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The Contribution of Small Indigenous Fish to Global Nutrition

Asha Belsan, MPH-PHP Candidate, University of Massachusetts Amherst

Final Report: Cornell University Research Practicum Experience

Site Supervisor: Katie Fiorella, Postdoctoral Fellow, Cornell University

August 2016

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Abstract:

This summer, I chose to participate in a research practicum studying the impact of small

indigenous fish on global nutrition. This practicum aligns well with my overarching goal of

completing my MPH-PHP degree and Global Health Graduate Certificate, in that I want be

equipped with the skills to identify and improve health and nutrition outcomes of people on the

community and population level. Specifically for this research-based practicum, my goal was to

understand how small indigenous fish contribute to global nutrition, and how they can be utilized

in new ways to improve nutrition deficits. My practicum was done remotely in conjunction with

Cornell University and I was fortunate to be able to work on the project with two other Cornell

undergraduate students, Santana Silver and Ismini Ethridge, as well as my site supervisor, Katie

Fiorella, a Postdoctoral Fellow at Cornell. Our team performed an extensive literature review

using several databases and search terms, abstracted the data in all articles found, and is currently

in the process of analyzing the results of the collated nutrition and fishery data. This report will

serve as an update to inform our processes and methods thus far, as well as an outline for our

plan for future publication of our findings.

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Update of Aims and Rationale:

It goes without saying that there are many under-researched and under-addressed public

health issues in our world today, but one of the most significant and ongoing problems is that of

malnutrition, especially in developing countries. Approximately 13% of the population in

developing countries are malnourished, and 1 in 6 children are classified as underweight (World

Food Program, 2016). People living in poverty often consume small indigenous species (SIS)

fish, which are usually widely available and generally do not grow longer than 25 cm (9 inches)

(Galib, 2009). Despite their popularity in many countries, there is minimal information and

analysis available on the current and potential nutritive properties of these fish (Puwastien et al.

1999). Thus, the goals of this research project were to perform a literature review, identify and

abstract SIS fish nutrition, compare our data findings to the data found in the Food and

Agriculture Organization’s InFoods Database, identify gaps in the research, collate the data for

analysis, and determine how these locally available fish can be used to address nutrition issues in

developing countries. Our goals remained the same throughout the project, with the exception of

triangulating with the InFoods Database, which will be discussed in the following section.

This experience most definitely expanded my knowledge about fish nutrition in the

developing world. Though I am very interested in global nutrition, I was not very well educated

about small-scale fisheries and the consumption of SIS fish in developing countries. The

practicum has allowed me to delve into this area of research and has brought to light the

importance of identifying areas of nutritional deficit, and understanding how locally-available

SIS can be used to reduce these deficits. One of my main career goals is to be able to improve

population health outcomes while utilizing readily-available resources in an area, as opposed to

coming in with “Westernized” ideas that do not take into consideration the history and deeply

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rooted culture of a people group. Thus, I feel this research project has allowed me to learn the

foundation of information that I can now use to build my Capstone upon.

Update of Approach, Methods and Findings:

My original approaches and methods included the completion of three things: literature

review, triangulation with InFood Database, and summarizing fish nutrition. For the literature

review, we used specific words, phrases, and cabicodes to discover relevant articles on small fish

nutrient composition information and use of small fish as food in developing regions. I contacted

a librarian from UMass Amherst, who was very helpful and gave me advice on how to use

additional search tools such as Agricola to locate relevant fish nutrition information. Initially, my

goal was to find all available articles through a literature review, abstract the data, analyze the

data, and be able to report my findings and offer suggestions for nutrition improvement, all by

the end of the practicum time period. However, I soon realized that while the topic of SIS fish is

not widely researched or reported, there are still a significant number of articles available from

many databases, dating back to 1987. In addition, since the literature review is the foundation of

this project, it must be done methodically to allow for easy replication. During the literature

review, we kept an updated Google Drive spreadsheet of databases, search terms, and articles

that yielded relevant results.

The next step we planned to take was to triangulate with the InFoods Database. This is a

cumulative, ever-growing database run by the Food and Agriculture Organization that documents

nutrition information of foods from all over the world. Anyone is encouraged to contribute to the

database in order to have the most recent and thorough information available. Our original plan

was to determine whether the information we found during the literature review was present in

the InFoods databases, but upon examining the databases, this task it proved to be time-

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consuming and difficult, primarily due to some language barriers and the way the data was

presented and referenced in the tables. Thus, in the interest of time, we collectively decided to

eliminate this step and focus on data abstraction.

When relevant articles were found, we abstracted the data and categorized it into tabs

labeled “Nutrition Composition” and “Fishery and Use”. For the “Nutrition Composition”, we

extracted nutrient information from relevant tables reported within the article. Each type of fish,

processing method, and nutrient info was listed on a separate line. All relevant nutrient

composition information was entered, and the units were recorded as they were presented in the

articles. We decided to record 5 different polyunsaturated fatty acids of interest: ALA, LA,

DHA, EPA, and ARA, and decided to forgo amino acids. For “Fishery and Use”, we recorded

information about the location of the fisheries, the size of the fish, and the way they are

processed, perceived, and valued in the fisheries and communities. The conclusions of the

articles were also recorded in this document.

We came up with a total of 75 relevant articles (93 total) and listed them in a Progress

document in the Google Drive. Since there are multiple people working on this project, the

Progress document allowed everyone to view in “real time” which articles were abstracted and

which articles were not. We did find several articles that we initially though had relevant

nutrition data, but after careful reading, it was decided to omit the articles due to irrelevant

information. I was surprised at how long the data abstraction actually took, but I know it was

imperative to record the data correctly in order to conclude accurate results.

At the time this report is being written, we are finishing up the data abstraction and

entering into the data analysis stage. Our plan going forward is to write a report which will

include an abstract, introduction, methods, and results sections. We will also create summary

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tables organized by continent which will present the number of studies, fisheries, types of fish,

and nutrition content. We also plan to submit our collated findings to the WorldFish organization

for use by researchers and other interested parties. Furthermore, and what will be different

because of this practicum, is that I plan to use the practicum project as a starting point for my

capstone project next semester. Using our research as a foundation, I plan to focus on a particular

country and create a culturally-appropriate health education program to encourage consumption

of SIS fish using various cooking methods or consumption of other parts of the fish (i.e. eyes or

bones) to reduce nutrition problems such as Vitamin A deficiency and calcium deficiency. So

far, this research practicum has evolved very similarly to how I anticipated it would, and I would

not change anything about our research approach or progression.

At the beginning of this course, I chose five competencies as goals for my practicum

experience. Below is an update on my progress towards meeting those goals:

1) Describe origins of current public health and health care dilemmas: I have met this

competency. Wild, indigenous fish serve as essential nutrition to many populations across the

globe, especially in developing regions. However, the exact nutrition these fish provide is not

fully understood, due to poor and inconsistent data collection and recording. Throughout this

practicum, I was able to understand how small scale fisheries provide fish to developing regions,

and the type of nutrition these fish offer. Malnutrition is a significant issue in developing

countries, and fish can be used to address these issues with proper cooking and processing

methods.

2) Research and propose an innovative new approach to health promotion: This

competency is one of my goals for next semester. I plan to use this research project as a starting

point, and develop a culturally-appropriate health promotion program focused on improving

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major nutrition deficits in South Asia. This program will educate and encourage populations to

adopt various cooking methods and processing using under-utilized parts of these locally

available fish to improve nutrition.

3) Interpret study findings from research literature and apply that knowledge to a

public health or health care problem: I have met this goal. As part of a team, we were able to

search various databases for relevant articles related to SIS nutrition and small-scale fisheries.

We kept track of search terms, which helps us understand how fish nutrition is represented in

research.

4) Employ appropriate quantitative or qualitative methods to analyze data on a public

health or health care issue: I am in the process of meeting this goal. At the time of this report,

we are finishing up the data abstraction and moving into the data analysis phase. This analysis

will be useful to help us gain a more well-rounded understanding of the changes occurring in the

utilization of various fish species in human diets.

5) Explain the influence of environmental factors on the public’s health: This

competency is another goal for next semester. As part of my Capstone project, I plan to examine

the impact of climate, pollution, and environmental changes on fish populations, and how these

changes consequently impact fish health and reproduction.

Reflection on the Practicum:

I am pleased with the progression of my practicum experience. Given the nature of this

research project, I am planning to continue working on it to provide a foundation for my

Capstone project next semester. In addition, though the practicum time period has nearly ended,

the project’s work has not, so I feel it is only fair to continue remaining on the research team

until the project is complete. One of the best parts about this practicum was working with my

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supervisor, Katie, as well as the other students, Santana and Ismini. It was very helpful to have

them assist with the research, abstraction, and analysis, as they all have backgrounds in global

health and nutrition. It was especially beneficial to have Katie leading the team, as she provided

guidance and expertise, and facilitated communication regarding all aspects of the project.

One challenge that I encountered in this process was getting into the groove of working

remotely with other people. In the past, I have done research projects independently and have

been able to organize my articles, findings, and final report in a way that works well for me.

Working with others and seeing different approaches to even simple things such as naming a

document or creating an article citation has been challenging at times. I do not feel as organized

as I would if I were doing this project independently, but I think I have improved in being able to

identify concerns and raise questions as they come. Another challenge that became evident

during my actual research was that I had difficulty knowing when to include articles and when to

exclude articles. For the first several weeks of this project, I was using specific search terms to

find articles that gave nutrition information on small indigenous fish. I noticed the line became

gray at times when I would find articles that may (or may not) be outside of our scope of interest.

I ended up including the articles in question, with the plan that we could always throw them out

when doing data abstraction if the information was determined not to be relevant. Finally, the

timeline of the research project was challenging only because it did not completely align with the

timeline of the practicum course. Research is usually very difficult to constrain to a time frame,

as it almost always involves “charting new waters”. Thus, the research project was not completed

at the same time this course final report was due. I was hoping the data would be analyzed and I

would be able to explain our conclusions, but I dealt with this issue by working ahead on the

conclusion of a small area of our focus.

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The person that had the most impact on my practicum experience was my site supervisor,

Katie Fiorella. From the very beginning, Katie was extremely involved, and never seemed

deterred by the fact that we live in different states or that I was attending a different university.

She implemented weekly Skype meetings which began with the two of us, and then expanded to

include Santana and Ismini when they joined the project. This was very helpful to ensure

everyone was on the same page and to address issues that arose with our research, abstraction,

and data analysis. I am aware that not all site supervisors are as involved as Katie is, so I

consider myself fortunate to have her guidance and supervision on this project. In particular, I

think her open communication via weekly calls and emails have made my practicum a very

efficient and enjoyable experience.

Overall, though this practicum experience was remote and not in-person as I had

originally planned, it proved to be a rewarding and challenging experience that allowed me to

expand my knowledge in global health and nutrition.

Future Directions:

As we finish up data abstraction and move into data analysis, we will be looking for

relationships between nutrition present in locally-available fish and the types of malnutrition

present in various continents and regions. We hope to be able to address these malnutrition issues

by understanding which SIS offer high vitamin and mineral contents that address malnutrition

issues, and recommending increased production and consumption of these particular fish. To

illustrate, here is a small-scale example using the country of Bangladesh:

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Common SIS fish present in Bangladesh: (references: Bogard et al. 2015; Roos et al. 2003; Roos et al. 2007)

Common Name Scientific Name

Mola Amblypharyngodon mola

Darkina Esomus danricus

Rui Labeo rohita

Chanda Parambassis baculis

Koi Anabas testudineus

Chikra Macrognathus aculeatus

Puti Puntius sophore

Taki Channa punctuatus

Tengra Mystus vittatus

Najari Icha Macrobrachium malcolmsonii

Trey changwa plieng Esomus longimanus

Malnutrition concerns and associated illnesses/diseases:

Malnutrition Concern: Major associated Illness/Disease

Calcium Rickets (Roy et al. 2011)

Vitamin A deficiency Night blindness, infant mortality (FAO, 1999)

Iron deficiency Anemia (FAO, 1999)

Iodine deficiency Goiter (FAO, 1999)

Zinc deficiency Physical and mental development problems (FAO, 1999)

SIS fish and major nutrients present:

Fish High source of:

(for raw, edible parts)

Puti, Tengra Calcium (Roos et al. 2003))

Mola, Chanda Vitamin A (Roos et al. 2003)

Darkina Iron (Roos et al. 2003)

Najari Icha, Darkina Iodine (Bogard et al. 2015)

Trey Changwa Plieng Zinc (Roos et al. 2007)

Conclusion:

In conclusion, this practicum experience was extremely beneficial in developing my

research skills as a future public health professional. As we continue to identify and address

global health issues, research remains the foundation of effective solutions. For this project, we

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have successfully performed a systematic literature review and have been able to collate SIS

nutrition and small-scale fishery data. Going forward, we will analyze the data, summarize our

findings, and recommend ways to improve nutrition using locally-available fish. We are

confident that our research will prove to be a valuable resource for other public health

professionals, and we plan to submit our work for publication. Overall, this practicum has been a

very positive experience and I have enjoyed working with Satana and Ismini, and especially with

my advisor, Katie. Working together reiterated the importance of teamwork, communication,

thoroughness, and keeping detailed records – all of which are valuable skills of a public health

professional. I know I will be able to look back fondly on this project and I hope to be able to use

this research in my future public health career.

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References:

Bogard, J.R, Thilsted, S.H., Marks, G.C., Wahab, M.A., Hossain, M.A.R., Jakobsen, J., &

Stangoulis, J. (2015). Nutrient composition of important fish species in Bangladesh and

potential contribution to recommended nutrient intakes. Journal of Food Composition and

Analysis 42: 120–133.

Food and Agriculture Organization (FAO). (1999). Nutrition Country Profile – BANGLADESH.

Retrieved from: ftp://ftp.fao.org/es/esn/nutrition/ncp/BGDmap.pdf

Galib, S.M. (2009). Small Indigenous Species (SIS) of Fishes. BdFISH Feature. Retrieved from:

http://en.bdfish.org/2009/11/small-indigenous-species-sis-of-fishes/

Puwastien, P., Judprasong, K., Kettwan, E., Vasanachitt, K., Nakngamanong, Y., &

Bhattacharjee, L. (1999). Proximate Composition of Raw and Cooked Thai Freshwater

and Marine Fish. JOURNAL OF FOOD COMPOSITION AND ANALYSIS 12, 9-16

Roos, N., Islam, M.M., &Thilsted, S.H. (2003). Small Indigenous Fish Species in Bangladesh:

Contribution to Vitamin A, Calcium and Iron Intakes. The Journal of Nutrition, 133(11),

4021S-4026S

Roos, N., Wahab, A., Chamnan, C., & Thilsted, S. (2007). The Role of Fish in Food-Based

Strategies to Combat Vitamin A and Mineral Deficiencies in Developing Countries. The

Journal of Nutrition, 137(4), 1106-1109.

Roy, S.K., Rakib, R., Alam, N., Haque, S., Das, H.K., Ali, M., Talukder, T.H., Rahaman,

S.M.M., Chowdhury, M.A.R., Amin, S., Iqbal, M., Bhuiya, A., Khanam, M., & Begum,

A. (2011). Rickets in Bangladesh: An Emerging Public Health Nutrition Crisis. High

burden of childhood rickets in Bangladesh: The first national prevalence survey of

mineral deficiency. ICDDR,B, Bangladesh & Rickets Interest Group (RIG), Bangladesh

(UNICEF, NNP, CARE, BRAC, SARPV, Plan BD). Retrieved from:

http://www.capgan.org/downloads/2011congress/Swapan%20Roy%20rickets%20CAPG

AN%202011.pdf

World Food Program. (2016). Hunger Statistics. Retrieved on August 15, 2016 from:

https://www.wfp.org/hunger/stats

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Attachments:

Below are screenshot examples of data recorded in Google Drive: