Peiman Milani

Rice fortification: a comparative analysis in mandated settings.

Legal mandates can play an important role in the success of rice fortification programs that involve the private sector. However, merely enacting mandatory legislation does not guarantee success; it requires a coordinated, multidimensional cross‐sector effort that addresses stewardship, develops an appropriate rice fortification technology, enables sustainable production and distribution channels through a range of private‐sector players, ensures quality, generates consumer demand, and monitors progress. Furthermore, economic sustainability must be built into the supply chain and distribution network to enable the program to outlast government administrations and/or time‐limited funding. Hence, mandates can serve as valuable long‐term enablers of cross‐sector mobilization and collaboration and as catalysts of civil society engagement in and ownership of fortification programs. This paper compares the rice fortification experiences of Costa Rica and the Philippines—two countries with mandates, yet distinctly different industry landscapes. Costa Rica has achieved national success through strong government stewardship and active market development—key elements of success regardless of industry structure. With a comparatively more diffuse rice industry structure, the Philippines has also had success in limited geographies where key stakeholders have played an active role in market development. A comparative analysis provides lessons that may be relevant to other rice fortification programs.

Patterns of cultural consensus and intracultural diversity in Ghanaian complementary feeding practices

Designing effective interventions to improve infant and young child (IYC) feeding requires knowledge about determinants of current practices, including cultural factors. Current approaches to obtaining and using research on culture tend to assume cultural homogeneity within a population. The purpose of this study was to examine the extent of cultural consensus (homogeneity) in communities where interventions to improve IYC feeding practices are needed to address undernutrition during the period of complementary feeding. A second, related objective was to identify the nature of intracultural variation, if such variation was evident. Selected protocols from the Focused Ethnographic Study for Infant and Young Child Feeding Manual were administered to samples of key informants and caregivers in a peri-urban and a rural area in Brong-Ahafo, Ghana. Cultural domain analysis techniques (free listing, caregiver assessment of culturally significant dimensions, and food ratings on these dimensions), as well as open-ended questions with exploratory probing, were used to obtain data on beliefs and related practices. Results reveal generally high cultural consensus on the 5 dimensions that were assessed (healthiness, appeal, child acceptance, convenience, and modernity) for caregiver decisions and on their ratings of individual foods. However, thematic analysis of caregiver narratives indicates that the meanings and content of the constructs connoted by the dimensions differed widely among individual mothers. These findings suggest that research on cultural factors that affect IYC practices, particularly cultural beliefs, should consider the nature and extent of cultural consensus and intracultural diversity, rather than assuming cultural homogeneity.

Results of Applying Cultural Domain Analysis Techniques and Implications for the Design of Complementary Feeding Interventions in Northern Senegal

Background: Designing effective nutrition interventions for infants and young children requires knowledge about the population to which the intervention is directed, including insights into the cognitive systems and values that inform caregiver feeding practices. Objective: To apply cultural domain analysis techniques in the context of implementation research for the purpose of understanding caregivers’ knowledge frameworks in Northern Senegal with respect to infant and young child (IYC) feeding. This study was intended to inform decisions for interventions to improve infant and young child nutrition. Methods: Modules from the Focused Ethnographic Study for Infant and Young Child Feeding Manual were employed in interviews with a sample of 126 key informants and caregivers from rural and peri-urban sites in the Saint-Louis region of northern Senegal. Descriptive statistics, cluster analysis, and qualitative thematic analysis were used to analyze the data. Results: Cluster analysis showed that caregivers identified 6 food clusters: heavy foods, light foods, snack foods, foraged foods, packaged foods, and foods that are good for the body. The study also revealed similarities and differences between the 2 study sites in caregivers’ knowledge frameworks. Conclusions: The demonstration of differences between biomedical concepts of nutrition and the knowledge frameworks of northern Senegalese women with regard to IYC feeding highlights the value of knowledge about emic perspectives of local communities to help guide decisions about interventions to improve nutrition.

Public and Private Sector Dynamics in Scaling Up Rice Fortification The Colombian Experience and its Lessons

Background: Fortification of cereal grains with at least iron or folic acid is legislated in 85 countries worldwide. Relative to wheat and maize flour, rice fortification is relatively new and provides an opportunity to deliver essential micronutrients to populations that consume rice as a dietary staple. Objective: To describe miller and public sector experiences and perspectives on rice fortification with micronutrients in Colombia and offer recommendations for policy makers. Methods: Interviews with Colombian rice millers, research and development personnel, and public sector leaders; desk review of key documents. Results: In Colombia, rice fortified with micronutrients is market driven and a few very large rice millers, currently representing about 35% of the market, have voluntarily fortified rice since 2002. The technology used (spraying) is unique to Colombia and to date there is no independent verification of nutrient retention after washing and cooking rice fortified through this technology. Millers are unwilling to switch to more proven methods, such as extrusion or coating, which will incur higher capital investment and recurring costs. Despite interest from multiple stakeholders between 2002 and 2011, mandatory rice fortification is not part of the Colombian government policy as of July 2015. Conclusion: Rice fortified with micronutrients through spraying technology has achieved moderate coverage in Colombia, but the technology is unproven, its effectiveness unknown, and public health impact likely limited. For rice fortification to be an effective nutrition intervention to improve micronutrient status, policy makers should explore standards to guide industry and improvements to regulatory capacity.

Naturally Fermented Milk From Northern Senegal: Bacterial Community Composition and Probiotic Enrichment With Lactobacillus rhamnosus

A variety of foods fermented with lactic acid bacteria serve as dietary staples in many African communities; yet, their bacterial profiles are poorly characterized. The integration of health-promoting probiotics into naturally fermented milk products could make a profound impact on human health. Here, we characterize the bacterial community composition of a naturally fermented milk product (lait caillé) from northern Senegal, prepared in wooden bowls (lahals) with a bacterial biofilm to steer the fermentation process. We incorporated a probiotic starter culture containing the most documented probiotic strain Lactobacillus rhamnosus GG (generic strain name yoba 2012) into the local fermentation process. Bar-coded 16S rRNA amplicon sequencing of lait caillé samples indicated that the bacterial community of lait caillé has high species richness with over 100 bacterial genera; however, few have high abundance. In contrast to the diverse bacterial compositions of other characterized naturally fermented milk products, the composition of lait caillé predominantly consists of the lactic acid bacteria Streptococcus and Lactobacillus, resembling the bacterial composition in regular yogurt. The bacterial community composition of lait caillé varies geographically based on the presence of some genera, including Lactoccoccus, Enterococcus, Bifidobacterium, and Bacillus, but this trend is not consistent within production communities. The diversity of bacterial communities is much higher in the lahal biofilm than in the naturally fermented milk products, which is in turn greater than in commercial yogurts. Addition of a starter culture with L. rhamnosus yoba 2012 to milk in lahals led to substantial growth of this probiotic bacterium during the fermentation process. Two independent quantitative PCR-analyses specific for L. rhamnosus yoba 2012 indicated a 20- to 60-fold increase in the total number of probiotic bacteria in the first batch after inoculation. A similar increase of the probiotic was observed in a variation of lait caillé prepared with carbohydrate-rich millet granules (thiakry) added prior to fermentation. This study shows the feasibility of integrating health-promoting probiotic strains into naturally fermented foods produced in regions with a high prevalence of malnutrition.

Social Marketing of a Fortified Staple Food at Scale: Generating Demand for Fortified Rice in Brazil

ABSTRACT This paper describes the social marketing strategy implemented by PATH and GAIN to create a sustainable market for rice fortification in Brazil and develop a replicable model relevant to other geographies. It draws on market research on consumer attitudes and practices, as well as key demand and consumer metrics before and after execution of the social marketing campaign in Brazil. This marketing endeavor succeeded in establishing the viability of introducing fortified rice in a country through a purely market-based approach. Whereas social marketing is vital to the introduction and scale-up of fortified staple foods through commercial markets, it is not sufficient to achieve meaningful scale and sustainability. Engagement from the public and social sectors, clear governance, and other factors are critical to substantial and long-term impact. Lessons from this first attempt to introduce a fortified staple food through a market-based approach are relevant to similar initiatives elsewhere.

An Exploration of Edible Palm Weevil Larvae (Akokono) as a Source of Nutrition and Livelihood: Perspectives From Ghanaian Stakeholders:

Background: Meeting the nutritive needs of infants and young children is a challenge in Ghana. Alternative animal source foods, including insects, could enhance infant and young child dietary quality while also improving livelihoods. Objective: To investigate the perspectives of Ghanaian stakeholders on the acceptability of the palm weevil larvae (akokono) as a food source and the feasibility of micro-farming this local edible insect as a complementary food for infants and young children. Methods: We conducted an ethnographic study in the Brong-Ahafo Region of Ghana. First, 48 caregivers were asked questions about feeding and care practices, including attitudes toward production and consumption of akokono. Then, a selection of previously interviewed respondents joined 1 of 8 focus group discussions to provide further insight on key themes that emerged from earlier interviews. Concurrently, interviews with 25 other key local stakeholders were conducted. Results: Respondents generally had favorable perceptions of akokono as a nutritious food. A small minority would not consume akokono for religious reasons. Key factors positively influencing the acceptability of akokono as a complementary food were familiarity with the consumption of akokono by the primary caregiver and health worker endorsement of akokono. Stakeholders consider the larvae farmable and were open to its domestication. Conclusions: Anticipated barriers to scaling up akokono micro-farming include a need for greater familiarity with and acceptance of the insect as food for infants and young children and creation of a sustainable market. Engagement with stakeholders, including health workers, will facilitate use of akokono as a complementary food.

Piloting a Commercial Model for Fortified Rice: Lessons Learned From Brazil.

Background: Two billion people worldwide have micronutrient deficiencies. Food fortification is a proven intervention to increase essential micronutrient availability in diets without requiring consumer behavioral change. Fortification of rice has high potential reach; however, cost, technology, market, and cultural constraints have prevented its wider adoption. Objective: From 2010 to 2014, PATH and Global Alliance for Improved Nutrition implemented a pilot project in Brazil testing a model to scale up rice fortification through commercial channels. The project focused on 5 areas: (1) building fortified rice kernel production capacity; (2) supply chain development; (3) distribution channel and market development; (4) demand generation; and (5) advocacy and knowledge dissemination. Methods: Primary data were collected in 2 rounds of quantitative research 6 months apart and conducted in 2 regions in Brazil. Secondary data were sourced from published literature, socioeconomic and demographic data, and sales figures from the project’s rice miller partner. Postmortem analysis was conducted by the project team with input from external sources. Results: Although the project successfully launched a fortified rice product and a category brand platform, it was unsuccessful in reaching meaningful scale. Market and industry dynamics affected producers’ willingness to launch new fortified products. Consumers’ strong attachment to rice combined with a weak understanding of micronutrient malnutrition hampered demand creation efforts. Conclusion: This project showed that a purely commercial approach is insufficient for sustainable scale-up of fortified rice to achieve public health goals in a 3- to 5-year period.