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Biofortification As a Vitamin a Deficiency Intervention in Kenya By: Angela Mwaniki

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Biofortification As a Vitamin a Deficiency Intervention in Kenya By: Angela Mwaniki Biofortification as a Vitamin A Deficiency Intervention in Kenya By: Angela Mwaniki CASE STUDY #3-7 OF THE PROGRAM: "FOOD POLICY FOR DEVELOPING COUNTRIES: THE ROLE OF GOVERNMENT IN THE GLOBAL FOOD SYSTEM" 2007 Edited by: Per Pinstrup-Andersen (globalfoodsystem@cornell■edu,) and Fuzhi Cheng Cornell University In collaboration with: Soren E. Frandsen, FOI, University of Copenhagen Arie Kuyvenhoven, Wageningen University Joachim von Braun, International Food Policy Research Institute Executive Summary Vitamin A deficiency is a serious global nutritional • designing a feasible distribution system problem that particularly affects preschool-age that ensures that OFSPs are economically children. Current efforts to combat micronutrient and physically accessible to all households; malnutrition in the developing world focus on and providing vitamin and mineral supplements for • promoting consumer acceptance by creat­ pregnant women and young children and on forti­ ing awareness of its benefits and develop­ fying foods through postharvest processing. In ing innovative products. regions with a high prevalence of poverty, inade­ quate infrastructure, and poorly developed markets Your assignment is to recommend a set of policies for food processing and delivery, however, these to the government of Kenya that would facilitate methods have had negligible impact, and biofortifi­ greater production and consumption of biofortified cation has been proposed as a more effective inter­ sweet potatoes, taking into account the interests of vention. various stakeholder groups. State the assumptions Inadequate dietary intake is the main cause of made in your argument. micronutrient malnutrition in Kenya. It is directly correlated with poverty. Micronutrient malnutri­ Background tion is directly linked to 23,500 child deaths in Kenya annually. Seventy percent of children under More than 40 percent of the world's population age six have subclinical vitamin A deficiency. The suffers from micronutrient malnutrition, including situation is aggravated by a high prevalence of vitamin A, iron, iodine, and zinc deficiencies [Misra diseases and conditions that directly interact with a et al. 2004], A large proportion of this population patient's vitamin A status, such as malaria, measles, is in developing countries. The consequences of HIV/AIDS, and deficiencies of other micro­ malnutrition impose immense economic and nutrients such as iron and zinc. societal costs on countries. Micronutrient malnutri­ tion greatly increases mortality and morbidity Orange-fleshed sweet potatoes have been scienti­ rates, diminishes children's cognitive abilities and fically determined to be a feasible tool for alleviat­ lowers their educational attainment, reduces labor ing vitamin A deficiency. In Kenya the bulk of productivity, hinders national development efforts, sweet potato cultivation is carried out in the and reduces the livelihood and quality of life of all western part of the country, and western Kenya those affected [Welch and Graham 2002], Micro­ also has the highest poverty and vitamin A defi­ nutrient malnutrition interventions may be broadly ciency prevalence. The region was therefore categorized into poverty alleviation strategies, clini­ selected for the first orange-fleshed sweet potato cal interventions, and nutritional interventions. [OFSP] pilot project. Nutritional interventions include dietary diversifica­ Success will have been achieved when Kenya can tion, fortification, supplementation, nutritional offer nationwide use of OFSPs as a vitamin A defi­ education, and, more recently, biofortification. ciency intervention. Options for achieving this Current efforts to combat micronutrient malnutri­ objective may include: tion in the developing world focus on providing vitamin and mineral supplements for pregnant • increasing investments in agricultural women and young children and on fortifying foods research and decentralizing the production through post-production processing. In regions of new sweet potato varieties; with adequate infrastructure and well-established • educating farmers on optimal cultivation markets for food processing and delivery, food practices for OFSPs; fortification has greatly improved the micro­ • providing incentives for farmers to adopt nutrient intake of vulnerable populations, particu­ OFSPs, including a ready market, and larly the urban poor. In cases of inadequate infra­ removing limitations that lead to producer structure, decentralized processing units, and a nonacceptance; high prevalence of poverty, however, fortification programs have not had sustainable impact. In Kenya it is estimated that 23,500 child deaths preventable blindness, but also leads to increased annually are directly linked to micronutrient malnu­ morbidity and risk of mortality. trition and that 70 percent of the children under age six have subclinical vitamin A deficiency Vitamin A deficiency is mainly caused by an inade­ [Micronutrient Initiative and UNICEF 2005], quate dietary intake of the micronutrient. Rapid growth and frequent infections are also critical More than 70 percent of the food-insecure popula­ factors [Underwood 2004], Other micronutrients tion in Africa lives in the rural areas [Heidhues et also affect vitamin A deficiency. The initial signs of al. 2004], Ironically, smallholder farmers—the vitamin A deficiency are night blindness and producers of more than 90 percent of the con­ impaired epidermal integrity manifested by hyper­ tinent's food supply—make up the majority of the keratosis. If left untreated, night blindness is rural food-insecure population. The rest of the followed by xerophthalmia, a disease associated food-insecure population consists of the landless with structural changes in the cornea. Epidemio­ poor in rural areas [30 percent] and the urban logical studies show that consumption of vitamin A poor. Throughout the developing world, agricul­ and carotenoids is inversely correlated with devel­ ture accounts for around 9 percent of gross opment of several types of cancer. Vitamin A defi­ domestic product [GDP] and more than half of ciency during gestation has been shown to induce total employment. In countries like Kenya, where fetal malformations in animals and is likely to have more than 34 percent of the population is under­ similar outcomes in humans. nourished, agriculture represents 30 percent of GDP, and nearly 70 percent of the population Vitamin A deficiency interventions include dietary relies on agriculture for their livelihood [FAO diversification, food fortification, supplementation, 2003], Because rural areas are home to more than nutrition education, food production, and, more 70 percent of the poor and the largest proportion recently, biofortification. The dietary sources of of the food insecure, significantly and sustainably vitamin A are preformed vitamin A and provitamin reducing food insecurity will require transforming A carotenoids. Preformed vitamin A is found in the living conditions in these areas. It is possible, foods of animal origin, whereas provitamin A however, to improve the health status of this carotenoids are found in yellow- and orange-fleshed population through biofortification while at the fruits and vegetables and in dark-green leafy vege­ same time working on long-term poverty alleviation tables. Palm oil is the universal source of pro­ strategies. vitamin A for the pharmaceutical industry. Vitamin A Deficiency Vitamin A Deficiency Alleviation Projects in Vitamin A deficiency is a serious worldwide nutri­ Kenya tional problem that particularly affects preschool- Current vitamin A deficiency interventions include age children. It has been estimated to cause about fortification and supplementation. Although these 70 percent of cases of child blindness worldwide interventions have had significant impact in projects [Underwood and Arthur 1996], Worldwide, 140 where they are administered, the results have not million children under five years of age, of whom been sustainable in the long run, especially in about 70 percent live in South Asia and Sub- resource-poor communities. This is because Saharan Africa, have low serum retinol concentra­ resource-poor households consume an insignificant tions [< 0.7 pimol/L], East and Southern African amount of processed foods, limiting the use of countries have the highest prevalence [37 percent] fortification. In addition, they tend to be situated in of preschool children with low serum retinol con­ remote areas characterized by poor infrastructure, centrations [Mason et al. 2001], The vitamin and its inadequate health care, and insufficient public metabolites are essential for vision, reproduction, funds. This situation limits the use of supple­ and immune function. They play important roles in mentation as a sustainable intervention. Dietary cellular differentiation, proliferation, and signaling. diversification is still the best way to alleviate mal­ Vitamin A deficiency in Kenya is most prevalent in nutrition. It aims at ensuring that the available diet children between the ages of 23 months and 6 is adequate in every nutrient. Dietary diversification years [Ngare et al. 2000] and in western Kenya. is a long-term objective, but it provides some indi­ Vitamin A deficiency not only contributes to cators about what strategies may be sustainable. NGOs, governments, and companies continue to vegetable technology are mushrooming around the make concerted efforts to control vitamin A defi­ country. ciency, especially in resource-poor households
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