69- Hidden hunger or knowledge hunger? Nutritional knowledge, diet diversity and micronutrient intake in Rwanda: The case of Vitamin A Julius J. Okello, Kirimi Sindi, Jan Low & Kelvin Shikuku International Potato Center, ILRI Campus, P.O. Box 25171, Nairobi, Kenya Paper Prepared for Presentation at the African Association of Agricultural Economists Conference, Tunisia, 22-25 September 2013 1 Hidden hunger or knowledge hunger? Nutritional knowledge, diet diversity and micronutrient intake in Rwanda: The case of Vitamin A Abstract The problem of hidden hunger has emerged as one of the major development issues alongside food security. This problem highlights the likelihood of households having access to inadequate amount of key micronutrients in a diet despite having access to adequate quantities of food. , This paper uses a recent detailed household consumption data to investigate households’ nutritional knowledge, the diversity of diets consumed, and the micronutrient uptake, focusing specifically on Vitamin A. The study finds high knowledge of Vitamin A but low understanding of the function of Vitamin A in human bodies. We find a disconnect between the knowledge of Vitamin A and diets consumed by the respondents. Further, the use of diet diversity scores (DDS) reveal a narrow range of foods consumed, with children age 6-23 months most affected. However, the predictions from DDS stand in stark contrast with actual consumption of Vitamin A rich foods. The study concludes that there is high awareness of Vitamin A and Vitamin A-rich foods among rural households although this knowledge does not directly translate into consumption Vitamin A rich foods. The study also concludes that care needs to be taken in using different measures of diet diversity to proxy micronutrient uptake. It discusses policy recommendations of these findings. Key words: Rural households, Nutritional knowledge, diet diversity, micronutrient intake, Rwanda 2 1. Introduction The concept of hidden hunger has become the “buzz word” in the development arena. The phrase is used to describe a situation where individuals/households may have access to food adequate quantity of food but the food is not nutritionally balanced. It implies that individuals may have food but are unable to utilize the food in order to have a functional life. More specifically “hidden hunger” is the lack of the appropriate balance of macro- (calories) and micronutrients (vitamins and minerals such as vitamin A, iron, zinc, and iodine). As part of the effort to tackle the problem of hidden hunger, members of the Consultative Group on International Agricultural Research (CGIAR) formed a “challenge program” called HarvestPlus in 2004. The program was specifically aimed at strengthening and coordinating efforts of the international agricultural research system to enhance micronutrient content in staple food crops. The initiative targeted three main nutritional deficiencies among rural households namely, Vitamin A, iron and zinc consumption. Since its formation, HarvestPlus initiatives have focused attention on breeding for enhanced nutrient content in six staple crops: sweetpotato, maize, beans, rice, cassava, wheat and potato. One of the most successful collaboration efforts by HarvestPlus and International Potato Center (CIP) has been the breeding of sweetpotato varieties with high beta carotene1 content, popularly referred to as the orange-fleshed sweetpotato (OFSP). Recent pilot studies have found evidence that the consumption of OFSP reduces Vitamin A Deficiency (VAD) in children and other members of rural households. Using data from Uganda, Chowdhuri et al (2013) find that consumption of OFSP reduces incidence of VAD. A similar study by Van Jaarsveld et al (2005) in South Africa found that children of age 5-10 feed on daily maeal of OFSP exhibited significantly lower symptoms of VA D. On a broader level, Low et al (2001) found that the substitution of OFSP for the other widely consumed local varieties would significantly reduce VAD. In tandem with enhanced effort to breed for biofortified sweetpotato and in view of the emerging evidence of the benefits of consumption of OFSP, there is intensified effort to develop and promote the consumption of biofortified foods that deliver essential micronutrients. However, 1 Beta carotene is a precursor for Vitamin A 3 emerging evidence suggests that consumers’ lack of awareness of the nutritional benefits of biofortified crop products (Okello et al, 2013). In addition, some of the crops being biofortified e.g., sweetpotato and sorghum have traditionally been viewed as inferior goods which excludes them from higher income segments of the consumers as well as city consumers. In this paper we use a very recent dataset collected by International Potato Center from 596 households in Rwanda to examine the nutritional knowledge, diet diversity and consumption of Vitamin A rich foods. Information about nutritional knowledge of the households, diet diversity and micronutrient consumption levels at the household levels is essential in the cost-effective targeting of efforts to promote consumption of biofortified crops and products in various regions and countries where VAD is an acute problem. The data used in this study was collected through personal interviews from households stratified by region. The regions covered were North (comprising Gakenke, Rulindo and Burera districts) and Southern (comprising Kamonyi and Muhanga districts). The data was collected as a part of the baseline for the project Rwanda Sweetpotato Super Foods project. This project seeks to build an effective public-private sector partnership. The proof of concept project seeks to provide solid evidence that sweetpotato processed products are profitable and acceptable to urban African consumers. Expected impacts also include understanding how to develop efficient and/or gender-equitable organizational model(s) for sweetpotato value chains and enhanced revenues for 500 participant households within 3 years. The districts chosen were where the project had targeted as the intervention areas based on the implementing partners on the ground coverage areas. 2. Methods and Study area The three districts chosen in the Northern region were based on the proximity to the main processor who is the main private sector partner in the project. The private sector partners provide the main market for the sweetpotato roots produced by the project beneficiaries. The private sector is in Rulindo hence we choose Rulindo district and the neighboring district Gakenke plus a few areas on Burera districts that were very near to the intervention areas to be part of the control. In the Southern region two best sweetpotato producing districts in Rwanda were chosen namely Kamonyi and Muhanga districts. 4 The project is testing two organizational models for building a viable sweetpotato based value chain. In model one the private sector partner is contracting individual farmers to produce the desired sweetpotato roots that are processed at their factory. In Model two implementing partners Catholic Relief Services and Young Women Christian Association are working with farmer groups. They chose some existing groups and others were formed for the intervention. So after choosing the groups that were to be intervened we got the list of members in each group. We then used a random table to select the individuals to be interviewed from each group. Therefore the sector was predetermined by the location of the group but the cell and the villages were randomly selected depending on the location of each member randomly selected. If for any reason the member of a group selected was not available for the interview a replacement member was chosen using the same criteria. For the contracted farmers, a list of all the farmers contracted or to be contracted was drawn. Since they were few all of them were interviewed. To have some control, villages were chosen from the nearby sectors that were not to be intervened and a village was chosen at random. A list of the members was drawn and then using random sampling, guided by random table, households to be interviewed were selected. In the event the chosen household in the control was not available another one was randomly selected. Using this procedure trained enumerators then administered the survey instrument in 17 sectors, 46 cells and 126 villages. A total of 596 households were surveyed. 3.0 Results Table 1 provides the summary statistics for the age, education, household size and period spent at home by the respondent for the two study regions. It shows that male and female respondents in the Northern region do not differ much in terms of mean age, household size, highest education attained and period spent in the farm. For instance the mean age of the male and female respondents in the Northern region is 24 years while highest education attained is about standard/grade 5. This implies that most of the study respondents have relatively low levels of education. Similar trends are observed for male and female respondents in the Southern region. Notably, the mean age of male and female respondents is 26years. At the same time, the mean level of education attained is grade/standard 5, the households have on average six members, and the average number of months in the farm is 11 for both female and male respondents in the South. These results suggest that the households in both the North and the South are similar in these key socioeconomic characteristics. 5 Table 1: Key socioeconomic characteristics of survey households, by gender and region highest months at Region Sex age hhd size education home North Female Mean 24.15 6.08 4.45 11.81 N 684 684 683 684 Std. Dev. 15.403 1.968 3.084 1.659 Male Mean 23.88 6.21 4.55 11.62 N 578 578 578 578 Std. Dev. 15.628 1.881 3.221 1.975 Total Mean 24.03 6.14 4.50 11.73 N 1262 1262 1261 1262 Std. Dev. 15.501 1.929 3.147 1.812 South Female Mean 26.27 6.04 4.95 11.53 N 790 790 790 790 Std.