Delivering Nutrition through Orange-Fleshed Sweetpotato:

The Growing Evidence BaseFood Nutrition in Eastern & Southern Africa

Nairobi, Kenya

10 September 2012

Jan Low, CIP-SSA

An estimated 32% of Africa’s children under five years of age are vitamin A deficient. Vitamin A deficiency can limit growth, weaken immunity, cause xeropthalmia leading to blindness, and increased risk of mortality VAD is caused by inadequate intakes and loss due to illnessFood-based approaches to combat VAD address one of the major underlying causes but criticized for lack of evidence

The Problem

Orange-fleshed Sweetpotato: A Potential Contribution to the Solution

Most varieties in SSA white-fleshed: marginal change The Challenge: Will OFSP yield as well as the local variety?

Will consumers like the taste? What is needed to impact VAD? Will initial adoption be sustained?

Answering these questions took more than a decade…:

1st pilot study in Western Kenya (1995-97) Nutrition education component essential Preferences differed --Adults: high dry matter --Children: low dry matterYellow-fleshed lack sufficient pro-vitamin A, focus on orange Easy to incorporate sweetpotato weaning foods into young child diet & improve feeding frequency

KARI/CIP/CARE collaboration funded by ICRW/OMNI/USAID

Bosbok

Resisto

Efficacy studies

1. Completed in South Africa in 20042. Modified relative dose response method3. 120 gm. fed to school children for 5 days a

week for 3 months significantly improved amounts of Vitamin A stored in the liver

Potential of OFSP in combating VAD

Efficacy Study Among School Children in South Africa

van Jaarsveld et al., AJCN 81, 1080-87, 2005.

Introduce new source of Vitamin A and Energy:

Biofortified OFSP

1. Substitute white with orange2. Improve agronomic practices3. Improve storage practices

1. Increased supply of beta-carotene & energy

2. Sustained yields3. Increased supply in off-season

Demand Creationand

Empowermentthrough

Knowledge

1. Create awareness of Vitamin A problem

2. Create awareness of Vitamin A-rich foods

3. Empower caregivers to change practices

1. Knowledge in local community

2. Increased demand for Vitamin A-rich foods

3. Increased intake Vitamin A & energy

Market Development for OFSP Roots andProcessed Products

1. Link to markets to earn income

2. Diversify use through development of OFSP products

1. Increased household income for growers

2. Sustained OFSP cultivation over time

Increased Serum Retinol Levels

NUTRITION MARKETING

Mechanisms

Outcomes

AGRICULTURE

Integrated (agriculture-nutrition-market) Integrated (agriculture-nutrition-market) Intervention at Community Level in MozambiqueIntervention at Community Level in Mozambique Median intake vitamin A almost 8 times higher (24 h recall) OFSP contributed 35% vitamin A intake, 6% of energy intake 15% decline in prevalence of low serum retinol status attributable to the intervention

Median nutrient intakes yesterday: non-breastfed children (mean 32 months old)

426

1414

56

1226

0

200

400

600

800

1000

1200

1400

1600

Vitamin A (μg RAE) P-value=0.00

Energy (kcal) P-value=0.00

Am

ou

nt

of

Nu

trie

nt

Intervention (n=465)

Control (n=234)

Low, JW et al., Journal of Nutrition 137: 1320-1327, 2007

Building the Orange Brand: Radio programs and market advertising to

increase awareness of Vitamin A rich foods & increase demand & combat myths

Learned that higher root yielding OFSP has insufficient vine vigor for drought-prone areas

RESISTO: -- Has β-Carotene

--More consistent medium root size desired in commercial market

CANASUMANA-- Hardier vines, more drought resistant

--Alternating not agglomerated storage roots

Sought funding for a major investment to Breed in Africa for Africa & to improve the “seed” system...

Breeder Maria Andrade (on right) focused on vine vigor,

drought tolerance, and taste… better yield alone is not

sufficient

15 new drought-tolerantOFSP varieties were

released in February 2011

Reaching End Users (REU): 2007-2009

Mozambique: 14,400 households 144 groups

Uganda: 10,292 Households 392 Groups

Wolfgang H PFEIFFERWolfgang H PFEIFFER

High adoption rates (>60%) & positive outcomes on vitamin A intake among children and their mothers (intent to treat figures, include non-adopters) (Impact Study led by IFPRI)

Wolfgang H PFEIFFERWolfgang H PFEIFFER

Estimated Average Requirements (EAR): satisfy 50% of needs of age group

Understanding the costs of using the integrated approach

Less intensive (M2) model 30% cheaper to implement No significant difference in 2 models on key metrics Mozambique (secondary staple):

Average cost for direct beneficiary: $86 Marginal cost for direct beneficiary: $36 Marginal cost if indirect beneficiaries included: $19

Uganda (staple crop): Average cost for direct beneficiary: $56 Marginal cost for direct beneficiary: $22 Marginal cost if indirect beneficiaries included: $12

$15-20 USD for disability life year (DALY) saved

Mean (± SEM) changes in serum retinol after supplementation

Source: Fasli Jalal et al., Am J Clin Nutr 1998; 68:623-9.

Baseline Fat + Deworming OFSP OFSP + Fat + Deworming

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

Treatment group

Change in

serum retinol

Would linking more explicitly to a health intervention substantially improve Vitamin A status?

Can linking an agricultural intervention and nutritional

training to existing ante-natal care services in Western Kenya provide an incentive to pregnant women to:

1) increase health service utilization

2) increase consumption of OFSP

and other vitamin A rich foods

by themselves and their

children than existing

health services alone?

3) Will there be a positive impact

on vitamin A status?

Conclusions

OFSP root consumption can significantly contribute to improved vitamin A intake & status More research needed on impact of other nutrients Still much to learn on: --effective delivery systems, how to cost- effectively reach large numbers of households & HIV/AIDS affected households & communities

(SUN Initiative may provide opportunities) --storage, extended shelf life, processed product development (new markets; reach urban consumers)

SPHI is a multi-partner, multi-donor initiative that seeks to reduce child

undernutrition and improve

smallholder incomes in 10 million African

families by 2020 through the

effective production and

expanded use of sweetpotato.

16 Target Countries

SASHA in 8 countriesOther projects in additional 4 Countries