B. Thompson

Combating micronutrient deficiencies : food-based approaches

1. Strategies for preventing multi-micronutrient deficiencies: a review of experiences with food-based approaches in developing countries 2. Addressing micronutrient malnutrition to achieve nutrition security 3. Agricultural interventions and nutrition: lessons from the past and new evidence 4. A 3 year cohort study to assess the impact of an integrated food- and livelihood-based model on undernutrition in rural western Kenya 5. Food-based, low-cost strategies to combat micronutrient deficiencies: evidence-based interventions in Lesotho and Malawi 6. Animal source foods as a food-based approach to address nutrient deficiencies and functional outcomes: a study among Kenyan schoolchildren 7. Small animal revolving funds: an innovative programming model to increase access to and consumption of animal source foods by rural households in Malawi 8. Aquacultures role in improving food and nutrition security 9. A home gardening approach developed in South Africa to address Vitamin A deficiency 10. AVRDC - The World Vegetable Centers approach to alleviate malnutrition 11. Introducing vegetables into the India Mid-Day Meal Programme (MDM): the potential for dietary change 12. Developing micronutrient-rich snacks for pre-conception and antenatal health: the Mumbai Maternal Nutrition Project (MMNP) 13. Approaches and lessons learned for promoting dietary improvement in Pohnpei, Micronesia 14. A food systems approach to increase dietary zinc intake in Bangladesh based on an analysis of diet, rice production and processing 15. Combating iron deficiency: food-based approaches 16. Human micronutrient deficiencies: linkages with micronutrient deficiencies in soils, crops and animal nutrition 17. Nationwide supplementation of sodium selenate to commercial fertilizers. History and 20-year results from the Finnish selenium monitoring programme 18. Leaf concentrate and other benefits of leaf fractionation 19. Disability-Adjusted Life Years (DALYs): a methodology for conducting economic studies of food-based interventions such as biofortification.

A 3-year cohort study to assess the impact of an integrated food- and livelihood-based model on undernutrition in rural western Kenya.

76 (eds B. Thompson and L. Amoroso) Abstract Reducing extreme poverty and hunger is the first Millennium Development Goal (MDG). With undernutrition contributing to nearly half of all child deaths, improving nutrition is a precondition for accelerating progress towards other MDG targets. While the role of technical interventions such as micronutrient fortification and supplementation in reducing morbidity and mortality has been well documented, evidence to support more comprehensive multi-sectoral approaches remains inconclusive. This chapter aims to evaluate the impact of an integrated foodand livelihood-based model on nutrition-related outcomes in rural western Kenya. A 3-year prospective cohort study was undertaken among 300 randomly selected wealth-stratified households. Detailed socio-economic and health surveys were conducted. A nutrition module assessed household levels of food security, food consumption frequency and diet diversity. This was complemented by anthropometric measurement and assessments of serum levels of vitamin A among children under 5 years old. The average food insecurity score decreased from 5.21 at baseline to 4.13 at follow-up (P < 0.0001). Average diet diversity scores for daily, weekly and monthly time periods increased from 6.7 to 7.3; from 10.7 to 11.2; and from 12.4 to 12.6, respectively (P < 0.0001). Daily consumption for 14 out of 16 food groups increased significantly. For children under 2 years of age, underweight and stunting decreased from 26.2% to 3.9% (P = 0.002) and from 62.3% to 38.3% (P = 0.014), respectively. Vitamin A deficiency as measured by serum vitamin A levels decreased from 70.0% to 33.3% (P = 0.007) for children under 5 years old. This study presents encouraging evidence that a multi-sectoral foodand livelihood-based model can improve diet quality, enhance food security and positively affect childhood nutritional outcomes. The wider application of this approach to a diversity of agro-ecological zones in sub-Saharan Africa is currently being assessed.

Critical issues to consider in the selection of crops in a food-based approach to improve vitamin A status - based on a South African experience.

Vitamin A deficiency is of public health significance in the developing world. Household food production of β-carotene-rich vegetables and fruit is a long-term strategy that can contribute to combating vitamin A deficiency. It is, however, important to grow food-crops to meet the nutritional needs of vulnerable populations taking into consideration the β-carotene content of foods and their potential contribution towards the vitamin A requirements of the target population. Although the focus is on vitamin A, β-carotene-rich vegetables and fruit do have the potential to contribute significantly towards dietary intake of various micronutrients other than vitamin A. Seasonality affects the availability of vegetables and fruit and a variety of both warm-weather and cool-weather crops should be planted to ensure year-round availability of β-carotene-rich vegetables and fruits. Focusing on both indigenous and exotic vegetables will further help to ensure year-round availability, particularly in terms of darkgreen leafy vegetables. When promoting increased consumption of indigenous vegetables it is important that the promotion campaign is appropriate for the setting. When introducing new crops, such as the orange-fleshed sweet potato, the nutrient content as well as the sensory attributes of the food need to be considered as to ensure consumer acceptance. The paper will discuss the above-mentioned issues, using published and unpublished South African case studies as examples.