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Addressing micronutrient deficiencies associated with the double burden of childhood malnutrition in China, a combined food system framework
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
The double burden of malnutrition (DBM) is a concept that describes the increasing prevalence of both undernutrition and overnutrition within the same communities, especially in low- and middle-income countries (LMICs). Both of these elements of malnutrition contribute to the burden of disease. Common to both are deficiencies in micronutrients (MND) such as iron, zinc, and vitamins, all of which are needed for healthy growth and development as well as maintaining general health and productivity. In China, despite rapid economic development, tens of millions living in rural poor communities lack food diversity and are frequently nutrient deficient, whilst urban populations show a rapid rise of obesity owing to unhealthy diets and imbalanced energy intake. Such micronutrient deficiencies (MND) associated with DBM are particularly problematic in children. Within the "Nutrition First" program under the "Healthy China 2030" national development strategies, interventions such as Ying Yang Bao (YYB), a soybean-based micronutrient supplementation package targeted at children, and biofortified crops with enriched micronutrients iron, zinc, and vitamin A etc., together with nutrition education and food diversity have been developed. These have been shown to be effective at improving nutrition in children affected by malnutrition/MND. However, outside of nutrition trials there is a challenge to promote uptake of these interventions. Combining expertise from the UK and China on nutrition and food systems, the focus of the current research is to determine the barriers to uptake of such interventions and to explore novel approaches to promoting their uptake, with the overall aim of improving child nutrition and health. Food is a key part of Chinese culture. Some foods that are considered to be healthful, such as sweet potato, millet, etc., have gone out of fashion and are seen as food for the poor. On the other hand, there may be an inherent resistance to unfamiliar food items for children such as YYB, and concerns about safety of food and biofortification. We will test the acceptance of context specific interventions in children in different age groups. In children from deprived areas, the benefits of early exposure to YYB for enhanced acceptance will be tested in children aged 6 months to 2 years old. Acceptance of biofortified foods (zinc+/iron+ wheat and b-carotene+ sweet potato) will be tested in nursery and school children based on the early exposure and uptake hypothesis. For urban school children at risk of obesity, the intervention will focus on increasing the diversity and optimising the nutrient content of the diet. Feasibility testing of an enhanced diet diversity, food supplementation and biofortification, and nutritional knowledge education will be studied using a survey method at school, family and community levels. Our research will engage with local communities, families and particularly mothers, to explore the determinants of malnutrition and MND, and the social and cultural barriers to uptake of nutrition interventions. When barriers to and drivers of uptake have been identified, photographic exhibitions using a story-telling approach to highlight positive messages will be used to promote the interventions in local communities, with social media campaigns to spread the word and promote engagement. We will develop a scalable food system-based intervention package for malnutrition/MND, and build this into the national food and health policies and guidelines. We will broaden the potential beneficiaries of the nutrition interventions by engaging with experts in Vietnam through communication and capacity-building activities.
Intervention Co-creation to Improve Community-based Food Production and Household Nutrition in Small Island Developing States (ICoFaN)
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
One in five members of the United Nations are small island developing states (SIDS): 38 countries with a combined population of 61 million. The majority of these are poor, eligible for official development assistance, and over a quarter are 'least developed' countries. They have high burdens of malnutrition, including overweight and obesity alongside anaemia in women of reproductive age, and additionally some, such as Haiti, also have high burdens of childhood stunting. Over the past 3 decades malnutrition in SIDS has been exacerbated by an increasing reliance on food imports, the majority of which are of low nutritional quality. SIDS Governments have committed to increasing the local production and consumption of nutritious food as a way of increasing food security and sovereignty and addressing the high burden of malnutrition related morbidity and mortality. This proposal is intended to add to the evidence base and research capacity to support these policy commitments. The proposal builds on development work undertaken in partnership with the Universities of the South Pacific and West Indies in two SIDS: Fiji and St Vincent and the Grenadines (SVG) respectively. Through this work evaluation methods were developed and pilot data collected. In addition, relationships were established with two local and very well established NGOs, the Foundation for Rural Integration and Enterprise Development (FRIEND) in Fiji and Richmond Vale Academy in SVG. In this proposal we will co-create community based interventions to improve local food production and consumption with these two NGOs and evaluate their impacts on household nutrition and household expenditures. Mixed methods will be used, including quantitative household surveys, qualitative in-depth group interviews and photo voice. The design of the interventions will be informed by preliminary work that identifies and appraises available evidence on current dietary intakes in those settings, and the nutritional value of locally produced foods. The design will also be informed by 'mapping' the food systems in Fiji and SVG. This will be done by engaging stakeholders from across the food value chain in a participatory process, including a workshop, in which the factors, and the relationships between them, contributing to the burdens of malnutrition will be drawn. In addition, to the full development and testing of interventions in Fiji and SVG, new work will be undertaken in Haiti. In Haiti available dietary and nutritional evidence will also be collated and appraised, and stakeholders engaged in mapping the food system. Pilot data will be collected in the Nippes region of Haiti, including on household nutrition and the opportunities for increasing household and small holder food production as a means to improving nutrition. This work will inform the design of an intervention ready for further roll out and evaluation.
The production and promotion of nutrient rich foodstuffs to address the double burden of malnutrition.
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
The United Nations have declared 2016 to 2025 as the decade of action to eradicate all forms of malnutrition worldwide; ensuring access to healthier and more sustainable diets for all, regardless of location and whoever they are. This brief also encompasses the double burden of malnutrition now facing most societies and characterised by the coexistence of undernutrition along with overweight, obesity or diet-related noncommunicable disease (NCDs). The proposed project "NUTRIFOOD" will improve the nutritional quality of diets in West Africa by identifying new nutritionally enhanced varieties of tomato, amaranth, cassava and yam; incorporating these fruits and vegetables and their derived products into the food systems will diversify the existing food basket and provide improved quality. The project will draw upon global resources and expertise, utilising unique germplasm. The tools and resources developed are generic in nature and although our focus will be Nigeria and Benin in West Africa the findings can be translated across other SSA countries and Low Medium Income countries globally. Fruit and vegetables are rich in provitamin A. One of our key performance indicators will be the provision of foodstuffs with the potential to reduce Vitamin A Deficiency (VAD). VAD is widespread in low-income countries and prevalent in sub-Saharan Africa (SSA) where 83% of children aged 2 to 5 years exhibit VAD. As a result of this malnutrition, 500,000 cases of blindness and 1.25 million deaths occur annually. With this aim, NUTRIFOOD will focus on high provitamin A fruits and vegetables as well as the high caloric staple crops cassava and yam biofortified with provitamin A and other nutrients The processing approaches used will potentially create storable products with improved nutrient uptake. As vitamin A is essential for well-being in the first 1000 days of life and the development of children, schools and households will be target in NUTRIFOOD. In Benin and Nigeria nutritional interventions in schools will be carried out. NUTRIFOOD will also target Colombia, specifically the rural Orinoquia and Amazonia regions where VAD is clinical, and implement a scaling-up of provitaminA cassava and its processed products. Potentially, these studies could contribute to the alleviation of VAD and improved cognitive development in infants. Modern communication technologies and approaches will be used to communicate the advantages of healthy diets and how to generate healthy diets in a cost-effective manner. The consortium will carried out a series of workshops to which multi-actors across the supply chain will be invited. With, scientists, NGO representatives, policy makers, parents (mothers) and civil organisations involved co-design approaches to the implementation of healthy diets will be attempted and promoted.
Addressing malnutrition with biofortified maize in Zimbabwe: from crop management to policy and consumers
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
The double burden of malnutrition refers to the suboptimal intake of essential nutrients (minerals, metals and vitamins), either caused simply by inadequate dietary intake and/or due to the intake of "empty calories" i.e., food that has sufficient calories but lacks adequate amounts of essential nutrients. This double burden falls disproportionally heavy on developing countries, and there on women and children. It directly increases child mortality and childhood stunting, and reduces people's ability mending diseases. In Zimbabwe, an estimated one in four children have vitamin A deficiency, two-thirds are living with iron deficiency and one in three have iron deficiency anaemia (UNICEF, 2019). And a quarter of children (0.76 million) under five in Zimbabwe are currently stunted. Among women of reproductive age, one in four have vitamin A deficiency, six in ten women have iron deficiency and one in four are anaemic. Malnutrition and its negative effects are particularly common in rural areas where people mostly live from their own crop production and the diet is mostly cereal based. This group is difficult to reach with supplements and has basically no access to fortified processed food. As an alternative method, plant breeders developed "biofortified" crops, meaning crops with a higher content of minerals, metals and (pro)vitamin A (PVA). However, recent research has shown that the effectiveness of such biofortified crops is a) affected considerably by soil characteristics, and that b) their nutrient content can be enhanced with micronutrient fertilizer and other crop management options. To enable making best use of the new biofortified crop varieties we propose the following research: Work package (WP) 1: what are the effects of agronomic management options on PVA concentration and micronutrient uptake of novel, biofortified maize lines. African soils are often poor and have a low fertility, resulting in low yields and low grain quality. This can, for example, be addressed with soil conservation methods (increased return of crop residues and reduced tillage), with macro and micro nutrient treatments, or with liming. However, little is known how such treatments affect the nutrient content in the newly developed biofortified maize varieties. We will, therefore, test a range of the new varieties under several agronomic management options, to identify the best conditions and treatments for high quality, nutritious maize. WP2. Testing the effectiveness of agronomic biofortification at the farm-scale. As mentioned above, African soils are often poor, but they are also very variable. Farmers of course know their soils well, they know where the crops grow well and where not, and they often increase soil fertility in particular fields (where they dump kitchen refuse or crop residues, where the cattle are kept at night, etc). Therefore, farmers could grow biofortified crops in preferential places but it is unknown how much this could contribute to an improved nutritional value. We will test these options with 60 farmers for two seasons for their effectiveness, feasibility, and possible impact. WP3. Closing the nutrient gap or Predicting the effect of bio + agro fortification at the national level. Although maize is a very important staple for most people in Zimbabwe, they also eat other food. And only their total "food basket" determines their nutrient uptake. Knowledge of the food basket composition and of the nutrient content of all items in the basket allows then to estimate the possible contribution of the bio-and agro-fortified food on the nutrition of the people. WP3 will estimate this impact for all regions in Zimbabwe based on WP1 and WP2 results in combination with national statistics on food consumption and, where necessary, some additional analysis of common food items. WP4. This WP focuses on upscaling and dissemination and has no research components.
Upscaling edible insect-based porridge to improve health and nutritional status of PrimarySchool children in Zimbabwean low socio-economic communities
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
Food and nutrition insecurities and malnutrition in the developing countries call for the identification of sustainable sources of food. The necessity for countries in sub-Saharan Africa (SSA) to be self-sustaining in the fight against malnutrition is of crucial importance to maintain their autonomy. To counteract the devastation of malnutrition, whilst ensuring food security for the SSA region, researchers nowadays suggest pathways such as the Indigenous Knowledge Systems (IKS) for sustenance. IKS in food processing practices form a bedrock of a community's composite and collective wisdom, which is passed through generations. Maize (Zea mays) is the staple food of Zimbabwe and is used in the production of several traditional foods for the whole household and for weaning children (1). Unfortunately, maize is low in protein, essential minerals (such as calcium, potassium, iron and zinc), essential amino acids (lysine and tryptophan) and essential fatty acids (2,3). Maize fortification with inexpensive sources of proteins is suggested strategy to help alleviate the ever-increasing problems of malnutrition in developing countries (4). Additionally, the current maize-based diet could also contribute to the onset of cardiometabolic traits (CTs) such as obesity, hypertension and diabetes (5). Edible insect's nutritional composition has been studied and it is concluded that are a valuable source of nutrients including essential amino acids, mineral content and essential fatty acids. The benefits of insect powders against malnutrition have been practised in some regions of the country. Despite the intervention showing observable nutrition changes in children, this claim has not been scientifically proven yet. However, the mechanistic link between insect consumption and health is missing. Knowledge of these aspects could promote a broader utilisation of insects in SSA countries. The proposed project aims to contribute to enhance the nutritional status of school-aged children (SAC) (7-11 years) in low socio-economic communities in Zimbabwe by developing new insect-based porridge through modification and upscaling of existing local recipes. To ensure sustainability and availability of the edible insects for processing into the porridge, the project seeks to strengthen the local insect value chains through upscaling some of the traditional rearing techniques being practised by existing mopane worm farmers in Zimbabwe. Despite malnutrition, childhood overweight and obesity is a serious public health problem worldwide (and in the communities of interest) in the 21st century. For the current study, besides focus on linear growth we will also incorporate social behaviour change communication approach to promote healthy eating and learners active lifestyles. We will test the effects of the insect-based food on cognitive function (school performance) and weight status and CTs of SAC based on a single-blinded RCT. This project builds on wealth of existing indigenous knowledge systems, experience of women insect experts that traditionally engage in insect rearing, and includes their active participation in research design, recipe experimentation and product innovation. The improving and upscaling of the traditional mopane worms rearing technologies will satisfy emerging demand while ensuring sustainability by reducing over-reliance on wild collections. Improved local recipes and modified insect-based products will enhance consumer acceptance towards insect consumption leading to increased customer demand, which would improve livelihoods and nutritional status in low socio-economic communities. 1.MUDIMU, G. 2002. Zimbabwe food security issues paper. 2.MBATA et al 2009. African Journal of Food Science 3, 107-112. 3. NUSS & TANUMIHARDJO. 2010. Comprehensive Rev. in Food Science and FoodSafety, 9. 4. TONTISIRIN et al. 2002. Proceedings of the Nutrition Society 61, 243-250. 5. ORDOVAS & CORELLA 2004. Annu. Rev. Genomics Hum. Genet., 5, 71-118
T-WASH II - Transforming Access to WASH and Nutrition Services in Mozambique
UK - Foreign, Commonwealth Development Office (FCDO)
To deliver sustainable, water, sanitation and hygiene (WASH) and nutrition services to the poor in Mozambique. The programme will focus in areas of high child malnutrition, and address the specific needs of women and adolescent girls. It will build on the success of the current WASH programme, using performance indicators to drive the sustainability and equity of government and private sector service delivery at sub-national level. The programme will use evidence to influence policies and strategies that will lead to better health and nutritional outcomes for the poor. The programme will also build human capital for longer term economic development.
Women and Girls Health: The Ending Preventable Deaths of Mothers, Babies and Children support programme
UK - Foreign, Commonwealth Development Office (FCDO)
This programme provides technical assistance (TA) to FCDO teams to complement all UK investments that support the manifesto commitment to End the Preventable Deaths of mothers, babies and children by 2030 (EPD). The FCDO EPD approach paper (2021) is central to women and girls’ health, encompassing aspects of policy and programme work in health systems, sexual reproductive health and rights, nutrition, water, sanitation and hygiene, climate resilient health and research.
South Sudan Health Pooled Fund Phase III
UK - Foreign, Commonwealth Development Office (FCDO)
To provide a government led effective health system that will deliver improved access to quality health services across eight states in South Sudan with a specific focus on reducing maternal and child mortality. The Health Pooled Fund (HPF3) will reduce maternal and under-five mortality rates in South Sudan, through (i) the delivery of a basic package of health and nutrition services; (ii) promoting community engagement in health as a public good and (iii) supporting local health systems stabilisation.
Hunger Safety Net Programme (HSNP Phase 3)
UK - Foreign, Commonwealth Development Office (FCDO)
To reduce poverty, hunger and vulnerability by providing 133,000 of the poorest households (approximately 798,000 people) in Kenya's arid and semi-arid lands with cash transfers and up to an additional 750,000 households (approximately 4,500,000 people) during drought emergencies. In addition, this final phase of the programme will ensure a transition of the Hunger Safety Net Programme to full Government of Kenya ownership and financing to guarantee the sustainability of the programme after a UK exit. The programme aims to graduate targeted HSNP households out of poverty and improve the nutrition status of pregnant mothers and children below 1,000 days of age.
Humanitarian Assistance and Resilience in South Sudan (HARISS) 2015 - 2024
UK - Foreign, Commonwealth Development Office (FCDO)
HARISS aims to save lives, avert suffering, maintain dignity, and reinforce coping capacities for people affected by conflict, disasters, and shocks in South Sudan. It is a large-scale, multi-sector and multi-year humanitarian programme providing humanitarian assistance and resilience building activities (although these reduced from 2022). HARISS focuses on: • Life-saving humanitarian assistance • Humanitarian protection for the most vulnerable • Resilience-building • Support to the enabling environment
Nutrition Action for Systemic Change
UK - Foreign, Commonwealth Development Office (FCDO)
The programme contributes to preventing and reducing malnutrition in all its forms with a particular focus on tackling undernutrition and improving diets of women, girls and children. It will do so by strengthening policy and accountability at country and global level so that health, food and other systems more effectively integrate nutrition objectives, increased public finance is mobilised for delivering nutrition services, and sustainable, healthy diets become more affordable and accessible.
Exiting Poverty in Rwanda
UK - Foreign, Commonwealth Development Office (FCDO)
The Exiting Poverty in Rwanda Programme will provide support to the Government of Rwanda to help create and scale up a more sustainable, self-financed and inclusive system for supporting the most vulnerable, helping the poor manage shocks and enabling more people to sustainably exit poverty. The programme will provide financial aid to the Government of Rwanda to scale up provision of Social Protection to the poorest. It will put a stronger emphasis on sustainability and on working towards a clear exit strategy from the Social Protection Sector in the future. The focus of the programme therefore is strengthening government systems to build effectiveness, government ownership and long-term sustainability of the programme. This phase of support is expected to deliver the impact of extreme poverty eradicated, and poverty levels reduced, with an outcome of the resilience of vulnerable men, women and children and of the Social Protection systems that help sustain them enhanced.
The Evidence Fund - 300708
UK - Foreign, Commonwealth Development Office (FCDO)
The Evidence Fund procures and manages research and evaluations that primarily benefit ODA eligible countries. Most research and evaluations paid for by the Evidence Fund are country-specific, and all respond to requests for evidence to inform programme or policy decisions. Primarily serving research requests from HMG’s Embassies and High Commissions in ODA eligible countries, and from HMG policy and strategy teams, the Evidence Fund strengthens the evidence behind the UK’s priority international development investments and development diplomacy. The Evidence Fund also invests modest amounts of non-ODA, to strengthen the evidence behind wider UK foreign policy.
Humanitarian Assistance and Resilience Programme ( HARP)
UK - Foreign, Commonwealth Development Office (FCDO)
In line with the G7 Famine Prevention Compact, Nigeria’s Humanitarian and Resilience Programme (HARP) will provide life-saving support to the most vulnerable and strengthen resilience, opening pathways to livelihoods. HARP will enhance overall effectiveness of the UN-led humanitarian response, including a focus on building Nigerian ownership.
Essential Services for Maternal and Child Health [Services Essentiels de Santé Maternelle et Infantile en RDC (SEMI)]
UK - Foreign, Commonwealth Development Office (FCDO)
To support essential maternal, child and infant health services to end preventable deaths in one of the poorest provinces in DRC and strengthen the health system at national and provincial level.
LAFIYA -UK Support for Health in Nigeria
UK - Foreign, Commonwealth Development Office (FCDO)
To save lives, reduce suffering and improve economic prospects for the poorest and most vulnerable in Nigeria through: i. Encouraging Government of Nigeria to increase resources invested in health (through advocacy, community accountability; and data to inform government prioritisation using a “delivery” approach, as used successfully in Pakistan) ii. Improving effectiveness and efficiency of public and private basic health services (through innovative financing mechanisms, strengthening health systems and working with private sector to deliver affordable health services for the poorest populations) iii. Reducing total fertility rate (through addressing social norms, demographic impact analysis, and support to family planning commodities and services).
Invest Salone: Private Sector Development, Trade and Job Creation in Sierra Leone
UK - Foreign, Commonwealth Development Office (FCDO)
To increase investment in Sierra Leone's exporting sectors, including agriculture, tourism, and fisheries leading to economic diversification, household income growth and job creation. The programme will help Sierra Leone meet the economic aspirations of its growing young population, tackling the drivers of instability and illegal migration. It will also make Sierra Leone more competitive in global markets putting put it on a pathway to becoming a future trading partner for the UK.
Innovative Ventures & Technologies for Development (INVENT)
UK - Foreign, Commonwealth Development Office (FCDO)
To encourage innovation amongst the private sector by provision of investment capital and business development services. To innovative enterprises in low income states of India for enterprises in developing countries by 2024. This will contribute to MDGs by benefitting 1 million individuals with improved access to affordable and efficient services in the Low Income States of India and Developing Countries.
Nepal Health Sector Programme III
UK - Foreign, Commonwealth Development Office (FCDO)
To improve the health of women, children, the poor and socially excluded in Nepal, including by restoring health services in areas affected by the 2015 earthquake, and improving the quality and governance of health services nationwide.
Tackling Maternal and Child Undernutrition Programme- Phase II
UK - Foreign, Commonwealth Development Office (FCDO)
To contribute towards improved health and nutrition status for children under two years measured primarily by a reduction in stunting by 2023.
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