in a leadership
efforts to Scale Up Nutrition in Africa. It recognized that there
journal. In addition, Aha! moments were pasted on the walls in
is a significant capacity gap in nutrition and a dearth of leaders
the conferences rooms as they arose throughout the sessions.
who are passionate about nutrition and African development.
Indeed the theme for this workshop was commitment. During
scientists,
program
implementers,
the application process commitment was the main thing For eight days, participants where challenged with study on
expected from participants.
three main areas 1) Leadership principles; articulated in the form of the nine principles (Leon Coetzee, Jane Badham and Johann Jerling), 2) Workshop facilitation techniques (Thabo Phutu)
AFRICAN NUTRITION MATTERS
Summer 2015
7
of underweight children in developing countries has fallen
Nutrition in the post 2015 development agenda By Dia Sanou & Nonsikelelo Mathe
(Haddad Global Nutrition report). Since the launch of MDGs, attention to addressing the challenge of undernutrition in Africa has increased substantially at national and global levels. Global development partners have a unanimous voice and many are aligning their strategies as suggested by the Rome
In the 1990’s, the UN Secretariat initiated a process to build
Declaration on Nutrition and Framework for Action
consensus on global development priorities for the 21st
(FAO/WHO 2015), the European Union Policy Framework for
century (Hulme 2009). This process led to the adoption by 189
Enhancing Maternal and Child Nutrition in External
UN member-states of the Millennium Declaration at the
Assistance (EU 2015) and the European Commission Action
Millennium Summit held in September 2000. This declaration
Plan on Nutrition (EU 2013) and The USAID Multi-Sectoral
set a “roadmap for world development by 2015” to eradicate
Nutrition Strategy USAID 2015 – 2025 (USAID 2015).
extreme poverty and improve the health and welfare of the
Learned bodies dedicated to advancing the nutrition agenda in
world's poorest people within 15 years. Eight time-bound
Africa are being created at national level and FANUS has
goals with 18 quantified targets, known as the Millennium
created a continental platform for these learned national
Development Goals (MDGs), were published a year later in
societies, Leadership development programmes (e.g. African
August 2001, to serve as the framework of international
Nutrtiion Leadership Programme (ANLP), PLAN and
development cooperation. Goal 1 of the declaration called for
SUNLEAD-Africa) have been established. Since 2002, ANEC
eradicating extreme poverty and hunger. The nutrition related
conferences are being held regularly and the African Nutrition
target of this MDG 1 was to reduce by half the proportion of
Society (ANS) was established in 2008 to serve as an umbrella
people suffering from hunger (UN 2015). Mention the links to
to this important event.
the other MDGs How to sustain progress and transform pre 2015 commitments Countries have progressed unevenly worldwide with the
into actions after 2015?
MGDs. The least progress in reducing child under-nutrition
MDGs have created an increased recognition for nutrition as
has been made in Africa. The 2014 Global nutrition report
central element for economic development and growth. About
suggested that many countries are simultaneously facing a
37 African countries joined the Scaling Up Nutrition (SUN)
rapid increase in both number of stunted children and those
movement (SUN website). To sustain the commitment and
affected by obesity (Haddad Global 2015).
translate momentum into concrete actions for better results, a high level panel appointed by the UN secretary general for the
Challenges ahead are very important, yet let’s be proud of and
post-2015 development agenda. The panel established an
celebrate the many accomplishments thanks to various efforts
Open Working Group to develop a set of sustainable
at different levels. Indeed, the MDGs have created an
development goals and appropriate actions that are aligned
unprecedented momentum around nutrition in the last two
with the post-2015 development agenda. The working has
decades leading to an increase in commitment and new
proposed a set of 17 indicators accompanied by targets which
initiatives particularly in developing countries. The proportion
are further elaborated into indicators with measurable outcome
AFRICAN NUTRITION MATTERS
Summer 2015
8
(Open Working Group 2014). In line with nutrition, SDGs
References
have defined a stand-alone goal for hunger and malnutrition
de Onis, M., Dewey, K. G., Borghi, E., Onyango, A. W.,
which is an important progress compared to the MDG where
Blössner, M., Daelmans, B., Piwoz, E. and Branca, F. (2013),
poverty and hunger were combined to form MDG 1 (UNSCN
The World Health Organization's global target for reducing
2014). Another feature of the post-2015 development agenda
childhood stunting by 2025: rationale and proposed actions.
is the emphasis on stunting for many reasons: 1) stunting is the
Maternal & Child Nutrition, 9: 6–26. doi: 10.1111/mcn.12075.
type of undernutrition that affects a large number of children globally and more than 80% of stunted children are living in
FAO / WHO 2015 . The Second International Conference on
poor-resource countries; 2) stunting is associated with high
Nutrition – Committed to a future free of malnutrition. Food
death rates and those surviving are at exposed to long-term
and Agriculture Organization of the United Nations. 24 p.
negative consequences such as impaired development, poor cognition, decreased learning capacity and educational
Gillespie S, Haddad L, Mannar V, Menon P, Nisbett N (2013)
performance in childhood, lower productivity and reduced
The politics of reducing malnutrition: building commitment
adult wages in adulthood and increased risk for nutrition
and accelerating progress. Lancet 382: 552–569. doi:
related chronic diseases in adulthood; 3) there is a critical
10.1016/S0140-6736(13)60842-9. pmid:23746781.
window – from conception to the first 2 years of life – to implement cost-effective interventions in order to reduce the
Hulme D, 2009. The Millennium Development Goals
health consequences of stunting ; 4) stunting is correlated with
(MDGs):A Short History of the World’s Biggest Promise.
poverty and other nutrition related SDG’s indicators; 5)
BWPI Working Paper 100. 52 p.
chronic undernutrition is a cross-cutting problem calling for a multisectoral response and therefore stunting has potential for
International Food Policy Research Institute. 2014. Global
sustainable impact (de Onis et al. 2013).
Nutrition Report 2014: Actions and Accountability to Accelerate the World’s Progress on Nutrition. Washington,
There are many opportunities, yet the major challenge for
DC.
stunting reduction is one of multisectorial planning and implementation. Indeed, given the multifactoral nature of
United Nations, 2014. Open Working Group Proposal for
chronic
Sustainable Development Goals. document A/68/970. 24 p.
malnutrition,
reducing
stunting
will
require
maximizing intersectorial – health, agricultural, education,
http://undocs.org/A/68/970
social protection, water and sanitation, poverty reduction and gender - nutrition sensitives strategies and to enhance and
UN millennium project 2015. Millennium development goals
expand the quality and coverage of nutrition-specific
what are their?
interventions (Gillepsie et al. 2013). Multisectorial planning
http://www.un.org/millenniumgoals/
also involves establishing a functional
and effective
coordination mechanism and creating and sustaining enabling
UNSCN, 2014. Priority Nutrition Indicators for the Post-2015
environments and processes to translate policies into result-
Sustainable Development Goals. 2 p.
oriented actions on the ground.
AFRICAN NUTRITION MATTERS
Summer 2015
9
Proposed Sustainable Development Goals (SDG) by 2030
Goal 1: End poverty in all its forms everywhere
Goal 11: Make cities and human settlements inclusive, safe, resilient and sustainable
Goal 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture
Goal 12: Ensure sustainable consumption and production patterns
Goal 3: Ensure healthy lives and promote well-being for all at all ages
Goal 13: Take urgent action to combat climate change and its impacts
Goal 4: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
Goal 14: Conserve and sustainably use the oceans, seas and marine resources for sustainable development
Goal 5: Achieve gender equality and empower all women and girls
Goal 15: Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests,
Goal 6: Ensure availability and sustainable management
combat desertification, and halt and reverse land
of water and sanitation for all
degradation and halt biodiversity loss
Goal 7: Ensure access to affordable, reliable, sustainable
Goal 16: Promote peaceful and inclusive societies for
and modern energy for all
sustainable development, provide access to justice for all and build effective, accountable and inclusive
Goal 8: Promote sustained, inclusive and sustainable
institutions at all levels
economic growth, full and productive employment and decent work for all
Goal 17: Strengthen the means of implementation and revitalize the global partnership for sustainable
Goal 9: Build resilient infrastructure, promote inclusive
development
and sustainable industrialization and foster innovation Goal 10: Reduce inequality within and among countries
AFRICAN NUTRITION MATTERS
Summer 2015
10
Priority Nutrition Indicators for the Post-2015 Sustainable Development Goals ----------------------------------------------------------------------------------------------------------------------------------Explicit attention to nutrition is needed as the world seeks to accelerate and sustain recent gains in development, and to expand these to include places and people who have been left behind. Without good nutrition, people’s mind and body cannot function well. When that happens, the foundations of economic, social and cultural life of society are undermined. Therefore, nutrition needs to be given a prominent role in the Sustainable Development Framework.
The UN Open Working Group’s (OWG) proposal for Sustainable Development Goals (SDGs) includes nutrition in the SDG 2 on ‘End hunger, achieve food security and improved nutrition, and promote sustainable agriculture’ – with targets to ensure access to nutritious food and end all forms of malnutrition. There is broad consensus around the priority indicators proposed below 1 that efficiently and comprehensively measure progress in the most critical areas of action to improve nutrition and other development outcomes.
AREA
PRIORITY INDICATOR
SDGs AND TARGETS
Prevalence of stunting (low height-for-age) in children under 5 years of age
Goal 2, Target 2.2
Prevalence of wasting (low weight-for-height) in children under 5 years of age
Goal 2, Target 2.2
GLOBAL NUTRITION TARGETS Percentage of infants less than 6 months of age who endorsed by Member States are exclusively breast fed at the 65 th World Health Percentage of women of reproductive age (15-49 Assembly (WHA 2012) years of age) with anaemia
Goal 2, Target 2.2 and Target 2.1 and Goal 3, Target 3.2 Goal 2, Target 2.2 and Goal 3, Target 3.1
Prevalence of overweight (high weight-for-height) in Goal 2, Target 2.2 and children under 5 years of age Goal 3, Target 3.4
DIETARY DIVERSITY POLICY
Percentage of infants born with low birth weight (< 2,500 grams)
Goal 2, Target 2.2 and Goal 3, Target 3.2
The percentage of women, 15-49 years of age, who consume at least 5 out of 10 defined food groups
Goal 2, Target 2.1
Percentage of national budget allocated to nutrition
Goal 2, Target 2.2a
1 - These recommendations have been developed through consultation with a wide range of experts and stakeholders: UNSCN member agencies, Bill & Melinda Gates Foundation, Bread for the World, Children’s Investment Fund Foundation (CIFF), Columbia University, Concern Worldwide, UK Department for International Development (DFID), FANTA/FHI360, Global Nutrition Report, International Food Policy Research Institute (IFPRI), Micronutrient Initiative, ONE, Sight and Life, Tufts University Friedman School of Nutrition Science and Policy, US Agency for International Development (USAID), US State Department, World Bank, and 1,000 Days Partnership. This proposal does not necessarily reflect organizational positions.
At a minimum, the SDG framework needs to include the indicators that measure all six global nutrition targets unanimously endorsed by Member States at the 65 th World Health Assembly (WHA 2012). The WHA targets are based on evidence on what is needed to comprehensively address malnutrition. Given the intergenerational nature of malnutrition, it is critical to include the indicator on women’s dietary diversity that reflects the nutritional quality of food intake and also the role of agriculture in ensuring the health of people. In addition, in order to achieve the above, the means of implementation need to be strengthened and it is critical to include the indicator on national budget allocations for nutrition. Several of these indicators can also be used to measure progress towards other SDGs and targets, especially towards SDG3 on ‘Ensuring healthy lives and promote well-being’.
Diet and the Millennium Development Goals By Keiron Audain The first target of the first MDG was to halve the amount of
of diet-related non-communicable diseases (Imamura et al.,
people that earn less than $1.25 a day between 1990 and 2015;
2015).
which were achieved in 2010, five years ahead of schedule
In low-income groups across Africa, a monotonous diet
(UN). This was equivalent to 700 million less people living in
consisting primarily of staples such as maize and cassava can
extreme poverty. Now, in accordance with the post-MDG agenda, the aim is to address the remaining 1.2 billion people that remain extremely poor. Out of the remaining poor people in the world, approximately
also render individuals susceptible to a chronic intake of foodborne toxins including aflatoxins and cassava cyanide (Wu et al., 2014). Incidences of immunotoxicity, cancer,
three-quarters of them live in rural areas and rely on
neurological deficits and growth impairment have all been
agriculture as a primary source of income. Hence improving
associated with regular exposure to such toxins (Wu et al.,
agriculture will have a significant impact on mitigating
2014). This further strengthens the argument for improved
poverty. With support to boost agricultural production small-
dietary diversity, as consuming a balanced diet would translate
scale farmers are better able to diversify their produce and
into an increased intake of nutrients to counteract the toxin
grow higher value crops, which can benefit both themselves
exposure (Wu et al., 2014).
and the wider economy. In addition, with more food available, farmers can consume a more balanced diet and increase food availability to surrounding communities. It is estimated that a 10 percent increase in agricultural productivity can reduce poverty in Africa by 7.2 percent (von Braun et al. 2004). Thus
In essence, an optimal food system would focus on the availability of a variety of locally grown foods that are representative of the food culture of the particular region. To achieve this, a range of factors need to be considered,
agricultural development has a major role to play in promoting
including the improvement of public policy, the promotion of
economic growth, food security and dietary diversity.
multi-sectorial community-based strategies, as well as
An improvement in diet quality (increased consumption of
empirical research into market creation for small-scale farmers
healthier foods) in Sub-Saharan Africa is needed as it has been
(Johns and Eyzaguirre, 2006).
reported that dietary patterns have not improved during the
References
MDG time period between 1990 and 2010 compared to other
Imamura, F. et al (2015). Dietary quality among men and women in 187
regions (Imamura et al., 2015). This may be related to trade liberalisation and an increase in marketing of globalised, unhealthy products to the wealthier segments of the population. A study by Imamura et al., (2015) pointed out that countries with a higher national income tended to have
countries in 1990 and 2010: a systematic assessment. Lancet Glob. Health 3, e132â&#x20AC;&#x201C;e142. Johns, T., and Eyzaguirre, P.B. (2006). Linking biodiversity, diet and health in policy and practice. Proc. Nutr. Soc. 65, 182â&#x20AC;&#x201C;189. United Nations Millennium Development Goals and Beyond. Available at: http://www.un.org/millenniumgoals/poverty.shtml
healthier dietary patterns. This is important given the
von Braun, J., et al. (2004). Agriculture, Food Security, Nutrition and the
prediction that close to 75 percent of all deaths and 60 percent
Millennium Development Goals. IFPRI Essay. Available at:
of all disability-adjusted life years by 2020 will be as a result
http://www.ifpri.org/sites/default/files/publications/ar03e.pdf.
AFRICAN NUTRITION MATTERS
Summer 2015
12
Enhancing infant and young child nutrition through agriculture for the reduction of vitamin A deficiency in rural communities By Robert Ackatia-Armah
generation as demand for nutritious sweetpotato varieties increases. Micronutrient deficiencies remain a major problem in many rural communities in Africa and Asia. Although significant progress has been made through supplementation programs to eliminate vitamin A deficiency (VAD) for example, coverage is unstable and remains a challenge in many countries. Food based approaches have and are contributing to improving the nutrition and reducing micronutrient malnutrition of rural farming households. In particular, CIP’s work with OFSP is contributing to the reduction of VAD in many rural Agriculture can increase its contributions towards sustainable food and nutrition security through local production of nutritious food. Smallholder farmers play a crucial role in this process. The International Potato Center (CIP), contributes sustainable solutions to the pressing world problems of hunger, poverty, and the degradation of natural resources through improved production and utilization of root and tuber crops. This work contributes to meeting several of the Millennium
Development
Goals
(MDG)
directly
and
indirectly, in particular reference to MDG1 (eradicate extreme poverty and hunger). CIP is also well placed through its programs to contribute to the post 2015 agenda of the Sustainable Development Goals (SDG’s). CIP contributes directly to farming families’ nutrition through household agricultural production and consumption of nutritious foods. Supplying appropriate planting materials of nutritious Orange Fleshed Sweet Potato (OFSP) that are high in beta carotene to rural farming households, in combination with nutrition messaging and counseling, has been shown to result in increased yields, improved diet quality, as well as income
communities where VAD remains a problem of public health significance coupled with other forms of malnutrition. OFSP offers ready opportunities for making a significant impact if the crop is utilized to its full potential. The importance of introducing and increasing the consumption of nutrient rich foods as part of improving household dietary diversity and improving nutrition status contribute significantly to meeting some of the MDG indicators. Newly developed OFSP varieties stand out as a proven, cost effective tool to reduce VAD and provide additional vital nutrients to vulnerable populations.
OFSP’s
efficacy
is
based
on
the
high
concentration of pro-vitamin A in roots and leaves, which have high levels of bioconversion when consumed as part of the local diet. As a result of national breeding efforts in several sub-Saharan African countries, a set of locally adapted OFSP varieties have been released and are now available. These varieties respond to the main agronomic, ecological and market conditions across the continent. The promotion of micronutrient-rich crop varieties carries great potential for improving food intake and access to diversification. OFSP can contribute significantly to safeguarding food and nutrition
AFRICAN NUTRITION MATTERS
Summer 2015
13
security at the household level by contributing to energy needs
Through CIP’s sweetpotato scaling up efforts aimed at
and providing vitamin A through roots and leaves to nutrient
agriculture, nutrition and markets under the SUSTAIN
requirements of millions of rural poor. It is well documented
program funded by DFID, CIP is providing technology
that micronutrient deficiencies result from poorly diversified
transfer support to improve agricultural practices, reduce post-
diets, which often are cereal based. Homestead food
harvest losses and increase nutrient availability in households
production is a great way increase the micronutrient contents
through appropriate crop and food handling, preparation and
of the diet, provided the produce is consumed at home. In
storage. This will contribute to increased nutrient availability
countries with approaches such as kitchen gardens, CIP
and use especially for children, pregnant and lactating mothers
encourages the incorporation of OFSP, a micronutrient rich
in smallholder farming households.
crop, into these gardens because both root and leaves are a great source of many micronutrients.
CIP’s women empowerment efforts encourage women (who form a significant proportion of smallholder farmers in Sub
OFSP varieties are extremely rich in bioavailable beta-
Saharan Africa) to channel earned income into the selection of
carotene, which the body converts into vitamin A. Moreover, it
nutrient rich foods to improve the health and education of their
contributes energy and significant amounts of vitamins C, E,
children. As part of the programmatic approach, CIP links
K and several B vitamins to local diets.
Further, bio-
smallholder farming families to market chains to generate
accessibility of vitamin A in OFSP is increased by the
income and help smallholder families diversify their diet with
presence of a small amount of oil in the diet. Just one small
increased purchasing power. It is well documented that
root (100-125 grams) of most OFSP varieties provides the
increasing
recommended daily allowance of vitamin A for children under
financial/physical) has been shown to positively impact food
five years of age (U5). Even at low yields (6 tons/ha), just 500
security, child nutrition, education and women’s own well-
square meters can generate an adequate annual supply of
being. While women are a natural and key demography
vitamin A for a family of five. OFSP can thus be used to
determinant in many of our field based programs, these
significantly reduce VAD in many parts of Sub-Saharan
programs are also gender-sensitive and consider the role of
Africa.
both men and women in an attempt to provide the highest
women’s
control
over
assets
(especially
nutrition impacts on infant and young child nutrition within farming households. Nutrition education using participatory approaches, behavior change approaches and messages such as counseling and cooking demonstrations are crucial to ensure that increased food supply leads to improved dietary quality, and improved nutritional status especially of vulnerable households. CIP’s infant and young child feeding programmatic component contributes to improving the nutrition security of children. Working with farmer groups, CIP provides nutrition education and counseling to caregivers by working with community health workers, healthcare facilities
and schools. Time
management
training to
beneficiary households also supports the transmission and
AFRICAN NUTRITION MATTERS
Summer 2015
14
dissemination of key lessons on nutrition and child care. This ensures that farming families, especially women, understand the importance of time allocation for child care and how best to balance farming activities with time investments in nutrition to ensure that minimum meal frequency and dietary diversification requirements are met for children and adults in the household. In particular, training sessions do not only afford smallholder farmers the ability to learn what impacts their household’s nutrient requirements, as related to food intake and energy expenditure, but also the principles of sustainable agriculture which promote farming approaches including environmentally friendly methods of farming. The latter refers to the production of nutritious crops without damage to the farming ecosystem. These measures, in addition to other national based social protection programs, contribute to reduced hunger, decreased malnutrition, reduced mortality, and improved cognitive attainment, healthy pregnancies and healthy newborns. Furthermore, increases in food supply and income through CIP’s work and partnerships lead to improved household nutrition and contribute to meeting the MDG in countries where we work. While several countries have made progress towards meeting some of the MDG’s, much slower progress on MDG1 will threaten the achievement of the other MDGs. Its is well recognized that most of the chronically food insecure and undernourished populations consist of smallholder farmers whose main source of livelihood is agriculture and food production. Insecure access to adequate land, production constraints, lack of capital investments, lack of post-harvest processing and storage equipment and techniques, lack of appropriate marketing systems, environmental and social constraints all impact negatively on the attainment of the MDG’s. CIP will continue to address these in its programs and through its partnerships and also explore ways of helping countries meet their MDG targets for the remaining months of 2015 and for the coming years under the SDG’s.
AFRICAN NUTRITION MATTERS
Summer 2015
15
Malawi Floods
(Smith, 2015).
By Keiron Audain
occurrence during the rainy season (FAO, 2015). In this
Flooding is far from new to Malawi; in fact it is a regular
instance however, the heavy rains came ahead of schedule and Improving agriculture, food and nutrition security is crucial
had a wider impact as banks of the Shire River, the only outlet
for achieving progress in all Millennium Development Goals
of Lake Malawi, had burst. In addition, the magnitude of the
(MDGs) , but especially for the first goal of eradicating
floods was possibly worsened by the accumulative effect of
extreme hunger and poverty. With looming climate threats
deforestation and population pressure.
such as the recent floods in Malawi, safety nets should be put
In 2014, cereal production in Malawi increased by 8%, which
in place to ensure that the progress made on the MDGs to date
saw the country experience a bumper maize harvest that
does not slow down or worse begin to regress.
lowered the number of people considered food insecure by
The third target of the first MDG was to halve the proportion
more than 50% (FAO, 2015). This all reversed when the
of people who suffer from hunger between 1990 and 2015.
floods came, and by October 2014 Malawi was added to the
Progress has indeed been made, but the goal remains far from
list of countries that required external food assistance (FAO,
achieved. In 1990, 40% of children under the age of five were
2015).
categorised as stunted; by 2012 this was down to 25%. Roughly 173 million fewer people were chronically hungry in 2011-2013 compared to 1990-1992; however around 842
Computable general equilibrium models show that Malawi stands to lose 1.7 percent of its GDP each year as a result of
million people remain chronically undernourished, with 99
climate disasters; with small-scale farmers and those from the
million being less than five years old (UN, n.d).
southern region of Malawi cited as most likely to be affected
Agriculture remains the driving force of economic growth for
(IFPRI, 2010).
many countries, making it the underlying factor to determine
Extreme climate events such as flooding, droughts, high
the socioeconomic success of the MDGs and the post-MDG agenda (von Braun et al. 2004). In rural areas across Africa, the primary source of food and income stems from agricultural
temperatures and poor rainfall distribution can dramatically impact farming practices. As the organic content is leached
practices. For instance, in Malawi 86% of the population live
from the soil and soil nutrients become limited, this inevitably
in rural areas and rely on agriculture crops including maize,
leads to crop failure (Coulibaly et al., 2015). Well over 63,000
cowpea, beans, rice and tomatoes, as well as livestock (FAO,
hectares of land and 35,000 hectares of crop land were
2015).
believed to be under water as a result of the recent floods (FAO, 2015).
The most recent floods in Malawi were described by the Guardian as “Malawi’s worst floods for half a century.” Reports indicated that fields of maize and other crops were buried, water sources contaminated and livestock washed away as half of the country was declared a disaster zone
By way of recovery, the Malawian government estimated that US$16 million would be required to ensure affected farmers can begin planting and harvesting by the upcoming agricultural season. If successful, it is predicted that some
AFRICAN NUTRITION MATTERS
Summer 2015
16
crops may be ready by as early as June this year (2015), thus
improving soil fertility and other soil conservation and agro-
reducing the dependency on food aid (FAO, 2015).
forestry practices that help create sustainable farming systems.
However, the climate situation in Malawi is expected to get worse, with higher temperatures and possibly higher rainfall being predicted. Thus, providing safety nets in the event of crop failure should be prioritised.
References Smith S (2015). Malawi floods leave grim legacy of death, destruction and devastation |.Guardian Global. Available at: http://www.theguardian.com/global-development/2015/jan/30/malawi-floods-
To date, farm irrigation has been the main agricultural strategy
grim-legacy-death-destruction-devastation
adopted to cope with floods, yet this accounts for only 10% of
FAO (2015) News Article: Farmers in Malawi need urgent help after heavy
households; with less than 5% engaging in crop diversification
flooding. Available at: http://www.fao.org/news/story/en/item/275944/icode/
(Coulibaly et al., 2015). In general, farmers have either ate less or found alternative sources of income, as reducing production/consumption and casual labour were cited as the
Coulibaly, J.Y., Gbetibouo, G.A., Kundhlande, G., Sileshi, G.W., and Beedy, T.L. (2015). Responding to Crop Failure: Understanding Farmers’ Coping Strategies in Southern Malawi. Sustainability 7, 1620–1636.
two most important coping strategies when crops fail (Coulibaly et al., 2015). Casual labour can translate to an
Pauw K, Thurlow J, van Seventer D (2010) Droughts and Floods in Malawi:
absence of labour on the farm, often when it is most needed;
Assessing the Economy-wide Effects. International Food Policy Research
which can lead to poor management and a repeating cycle of crop failure that increases food insecurity.
Crop failure can have a variety of causes, one of which
Institute (IFPRI). Available at: http://www.ifpri.org/publication/droughts-and-floods-malawi?print
von Braun J, Swaminathan MS, Rosegrant MW (2004) Agriculture, Food Security, Nutrition and the Millennium Development Goals. IFPRI Essay.
includes climate stress; another includes a lack of agricultural
Available at: http://www.ifpri.org/sites/default/files/publications/ar03e.pdf
inputs and technologies. It is evident that the actions of
United Nations Millennium Development Goals and Beyond. Available at:
farmers are in a response to crop failure and not necessarily to
http://www.un.org/millenniumgoals/poverty.shtml
climate changes (Coulibaly et al., 2015). This is observed when farmers engage in the sale of forest products, which contributes to deforestation, an identified agitator of climate events.
Identifying and sharing information regarding the risks of extreme climate events that directly lead to crop failure can be an important strategy to promote effective adaptation responses. The need for policies to assist farmers’ access effective and sustainable climate change adaptation/mitigation strategies has been highlighted (Coulibaly et al., 2015). This may include the adoption
of
climate-resilient
crop
varieties,
alongside
AFRICAN NUTRITION MATTERS
Summer 2015
17
Improvement in the nutrition related MDG through integrated Health Centers in Niger - Reported by Elom Kouassivi Aglago
measurements mainly weight and height. Daily counseling is also available for mothers willing to have more information about breastfeeding or about any other positive attitude towards pregnancy. We distribute supplements to malnourished children. Monthly, we receive 23 severely malnourished children on average. Five employees of the center are dedicated to the care of malnourished children. Have you had satisfactory results since the opening of the center?
Niger has performed towering improvement since the launching of the MDGs in the management of maternal and child health care. ANM has decided to visit one of the Integrated Health Centers (ed. CSI- Centre de SantĂŠ IntegrĂŠ in french) which are the cornerstone of this challenge.
Good morning, thank you for accepting this invitation. Mr Bachir Rabiou, you are the director of Foulankoira health center in Niamey involved in the management of maternal and child health care. Can you tell us briefly what are the activities of your center and since when did you start to work in this center? B.R: This is a public health center of type 2, meaning that it includes both a maternity and a laboratory. The objectives of the CSIs are to provide a care to the population, to assist women to deliver without difficulty and encourage them to attend the health center for treatment after childbirth. The center also includes units which monitor the health of infants. To summarize, we deliver general health care for women at childbearing age, to pregnant and lactating mothers, and infants. What is the treatment procedure for malnourished children and how many do you receive per day or per month? B.R Management of sick children is performed weekly for severely malnourished and every two weeks for other children. However, screening is done daily using anthropometric
B.R: Hundred percent of the children who come to the center recover in few months because we have a scaled intervention including intensive care. Since the opening of the center it recorded a satisfactory result because the malnutrition rate has decreased significantly. We have many testimonies which corroborate that. Despite the number of cases of malnourished children and the smallness of our center, we always manage to bring in more children. Do you think that the recovery rate you experience is mainly due to supplements of micronutrients distributed to mothers? B.R: Not really, distribution of supplements has not really participated in the reduction of malnutrition in Niger. In contrary, it contributes to the increase of the number of cases and an increase in the length of hospital stay because some mothers knowingly maintain this malnutrition. Others even provoke it for the sole purpose of benefiting from these supplements and sell them in return. Niger is successfully about to achieve some of the MDGs, what do you have to say about the existence of health centers like yours and this success? Centers like the CSI of Foulankoira generally contribute to the reduction of maternal and infant mortality rates and the reduction in the number of infections especially in children under 5 years through free vaccination. Moreover, by our intervention we decrease malnutrition rate and we highly contribute to lower childhood malnutrition in Niger. This year alone, screening rate of malnutrition has increased from 10%
AFRICAN NUTRITION MATTERS
Summer 2015
18
in 2013 to 90% in 2014, which is a huge success.
B.R: We are delighted about the job UNICEF and WFP are doing. We hope that they will continue it and more other donors will be interested to promote health care in Niger.
there is weight gain or if the weight remains stationary. From my experience, we have distributed supplements in the past, but the results were mitigated. We found that some parents prefer to sell supplements. Therefore, in our center we have developed a revolutionary method. To avoid this unconscious attitude, we developed home distribution where supplements are given directly to the children who then consume it immediately and the consumption is recorded.
On a scale of 1 to 10, how much will you evaluate the success rate and patient satisfaction of your center?
What is your general impression about malnutrition trend in Niger?
What are the funding sources of your center?
B.R: Modestly I can evaluate it to 7. This is interesting. Thank you for sharing your story with us, do you want to add some more information? B.R: I just want to say ÂŤ Thank you Âť
We also met with one of the nurses at the health center: Good morning Ms. Karim, you are a nurse at Foulankoira health center in Niamey, since when have you been working in this center and what are your duties?
Ms. Karim: I'm mostly disappointed to say that poverty and lack of hygiene are the one sponsoring malnutrition more than anything. For me, tackling malnutrition should be accompanied with the fight against poverty. We are so proud about what you are doing and we encourage you to continue this challenging job which brings happiness to the heart of malnourished children of Niamey. Thank you. MK: The pleasure is mine.
African Nutrition Matters would like to thank Mr Aminou Aminou Maman, nutrition expert in Niamey at Centre for Research and Studies in Nutrition and Food (CRENAP) for his contribution to this interview.
Ms. Karim: I have been a nurse in this center for 3 years. My duty is to measure the weight, height, and arm circumference. I additionally check growth charts for children and body mass index and waist-hip values for mothers. You are constantly in contact with women and malnourished children. What is the procedure to accept children to be followed with supplements? Ms. Karim: After screening, some children are oriented to CRENAM or CRENAS (ed. other specialized health centers) to be followed. We still keep their appointment in our health center every two weeks to check their status, to see whether
AFRICAN NUTRITION MATTERS
Summer 2015
19
Social responsibility of food industries The foundation for the children’s nutrition funded by the group Danone-Centrale Laitière since 2007, is a Moroccan foundation dedicated to improving the nutritional status of children in Morocco. The foundation distributes 23 000 fortified milk packs daily to school-age children. ANM approached the foundation to enquire about its activities and ambitions. - Reported by Elom Kouassivi Aglago
Interview No. 1:
The Foundation distributes breakfast fortified with micronutrients to children attending school in rural areas of Morocco. How did the idea come to you, and can you tell us how many meals are distributed a day? AA: The creation of the Foundation originated from Central Laitière-Danone, an experienced and leading food company in Morocco, regarded as a responsible corporation for its contributions to improving the living conditions of the population. With its expertise in the industry of milk processing and with the support of an expert committee, Central Laitière-Danone has developed a formula of a fortified milk that covers 30% RDA of vitamin A, vitamin D3, iron and Iodine representing the major deficiencies reported in Moroccan children. Distribution is done every school-day for 23,000 beneficiary children, located in 177 primary schools in rural areas, in the regions of Doukkala and Azilal. Do you have sufficient financial, human and logistical resources to sustain these actions?
Good morning Mr. Amjed Achour, you are the director of the Foundation for Child Nutrition (ed. Fondation pour la Nutrition de l’Enfant in French). Can you tell us briefly about the foundation, its objectives and activities undertaken? Amjed Achour : The Foundation was created in 2007 to actively contribute to improving the health of young Moroccan children through nutrition. Its aim is to raise awareness on healthy and balanced diets and particularly to contribute to the fight against micronutrient deficiencies in children. The Foundation currently has two programs: The first program is to educate annually more than 4 million schoolchildren on the basic principles of hygiene and food, through a course adapted to their grade level and given by their teacher. The principle of this program is to introduce the gestures and reflexes in each-day living of kids to improve their nutrition. The second program of the Foundation is the distribution of NUTRILAIT, milk fortified with vitamins and minerals to school children in rural areas where nutritional deficiencies are reported to be high.
A.A: Financial resources are mainly provided by Centrale Laitière-Danone which contributes technical support and finance annualy to support the activities. Our Foundation has a team of 5 people, including 3 who are on the field every day and continuously travel more than 1700 km per week to distribute these little enriched breakfasts. What advantage, or what profit, if it may be the foundation harvest from this generosity? A.A: The main advantage is to contribute to a significant improvement of the nutritional status of children. This affects both their health status but also their academic performance and we have evidence that the program lowers school dropout rates in rural areas. These children will be healthier and will live and work in better conditions for a better future. What is your view on the actions conducted by your foundation and the achievement of Morocco's national objectives, including the Millennium Development Goals? A.A: The actions of our Foundation are directly in line with the National Strategy for Nutrition (ed. launched in 2012) in
AFRICAN NUTRITION MATTERS
Summer 2015
20
the aspects of enhancing the nutrition component of health programs, as well as the integration of nutrition component in educational programs. These actions are also part of the national program for fighting micronutrient deficiencies through food fortification and nutritional education. How are children and schools selected to be involved in the program? A.A: We place emphasis on equity in our daily work, and we work closely with our partners in the Ministry of National Education and the Ministry of Health to select the areas of intervention and the beneficiary schools based on not only indicators from food shortages, purchasing indices and human development, but also on school wastage and accessibility for our distribution teams. . What difficulties have you encountered, and what actions have you taken to counter them? A.A: Difficulties are rather logistical and linked to accessibility. Many schools are located in remote areas which limits the intervention. We have done background work with various stakeholders (institutions, local authorities, parents) to bring a solution for every group of schools and allow all students of these 177 schools to receive their fortified milk on a daily basis.. Currently, how do you spend your days as director of such engaging foundation especially the administrative aspect? A.A: It is certainly an administrative work since there is an operational management component that runs from the production planning of the NUTRILAIT and organization of its distribution. The administrative component is also to manage different partnerships and to keep the continuous improvement of the program and its reputation. What are your plans for 2015 and beyond? A.A : We recently published the results of an efficacy study conducted in partnership with the UnitĂŠ Mixte de Recherche en Nutrition et Alimentation of Ibn Tofail University and CNESTEN (ed. National center for nuclear research) directed by Prof Hassan Aguenaou. The results showed an
improvement of the nutritional status of children. This reinforces our commitment to continue our work and expand it to more beneficiaries in Moroccan regions where deficiencies rate are high. Do you think about more partnership? And do you think about expanding the activities of the Foundation in the whole Morocco, and possibly in Sub-Saharan Africa? A.A: The extension of the activity is of course in our strategy, but it will be done gradually since, beyond the financial aspects, we have to take into account aspects of logistics and production capacity. For sure, more partnership will be essential. Are you satisfied with the results obtained since the launching of the distribution program? A.A: We started this operation in 2008 with 4,000 beneficiaries and gradually we got power to reach the milestone of 23,000 beneficiaries in 2013. The teachers found beyond improving school attendance, the seriousness of the students in the classroom and improvement of school performance with improved physical condition. We wanted to methodically verify this observation through an effectiveness study. This study revealed a significant decrease in the prevalence of vitamin A from 50% to 4.3%. For vitamin D3, the prevalence decreased by 54%, from 60% to 25.5%. Regarding the prevalence of IDD(full meaning??), it decreased from 74.7% to 29.4%, and finally for iron, 50% to 36.4%. If you have to provide an advice to food companies from what you do, what would you say? A.A: I wish to say that food fortification efficacy has been proven internationally and according to experts, is the most cost-effective intervention to reduce micronutrient deficiency. In our case, we decided to fortify milk without being constrained by the national policy and we have obtained good results. I encourage other actors in food industries to consider this action which can easily improve the lives of people. Thank you for sharing your story with us. A.A: My pleasure.
AFRICAN NUTRITION MATTERS
Summer 2015
21
Interview No. 2:
Good morning, Mr. Redouane Allali, you are the Logistics coordinator of the project of the Foundation. Your job is to convey packs of fortified milk for children participating in the actions of the Foundation, since when did you start this job? R.A: I started this work in 2008, with the launching of the "Nutrition and development" program of the Foundation for Child Nutrition. Initially it concerned only 3700 students enrolled at two municipalities in the region of Doukkala-Abda, in 37 schools. This number has increased over the years to 23 500 students today, spread over 10 cities including 4 in the Doukkala region and 6 in the region of Azilal through 177 schools. How long and how often do you drive between the production site and the regions concerned by the program? R.A: The total distance between the site of production and storage and the different schools we serve in the two regions is about 1500 km each week. Each day of the week is dedicated to the delivery of a group of schools. We usually deliver milk for the whole week at every school. Once there, how is the distribution organized? R.A: When our distribution truck arrives, we unload the alloted amount to the school which we keep in the storage area dedicated for this purpose. We routinely check for the storage conditions whether the milk is kept in good conditions of hygiene and food safety. Our computer system allows us to previously edit distribution of the quantities of milk distributed by school and area. We request order form signed and sealed by the Director of each school so that we can keep track of this operation and ensure its proper implementation.
R.A: Of course yes! Inaccessible area means very isolated and vulnerable villages. The consumption of milk by children in these villages is a luxury; their parents do not have the resources to deliver. Yes it's worth it, after travelling kilometers in freezing cold or extreme heat, but once there, you feel the joy and gratitude of parents and children, and it makes me happy to be a member of that solidarity program, it is a pride for me. Tell us the worst day you lived on the road? R.A: One day during my delivery round, I had a very serious accident, very serious, causing structural damage. I was hospitalized with multiple fractures, with 40 days off. During this period, my despair was not to participate in the running of the program. I also remember a very special moment, during a delivery round in very extreme climatic conditions, my truck got completely stuck in the mud. I could not get out without the help and support of the locals, who gave me a real helping hand, and together we managed to get the truck on dry land. Do you have any evidence that children involved in the activity of the foundation appreciate what you do? R.A: Kids love our milk; they keep coming to school even after the end of classes and year-end exams to consume their NUTRILAIT and that is constant until the closure of the establishment during the final holiday. Also considering the testimony of teachers, children concentrate and participate more in class. It just brings a smile and health in these children and I have seen it with my own eyes from the start of the program till today. Thank you Mr Allali R.A: Marhaba (ed. You are welcome, in Arabic)
Azilal region is difficult to access, with mountains, sometimes impassable roads and sometimes extreme temperatures. Do you think what you do is worth it?
AFRICAN NUTRITION MATTERS
Summer 2015
22
Review:
viable source of nutrition during dry season, and has been
Can Moringa adoption and utilization combat undernutrition?
west Africa (Sena, L. et al., 1998). Although there are 13 other
controversially referred to as a ‘famine food’ in some areas of known species of the plant family, Moringaceae, Moringa Oleifera has been found to bear the greatest nutritive value and its leaves and seeds are deemed rich in protein. It is estimated that one rounded tablespoon will supply a child between ages
By Natalie Gyenes & Mary Grimanis
of 1 to 3 with 14% of protein, 40% of calcium, 20% of iron
Harvard University - T.H.Chan School of Public Health
and all of a child’s Vitamin A needs for the day (Fuglie, 2000).
Boston Children’s Hospital
However, there have been limited population-based studies determining the prevalence of this plant’s use in the diet as well as its potential role in maintaining health and adequate
Introduction
nutritional status. The goal of this review is to establish the
In a world where the burden of malnutrition still remains the
current state of research involving Moringa and the
cause of high children mortality, Moringa oleifera has
mechanisms through which it affects maternal and child health
captured global attention for its nutritional and health
and nutrition.
promoting characteristics. Native to the tropics and subtropics, it is viewed as a highly promising tree whose leaves, seeds and roots are of high nutritive value (Fahey, J., 2005). Numerous anecdotal accounts affirm that diets supplemented with Moringa oleifera leaves are capable of averting and reversing malnutrition, specifically referencing experimental studies conducted in Burkina Faso as well as at the University of Baroda in India (Fahey, J., 2005; Price, M., 2007). It has been estimated that one rounded tablespoon of dried Moringa can supply a child between ages of 1 to 3 with: -14% of the protein -40% of the calcium -20% of the iron and all of the vitamin A needs for one day (Fuglie, 2001).
Since the Moringa Oleifera tree can grow where there is poor soil and a inadequate water supply, it serves as a sustainable nutrient rich plant based food during periods of drought and carries the potential for narrowing the gap of food insecurity and malnutrition (Dhakar, R. et. al, 2011; Fahey J., 2005; Thurber M. and Fahey J., 2009). It has been examined as a
Biochemical Content Moringa advocates have emphasized it as a valuable source of highly digestible protein, calcium, iron, vitamin C and carotenoids, among other micronutrients (Fahey, 2005). Moringa Oleifera is the most widely cultivated, and has been used by humans in India, Africa, Southeast Asia, South and Central America and in the Caribbean for a variety of purposes (Hassan, F. & Ibrahim, M., 2013). Many notable studies on the chemical composition of Moringa demonstrate discrepancies in the amounts of particular biochemical constituents, which may be attributed to regional and seasonal differences. One example (below), compares nutritional content of Moringa from three harvests in West Africa. Nutritional values of mature moringa leaves for three harvests 100 g FW
June 2004 (summer)
January 2005 (Winter)
April 2005 (Spring)
Dry matter, g
23.8 ± 0.9
21.4 ± 0.7
21.4 ± 1.5
Protein, g
7.59 ± 0.4
6.59 ± 0.3
6.46 ± 0.9
Fiber, g
1.83 ± 0.2
1.93 ± 0.1
1.47 ± 0.1
Sugars, g
3.17 ± 0.4
3.04 ± 0.2
2.59 ± 0.4
AFRICAN NUTRITION MATTERS
Summer 2015
23
June 2004 (summer)
January 2005 (Winter)
April 2005 (Spring)
in Senegal, Togo, and Benin, reference benefits in nutritional
Calcium, mg
434 ± 66
448 ± 48
481 ± 67
but lack the methodological rigor to evidence these results. Of
Iron, mg
6.24 ± 0.8
9.73 ± 1.0
4.10 ± 2.4
the studies reviewed, 6 clinical studies with well-documented
Β-carotene
20.1 ± 1.8
7.8 ± 0.7
13.8 ± 0.9
methods were included, 5 of which discuss some aspect of
Vitamin C
244 ± 18
320 ± 28
206 ± 21
childhood malnutrition, and one of which references breast
Vitamin E
18.1 ± 3.6
17.4 ± 2.6
14.8 ± 2.3
milk production.
AOA, μmol TE
4380 ± 862
2341 ± 205
4166 ± 1211
100 g FW
outcomes and health in children and breastfeeding mothers,
Phenolics, mg 558 ± 70 802 ± 54 681 ± 51 Source: Yang, R. et al. Nutrition Unit, Plant Breeding Unit,
One potential avenue through which Moringa can impact early
West Africa Office, AVRDC – the World Vegetable Center
in supplementary feeding programs. Jilcott et al. (2010)
child development is the development of appropriate recipes examined weight gains associated with implementing a locally
Further, Yang, R. et al (2006) found the following: high density planting and frequently trimming enable convenient and continuous weekly harvests of young shoots; mature leaves were more nutritious than young shoots and could be quickly dried with minimum nutrient loss; however, young shoots exhibited better eating quality and more acceptable for the fresh market; seasonal effects caused 1.5–3 times content variation for vitamin A, iron and antioxidants in moringa leaves; higher vitamin A was obtained in hot-wet season while higher iron and vitamin C were found in cool-dry season”
produced ready-to-use food (RUF) that combined soybeans, groundnuts, and Moringa leaf powder, in western Uganda. Children in Bundibugyo between the ages of 6 and 59 months with a weight for age lower than the 3rd percentile and/or a MUAC <12 cm, or if referred to the program by the local World Harvest Mission inpatient feeding program, received RUF of 682 calories per day for 5 and 10 week cycles. This study found that children gained a mean of 2.5 g/kg/day, and that local RUF had a higher protein content than commercial RUF (30 g compared to 13 g), potentially attributed to the
(Yang, R. et. al., 2006).
inclusion of Moringa (Jilcott, S. et al., 2010).
Clinical Studies
Protein
In low income countries within Africa and South East Asia, Vitamin A deficiency has been found to pose one of the greatest risks to infants, children and mothers. Moringa is a readily available source of calcium, iron, vitamin A and other essential nutrients for infants and children in areas of the globe where malnutrition is endemic. However, there continues to be limited population based studies measuring the nutritional and healing effects of Moringa. Moringa remains an underutilized source of nutrition and healing in the developing world, though more work is needed to demonstrate its full nutritional and medical potential.
A number of informal malnutrition interventions, particularly
A randomized control clinical trial in Bangalore, India studied the effect of supplementing the diet of children with grade I and grade II protein energy malnutrition by adding 15 g of Moringa leaf powder twice per day for two months. Study results were notable for clinically significant improvement in weight gain and nutritional status among children in the experimental group compared to the control group(Srikanth, V. et al., 2014). In the intervention group, children between the ages of 2 and 5 years of age demonstrated a significant weight gain after 2 months of daily Moringa supplementation (P<0.01). Overall, 70% of children with grade 2 PEM improved to grade I PEM, and 60% of those children with grade I PEM showed encouraging indicators of nutritional recovery (Srikanth, V. et al., 2014). AFRICAN NUTRITION MATTERS
Summer 2015
24
A similar study was conducted in Nigeria in 2014, also Iron
focusing nutritional supplementation given to infants aged 6-
Though analyses of fresh and powdered leaves indicate
12 months who had already been started on complementary
Moringa is iron-rich, few available studies inconsistently
foods at an MCH clinic. The purpose of this trial was to
support this characteristic. Of the 6 clinical trials examined, 4
determine the nutrient value, and acceptability of maize-based
studies used hemoglobin as an outcome measure. In a
complementary food fortified with Moringa (control diet
randomized trial of 82 moderately anemic lactating women in
60:40 (maize and soybean), treatment diet 60:30:10 maize +
Senegal was conducted to examine the potential for Moringa
soybean + Moringa leaves) when provided to infants for 12
to affect both iron status and weight gain during the rainy
weeks (Nwosu Odinakachukwu I. C. et al., 2014). After the 12
season (Idohou-Dossou, N. et al., 2011). For three months,
week intervention period, there was a significant difference in
mothers in the treatment group received a weekly dose of
the mean weight of the treatment group (p<0.05), with no
either 100 g Moringa powder, and mothers in the control
significant changes in the weight of the control group (Nwosu
group received 120 mg iron sulfate with 0.5 mg of folic acid.
Odinakachukwu I. C. et al., 2014). Both groups showed an
This study concluded that Moringa supplementation did not
increase in blood calcium level, and the control group showed
improve iron stores in lactating women, suggesting that
a significant increase (p<0.05) in blood zinc level. Finally,
although Moringa powder does have high iron content, there
hemoglobin levels were higher in the treatment group, and
may be low bioavailability, (determined by Idohou-Dossou, N.
also showed increases in unsaturated iron binding capacity and
et al., to be 2.2%), which seems to contrast hypothesis put
total iron binding capacity (Nwosu Odinakachukwu I. C. et
forth by Fuglie (2001). However, Moringa supplementation
al., 2014).
did prevent significant weight loss during the rainy season (Idohou-Dossou, N. et al., 2011). A study in Nigeria was conducted to examine the iron status among infants aged 6-12 months. Infants in the treatment group had ground Moringa leaves added to their maize traditional complementary foods (MTCF), while the control group was given the traditional maize formula. After the four week intervention, it was found that the mean hemoglobin concentrations increased from 10.65 to 12.98 g/dL (Nnam N.M., 2009). The control group showed no significant changes, while in the treatment group, the proportion of infants with serum retinol levels below 20 μg dl−1 fell from 85% to 15% decreased to 15% from 85%, and those with serum ferritin levels below 12 μg l−1 fell from 90% to 5% (Nnam N.M., 2009). These results do contrast those found in the maternal iron study by Idohou-Dossou N. et al., and may be attributed to the form of powdered Moringa (see Table 1), or differences in bioavailability based on geographic location. This difference has been acutely studied, but should be examined more closely.
Vitamin A Although the intake of yellow and green leafy vegetables has been looked upon as key sources of Vitamin A, the dry hot climates in many developing countries lend themselves to poor soil and an extremely limited availability of Vitamin A rich vegetables. For some geographic areas, the unavailability is seasonally yet, for other areas, the deficit remains year around. The attributes of Moringa leaves have consistently been shown to contain both alpha and beta carotene. A study analyzing the caretenoid content of Moringa leaves did show variability in content. The leaves in Senegal provided the highest values between 12-16 mg/100 grams DW. During pregnancy and lactation, Vitamin A is a vital nutrient important for the development of the fetal lung maturation and overall development of the fetus and neonate. It is therefore advised that pregnant mothers also increase intake of Vitamin A by 40% and that breastfeeding mothers increase their intake by 90%(Strobel, M et, al, 2007). A deficiency in an expectant mother’s intake of beta-carotene could contribute to an
AFRICAN NUTRITION MATTERS
Summer 2015
25
inadequate supply of breast milk potentially having an impact
A study conducted in Katsina State, Nigeria afound that 98.6%
on growth and development (Strobel, M et, al, 2007).
of respondents had eaten Moringa over the past 20 years (Ikwuakam O. T. et al., 2013). Another study in Nigeria found
A double blind randomized control trial was conducted in the
that 73.3% of the respondents use Moringa for medicinal
Philippines to evaluate the effects of Moringa on breast milk
purposes while 15.6% use it for food and cultural practices
volume (Estrella, C. P. et al., 2000). The study included
(Kola-Oladiji K.I. et al., 2014). A relatively uncommon
women with infants less than 37 weeks of age who were
practice in West Africa is the consumption of raw Moringa
admitted to the NICU for tube feedings. The treatment group
leaves, but this form is identified as widely eaten in
was provided with 250 mg every 12 hours starting on the 3rd
Zimbabwe, as it can be harvested during dry season with the
day postpartum, while the placebo group was given the same
unavailability of other vegetables (Maroyi, A., 2006). A
schedule but with flour in the capsules; results demonstrated a
significant gender difference was also found with respect to
statistically significant higher breast milk volume on the
uses of Moringa, significant differences, women preferred to
fourth day (Estrella, C. P. et al., 2000). Though this study did
use Moringa mainly for “food and firewood while men cited
not directly assess vitamin A, it was the only study that
and used the plant for medicine and for demarcating
focused on breast milk volume as a clinical outcome and met
boundaries”
this review’s inclusion criteria.
Appropriately, it was found a lack of awareness of Moringa
(Popoola,
J.
and
Obembe,
O.,
2013).
was found to be one of the major barriers of use; 87% of nonKnowledge and Awareness Knowledge and awareness-focused papers using semistructured questionnaire formats showed differences in value associated with Moringa varying by both ethnic groups and
users reported this as the primary reason (Williams F.E. et al., 2013). It was also found that in villages in parts of Matebeleland, Zimbabwe, Moringa is becoming an important livelihood source (Maroyi, A., 2006).
age. It was found that older populations had greater knowledge and fidelity associated with Moringa (100%
Perceived Nutritional and Medical Benefits
fidelity level for respondents > 65 years, 73.3% fidelity level
Willingness to adopt Moringa and perceived constraints for
for respondents between age 35 and 65, and 46.7% fidelity
utilization was an important theme that presented itself in two
recorded for respondents under the age of 35) (Popoola, J. &
of the studies, which is an important aspect to consider when
Obembe, O., 2013). The significant differences observed
integrating Moringa into existing supplementary feeding
among the ethnic and age groups regarding the uses of
programs – a practice that has been employed by a number of
Moringa may allude towards discrepancies in the propagation
non-government organizations and programs (see below). It
of indigenous knowledge (Popoola J. and ObembeO., 2013).
was found that the leaves are eaten frequently to treat the
A pilot study in India found that both the feasibility and
following ailments: malaria, typhoid fever, arthritis, diabetes,
acceptability of integrating Moringa into supplementary foods
and to boost the immune system (Popoola, J. & Obembe, O.,
was high, and that education by way of NGO staff was an
2013). It was found that the roots are used for infertility and
effective method for knowledge dissemination (Nambiar, V. et
high blood pressure, and that the bark, when boiled, is used
al., 2003).
against chronic hypertension and, when powdered, is active
Studies in Nigeria and Zimbabwe demonstrated that different
against snake and scorpion poisons (Popoola, J. & Obembe,
parts of the plant have been used for nutrition purposes as well
O., 2013). It was found that there were significant
as medicines, but also as a coagulate, as animal fodder and for
relationships between the following factors and the nutritional
firewood (Popoola, J. & Obembe, O., 2013;Maroyi, A., 2006).
and health benefits of Moringa, respectively, religion (χ2 =
AFRICAN NUTRITION MATTERS
Summer 2015
26
6.507 and 5.861), level of exposure to information (r = 0.237
Moringa to alleviate malnutrition in children as well as
and 0.332) and level of awareness (r = 0.484; and 0.383)
pregnant and lactating women, and has stated that there was an
(Ikwuakam O. T. et al., 2013). It is important to note that a
“improvement in malnourished children in just a few days”
similar study conducted in Nigeria concluded that there are no
(Fuglie, 2001). Peace Corps volunteers in Burkina Faso and
religious barriers to awareness and knowledge of Moringa,
Benin, in addition to Madagascar, have integrated Moringa
where findings were equally distributed among the 70%
agriculture and nutritional programming into a number of
Christian(,) 28.9% Muslims and 1.1% traditional religion
projects (Peace Corps, 2010).World Vision Nigeria has also
practicing communities (Kola-Oladiji K.I. et al., 2014).
included Moringa leaf powder in their recommended home supplementary feeding recipe for children with malnutrition
Though many programs that have been implemented focus on educating non-users about the potential benefits of Moringa, a study in Nigeria found that though this education led to prospective adoption by 85% of non-users, a major factor influencing resistance to adopting Moringa was safety
(Pee, S. & Bloem, W.) In addition to the health and nongovernment
sectors,
a
number
of
pharmaceutical
companies, such as Phyto-Riker and Plant Medicine Company ltd., are interested in conducting R&D related to Moringa (AlBader, S., Daar, A.S., Singer, P.A., 2010).
concerns (statistically significant at p<0.01) (Williams, F.E., 2013).
Conclusions Though studies have demonstrated a promising beginning
Applications Globally International malnutrition programs have attempted at integrating Moringa, however, the lack of clinical data has prevented implementation. World Vision, for example, has incorporated education about cultivating Moringa in programs in Mauritania, but is “is not using Moringa in feeding programs” due to a lack of scientific evidence (Abidjan, 2003). The World Food Program Executive Board in Rome was contracted to distribute Moringa in Mauritania, but cancelled the contract, as they “did not want to take the risk of distributing a little-known product via its programs fighting malnutrition. The existing clinical and toxicological studies were not enough to dispel their concerns” (de Saint Sauveur, A. & Bronin, M., 2006). On the other hand, many countries around the globe have demonstrated a commitment to better understanding and utilizing the benefits of Moringa; As of March 14, 2014, the Philippines House of Representatives passed a proposed law approving the Malunggay (Moringa) tree as the country’s national vegetable, emphasizing its economic, nutritional and medicinal benefits. Dr. Lowell Fuglie, a notable Moringa researcher, has directed the Church World Service nutrition program in Senegal which has utilized
towards understanding the nutritional and health impacts of Moringa, further study is needed to investigate the full potential of the plant, as well as implementing strategies for its sustainable integration into local diets. Research conducted by the UN Food and Agriculture Organization (FAO) reveals that investment in agriculture is five times more effective in reducing poverty and hunger than any other area (2013). Policies directed toward enhancing agriculture through social and economic initiatives could offer improved incomes for indigent families enhance employment opportunities and stimulate economic growth. For future study, it is necessary to evaluate the effectiveness of Moringa as a source of nutrition, as part of either complementary or supplementary feeding programs. It is recommended that a systematic review of the chemical constituents, bioavailability and toxicity of Moringa be conducted, expanding upon the literature on Moringa Oleifera to include other common species of Moringaceae, in addition to clinical trials that examine its nutritive effects. Though invivo and in-vitro studies have demonstrated the chemical constituents of Moringa, and anecdotal, community-based qualitative data do indicate benefits for nutrition and health
AFRICAN NUTRITION MATTERS
Summer 2015
27
promotion, there continues to be limited population based studies measuring the nutritional effects of Moringa. The Moringa tree deserves high priority attention in determining whether the anecdotal evidence supporting its clinical value, the demonstrated bioavailability of valuable nutrients in the leaves, and its strategic presence in areas of the globe home to the most vulnerable, can be utilized towards alleviating the burden of undernutrition.
References
Maroyi A. The Utilization of Moringa Oleifera in Zimbabwe. J Sustain Dev Africa [Internet]. 2006;8(2):160–8. Available from: http://jsdafrica.com/Jsda/Summer_2006/PDF/ARC_UtilizationMOeifera.pdf Nnam N. Moringa oleifera leaf improves iron status of infants 6-12 months in Nigeria. Int J Food Safety, Nutr Public Heal [Internet]. 2009;158–64. Available from: http://inderscience.metapress.com/content/n057880577141666/ Nwosu Odinakachukwu IC et al. Development and Nutritional Evaluation of Infant Complementary Food from Maize (Zea Mays), Soybean (Glycine Max) and Moringa Oleifera Leaves. Int J Nutr Food Sci [Internet]. 2014;3(4):290. Available from: http://www.sciencepublishinggroup.com/journal/paperinfo.aspx? journalid=153&doi=10.11648/j.ijnfs.20140304.19
de Saint Sauveur A., Bronin M. Growing and processing moringa leaves Moringa oleifera. 2006; Available from: http://miracletrees.org/moringadoc/moringa_book_growing_and_processing_moringa_leaves.pdf
Popoola J et al. Local knowledge, use pattern and geographical distribution of Moringa oleifera Lam. (Moringaceae) in Nigeria. J Ethnopharmacol [Internet]. 2013;150:682–91. Available from: http://www.researchgate.net/publication/257463167_Local_knowledge_use_p attern_and_geographical_distribution_of_Moringa_oleifera_Lam._ %28Moringaceae%29_in_Nigeria
Dhakar R et al. Moringa: The herbal gold to combat malnutrition. Chronicles Young Sci. 2011;2(3):119–25.
Price M. The Moringa Tree. ECHO Technical Note [Internet]. 2007 [cited 2015 Mar 20]. Available from: http://chenetwork.org/files_pdf/Moringa.pdf
Estrella C et al. A double-blind, randomized controlled trial on the use of malunggay (Moringa oleifera) for augmentation of the volume ofbreastmilk among non-nursing mothers of preterm infants [Internet]. Miracle Trees. Available from: http://miracletrees.org/moringadoc/moringa_breastfeeding_study.pdf
Sena L et al. Analysis of nutritional components of eight famine foods of the Republic of Niger. Plant Foods Hum Nutr. 1998;52(1):17–30.
Fahey J. Moringa oleifera: A Review of the Medical Evidence for Its Nutritional, Therapeutic, and Prophylactic Properties. Part 1. Trees for Life Journal. 2005.
Strobel M et al. The importance of beta-carotene as a source of vitamin A with special regard to pregnant and breastfeeding women. Eur J Nutr. 2007;46.
Foidl N et al. The potential of Moringa Oleifera for agricultural and industrial uses. Moringa Oleifera: Natural Nutrition for the Tropics. Training Manual. Dakar, Senegal: Church World Service. 2001. p. 29.
Thurbur J et al. Adoption of Moringa Oleifera to combat undernutrition from the Diffusion of Innovations theory. Ecol Food Nutr [Internet]. 2007;48(3):212–25. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2679503/
Abidjan. MAURITANIA: World Vision promotes Moringa to combat malnutrition. IRIN Humanitarian News and Analysis. 2003;
Fuglie L. Moringa Oleifera: Natural Nutrition for the Tropics. Training Manual. Dakar, Senegal: Church World Servie; 2001. Idohou-Dossou N, Diouf a, Gueye A, Guiro A, Wade S. Impact of daily consumption of Moringa (Moringa oleifera) dry leaf powder on iron status of Senegalese lactating women. African J Food, Agric Nutr Dev. 2011;11(4):4985–99.
Srikanth VS, Mangala S, Subrahmanyam G. Improvement of Protein Energy Malnutrition by Nutritional Intervention with Moringa Oleifera among Anganwadi Children in Rural Area in Bangalore , India. :32–5.
Yang R et al. Nutritional and Functional Properties of Moringa Leaves − From Germplasm, to Plant, to Food, to Health [Internet]. 2006. Available from: http://miracletrees.org/moringa-doc/from-germplasm-to-plant-to-food-tohealth.pdf Moringa Association Takes Root in Benin [Internet]. Peace Corps. 2010. Available from: http://www.peacecorps.gov/media/forpress/news/1674/
Ikwuakam OT et al. PERCEIVED NUTRITIONAL AND MEDICINAL VALUES OF MORINGAOLEIFERA (ZOGALE) AMONG RURAL DWELLERS OF KATSINA STATE, NIGERIA. Niger Jouranl Rural Sociol. 2013;14(1). Jilcott SB, Ickes SB, Ammerman AS, Myhre J a. Iterative design, implementation and evaluation of a supplemental feeding program for underweight children ages 6-59 months in western Uganda. Matern Child Health J. 2010;14:299–306. Kola-Oladiji KI et al. Consumption Pattern and Indigenous Knowledge of Moringa Oleifera among Dwellers of Rural Enclaves around Ibadan. 2014;4(10):140–8.
AFRICAN NUTRITION MATTERS
Summer 2015
28
African Nutrition Matters
Publication by the African Nutrition Society ISSN: 2412-3757 Volume 3 No. 4 â&#x20AC;&#x201C; Summer 2015