Issue of Summer 2015

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

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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

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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

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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

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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

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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

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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%

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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

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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

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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.

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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?

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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

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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).

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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

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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 =

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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

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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.

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African Nutrition Matters

Publication by the African Nutrition Society ISSN: 2412-3757 Volume 3 No. 4 â&#x20AC;&#x201C; Summer 2015