Issue of Summer 2015

AFRICAN NUTRITION MATTERSVolume 3 No. 4 | Summer 2015

AFRICAN NUTRITION SOCIETYAFRICAN NUTRITION SOCIETY

T H E N E W S L E T T E RT 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 MATTERSVolume 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: [email protected]

Cover photo: Flickr / Ali Jafri: BY-NC-SA 2.0 https://flic.kr/p/cPCqFC

mailto:[email protected]

https://flic.kr/p/cPCqFC

7th Africa Nutrition Epidemiology Conference

10-15 October 2016

Marrakesh, Morocco

Flickr / teosaurio: BY-SA 2.0https://flic.kr/p/8XofK7

The seventh African Nutrition Epidemiology Conference

will be hosted in the ancient Moroccan city of Marrakesh

in 2016.

Editorial

By Nonsikelelo Mathe, Francis Zotor & Dia Sanou

The 2000 Millennium Development Goals (MDGs) called for

halving the proportion of people living in hunger. Important

progress has been made and the goal of ending hunger and

malnutrition rose higher on the agenda of governments and

global development agencies.With just half year to go until the

MDGs expire, let’s celebrate accomplishments. The

proportion of underweight children in developing countries

has fallen; and, some progress has been made in reducing

mortality in children under five.

Despite these successes, progress remains uneven around the

world. Many African countries have taken advantage of the

winds of change, but many are still struggling particularly

with stunting. Data suggest that the least progress in reducing

child undernutrition has been made in sub-Saharan Africa. The

2014 Global nutrition report suggested that many countries are

simultaneously facing a rapid increase in both number of

stunted children and those affected by obesity.

MDGs have created a great momentum for nutrition and an

increased recognition for nutrition as central to development.

This was especially so with the advent of the Scaling Up

Nutrition (SUN) in the last four years of the MDGs. These

commitments need to be sustained and innovative strategies

are required to translate momentum into actions and results.

The international community has therefore appointed a high

level panel to propose a framework for the post-2015

development agenda. The draft framework that could be

adopted in September 2015 contains 17 goals as compared to

eight time-bound goals in the 2000 MDG. An important

development for nutrition is the agreement to define a stand-

alone goal for hunger and nutrition.

What role for the African Nutrition Society?

The African Nutrition Society’s (ANS) role remains central to

the multisectorial emphasis in nutrition intervention and other

conditions. Through its representation on several global

nutrition committees such as the SUN Civil Society Network,

the International Union of Nutritional Sciences (IUNS)

presidency, the Federation of African Nutrition Societies

(FANUS), etc., the ANM will advocate and put voice behind

the nutrition agenda in Africa. The ANS will harness the

continent’s vast natural and human resources to alleviate

hunger and poverty, and advancing the overall effectiveness of

nutritional issues across Africa. Most importantly, the ANS

recognizes the need for stronger leadership and capacity

development. This was most recently articulated in a

publication in the Proceedings of the Nutrition Society (Ellahi

et al 2015). In this paper, the ANS leadership discusses the

need for systematic capacity development in nutrition in

Africa. At FANUS’s recent conference in Arusha, Tanzania

during which ANS played a leading role, deliberations

emphasis was placed on the need for African nutritionists to

strengthen South-South collaborations that will bring together

partners with distinct and complementary strengths, foster the

promotion of closer technical and economic cooperation

amongst each other, share best practices and build

partnerships.

Africa’ nutrition matters (ANM) is calling for reflection on

innovative actions to support the global efforts to ending

hunger and malnutrition in Africa. As the voice of ANS and

heartbeat of ANS on nutrition matters across the continent of

Africa, ANM is committed to sharing knowledge and

information relevant for actions and connect researchers,

policy makers, implementers and beneficiaries. ANM will also

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 sub-

editor 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


Scaling Up Nutrition Leadership Development in Africa (SUNLEAD)

From the 26th May- 4th June 2015, Scaling Up Nutrition

Leadership Development in Africa (SUNLEAD) workshop

2015 was held in at North West University in Potchesftroom,

South Africa. SUNLEAD is an advanced leadership program,

whose purpose is to develop leadership capacity among

nutrition scientists, program implementers, academics,

government, industry and NGO workers who had previously

participated in the African Nutrition Leadership Program

(ANLP). All ANLP alumni since 2001, were eligible to apply

for this program. After a competitive process, eighteen Alumni

were selected to participate.

The SUNLEAD initiative aimed to support the different

efforts to Scale Up Nutrition in Africa. It recognized that there

is a significant capacity gap in nutrition and a dearth of leaders

who are passionate about nutrition and African development.

For eight days, participants where challenged with study on

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)

3) The way forward for SUNLEAD (Johann Jerling).

The workshop was facilitated through a range of interactive

activities including role play, discussions, individual and

group assignments. Participants were introduced to key

concepts in change management, Polarity management,

managing resistance to change, developing values and more.

A key fourth pillar was the peer-to-peer feedback and

feedback from facilitators and mentors. Participants gave each

other feedback on how they could improve their leadership

capacity. Each participant had the opportunity to observe at

least two of their peers who they later gave positive and

constructive feedback on what they could do to improve their

leadership style. As with ANLP, reflection was a very

important component. Participants were encouraged to reflect

each evening and document their reflections in a leadership

journal. In addition, Aha! moments were pasted on the walls in

the conferences rooms as they arose throughout the sessions.

Indeed the theme for this workshop was commitment. During

the application process commitment was the main thing

expected from participants.


Nutrition in the post 2015 development agenda By Dia Sanou & Nonsikelelo Mathe

In the 1990’s, the UN Secretariat initiated a process to build

consensus on global development priorities for the 21st

century (Hulme 2009). This process led to the adoption by 189

UN member-states of the Millennium Declaration at the

Millennium Summit held in September 2000. This declaration

set a “roadmap for world development by 2015” to eradicate

extreme poverty and improve the health and welfare of the

world's poorest people within 15 years. Eight time-bound

goals with 18 quantified targets, known as the Millennium

Development Goals (MDGs), were published a year later in

August 2001, to serve as the framework of international

development cooperation. Goal 1 of the declaration called for

eradicating extreme poverty and hunger. The nutrition related

target of this MDG 1 was to reduce by half the proportion of

people suffering from hunger (UN 2015). Mention the links to

the other MDGs

Countries have progressed unevenly worldwide with the

MGDs. The least progress in reducing child under-nutrition

has been made in Africa. The 2014 Global nutrition report

suggested that many countries are simultaneously facing a

rapid increase in both number of stunted children and those

affected by obesity (Haddad Global 2015).

Challenges ahead are very important, yet let’s be proud of and

celebrate the many accomplishments thanks to various efforts

at different levels. Indeed, the MDGs have created an

unprecedented momentum around nutrition in the last two

decades leading to an increase in commitment and new

initiatives particularly in developing countries. The proportion

of underweight children in developing countries has fallen

(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

Declaration on Nutrition and Framework for Action

(FAO/WHO 2015), the European Union Policy Framework for

Enhancing Maternal and Child Nutrition in External

Assistance (EU 2015) and the European Commission Action

Plan on Nutrition (EU 2013) and The USAID Multi-Sectoral

Nutrition Strategy USAID 2015 – 2025 (USAID 2015).

Learned bodies dedicated to advancing the nutrition agenda in

Africa are being created at national level and FANUS has

created a continental platform for these learned national

societies, Leadership development programmes (e.g. African

Nutrtiion Leadership Programme (ANLP), PLAN and

SUNLEAD-Africa) have been established. Since 2002, ANEC

conferences are being held regularly and the African Nutrition

Society (ANS) was established in 2008 to serve as an umbrella

to this important event.

How to sustain progress and transform pre 2015 commitments

into actions after 2015?

MDGs have created an increased recognition for nutrition as

central element for economic development and growth. About

37 African countries joined the Scaling Up Nutrition (SUN)

movement (SUN website). To sustain the commitment and

translate momentum into concrete actions for better results, a

high level panel appointed by the UN secretary general for the

post-2015 development agenda. The panel established an

Open Working Group to develop a set of sustainable

development goals and appropriate actions that are aligned

with the post-2015 development agenda. The working has

proposed a set of 17 indicators accompanied by targets which

are further elaborated into indicators with measurable outcome


(Open Working Group 2014). In line with nutrition, SDGs

have defined a stand-alone goal for hunger and malnutrition

which is an important progress compared to the MDG where

poverty and hunger were combined to form MDG 1 (UNSCN

2014). Another feature of the post-2015 development agenda

is the emphasis on stunting for many reasons: 1) stunting is the

type of undernutrition that affects a large number of children

globally and more than 80% of stunted children are living in

poor-resource countries; 2) stunting is associated with high

death rates and those surviving are at exposed to long-term

negative consequences such as impaired development, poor

cognition, decreased learning capacity and educational

performance in childhood, lower productivity and reduced

adult wages in adulthood and increased risk for nutrition

related chronic diseases in adulthood; 3) there is a critical

window – from conception to the first 2 years of life – to

implement cost-effective interventions in order to reduce the

health consequences of stunting ; 4) stunting is correlated with

poverty and other nutrition related SDG’s indicators; 5)

chronic undernutrition is a cross-cutting problem calling for a

multisectoral response and therefore stunting has potential for

sustainable impact (de Onis et al. 2013).

There are many opportunities, yet the major challenge for

stunting reduction is one of multisectorial planning and

implementation. Indeed, given the multifactoral nature of

chronic malnutrition, reducing stunting will require

maximizing intersectorial – health, agricultural, education,

social protection, water and sanitation, poverty reduction and

gender - nutrition sensitives strategies and to enhance and

expand the quality and coverage of nutrition-specific

interventions (Gillepsie et al. 2013). Multisectorial planning

also involves establishing a functional and effective

coordination mechanism and creating and sustaining enabling

environments and processes to translate policies into result-

oriented actions on the ground.

References

de Onis, M., Dewey, K. G., Borghi, E., Onyango, A. W.,

Blössner, M., Daelmans, B., Piwoz, E. and Branca, F. (2013),

The World Health Organization's global target for reducing

childhood stunting by 2025: rationale and proposed actions.

Maternal & Child Nutrition, 9: 6–26. doi: 10.1111/mcn.12075.

FAO / WHO 2015 . The Second International Conference on

Nutrition – Committed to a future free of malnutrition. Food

and Agriculture Organization of the United Nations. 24 p.

Gillespie S, Haddad L, Mannar V, Menon P, Nisbett N (2013)

The politics of reducing malnutrition: building commitment

and accelerating progress. Lancet 382: 552–569. doi:

10.1016/S0140-6736(13)60842-9. pmid:23746781.

Hulme D, 2009. The Millennium Development Goals

(MDGs):A Short History of the World’s Biggest Promise.

BWPI Working Paper 100. 52 p.

International Food Policy Research Institute. 2014. Global

Nutrition Report 2014: Actions and Accountability to

Accelerate the World’s Progress on Nutrition. Washington,

DC.

United Nations, 2014. Open Working Group Proposal for

Sustainable Development Goals. document A/68/970. 24 p.

http://undocs.org/A/68/970

UN millennium project 2015. Millennium development goals

what are their?

http://www.un.org/millenniumgoals/

UNSCN, 2014. Priority Nutrition Indicators for the Post-2015

Sustainable Development Goals. 2 p.


Goal 1: End poverty in all its forms everywhere

Goal 2: End hunger, achieve food security and improved

nutrition and promote sustainable agriculture

Goal 3: Ensure healthy lives and promote well-being for

all at all ages

Goal 4: Ensure inclusive and equitable quality education

and promote lifelong learning opportunities for all

Goal 5: Achieve gender equality and empower all

women and girls

Goal 6: Ensure availability and sustainable management

of water and sanitation for all

Goal 7: Ensure access to affordable, reliable, sustainable

and modern energy for all

Goal 8: Promote sustained, inclusive and sustainable

economic growth, full and productive employment and

decent work for all

Goal 9: Build resilient infrastructure, promote inclusive

and sustainable industrialization and foster innovation

Goal 10: Reduce inequality within and among countries

Goal 11: Make cities and human settlements inclusive,

safe, resilient and sustainable

Goal 12: Ensure sustainable consumption and

production patterns

Goal 13: Take urgent action to combat climate change

and its impacts

Goal 14: Conserve and sustainably use the oceans, seas

and marine resources for sustainable development

Goal 15: Protect, restore and promote sustainable use of

terrestrial ecosystems, sustainably manage forests,

combat desertification, and halt and reverse land

degradation and halt biodiversity loss

Goal 16: Promote peaceful and inclusive societies for

sustainable development, provide access to justice for all

and build effective, accountable and inclusive

institutions at all levels

Goal 17: Strengthen the means of implementation and

revitalize the global partnership for sustainable

development


Proposed Sustainable Development Goals (SDG) by 2030

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

GLOBAL NUTRITION TARGETS endorsed by Member States

at the 65 th World HealthAssembly (WHA 2012)

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

Percentage of infants less than 6 months of age who are exclusively breast fed

Goal 2, Target 2.2 and Target 2.1 and Goal 3, Target 3.2

Percentage of women of reproductive age (15-49 years of age) with anaemia

Goal 2, Target 2.2 and Goal 3, Target 3.1

Prevalence of overweight (high weight-for-height) in children under 5 years of age


Percentage of infants born with low birth weight (< 2,500 grams)


DIETARY DIVERSITYThe percentage of women, 15-49 years of age, who consume at least 5 out of 10 defined food groups

Goal 2, Target 2.1

POLICY Percentage of national budget allocated to nutrition Goal 2, Target 2.2a1 - 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’.

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 first target of the first MDG was to halve the amount of

people that earn less than $1.25 a day between 1990 and 2015;

which were achieved in 2010, five years ahead of schedule

(UN). This was equivalent to 700 million less people living in

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

three-quarters of them live in rural areas and rely on

agriculture as a primary source of income. Hence improving

agriculture will have a significant impact on mitigating

poverty. With support to boost agricultural production small-

scale farmers are better able to diversify their produce and

grow higher value crops, which can benefit both themselves

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

agricultural development has a major role to play in promoting

economic growth, food security and dietary diversity.

An improvement in diet quality (increased consumption of

healthier foods) in Sub-Saharan Africa is needed as it has been

reported that dietary patterns have not improved during the

MDG time period between 1990 and 2010 compared to other

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

healthier dietary patterns. This is important given the

prediction that close to 75 percent of all deaths and 60 percent

of all disability-adjusted life years by 2020 will be as a result

of diet-related non-communicable diseases (Imamura et al.,

2015).

In low-income groups across Africa, a monotonous diet

consisting primarily of staples such as maize and cassava can

also render individuals susceptible to a chronic intake of

foodborne toxins including aflatoxins and cassava cyanide

(Wu et al., 2014). Incidences of immunotoxicity, cancer,

neurological deficits and growth impairment have all been

associated with regular exposure to such toxins (Wu et al.,

2014). This further strengthens the argument for improved

dietary diversity, as consuming a balanced diet would translate

into an increased intake of nutrients to counteract the toxin

exposure (Wu et al., 2014).

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,

including the improvement of public policy, the promotion of

multi-sectorial community-based strategies, as well as

empirical research into market creation for small-scale farmers

(Johns and Eyzaguirre, 2006).

References

Imamura, F. et al (2015). Dietary quality among men and women in 187

countries in 1990 and 2010: a systematic assessment. Lancet Glob. Health 3,

e132–e142.

Johns, T., and Eyzaguirre, P.B. (2006). Linking biodiversity, diet and health in

policy and practice. Proc. Nutr. Soc. 65, 182–189.

United Nations Millennium Development Goals and Beyond. Available at: http://www.un.org/millenniumgoals/poverty.shtml

von Braun, J., et al. (2004). Agriculture, Food Security, Nutrition and the

Millennium Development Goals. IFPRI Essay. Available at: http://www.ifpri.org/sites/default/files/publications/ar03e.pdf.


Diet and the Millennium Development Goals

By Keiron Audain

http://www.ifpri.org/sites/default/files/publications/ar03e.pdf

http://www.un.org/millenniumgoals/poverty.shtml

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

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

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


Enhancing infant and young child nutrition through agriculture for thereduction of vitamin A deficiency in rural communities

By Robert Ackatia-Armah

security at the household level by contributing to energy needs

and providing vitamin A through roots and leaves to nutrient

requirements of millions of rural poor. It is well documented

that micronutrient deficiencies result from poorly diversified

diets, which often are cereal based. Homestead food

production is a great way increase the micronutrient contents

of the diet, provided the produce is consumed at home. In

countries with approaches such as kitchen gardens, CIP

encourages the incorporation of OFSP, a micronutrient rich

crop, into these gardens because both root and leaves are a

great source of many micronutrients.

OFSP varieties are extremely rich in bioavailable beta-

carotene, which the body converts into vitamin A. Moreover, it

contributes energy and significant amounts of vitamins C, E,

K and several B vitamins to local diets. Further, bio-

accessibility of vitamin A in OFSP is increased by the

presence of a small amount of oil in the diet. Just one small

root (100-125 grams) of most OFSP varieties provides the

recommended daily allowance of vitamin A for children under

five years of age (U5). Even at low yields (6 tons/ha), just 500

square meters can generate an adequate annual supply of

vitamin A for a family of five. OFSP can thus be used to

significantly reduce VAD in many parts of Sub-Saharan

Africa.

Through CIP’s sweetpotato scaling up efforts aimed at

agriculture, nutrition and markets under the SUSTAIN

program funded by DFID, CIP is providing technology

transfer support to improve agricultural practices, reduce post-

harvest losses and increase nutrient availability in households

through appropriate crop and food handling, preparation and

storage. This will contribute to increased nutrient availability

and use especially for children, pregnant and lactating mothers

in smallholder farming households.

CIP’s women empowerment efforts encourage women (who

form a significant proportion of smallholder farmers in Sub

Saharan Africa) to channel earned income into the selection of

nutrient rich foods to improve the health and education of their

children. As part of the programmatic approach, CIP links

smallholder farming families to market chains to generate

income and help smallholder families diversify their diet with

increased purchasing power. It is well documented that

increasing women’s control over assets (especially

financial/physical) has been shown to positively impact food

security, child nutrition, education and women’s own well-

being. While women are a natural and key demography

determinant in many of our field based programs, these

programs are also gender-sensitive and consider the role of

both men and women in an attempt to provide the highest

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


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.


Malawi Floods

By Keiron Audain

Improving agriculture, food and nutrition security is crucial

for achieving progress in all Millennium Development Goals

(MDGs) , but especially for the first goal of eradicating

extreme hunger and poverty. With looming climate threats

such as the recent floods in Malawi, safety nets should be put

in place to ensure that the progress made on the MDGs to date

does not slow down or worse begin to regress.

The third target of the first MDG was to halve the proportion

of people who suffer from hunger between 1990 and 2015.

Progress has indeed been made, but the goal remains far from

achieved. In 1990, 40% of children under the age of five were

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

million people remain chronically undernourished, with 99

million being less than five years old (UN, n.d).

Agriculture remains the driving force of economic growth for

many countries, making it the underlying factor to determine

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

practices. For instance, in Malawi 86% of the population live

in rural areas and rely on agriculture crops including maize,

cowpea, beans, rice and tomatoes, as well as livestock (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

(Smith, 2015).

Flooding is far from new to Malawi; in fact it is a regular

occurrence during the rainy season (FAO, 2015). In this

instance however, the heavy rains came ahead of schedule and

had a wider impact as banks of the Shire River, the only outlet

of Lake Malawi, had burst. In addition, the magnitude of the

floods was possibly worsened by the accumulative effect of

deforestation and population pressure.

In 2014, cereal production in Malawi increased by 8%, which

saw the country experience a bumper maize harvest that

lowered the number of people considered food insecure by

more than 50% (FAO, 2015). This all reversed when the

floods came, and by October 2014 Malawi was added to the

list of countries that required external food assistance (FAO,

2015).

Computable general equilibrium models show that Malawi

stands to lose 1.7 percent of its GDP each year as a result of

climate disasters; with small-scale farmers and those from the

southern region of Malawi cited as most likely to be affected

(IFPRI, 2010).

Extreme climate events such as flooding, droughts, high

temperatures and poor rainfall distribution can dramatically

impact farming practices. As the organic content is leached

from the soil and soil nutrients become limited, this inevitably

leads to crop failure (Coulibaly et al., 2015). Well over 63,000

hectares of land and 35,000 hectares of crop land were

believed to be under water as a result of the recent floods

(FAO, 2015).

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


http://www.theguardian.com/world/2015/jan/17/malawi-floods-kill-176-people

crops may be ready by as early as June this year (2015), thus

reducing the dependency on food aid (FAO, 2015).

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.

To date, farm irrigation has been the main agricultural strategy

adopted to cope with floods, yet this accounts for only 10% of

households; with less than 5% engaging in crop diversification

(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

two most important coping strategies when crops fail

(Coulibaly et al., 2015). Casual labour can translate to an

absence of labour on the farm, often when it is most needed;

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

includes climate stress; another includes a lack of agricultural

inputs and technologies. It is evident that the actions of

farmers are in a response to crop failure and not necessarily to

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

improving soil fertility and other soil conservation and agro-

forestry practices that help create sustainable farming systems.

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-

grim-legacy-death-destruction-devastation

FAO (2015) News Article: Farmers in Malawi need urgent help after heavy

flooding. Available at: http://www.fao.org/news/story/en/item/275944/icode/

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.

Pauw K, Thurlow J, van Seventer D (2010) Droughts and Floods in Malawi:

Assessing the Economy-wide Effects. International Food Policy Research

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.

Available at: http://www.ifpri.org/sites/default/files/publications/ar03e.pdf

United Nations Millennium Development Goals and Beyond. Available at:




http://www.ifpri.org/sites/default/files/publications/ar03e.pdf

http://www.ifpri.org/publication/droughts-and-floods-malawi?print

Improvement in the nutrition related MDG through integrated Health Centers in Niger

- Reported by Elom Kouassivi Aglago

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 Santé Integré in french) which are the cornerstone of this challenge.

Good morning, thank you for accepting this invitation. MrBachir Rabiou, you are the director of Foulankoira healthcenter in Niamey involved in the management of maternaland child health care. Can you tell us briefly what are theactivities of your center and since when did you start towork in this center?

B.R: This is a public health center of type 2, meaning that itincludes both a maternity and a laboratory. The objectives ofthe CSIs are to provide a care to the population, to assistwomen to deliver without difficulty and encourage them toattend the health center for treatment after childbirth. Thecenter also includes units which monitor the health of infants.To summarize, we deliver general health care for women atchildbearing age, to pregnant and lactating mothers, andinfants.

What is the treatment procedure for malnourishedchildren and how many do you receive per day or permonth?

B.R Management of sick children is performed weekly forseverely malnourished and every two weeks for other children.However, screening is done daily using anthropometric

measurements mainly weight and height. Daily counseling isalso available for mothers willing to have more informationabout breastfeeding or about any other positive attitudetowards pregnancy. We distribute supplements tomalnourished children. Monthly, we receive 23 severelymalnourished children on average. Five employees of thecenter are dedicated to the care of malnourished children.

Have you had satisfactory results since the opening of thecenter?

B.R: Hundred percent of the children who come to the centerrecover in few months because we have a scaled interventionincluding intensive care. Since the opening of the center itrecorded a satisfactory result because the malnutrition rate hasdecreased significantly.We have many testimonies which corroborate that. Despite thenumber of cases of malnourished children and the smallness ofour center, we always manage to bring in more children.

Do you think that the recovery rate you experience ismainly due to supplements of micronutrients distributed tomothers?

B.R: Not really, distribution of supplements has not reallyparticipated in the reduction of malnutrition in Niger. Incontrary, it contributes to the increase of the number of casesand an increase in the length of hospital stay because somemothers knowingly maintain this malnutrition. Others evenprovoke it for the sole purpose of benefiting from thesesupplements 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 healthcenters like yours and this success?

Centers like the CSI of Foulankoira generally contribute to thereduction 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%


in 2013 to 90% in 2014, which is a huge success.

What are the funding sources of your center?

B.R: We are delighted about the job UNICEF and WFP aredoing. We hope that they will continue it and more otherdonors will be interested to promote health care in Niger.

On a scale of 1 to 10, how much will you evaluate the success rate and patient satisfaction 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 « Thank you »

We also met with one of the nurses at the health center:

Good morning Ms. Karim, you are a nurse at Foulankoirahealth center in Niamey, since when have you beenworking in this center and what are your duties?

Ms. Karim: I have been a nurse in this center for 3 years. Myduty is to measure the weight, height, and arm circumference.I additionally check growth charts for children and body massindex and waist-hip values for mothers.

You are constantly in contact with women andmalnourished children. What is the procedure to acceptchildren to be followed with supplements?

Ms. Karim: After screening, some children are oriented toCRENAM or CRENAS (ed. other specialized health centers)to be followed. We still keep their appointment in our healthcenter every two weeks to check their status, to see whether

there is weight gain or if the weight remains stationary. Frommy experience, we have distributed supplements in the past,but the results were mitigated. We found that some parentsprefer to sell supplements. Therefore, in our center we havedeveloped a revolutionary method. To avoid this unconsciousattitude, we developed home distribution where supplementsare given directly to the children who then consume itimmediately and the consumption is recorded.

What is your general impression about malnutrition trendin Niger?

Ms. Karim: I'm mostly disappointed to say that poverty andlack of hygiene are the one sponsoring malnutrition more thananything. For me, tackling malnutrition should beaccompanied with the fight against poverty.

We are so proud about what you are doing and weencourage you to continue this challenging job whichbrings happiness to the heart of malnourished children ofNiamey. Thank you.

MK: The pleasure is mine.

African Nutrition Matters would like to thank Mr AminouAminou Maman, nutrition expert in Niamey at Centre forResearch and Studies in Nutrition and Food (CRENAP) forhis contribution to this interview.


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:

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 toactively contribute to improving the health of youngMoroccan children through nutrition. Its aim is to raiseawareness on healthy and balanced diets and particularly tocontribute to the fight against micronutrient deficiencies inchildren. The Foundation currently has two programs:The first program is to educate annually more than 4 millionschoolchildren on the basic principles of hygiene and food,through a course adapted to their grade level and given bytheir teacher. The principle of this program is to introduce thegestures and reflexes in each-day living of kids to improvetheir nutrition.

The second program of the Foundation is the distribution ofNUTRILAIT, milk fortified with vitamins and minerals toschool children in rural areas where nutritional deficienciesare reported to be high.

The Foundation distributes breakfast fortified withmicronutrients to children attending school in rural areasof Morocco. How did the idea come to you, and can youtell us how many meals are distributed a day?

AA: The creation of the Foundation originated from CentralLaitière-Danone, an experienced and leading food company inMorocco, regarded as a responsible corporation for itscontributions to improving the living conditions of thepopulation. With its expertise in the industry of milkprocessing and with the support of an expert committee,Central Laitière-Danone has developed a formula of a fortifiedmilk that covers 30% RDA of vitamin A, vitamin D3, iron andIodine representing the major deficiencies reported inMoroccan children. Distribution is done every school-day for23,000 beneficiary children, located in 177 primary schools inrural areas, in the regions of Doukkala and Azilal.

Do you have sufficient financial, human and logisticalresources to sustain these actions?

A.A: Financial resources are mainly provided by CentraleLaitière-Danone which contributes technical support andfinance annualy to support the activities. Our Foundation has ateam of 5 people, including 3 who are on the field every dayand continuously travel more than 1700 km per week todistribute these little enriched breakfasts.

What advantage, or what profit, if it may be thefoundation harvest from this generosity?

A.A: The main advantage is to contribute to a significantimprovement of the nutritional status of children. This affectsboth their health status but also their academic performanceand we have evidence that the program lowers school dropoutrates in rural areas. These children will be healthier and willlive and work in better conditions for a better future.

What is your view on the actions conducted by yourfoundation and the achievement of Morocco's nationalobjectives, including the Millennium Development Goals?

A.A: The actions of our Foundation are directly in line withthe National Strategy for Nutrition (ed. launched in 2012) in


the aspects of enhancing the nutrition component of healthprograms, as well as the integration of nutrition component ineducational programs. These actions are also part of thenational program for fighting micronutrient deficienciesthrough food fortification and nutritional education.

How are children and schools selected to be involved in theprogram?

A.A: We place emphasis on equity in our daily work, and wework closely with our partners in the Ministry of NationalEducation and the Ministry of Health to select the areas ofintervention and the beneficiary schools based on not onlyindicators from food shortages, purchasing indices and humandevelopment, but also on school wastage and accessibility forour distribution teams. .

What difficulties have you encountered, and what actionshave you taken to counter them?

A.A: Difficulties are rather logistical and linked toaccessibility. Many schools are located in remote areas whichlimits the intervention. We have done background work withvarious stakeholders (institutions, local authorities, parents) tobring a solution for every group of schools and allow allstudents of these 177 schools to receive their fortified milk ona daily basis..

Currently, how do you spend your days as director of suchengaging foundation especially the administrative aspect?

A.A: It is certainly an administrative work since there is anoperational management component that runs from theproduction planning of the NUTRILAIT and organization ofits distribution. The administrative component is also tomanage different partnerships and to keep the continuousimprovement of the program and its reputation.

What are your plans for 2015 and beyond?

A.A : We recently published the results of an efficacy studyconducted in partnership with the Unité Mixte de Rechercheen Nutrition et Alimentation of Ibn Tofail University andCNESTEN (ed. National center for nuclear research) directedby Prof Hassan Aguenaou. The results showed an

improvement of the nutritional status of children. Thisreinforces our commitment to continue our work and expand itto more beneficiaries in Moroccan regions where deficienciesrate are high.

Do you think about more partnership? And do you thinkabout expanding the activities of the Foundation in thewhole 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 financialaspects, we have to take into account aspects of logistics andproduction capacity. For sure, more partnership will beessential.

Are you satisfied with the results obtained since thelaunching of the distribution program?

A.A: We started this operation in 2008 with 4,000beneficiaries and gradually we got power to reach themilestone of 23,000 beneficiaries in 2013. The teachers foundbeyond improving school attendance, the seriousness of thestudents in the classroom and improvement of schoolperformance with improved physical condition. We wanted tomethodically verify this observation through an effectivenessstudy. This study revealed a significant decrease in theprevalence 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??), itdecreased from 74.7% to 29.4%, and finally for iron, 50% to36.4%.

If you have to provide an advice to food companies fromwhat you do, what would you say?

A.A: I wish to say that food fortification efficacy has beenproven internationally and according to experts, is the mostcost-effective intervention to reduce micronutrient deficiency.In our case, we decided to fortify milk without beingconstrained by the national policy and we have obtained goodresults. I encourage other actors in food industries to considerthis action which can easily improve the lives of people.

Thank you for sharing your story with us.A.A: My pleasure.


Interview No. 2:

Good morning, Mr. Redouane Allali, you are the Logistics coordinator of the project of the Foundation. Your job is toconvey packs of fortified milk for children participating in the actions of the Foundation, since when did you start thisjob?

R.A: I started this work in 2008, with the launching of the"Nutrition and development" program of the Foundation forChild Nutrition. Initially it concerned only 3700 studentsenrolled at two municipalities in the region of Doukkala-Abda,in 37 schools. This number has increased over the years to 23500 students today, spread over 10 cities including 4 in theDoukkala region and 6 in the region of Azilal through 177schools.

How long and how often do you drive between theproduction site and the regions concerned by theprogram?

R.A: The total distance between the site of production andstorage and the different schools we serve in the two regions isabout 1500 km each week. Each day of the week is dedicatedto the delivery of a group of schools. We usually deliver milkfor the whole week at every school.

Once there, how is the distribution organized?

R.A: When our distribution truck arrives, we unload thealloted amount to the school which we keep in the storage areadedicated for this purpose. We routinely check for the storageconditions whether the milk is kept in good conditions ofhygiene and food safety. Our computer system allows us topreviously edit distribution of the quantities of milkdistributed by school and area. We request order form signedand sealed by the Director of each school so that we can keeptrack of this operation and ensure its proper implementation.

Azilal region is difficult to access, with mountains,sometimes impassable roads and sometimes extremetemperatures. Do you think what you do is worth it?

R.A: Of course yes! Inaccessible area means very isolated andvulnerable villages. The consumption of milk by children inthese villages is a luxury; their parents do not have theresources to deliver. Yes it's worth it, after travellingkilometers in freezing cold or extreme heat, but once there,you feel the joy and gratitude of parents and children, and itmakes me happy to be a member of that solidarity program, itis 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 seriousaccident, very serious, causing structural damage. I washospitalized with multiple fractures, with 40 days off.During this period, my despair was not to participate in therunning of the program. I also remember a very specialmoment, during a delivery round in very extreme climaticconditions, my truck got completely stuck in the mud. I couldnot get out without the help and support of the locals, whogave me a real helping hand, and together we managed to getthe truck on dry land.

Do you have any evidence that children involved in theactivity of the foundation appreciate what you do?

R.A: Kids love our milk; they keep coming to school evenafter the end of classes and year-end exams to consume theirNUTRILAIT and that is constant until the closure of theestablishment during the final holiday. Also considering thetestimony of teachers, children concentrate and participatemore in class. It just brings a smile and health in thesechildren and I have seen it with my own eyes from the start ofthe program till today.

Thank you Mr Allali

R.A: Marhaba (ed. You are welcome, in Arabic)


Review:

Can Moringa adoption and utilization combat under-nutrition?

By Natalie Gyenes & Mary Grimanis

Harvard University - T.H.Chan School of Public Health

Boston Children’s Hospital

Introduction

In a world where the burden of malnutrition still remains the

cause of high children mortality, Moringa oleifera has

captured global attention for its nutritional and health

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

viable source of nutrition during dry season, and has been

controversially referred to as a ‘famine food’ in some areas of

west Africa (Sena, L. et al., 1998). Although there are 13 other

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

of 1 to 3 with 14% of protein, 40% of calcium, 20% of iron

and all of a child’s Vitamin A needs for the day (Fuglie, 2000).

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

nutritional status. The goal of this review is to establish the

current state of research involving Moringa and the

mechanisms through which it affects maternal and child health

and nutrition.

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


100 g FW June 2004(summer)

January 2005(Winter)

April 2005(Spring)

Calcium, mg 434 ± 66 448 ± 48 481 ± 67

Iron, mg 6.24 ± 0.8 9.73 ± 1.0 4.10 ± 2.4

Β-carotene 20.1 ± 1.8 7.8 ± 0.7 13.8 ± 0.9

Vitamin C 244 ± 18 320 ± 28 206 ± 21

Vitamin E 18.1 ± 3.6 17.4 ± 2.6 14.8 ± 2.3

AOA, μmol TE 4380 ± 862 2341 ± 205 4166 ± 1211

Phenolics, mg 558 ± 70 802 ± 54 681 ± 51Source: Yang, R. et al. Nutrition Unit, Plant Breeding Unit,

West Africa Office, AVRDC – the World Vegetable Center

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”

(Yang, R. et. al., 2006).

Clinical Studies

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

in Senegal, Togo, and Benin, reference benefits in nutritional

outcomes and health in children and breastfeeding mothers,

but lack the methodological rigor to evidence these results. Of

the studies reviewed, 6 clinical studies with well-documented

methods were included, 5 of which discuss some aspect of

childhood malnutrition, and one of which references breast

milk production.

One potential avenue through which Moringa can impact early

child development is the development of appropriate recipes

in supplementary feeding programs. Jilcott et al. (2010)

examined weight gains associated with implementing a locally

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

inclusion of Moringa (Jilcott, S. et al., 2010).

Protein

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).


Iron

Though analyses of fresh and powdered leaves indicate

Moringa is iron-rich, few available studies inconsistently

support this characteristic. Of the 6 clinical trials examined, 4

studies used hemoglobin as an outcome measure. In a

randomized trial of 82 moderately anemic lactating women in

Senegal was conducted to examine the potential for Moringa

to affect both iron status and weight gain during the rainy

season (Idohou-Dossou, N. et al., 2011). For three months,

mothers in the treatment group received a weekly dose of

either 100 g Moringa powder, and mothers in the control

group received 120 mg iron sulfate with 0.5 mg of folic acid.

This study concluded that Moringa supplementation did not

improve iron stores in lactating women, suggesting that

although Moringa powder does have high iron content, there

may be low bioavailability, (determined by Idohou-Dossou, N.

et al., to be 2.2%), which seems to contrast hypothesis put

forth by Fuglie (2001). However, Moringa supplementation

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.

A similar study was conducted in Nigeria in 2014, also

focusing nutritional supplementation given to infants aged 6-

12 months who had already been started on complementary

foods at an MCH clinic. The purpose of this trial was to

determine the nutrient value, and acceptability of maize-based

complementary food fortified with Moringa (control diet

60:40 (maize and soybean), treatment diet 60:30:10 maize +

soybean + Moringa leaves) when provided to infants for 12

weeks (Nwosu Odinakachukwu I. C. et al., 2014). After the 12

week intervention period, there was a significant difference in

the mean weight of the treatment group (p<0.05), with no

significant changes in the weight of the control group (Nwosu

Odinakachukwu I. C. et al., 2014). Both groups showed an

increase in blood calcium level, and the control group showed

a significant increase (p<0.05) in blood zinc level. Finally,

hemoglobin levels were higher in the treatment group, and

also showed increases in unsaturated iron binding capacity and

total iron binding capacity (Nwosu Odinakachukwu I. C. et

al., 2014).

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


inadequate supply of breast milk potentially having an impact

on growth and development (Strobel, M et, al, 2007).

A double blind randomized control trial was conducted in the

Philippines to evaluate the effects of Moringa on breast milk

volume (Estrella, C. P. et al., 2000). The study included

women with infants less than 37 weeks of age who were

admitted to the NICU for tube feedings. The treatment group

was provided with 250 mg every 12 hours starting on the 3rd

day postpartum, while the placebo group was given the same

schedule but with flour in the capsules; results demonstrated a

statistically significant higher breast milk volume on the

fourth day (Estrella, C. P. et al., 2000). Though this study did

not directly assess vitamin A, it was the only study that

focused on breast milk volume as a clinical outcome and met

this review’s inclusion criteria.

Knowledge and Awareness

Knowledge and awareness-focused papers using semi-

structured questionnaire formats showed differences in value

associated with Moringa varying by both ethnic groups and

age. It was found that older populations had greater

knowledge and fidelity associated with Moringa (100%

fidelity level for respondents > 65 years, 73.3% fidelity level

for respondents between age 35 and 65, and 46.7% fidelity

recorded for respondents under the age of 35) (Popoola, J. &

Obembe, O., 2013). The significant differences observed

among the ethnic and age groups regarding the uses of

Moringa may allude towards discrepancies in the propagation

of indigenous knowledge (Popoola J. and ObembeO., 2013).

A pilot study in India found that both the feasibility and

acceptability of integrating Moringa into supplementary foods

was high, and that education by way of NGO staff was an

effective method for knowledge dissemination (Nambiar, V. et

al., 2003).

Studies in Nigeria and Zimbabwe demonstrated that different

parts of the plant have been used for nutrition purposes as well

as medicines, but also as a coagulate, as animal fodder and for

firewood (Popoola, J. & Obembe, O., 2013;Maroyi, A., 2006).

A study conducted in Katsina State, Nigeria afound that 98.6%

of respondents had eaten Moringa over the past 20 years

(Ikwuakam O. T. et al., 2013). Another study in Nigeria found

that 73.3% of the respondents use Moringa for medicinal

purposes while 15.6% use it for food and cultural practices

(Kola-Oladiji K.I. et al., 2014). A relatively uncommon

practice in West Africa is the consumption of raw Moringa

leaves, but this form is identified as widely eaten in

Zimbabwe, as it can be harvested during dry season with the

unavailability of other vegetables (Maroyi, A., 2006). A

significant gender difference was also found with respect to

uses of Moringa, significant differences, women preferred to

use Moringa mainly for “food and firewood while men cited

and used the plant for medicine and for demarcating

boundaries” (Popoola, J. and Obembe, O., 2013).

Appropriately, it was found a lack of awareness of Moringa

was found to be one of the major barriers of use; 87% of non-

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).

Perceived Nutritional and Medical Benefits

Willingness to adopt Moringa and perceived constraints for

utilization was an important theme that presented itself in two

of the studies, which is an important aspect to consider when

integrating Moringa into existing supplementary feeding

programs – a practice that has been employed by a number of

non-government organizations and programs (see below). It

was found that the leaves are eaten frequently to treat the

following ailments: malaria, typhoid fever, arthritis, diabetes,

and to boost the immune system (Popoola, J. & Obembe, O.,

2013). It was found that the roots are used for infertility and

high blood pressure, and that the bark, when boiled, is used

against chronic hypertension and, when powdered, is active

against snake and scorpion poisons (Popoola, J. & Obembe,

O., 2013). It was found that there were significant

relationships between the following factors and the nutritional

and health benefits of Moringa, respectively, religion (χ2 =


6.507 and 5.861), level of exposure to information (r = 0.237

and 0.332) and level of awareness (r = 0.484; and 0.383)

(Ikwuakam O. T. et al., 2013). It is important to note that a

similar study conducted in Nigeria concluded that there are no

religious barriers to awareness and knowledge of Moringa,

where findings were equally distributed among the 70%

Christian(,) 28.9% Muslims and 1.1% traditional religion

practicing communities (Kola-Oladiji K.I. et al., 2014).

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

concerns (statistically significant at p<0.01) (Williams, F.E.,

2013).

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

Moringa to alleviate malnutrition in children as well as

pregnant and lactating women, and has stated that there was an

“improvement in malnourished children in just a few days”

(Fuglie, 2001). Peace Corps volunteers in Burkina Faso and

Benin, in addition to Madagascar, have integrated Moringa

agriculture and nutritional programming into a number of

projects (Peace Corps, 2010).World Vision Nigeria has also

included Moringa leaf powder in their recommended home

supplementary feeding recipe for children with malnutrition

(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 (Al-

Bader, S., Daar, A.S., Singer, P.A., 2010).

Conclusions

Though studies have demonstrated a promising beginning

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 in-

vivo and in-vitro studies have demonstrated the chemical

constituents of Moringa, and anecdotal, community-based

qualitative data do indicate benefits for nutrition and health


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.

References

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African Nutrition Matters

Publication by the African Nutrition SocietyISSN: 2412-3757

Volume 3 No. 4 – Summer 2015

Documents

Issue of Summer 2015