C H R I S T I N A B R U M M E[ T W O O T H E R G R O U P

M E M B E R N A M E S H AV E B E E N R E M O V E D F O R

C O N F I D E N T I A L I T Y ]

HarvestPlus Orange Sweet Potatoes

in Mozambique

Nutrition Sensitive Interventions

2013 Lancet Nutrition Series

Underlying determinants of nutrition

Complementary sectors

Help leverage and accelerate nutrition-specific interventions

(Ruel & Alderman, 2013)

Nutrition-sensitive vs. Nutrition-specific

Address underlying determinants of nutrition and development

• Agriculture & food security• Social safety nets• Women’s empowerment• Schooling• Water, sanitation, hygiene• Family planning

Address immediate determinants of nutrition and development

• Dietary diversification• Preconception supplementation• Optimum breastfeeding• Dietary supplementation• Micronutrient supplementation.• Treatment of severe acute malnutrition

HarvestPlus

HarvestPlus seeks to reduce hidden hunger and provide micronutrients to billions of

people directly through the staple foods that they eat. We use a novel process called biofortification to breed higher levels of

micronutrients directly into key staple foods.

HarvestPlus

Crop Micronutrient Country TimelineBean Iron DR Congo, Rwanda 2012Cassava Vitamin A DR Congo, Nigeria 2011Maize Vitamin A Nigeria, Zambia 2012Pearl Millet Iron India 2012Rice Zinc Bangladesh, India 2013Sweet Potato

Vitamin A Mozambique, Uganda

2007

Wheat Zinc India, Pakistan 2013

What is Biofortification?

Breeding staple food crops with a higher

micronutrient content.

Milestones:1. Breeding objectives

(micronutrient target concentration)

2. Retention and Bioavailability of micronutrients

3. Farmer adoption rates and intakes

Vitamin A deficiency

Vitamin A accounts for > 600,000 deaths globally for children < 5

VAD: <0.7 µmol/l

Africa:Prevalence of VAD is 42% children 6-59 months

Mozambique: Prevalence of VAD is 69% in children 6-59 months

Existing Vitamin A interventionsHigh dose capsule twice per year43% coverage in 2003

Orange Sweet Potato

White-yellow varieties2ppm beta carotene

Orange Sweet Potato30-200ppm beta

carotene 2.5 times RDA of

vitamin A for 4-8year old children (van Jaarsveld et al. 2005)

Why Orange Sweet Potatoes? (OSP)

High beta carotene levels 50% of mean daily

vitamin A requirement High consumption in

Mozambique Average consumption

200g/dayGood source of

EnergyDrought resistantLong cultivation

seasonAccepted by children

Mozambique

Zambezia province

Main staple crop—maize or cassava

33% of farmers grow sweet potatoes as seasonal secondary crop

Pilot Effectiveness Study, 2007-2009 14,000 households in

Zambezia province 10,000 households in

Uganda

Partners & Donors

Implementation World VisionHellen Keller International-

Operations Research International Potato CenterHarvest PlusNatural Resources Institute—University of Greenwich

Impact Evaluation International Food Policy Research Institute

Donors Bill and Melinda Gates FoundationHarvestPlus core funding

Denmark, Sweeden, Syngenta Foundation, United Kingdom, USAID, and the World Bank

Intervention Components

Agriculture

Demand creation and behavior change

Marketing

Agriculture

Distribution of vines Initial: 2kg to farm households at no cost Continual: 8kg available for purchase Repeated every year as necessary

Training on best production practices Avoidance of pests and diseases Vine conservation between planting seasons Both men and women were included

Demand Creation & Behavior Change

Education Maternal and child health and nutrition Targeted to women

Campaign for the general public Raise awareness about OSP and Vitamin A Community drama, field-day events Radio programs

Marketing

Training for OSP tradersUrban and rural market developmentDistinct market stalls with OSP and

informationNot targeted to all growers

Small group of traders Medium-scale growers Business owners

Implementation

Model 1, Model 2, or ControlRandomized by clusterClusters selected based on:

The number of households with children 6-35 months Access to lowlands No other agricultural interventions being implemented Did not participate in previous OSP intervention Impact evaluation clusters were 5km apart

Implementation

Year 1 was the same for Model 1 and 2Years 2-3: Model 1

Refresher training on agriculture and nutrition continued* Vine distribution continued Marketing and promotional components continued

Years 2-3: Model 2 Agriculture and Education components and support did

not continue* Vine distribution continued Marketing and promotional components continued

Implementation

World Vision and Helen Keller InternationalHarvestPlus staff provided overall

coordinationPromoters

Community-based volunteers Trained by project staff Provided training and education to participants

Effectiveness Evaluation

Nutrition Impact SurveyParticipants

Women and children surveyed at baseline and 2-5 years after

At follow-up additional children were surveyedBaseline: Nov-Dec 2006Follow-up: May-June 2009

Effectiveness Evaluation

24-hr Recall 2 days collected for some Used the multiple-pass

method Group training for

participants

Food Frequency Common foods Focus on Vit. A rich foods

Effectiveness Evaluation

Anthropometry Weight, length, height

β-Carotene content Samples of each farm Samples of each

variety tested for vit. A content after boiling

Coverage and Agricultural component

68% of famers in Mozambique adopted OSP Adopted = retained OFSP vines for next season

White and yellow sweet potatoes substituted with OSP

Increased Intake of OSP

Low et al. (2006), after controlling for inflammation, demonstrated that increase intake of OSP increased serum retinol concentrations Increased by 0.100 micromole/L

47-60% increase intake OSP

Difference in Proportion of Sweet Potato Intake

***=1% level

Increased Intake of OSP

Low et al. (2006), after controlling for inflammation, demonstrated that increase intake of OSP increased serum retinol concentrations Increased by 0.100 micromole/L

47-60% increase intake OSP

47% increase among women

63% increase among children (6-35 month)

Diff. in Retinal Activity Equivalents/Day

Model Comparison

Model 1 Three years of Agricultural training and health and

nutrition education (refresher training sessions) More expensive

Model 2 One year of Agricultural training and health and nutrition

education

Similar OSP adoption and intake between models

Cost Implication

Lowest marginal cost and average cost were $17 and $52 per target beneficiary (children 6-59months and mothers)

$15-20 per Disability-Adjusted Life Years (Uganda) Measure of cost-effectiveness

Cost Implication

Advantage of implementing Model 2 Less expensive

Model 2 can be trimmed down when scale up Marketing component does not enhance adoption or

consumption Could scale back intensity of demand creation

component-nutrition messages had little affect on OSP consumption

Strengths

StrengthsLarge-scale

effectivenessMany partnersVine conservationMarketingControl groupTransparent in

sample size and vit. A analysis methods

Acceptability

Weaknesses

WeaknessesSelf-report of intakeRetinol not

measured*Expensive compared

to UgandaNo discussion of

sustainability of vines No discussion of

government roleCost non-growers*

Future Directions

Scaling-upExpand to other countriesOthers…?

Current Activities

Currently expanding to: Angola, Kenya, Tanzania, Rwanda, Zambia, Ghana, Nigeria, and others

Spillover countries: Burundi, Ethiopia, Ghana, Kenya, Malawi, Mali, Nigeria, Rwanda, South Africa, Tanzania, Zambia, Zimbabwe

Sharing knowledge: http://www.sweetpotatoknowledge.org

Current Activities

Future Directions

Future Directions

Future Directions

Future Directions

Thank you!

Questions?

Resources

Hotz, C., Loechl, C., de Brauw, A., Eozenou, P., Gilligan, D., Moursi, M., . . . Meenakshi, J. V. (2012). A large-scale intervention to introduce orange sweet potato in rural Mozambique increases vitamin A intakes among children and women. British Journal of Nutrition, 108(1), 163-176. doi: 10.1017/s0007114511005174

Asare-Marfo, D., Birol, E., Gonzalez, C., Moursi, M., Perez, S., Scharz, J., Zeller, M. (2013). Prioritizing Countries for Biofortification Interventions Using Country-Level Data. HarvestPlus Working Paper, 11.

http://www.harvestplus.org/content/vitamin-sweet-potato http://www.sweetpotatoknowledge.org