Invest in Nutrition

Eden, a young boy of 3 years old, was just diagnosed with speech delay. This is one more illness that is affecting him. He also suffers from immune deficiency and deafness. All are related to his first year of life when he has faced severe chronic malnutrition. He looks normal, but the consequences are detrimental; this lack of food (hunger), at a critical moment in his early life, will hamper his ability to learn and hinder opportunities later in life.

This disturbing story may be the intolerable reality of children living in India or Ethiopia; but in fact, this story happens next door to us in America. Eden is one among other protagonists of a provoking documentary launched last month – A Place at the Table.

This documentary is thought-provoking mainly because it shows us that obesity and hunger are neighbours, our neighbours. Access to affordable nutritious foods in a world of plenty seems an unacceptable challenge for too many. In fact, this is increasingly the reality for many children living in both the developing and developed world, mainly because hunger and obesity are globally interconnected. We cannot pretend that it is not visible; it is in fact in our backyard. The burden of malnutrition is one major challenge in the context of the post-MDGs if we really want to achieve sustainable human development for every child in the world.

It is true that we have made significant progress over the past 50 years in the sector of population health. Life expectancies for men and women have increased. A greater proportion of deaths are taking place among people older than 70 years. The burdens of HIV and malaria are falling. Far fewer children younger than five years are dying. But this encouraging picture is being challenged by old and new threats. Africa remains the most afflicted continent, where maternal, newborn, and child mortality, along with a broad array of vaccine-preventable and other communicable diseases, are still urgent concerns. Malnutrition and stunting continue to be a long-term damaging stigma for children in Africa and South East Asia, with an estimated 75% of the world’s 165 million stunted children living there.

The link to extreme poverty is incontestable – as children in the poorest communities are more than twice as likely to be stunted, particularly in rural areas where as many as one third of children are affected.

On the other hand, more young and middle-aged adults in low and middle-income countries are suffering from obesity and diet-related non-communicable diseases (diabetes, hypertension, stoke and cardiovascular disease…). These diseases are driven primarily by phenotypic predisposition and high consumption of ultra-processed foods. With increasing urbanization and shifts in diet and lifestyle, the result could be an escalating epidemic of such conditions in many low- and middle-income countries. This would create new economic and social challenges, especially among vulnerable groups.

Fighting stunting is the emerging battle in the context of optimal human development. It is the irreversible impact of not receiving enough nutrient dense foods within the first 1000 days of life, from pregnancy to a child’s second birthday. But stunting is more than a problem of stature; this lack of nutritious food also impacts the overall physical (organ as well as immune cell function) and cognitive development, and determines the susceptibility to obesity and food-related non communicable diseases later in life.

During the first 1000 days, nutritional requirements to support rapid growth and development are very high, and the baby is totally dependent on others for nutrition, care and social interactions. For example, the first year of life is a time of astonishing change during which babies in normal conditions, on average, grow 55% in length, triple their birth weights and increase head circumference by 40%. Between 1 and 2 years age, an average child grows about 12 cm in length and gains about 3.5 kg in weight. During these crucial days as well as during fetal life, the body is putting together the fundamental human machinery (similar to hardware and software for computer). This process is done over a very short period of time and requires specific nutrients like vitamin A, iron, folic acid, zinc but also protein, long-chain polyunsaturated fatty acids and choline. The immune-system and brain-synapse development are particularly vulnerable. As a result, any disturbance of this frantic activity leaves a terrible mark. Smaller than their non-stunted peers, stunted children are more susceptible to sickness. In school, they often fall behind in class. They enter adulthood more likely to become overweight and more prone to non-communicable diseases. When they start work, they often earn less than their non-stunted co-workers. The drama of this situation is the fact that an undernourished mother is more likely to give birth to a stunted child, perpetuating a vicious cycle of high prevalence of premature death (an estimated 60-80% of neonatal deaths occur among low birth weight babies), undernutrition and poverty.

It is imperative to focus on the first 1000 days of a child’s life as the crucial window of opportunity for change. It is during this time that proper nutrition has the greatest impact on a child’s health and potential future wellbeing and opportunities. A recent publication in Lancet has reinforced this idea, and has showed that attaining optimal growth before 24 months of age is desirable; becoming stunted but then gaining weight disproportionately after 24 months is likely to increase the risk of becoming overweight and developing other health problems. UNICEF’s latest publication “Improving Child Nutrition: The achievable imperative for global progress” is closing the loop. It shows that there are proven low cost solutions for reducing stunting and other forms of undernutrition. These simple and proven nutrition activities need to be integrated together. They include improving women’s nutrition, early and exclusive breastfeeding, providing additional vitamins and minerals as well as giving appropriate nutrient dense foods, especially in pregnancy and the first two years of a child’s life.

Investing in children’s and women’s nutrition is not only the right thing to do from a human right point of view; it is also a cost-effective investment. It can increase a country’s gross domestic product (GDP) by at least 2-3% annually. Every US$1 spent on nutrition activities to reduce stunting will have a return on investment of US$30. This integrated nutritional strategy as proposed by UNICEF and other international stakeholders is the locomotive that can accelerate economic growth and pull millions of people out of poverty.

Let’s work all together to be sure that every children around the world has a place at the table. This is our responsibility!

This article was publish in the Ottawa Citizen last week. This is the link:

http://blogs.ottawacitizen.com/2013/04/26/francoise-briet-invest-in-nutrition/

Don’t bring me the food that western people love!

Over the past few months, I was busy writing articles for different magazines and newspapers.

This is one of them: Don’t bring me the food that western people love!

OCIC article

This is part of a series of articles on food in the context of global development.

All the articles are really interesting. It will give you a different perspective on some key issues. But not only this, there is more. 

This is the link:

http://content.yudu.com/A24lyd/iAMVol4/resources/index.htm?referrerUrl=http%3A%2F%2Focic.on.ca%2Fiam

Hope you will enjoy the voyage…  

Focusing on linear growth and relative weight gain during early life – a winner ticket for human capital development and future adult health

We have seen in the previous blog that the children who are suffering from stunting (short stature) may look normal but the consequences of becoming and remaining stunted can be detrimental. In fact, we can observe an increased risk of morbidity and mortality, but also delays in cognitive (ability to think and understand) and physical development, which result in a decreased ability to learn and capacity to work.

In fact, stunted height (and not underweight) is a dreadful marker of multiple deprivations regarding food intake, care and play, clean water, good sanitation and health care. It is an important indicator of child well-being – not only physical growth but also cognitive and socio-emotional development.

These days, not only in the context of post Millennium Development Goals (MDGs) but also because of the importance to focus on sustainable human development, the key questions for nutritionists, pediatricians and policy makers are:

  • What is the optimum age for promotion of growth for enhanced survival and human capital?
  • Will this promotion necessarily lead to an increase in cardio-metabolic disease later in life?  

These aspects have their importance knowing that a lot of feeding programs in developing countries are aimed at older children, at a time where optimal linear growth is already compromise. For example, traditional school feeding programs that increase BMI with little effect on height might be doing more harm than good in terms of future health.

Why?

According to a study published in Lancet last month (see reference below), patterns already observed in the Western world are starting to be seen in low- and middle-income countries: i.e. putting on too much weight in relation to height in middle and late childhood (after 2 years old) can increase the risk for chronic diseases, such as diabetes, in later life.

This scientific analysis that involved five prospective birth cohort studies from Brazil, Guatemala, India, the Philippines, and South Africa showed that it is important to focus on improved nutrition in the first few years of life, i.e. the 1,000 days from the start of a woman’s pregnancy until her child’s 2nd birthday.

Their analysis showed that:

  • Higher birth weight is associated with an adult BMI of greater than 25 kg/m² (mostly lean body mass – muscle, which is good), and a reduced likelihood of short stature and of not completing secondary school,
  • Fast linear growth during the first 2 years of life is associated with increased adult height and amount of schooling,
  • Weight gain earlier in infancy is not associated later with any increased risk of chronic disease. In fact, it is good for the child, good for survival, giving some protection from adult chronic disease and better educational attainment,
  • Faster relative weight gain after the age of 2 years has little benefit for human capital, and weight gain after mid-childhood could lead to large adverse effects on later cardiovascular risk factors like elevated blood pressure. Notably, this is particularly true for weight gain that is not accompanied by height gain,
  • In fact, rapid weight gain should not be promoted after the age of 2–3 years in children who are underweight (weight for age) but not wasted (weight for height)

This study shows the importance to promote nutrition and linear growth during the first 1,000 days of life (from conception to age 2 years), and also reinforces the importance of prevention of rapid relative weight gain after age 2 years.

These findings have implications for present practices in low-income and middle-income countries, particularly emphasizing the need to monitor linear growth as well as weight, and to avoid promotion of excess weight gain in children older than 2 years. Optimum growth patterns in early life are likely to lead to less undernutrition, increased human capital, and reduced risks of obesity and non-communicable diseases, thus addressing both components of the double burden of nutrition.

According to one of the authors, Dr Fall: One of the challenges we are facing is the fact that we need to find ways to get very small children to be taller, and we don’t really know how to do it. More work is needed on imaginative interventions to specifically promote height growth, instead of weight gain. These could include exclusive breast-feeding, long-chain polyunsaturated fatty acids like DHA, high-quality protein, and micronutrients.

Mortality and undernutrition are falling substantially in most parts of the world, except for Sub-Saharan Africa, and new targets are being formulated to replace the present set of 2015 MDGs. A new goal for optimum linear growth that is expressed as a reduction in stunting can replace the present target of a reduction in underweight alone, which is one of the indicators for the first MDGs towards the eradication of extreme poverty. This new target can be associated with the assessment of developmental functioning using a set of indicators based on the Psychomotor Development Index (PDI) and Mental Development Index (MDI) of the Bayley Scales of Infant Development. This integrated approach will help to evaluate appropriately physical as well as cognitive and socio-emotional development, which is so important when building human capital.

 

References:

http://www.medscape.com/viewarticle/781535

Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Adair LS et al, Lancet 28th March 2013 (http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673613601038.pdf?id=a02f57d1811fcb77:524f7ce2:13db1412973:-60f11364479623359)

 

Quinoa Year aims to ease food insecurity and transform the global diet

2013 is the International Quinoa Year: http://www.rlc.fao.org/en/about-fao/iyq-2012/

This is an interesting article published by the UN news Centre…. and I would like to share with you some of the key points and highlight why quinoa is an interesting staple in the global context of food security. However, quinoa’s success starts to initiate problems and challenges that need to be addressed if we want to make this food revolution sustainable locally as well as globally. 

Quinoa farmed on the Bolivian antiplano ranges in colour from white to pink to orange. Photo: Claudio Guzmán/FAO

Quinoa, a highly nutritious grain-like crop that has made its entry into the food basket of culinary connoisseurs has been a staple for centuries in South America, among pre-Columbian Andean farming communities from Colombia to Ecuador. In fact, most of the world’s quinoa is grown on the altiplano, a vast, cold, windswept, and barren 14,000-foot Andean plateau spanning parts of Peru and Bolivia.

By declaring 2013 the ‘International Year of Quinoa’, the United Nations is hoping to popularize a life-sustaining seed that could help promote food security and poverty eradication, cut malnutrition and boost biodiversity in support of the achievement of the Millennium Development Goals. It is also a way to recognize the indigenous peoples who preserved quinoa through traditional knowledge and practices passed down through the ages.

Quinoa famers in Bolivia show off their latest crop which could help promote food security and eradicate poverty. Photo: Claudio Guzmán/FAO

In Resolution 66/221, the General Assembly declared the International Year of Quinoa in recognition of the Andean indigenous people “who have managed to preserve quinoa in its natural state as food for present and future generations, through ancestral practices of living in harmony with nature.” Hence the theme for this year: “A future sown thousands of years ago.”

Pronounced ‘keen-wah’, quinoa is not really a grain, not really a vegetable. It is a pseudo-cereal, part of the chenopodium family related to beets and spinach. Quinoa seeds are gluten-free and have all the essential amino acids, trace elements and vitamins needed to survive. Due to its high nutritional value, indigenous peoples and researchers call it “the golden grain of the Andes.”

One cup of quinoa (a single serving size) brings:
  • 220 calories (70 % carbs, 15 % fat, 15 % protein)
  • 40 grams of carbohydrates (13 % daily value)
  • 8 grams of protein (16 % of daily value)
  • 3.5 grams of fat (5 % daily value with no saturated fat)
  • A glycemic load (blood sugar spike) of only 18 out of 250
  • 5 grams of fiber (20 % of daily value)
  • 20 % of daily value of folate (various forms of Vitamin B)
  • 30 % of magnesium daily value; 28 % daily value of phosphorous; iron (15 %); copper (18 %); and manganese (almost 60 %)

Quinoa’s link to food security

Cautioning that the crop is “still in the experimental phase” in some areas, Mr. Bojanic, who is the Deputy Regional Representative at the FAO Regional Latin America and the Caribbean Office and also serves as the Secretary for the International Year of Quinoa’s Secretariat, said that quinoa “is beginning to be taken up by countries that would not have thought of having it a few years ago.” Those include Canada, China, Denmark, Italy, India, Kenya, Morocco and the Netherlands, which are already producing or undertaking agronomic trials towards commercial production of quinoa.

Bolivia and Peru account for more than half of the annual 70,000 tons produced of quinoa, with the United States responsible for about 7,000 tons and France close behind, FAO reports. Quinoa is hardy. It thrives in temperatures from -8 degrees Celsius to 38 degrees Celsius, at sea level or 4,000 metres above, and is not impacted by droughts or poor soils.

This crop can be grown under very difficult conditions like semi-arid, at high altitudes, sea level, with no fertilizer. It’s an amazing crop in terms of the adaptability that it has to stressful environments,” Mr. Bojanic said.

Researcher from the University de Valparaiso with quinoa farmers in Chile. Photo: Didier Bazile/CIRAD

This adaptability makes quinoa potentially viable for areas with regular droughts, such as the Sahel Region – which includes Senegal, Chad, Niger and Mauritania – where million of people are in need of emergency food aid and malnutrition is rampant.

The latest figures in FAO’s State of Food Insecurity in the World 2012 Report show that despite significant progress, almost 870 million people – or one in eight – are still suffering from chronic malnutrition.

UN officials say there is still time to reach the Millennium Development Goal for reducing the proportion of hungry people around the world by half by 2015, but countries need to step up their efforts and quinoa offers hope.

The quinoa quandary

Agronomical and nutritional attributes aside, quinoa’s global success relies on making it affordable. Consumers will not buy what they cannot afford, and farmers will not grow large quantities of a crop that is not financially viable.

Such is the so-called quinoa quandary that as the demand for quinoa has grown in recent years, so has its price. Less than $70 per ton a decade ago, quinoa now sells for more than $2,000, according to FAO figures.

In Bolivia, quinoa farmers near Lake Titicaca, the world’s highest body of water, carry waist-high stalks covered with purple, yellow, green and orange flowers to harvest. This is considered the cradle of great civilizations for the Tiahuanaco and the Incas, and is the origin of quinoa.

“Now people everywhere are buying quinoa. In La Paz, they sell it in the markets. It’s everywhere. For that reason we are also able to sell small quantities. With that money we sustain our families,” Elias Vargas, a farmer, told the United Nations.

Mr. Vargas and his neighbours sell their crops to a Bolivian coffee chain, Alexander Coffee, which uses quinoa in its salads, sandwiches and desserts. The company bakery turns out more than 1,000 quinoa chocolate chip cookies per day.

In the beginning it was hard to change the mentality,” recalled Pamy Quezada Velez, CEO of Alexander Coffee. Quinoa used to be known as ‘poor man’s food’ with Bolivians preferring to eat wheat and rice. “More people are opening up to the idea, and we’re doing well with quinoa.”

The partnership between small farmers and small businesses is part of a project supported by the UN’s International Fund for Agricultural Development (IFAD). While farmers like Mr. Vargas do not grow enough to sell to foreign markets, increased domestic consumption provides them with new opportunities.

Almost all of the estimated 250,000 acres of quinoa farmland is in the hands of small farmers and associations around the world. FAO estimates that at least 130,000 small quinoa growers from South America alone will benefit this year from increased sales, higher prices for their crops and a return to indigenous practices in a sustainable manner.

“In the traditional markets, it is still rather accessible to poor people but when you find it in the supermarket it tends to be rather expensive,” Mr. Bojanic said.

The rapid expansion of quinoa farming in the last years has been a double-edged sword. As prices rise, farmers are more likely to sell the quinoa crops they would have consumed, sparking concerns of malnutrition. About one-third of children under the age of five in the Andean countries are already chronically malnourished, according to figures from the World Health Organization (WHO).

Quinoa fields on the Bolivian altiplano. Photo: Claudio Guzmán/FAO

The change in food choices as a result of higher income is also causing some farmers to turn from traditional staples to more caloric, processed foods. The change is particular among youth who would prefer a sugary soda to a home-made drink of boiled water, sugar and quinoa flour.

In addition, the increased incentives to produce more quinoa are also contributing to land disputes. “Land that had barely any use in the past and small farmers who were not in conflict are starting to – now that the land has more value – struggle among themselves so they can claim such lands to produce quinoa,” Mr. Bojanic said.

Property disputes are further aggravated by reverse migration, as the high prices for quinoa are motivating residents who moved to cities to return to plots, and by not giving the soil enough time to rest between harvests.

The push for increased production is seemingly at odds with the traditional life of the quinoa farmers, a main reason quinoa was selected for the honour. But UN officials stress that boosting the importance of developing sustainable production systems for quinoa consumption and food security are among the main objectives for the year.

Boosting sustainable agricultural practices and partnerships

The International Year of Quinoa, is overseen by the IYQ- International Coordination Committee composed of the ministries of agriculture of Andean countries and France. Bolivia has the presidency of the Committee, with Ecuador, Peru and Chile sharing the vice-presidency.

“The reaction is very enthusiastic,” said Mr. Bojanic. “Governments are looking at a coordinated approach to increase production nationally and regionally.”

Experimental quinoa plants at the Instituto Nacional Autónomo de Investigaciones Agropecuarias in Ecuador. Photo: INIAP

In the public sector, the UN is looking to engage with international agricultural research centres and national research centres on a global research network and gene bank database to maintain the crop’s 120 variations. The idea is that experts will test the crops and show farmers how they can best be grown under different conditions.

Professor Luz Gomez Pando is one of the local experts and scholars working with the UN in Lima, Peru. Based at La Molina University, she uses nuclear radiation to develop new varieties of quinoa that have a higher yield. The gamma rays speed up the evolution process that would take millions of years in nature. She then gives her seeds to the women farmers and at harvest time, cooks quinoa with them.

“I am from the highland above 3,000 metres and I was the daughter of two farmers,” Ms. Gomez told UN Radio and the International Atomic Energy Agency (IAEA). “What we need right now is to have these crops very fast in big fields.”

The majority of quinoa is produced using traditional technologies that result in low yields. A hectare normally results in 600 kg of quinoa. FAO wants to raise the production to a ton of quinoa per hectare. That would help raise the overall production from 70,000 tons per year to 200,000 tones annually by 2018 through improved technologies and engagement with businesses already processing quinoa, including large importers and exporters.

02-20-2013quinoa

References:

http://www.un.org/apps/news/story.asp?NewsID=44180#.US1C3jCR98E

http://nutritiondata.self.com/facts/cereal-grains-and-pasta/10352/2

Understanding the different dimensions of malnutrition (undernutrition) to maximize human capital development (Part 2: the facts)

This is it!

We are moving to the next blog and we will start by defining briefly the different dimensions of malnutrition (undernutrition) using an interactive approach (maps, figures and facts). It will be a long journey, but I think an interesting learning path not only for you, the people who are reading this blog but also for me and CKi. Let’s start …

1st_Alfredo_Sabat_cartoon2006

(http://timpanogos.wordpress.com/2006/12/22/ranan-lurie-cartoon-competition/)

What is malnutrition?

I won’t give you an academic definition of what is malnutrition. A simple way to understand the concept is the fact that:

Hunger = Undernutrition = Malnutrition

 

Malnutrition = undernutrition or overnutrition

Malnutrition = not enough diversified foods in quantity and/or quality

 

To be healthy (not malnourished): you need to eat well….Your body needs to digest the food and absorb the nutrients released during the digestion process appropriately… Finally, the cells in your body need to use effectively the absorbed nutrients to build tissue, provide energy and/or regulate various organ and cell functions

 

Environmental issues like disease, stress… can affect the overall mechanism and exacerbate the degree of malnutrition

 

Complicate…. No!

 

Tackling the problem of malnutrition demands an integrated approach

 

 Undernitrition – where are we in 2013?

Undernutrition affects millions of people each year all over the world, although the main concentration of cases is found in Sub-Saharan Africa and Asia (see figure below).

figure 1

870 million people are undernourished in the world today. That means one in eight people do not get enough food to be healthy and lead an active life.

Hunger and malnutrition are in fact the number one risk to the health worldwide — greater than AIDS, malaria and tuberculosis combined. It is recognized as the underlying cause of nearly a third of deaths from all diseases in children in pre-school years. In fact, maternal and child undernutrition account for 11 % of the global burden of disease.

The different types of undernutrition:

figure 2

(UNICEF information)

There are two main types of undernutrition as shown in the figure above: growth failure and micronutrient deficiency(see figure below). Each form of undernutrition depends on what nutrients are missing in the diet, for how long and at what age. They include:

1)      Growth failure:

  • Severe and moderate forms of acute malnutrition (leading to wasting) are indicated by a low weight-for-height or presence of bilateral oedemas. This occurs as a result of recent rapid weight loss, or a failure to gain weight within a reasonably short period of time. Wasting occurs more frequently with infants and young children, often during the stages where complementary foods are being introduced to their diets (6 to 24 months), and when children are typically more susceptible to infectious diseases. Acute malnutrition can result from food shortages, a recent bout of illness, inappropriate child care or feeding practices or a combination of these factors.

According to Action Against Hunger, It is estimated that around 41 million children globally have moderate acute malnutrition (MAM). Most children with MAM live in southern Asia and sub-Saharan Africa. Furthermore, it is suggested that there are potentially 20 million children suffering from severe acute malnutrition (SAM) every year, and an estimated 0.5 million to 2 million children with SAM die each year, depending on the type of reporting mechanism.

Sixty percent of all the wasted children (both moderate and severe) in the world live in ten countries (see table below); India being the more affected with ~25 million children suffering of moderate and/or severe acute malnutrition.

figure 3

(UNICEF information)

  • Stunting or chronic undernutrition, resulting in growth retardation, is indicated by a low height for-age. The causes and etiology of stunting include nutrition, infection and mother-infant interaction. Stunting is a cumulative process that can begin in utero and continue until the age of 3 years after birth, compromising the growth of a child. The consequences of becoming and remaining stunted are increased risk of morbidity, mortality, delays in motor and mental development, and decreased work capacity.

Stunting is estimated by the UNICEF to affect 800 million people worldwide. 195 million children under 5 years of ages are stunted. The prevalence of stunting is highest in Africa (40%), and the largest number of stunted children is in Asia (112 million), mostly in South-central Asia (India). Ninety per cent of the overall global burden of child stunting is attributable to 36 countries (see figure below).

WHO-Child-Stunting-map-e1280356202549

(HUMANOSPHERE information)

  • Underweight is a composite measure of both acute and chronic malnutrition, indicated by a low weight-for-age.

figure 6

In 2011, an estimated 17%, or 99 million children under five years of age in developing countries were underweight. As shown in the figure above, underweight is most common in South-central Asia (30%), followed by Western, Eastern, and Middle Africa (22%, 19% and 17%, respectively) and South-Eastern Asia (17%). The situation is better in Eastern and Western Asia, Northern Africa and Latin America and the Caribbean, where less than 10% of children were underweight.

What is well known is the fact that:

1)  Children in the poorest households are twice as likely to be underweight as those in the least poor households.

2) Children living in rural areas are more likely to be underweight than those living in urban areas.

The proportion of children under five years old in developing countries who were underweight has declined by 11 percentage points between 1990 and 2011, from 28% to 17% (see figure below). During this period of time, good progress has been made in Western Asia (reduction from 14% to 5%), Eastern Asia (reduction from 15% to 3%), Caribbean (reduction from 9% to 4%), Central America (reduction from 11% to 4%) and South America (reduction from 6% to 3%). In South-eastern Asia, underweight has declined but remains high at 17%. In contrast, underweight continues to be very high in South-central Asia (30%). This combined with large population, means that most underweight children live in South-central Asia (56 million in 2011). Actually, India has the second higher % of children aged <5 years that are underweighed (43.5%). Finally, as shown in the figure below, progress is still insufficient in Africa. One interesting point is the fact that we don’t know yet if rising food prices and the current economic crisis have affected the latest trends in some populations, it is too early to draw firm conclusions.

figure 7 

2)      The micronutrient deficiency:

Micronutrient deficiencies occur when the body does not have sufficient amounts of vitamins or minerals due to insufficient dietary intake and/or insufficient absorption and/or suboptimal utilization of the vitamins or minerals by the body. One out of 3 people (2 billion people) worldwide are affected by vitamin and mineral deficiencies, according to the WHO.

Three, perhaps the most important in terms of health consequences for poor people in developing countries, are:

  • An estimated 250 million preschool children are vitamin A deficient. An estimated 250,000 to 500 000 vitamin A-deficient children become blind every year, half of them dying within 12 months of losing their sight. Moreover, in vitamin A deficient areas, it is likely that a substantial proportion of pregnant women is vitamin A deficient.
  • Iron deficiency is a principal cause of anemia. Two billion people—over 30% of the world’s population—are anemic. For children, health consequences include premature birth, low birth weight, infections, and elevated risk of death. For pregnant women, anemia contributes to 20% of all maternal deaths.

In many countries, more than half of all women of reproductive age are anemic (see figure below).

anemia-prevalence

  • Iodine deficiency disorders (IDD) put at risk children´s mental health– often their very lives. Serious iodine deficiency during pregnancy may result in stillbirths, abortions and congenital abnormalities such as cretinism, a grave, irreversible form of mental retardation that affects people living in iodine-deficient areas of Africa and Asia. IDD affects over 740 million people, 13% of the world’s population. Fifty million people have some degree of mental impairment caused by IDD.

The figure below shows the areas at high risk of micronutrient deficiency for iron, vitamin A and iodine in the developing world. What is interesting to note is the fact that micronutrient deficiency affects a larger range of low and middle-income countries, more than the problem of underweight and/or stunting (see figure above). Globally, the problem is enormous and needs a special attention.

y7352e32

The two new dimensions of undernutrition:

Improving the health of mothers, newborns and children and reducing the number of preventable deaths are top priorities for many stakeholders working in both the developed and developing worlds. Improving child and maternal health is also an important strategy in the long term because it relates to the fetal origin of adult disease like hypertension, obesity, diabetes and cardiovascular disease. In this new context where we are moving from saving life to improving human development and preventing adult disease, two important dimensions of undernutrition need to be discussed independently. They are:

  • Maternal undernutrition, resulting in poor nutritional status of the mother during preconception, pregnancy and post-natal stages, is indicated by a low Body Mass Index (BMI) and micronutrient deficiencies.

In nowadays, the prevalence of low body mass index (BMI <18.5 kg m-2) among women 15–49 years of age may be as high as 26.5% in Sub-Saharan Africa, 35% in South/Southeast Asia, 15.5% in Caribbean and 4% in Latin America. As shown in the figure below, India is again among the countries with the higher level of underweight women (> 20%). It is important to keep in mind that maternal short stature and low body mass index independently have adverse effects on pregnancy outcomes.

figure 4

(http://openi.nlm.nih.gov/detailedresult.php?img=3182195_pone.0025120.g001&req=4)

It was really difficult to find a visual representation of the worldwide prevalence of underweight among women aged 20-49 years old. The map above shows both the prevalence of underweight and overweight in 57 low to middle income countries. What is quite interesting is the fact thatthe prevalence of overweight in young women residing in both urban and rural areas is higher than those in underweight women, especially in countries at higher levels of socioeconomic development. The best examples are Brazil and South Africa (the worse situation), the exception is India.

  • Low birth weight (LBW) of newborn infants is defined as weighing less than 2,500 g at birth irrespective of gestational age (WHO). More common in developing than developed countries, a birth weight below 2,500 g contributes to a range of poor health outcomes like low fetal and neonatal mortality and morbidity, inhibited growth and cognitive development, and chronic diseases later in life. Birth weight is affected to a great extent by the mother’s own fetal growth and her diet from birth to pregnancy, and thus, her body composition at conception.

 More than 20 million infants worldwide, representing 15.5 %of all births are born with low birth weight, 95.6 % of them in developing countries. The level of low birth weight in developing countries (16.5 %) is more than double the level in developed regions (7 %).

figure 5

Half of all low birth weight babies are born in South-central Asia, where 27 % of all infants weigh less than 2,500 g at birth. Low birth weight levels in sub-Saharan Africa are around 15 %. Central and South America have, on average, much lower rates (10 %), while in the Caribbean the level is almost as high as in sub-Saharan Africa (14%). About 10 % of births in Oceania are low birth weight births. Interestingly, almost 70 % of all low birth weight births occur in Asia; mainly in India, which is also the country with the high prevalence of stunting.

To summarize:

Undernutrition is a major issue, the numbers talk by themselves:

  • 2 billion people worldwide are micronutrient deficient
  • 870 million undernourished people in the world
  • 800 million people worldwide are stunted
  • Asia and the Pacific have the largest share of the world’s hungry people (563 million)
  • 195 million children under 5 are stunted
  • 99 million children under 5 worldwide are underweight
  • 61 million children suffered from acute malnutrition, including 20 million suffering from severe acute malnutrition
  • 20 million children are born with restricted intrauterine growth or prematurely
  • Every year at least 3.5 million of children under 5 die from malnutrition-related causes
  • Women make up a little over half of the world’s population, but they account for over 60% of the world’s hungry
  • 468 million women aged 15 to 49 years (30% of all women) are anemic, at least half because of iron deficiency

Tackling the issue of undernutrition in the word will need significant progress in India because:

  • 230 million people go hungry daily (~1/3 of the worldwide undernourished people)
  • An estimated 40% of the world’s severely malnourished children under 5 live in India
  • 60 million children are underweight
  • 48 % children under 5 are stunted
  • Half of the country’s children are chronically malnourished and 80 % are anemic
  • 30 % of children are born with low birth weight
  • Child malnutrition is responsible for 22 % of the country’s burden of disease
  • At least half of infant deaths are related to malnutrition, often associated with infectious disease
  • More than 90 % of adolescent girls and 50 % of women are anemic

References:

http://www.fao.org/docrep/016/i3027e/i3027e.pdf

 http://www.unicef.org/nutrition/training/2.3/2.html

 http://ccafs.cgiar.org/bigfacts/undernourishment/

 http://jn.nutrition.org/content/129/2/529.full.pdf

 http://blogs.scientificamerican.com/observations/2011/12/08/stunted-growth-from-common-causes-threatens-childrens-later-achievement/

 http://www.childinfo.org/files/low_birthweight_from_EY.pdf

 http://gamapserver.who.int/gho/interactive_charts/mdg1/atlas.html

 http://www.who.int/gho/mdg/poverty_hunger/underweight_text/en/index.html

 http://www.actionagainsthunger.org/impact/nutrition

 http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/0,,contentMDK:20916955~pagePK:146736~piPK:146830~theSitePK:223547,00.html

 http://www.cini.org.uk/childmalutrition.pdf

 http://www.unicef.org/infobycountry/india_statistics.html

 http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_12-en.pdf

 https://www.wfp.org/hunger/stats

 http://articles.timesofindia.indiatimes.com/2012-01-15/india/30629637_1_anganwadi-workers-ghi-number-of-hungry-people

 

Going beyond food aid: the challenge of improving nutrition

Food security programs are shifting their focus from quantity to quality, but what is the best approach?

Article published in the Guardian, December 2012 – http://www.guardian.co.uk/global-development-professionals-network/2012/dec/03/food-aid-improving-nutrition

This is a great article … then we hope you will enjoy it. It highlights the importance to focus on quality (diversity in foods, indigenous staples…) and not anymore (or not only) on food quantity (calories) – A vision for program development shared by Challenged Kids International.  

128094-Food_Security_Risk_Index_2013_Map

Food security and malnutrition remain some global development‘s biggest challenges. Latest UN figures show that 870 million people were chronically undernourished between 2010–12the vast majority of whom, 850 million, live in developing countries. Yet despite this the UN’s Scaling Up Nutrition (SUN) movement said in it’s report that 2012 was the year “when chronic under-nutrition moved from the side-lines to the centre”. It argues that the international community has now realized the need to shift focus from simply food quantity, to one of food quality. In a word: nutrition.

There are, however, differing views as to how best to increase nutrition levels.

Monique Mikhail, policy adviser on sustainable agriculture at Oxfam, welcomes initiatives such as SUN, which has 28 developing country government members. But she and many others in the NGO community fear that international efforts to target government agricultural policies often result in more cereals to be sold as export, rather than the locally-produced diverse foods needed to improve nutrition.

“A lot of the discourse out there is pushing this large-scale, mono-culture model, without realizing the impacts of that on communities”, says Mikhail. “Land is being taken away from small-scale producers.” The World Bank identifies five ‘pathways’ that link food production to nutrition: subsistence-oriented production, income-oriented production for sale in markets, increased agricultural production, empowerment of women to control household food and health, and macroeconomic growth. But in practice, one is favored over another.

According to SUN, a 2005 Ethiopian health survey found that chronic malnutrition was highest in its most agriculturally productive regionsThe inference was large-scale production can lead directly to export, or simply a lack of local food diversity.

It is a problem that Samuel Hauenstein Swan, senior policy adviser, Action Against Hunger, recognizes  “Malawi promoted corn – it didn’t dramatically improve the food security of the people, but it dramatically improved the exports. They are one of the big maize exporters now. But did that reduce the numbers of stunting? Not really … ministers of agriculture are still focused on these very few grains [while] nutritious crops like sweet potatoes are not easily commercial.”

NGOs working on the ground, therefore, are increasingly promoting small-scale food production within communities. Cristina Ruiz, humanitarian program unit manager, Africa, at Christian Aid, has recently returned from two years in the Sahel region of Africa – one of the world’s most malnourished regions. “We start by working with communities to do a capacity assessment, which lasts for two or three days in a community, conducting an in-depth analysis of the risks and threats they face and the capacity they have in the community to deal with that”, she explains. “Out of that comes an action plan for how they could improve their resilience to those risks.”

The Sahel’s staples of millet and maize, of low nutritional value and severely diminished by years of drought, are now supplemented by market gardening, says Ruiz. “We help them to grow vegetables they can eat but also sell as a cash crop locally. That has been the biggest change and the biggest success. You need water to do that – so we have been providing bore holes and solar pumps.”

Mikhail also advises that development professionals look to small-scale farming when addressing malnutrition. “Small-scale livestock is also incredibly important. Consuming more meat, milk and protein contributes greatly to your overall nutritional status in a way that allows you to absorb vitamins from the other vegetable products,” he says.

Crucially NGOs seem to be finding more success by concentrating their efforts on women. The FAO argues that when women have control over household income, more money tends to be spent on items that improve nutrition and health. Mikhail agrees: “The important role that women play as carers, food producers and providers is the critical nexus for improving agricultural production, increasing production, as well as improving the quality and nutrition at consumption … I think where we had mainly fallen short in the past was that we hadn’t focused directly on women.”

Hauenstein Swan believes that food security remains dominated by calorie intake and food aid. But he says the knowledge now exists to move beyond that towards resilience, empowerment and hardier, more nutritious staples such as sweet potato, QP Maize and golden rice, rather than allocating vast amounts of land for export crops. “On the global level”, he says, “you can’t escape nutrition now when you talk about food security.”

A field guide nutrition checklist

1. Identify the scale and cause of undernutrition. Collect information about the magnitude of undernutrition, its causes and severity. Then identify and target the most vulnerable groups, especially pregnant mothers and children under two.

2. Assess food consumption patterns. Gain an understanding of what the community eats, where they obtain food, and the nutritional gaps.

3. Assess the level of government commitment. Look at the national nutrition strategy and policy framework and the level of current/planned budget to roll that out, including local representation and extension services.

4. Identify care and health practices. This includes informal care – mothers, siblings, fathers – as well as formal health care services in the area.

5. Promote biodiversity and sustainable agricultural practices.

6. Give women the means to empower themselves.

7. Promote the production and consumption of meat, dairy products and fish (where available).

8. Reach out through multiple channels. Home visits, agricultural extension services, nutrition counselling, women’s groups, dramas and storytelling. These could be combined with other essential health services such as immunization.

Source: ACF International

“Is organic food more nutritious or safer? This is definitively not the right question.”

Stanford University researchers conducted a meta-analysis* of seventeen studies in humans and 230 field studies of nutrient and contaminant levels in unprocessed foods (e.g., fruits, vegetables, grains, milk, eggs, chicken, pork, and meat). The study, published in The Annals of Internal Medicine (http://www.ncbi.nlm.nih.gov/pubmed/22944875), concluded that “the published literature lacks strong evidence that organic foods are significantly more nutritious than conventional foods. Consumption of organic foods may reduce exposure to pesticide residues and antibiotic-resistant bacteria.” 

This conclusion has received vast media coverage – announcing that this meta-analysis demonstrates clearly that organic foods might not have more nutritious value than conventional foods and questioning the “value add” of producing and eating organic. Is organic food little more than a made up marketing scheme, another way for affluent consumers to waste money? This was the kind of questions that came to my mind when reading the articles from influential newspapers like the New York Times and the Washington Post.

In fact, there are major issues and gaps when reading both the scientific article as well as the media coverage.

One of them is the simplistic way that the media has used to report on this study. They mainly focused on the conclusion that summarized two results as a key statement. However, when reading the article, each of us can appreciate all the results (or non-results) as well as the limitations of this study and can conclude that things in nutrition science are not so simple.

The fact that the journalists have not done a critical analysis of the study and available scientific publications on the subject, or have not highlighted its limitations that are quite substantial or have not offered a fair presentation of what the study’s critics have to say is intriguing and disconcerting because a good scientific investigation can minimize the impact that this “single” study can have on our choice to eat or not organic foods. In fact, more clinical long-term investigations are needed to answer the question: “is organic food more nutritious or safer?” It will bring an important component – tangible outcomes to validate its real value in prevention and promotion. The challenges associated to scientific research of the benefice of eating organic foods will be discussed in another blog.

This is a very hot topic and we would like in this blog to ask some pertinent questions and answer them, when possible. This will help to clarify why it is important to continue to develop organic farming as well as to eat and promote organic foods not only at the local but also at the global levels.

What are the advantages of doing organic farming – locally and globally?

There are many explanations and definitions for organic agriculture but all converge to state that it is a system that relies on ecosystem management rather than external agricultural inputs. This is a system that begins to consider potential environmental and social impacts by eliminating the use of synthetic inputs, such as synthetic fertilizers and pesticides, veterinary drugs, genetically modified seeds and breeds, preservatives, additives and irradiation. These procedures are replaced with site-specific management practices that maintain and increase long-term soil fertility and prevent pest and diseases.

According to the FAO/WHO (Codex Alimentarius Commission, 1999):”Organic agriculture is a holistic production management system which promotes and enhances agro-ecosystem health, including biodiversity, biological cycles, and soil biological activity. It emphasizes the use of management practices in preference to the use of off-farm inputs, taking into account that regional conditions require locally adapted systems. This is accomplished by using, where possible, agronomic, biological, and mechanical methods, as opposed to using synthetic materials, to fulfill any specific function within the system.”

When doing organic farming, a variety of crops and livestock are cultivated in order to optimize competition for nutrients and space between species. This results in less chance of low production or yield failure in all of these simultaneously. This diversity in production can have an important impact on local food security and resilience. In rain-fed systems, organic agriculture has demonstrated to outperform conventional agricultural systems under environmental stress conditions. Under the right circumstances, the market returns from organic agriculture can potentially contribute to local food security by increasing family incomes.

At nowadays, the organic agricultural movements can be seen as tangible efforts to create a more sustainable development. However, these efforts are challenged by globalization, which strongly influences and impacts organic agriculture and food chains. In fact, global agriculture and food systems hold large differences between, on the one hand, industrialized farming and consumption based on global food chains and, on the other, smallholder farmers and resource poor people primarily linked in local food markets in low-income countries. This potential more sustainable development in opposition to the more conventional farming/food system gives rise to a number of questions such as:

Does global trade with organic products support a sustainable development?

Can organic agriculture contribute to global food security?

Does organic certification safeguard natural resources and improve working conditions?

Can fair trade with organic products be realized?

These questions need answers if we really want to impact the current and future food insecurity and demonstrate the viability of a sustainable global agriculture system based on organic farming.

Why are we eating organic food (or local food)? …

Because it is safe, nutritious as well as socially responsible and it allows us to reconnect with the essence of “good and tasty eating behaviors”! This is our vision at Challenged Kids International.

The discussion of these different points comes next.

Isn’t reducing exposure to pesticides and antibiotic use precisely what organic production is supposed to do?

Today, agricultural contaminants such as inorganic fertilizers, herbicides and insecticides as well as hormones and antibiotics used in conventional agriculture are a major concern all over the world. These chemicals have accumulated up the food chain where top predators (e.g. humans) can consume toxic quantities. Organic agriculture restores the environmental balance and organic foods are far safer in terms of pesticide content, antibiotic-resistant bacteria and GMOs.

And the Stanford University study corroborated partially this conclusion by finding that organic food had 30% less pesticide residue (see Wayne Roberts’ Blog for this specific point  – http://blogs.worldwatch.org/nourishingtheplanet/citywatch-getting-to-the-right-question-on-the-nutrient-benefits-of-organic-food/). Even though the pesticide levels in conventional foods in this study fall within the safety guidelines set by different environmental protection agencies, it is important to note that the health effects of the pesticides are cumulative, and that what we would consider safe at one time point might not be anymore the same over a period of 20 to 40 years of accumulation.

For example, it is well documented that:

• Herbicide residue on GMO crops may be causing fertility problems,

• Organophosphate exposure can lead to pre-term births, and both attention deficit hyperactivity disorders and lower IQs in children

This is quite scary!

Moreover, the Stanford study also noted that the risk for ingesting antibiotic-resistant bacteria was 33% higher in conventional than in organic chicken and pork but did not discuss at all the potential health outcome of this kind of results.

Why this result is so important?

Let me take one recent example to show you the potential link between ingestion of antibiotic resistant bacteria, and clinical morbidity and mortality.

As highlighted recently in the Huffington Post (as well as in other newspapers and magazines), superbugs (drug-resistant E. coli) in chickens could be an underlying cause of antibiotic-resistant bladder infections in 8 million women (http://www.huffingtonpost.com/2012/07/12/chicken-bladder-infection-superbug-uti_n_1668255.html).

In fact, chickens are injected with antibiotics from day one to help them grow bigger and faster and protect them from diseases. The problem is that these are the same antibiotics sold in the U.S. for humans to treat bladder infections, among other conditions, which means our bodies eventually become resistant to the drugs because we’re getting so much of it. McGill University researchers who have published this interesting result, had previously reported that the E. coli in the chicken was much more genetically related to those of human urinary tract infections, compared with the E. coli in the beef and pork. An interesting but implacable demonstration!

More importantly, from a public health safety point of view, this kind of results has led the USDA to routinely sterilize commercially harvested meat, a practice not necessary in organically raised animals.
Is organic food more nutritious than conventional food?

…. Yes, may be, perhaps…. It all depends on what you mean by nutritious food and its relation to seasonal food.

This Stanford University study has also showed that organic foods may have higher levels of anti-oxidants – plant phytochemicals thought to be important to human health as well as omega-3 fatty acids in organic milk and chicken, and vaccenic acid (potential anticancer effect) in organic chicken.

These results corroborate our reading of other scientific articles that have already proved some benefits of organic food and farming. To reinforce this statement, six articles have been published just this year on the nutritional value of organic foods showing interesting results like:

(1) Organic broccoli maintained higher concentrations of bioactive compounds (ascorbic acid and phenolics) and antioxidant potential during storage than conventional broccoli, with higher potential health beneficial effects (http://www.ncbi.nlm.nih.gov/pubmed/22936597),

(2) Organic cropping systems result in spinach with lower levels of nitrates and higher levels of flavonoids and ascorbic acid (http://www.ncbi.nlm.nih.gov/pubmed/22393895),

(3) Organic growing increased the level of antioxidant compounds such as carotenoids, phenolic compounds and vitamin C in sweet bell pepper (http://www.ncbi.nlm.nih.gov/pubmed/22368104),

(4) The organic growing system affects tomato quality parameters such as nutritional value and phenolic compound content (http://www.ncbi.nlm.nih.gov/pubmed/22351383),

(5) The concentrations of several nutritionally desirable compounds in milk (β-lactoglobulin, omega-3 fatty acids, omega-3/omega-6 ratio, conjugated linoleic acid and/or carotenoids…) decreased with increasing feeding intensity (organic outdoor ≥ conventional outdoor ≥ conventional indoors) (http://www.ncbi.nlm.nih.gov/pubmed/22737968; http://www.ncbi.nlm.nih.gov/pubmed/22430502)

Evaluating the health benefits of eating organic foods is a relatively new research focus (less than 10 years of investigation). The number of publications is increasing significantly each year and we can expect more sophisticated research projects and as a result, more and more interesting results will be available to demonstrate the benefit of eating organic foods.

Moreover, the long term health impact of eating organic foods is not currently appropriately addressed. The duration of the human studies ranged from two days to two years. Most of the health effects will take a lot longer than that to show up.

According to the Stanford University article, this kind of clinical investigations won’t be possible because it is too expensive. Past (the SUVIMAX 1 study in France) and current experiences (the SUVIMAX 2 and Nutrinet studies in France, the Raine study in Australia and the Ontario Birth Study here in Toronto, Canada) to name some of them show that this is possible to investigate long-term effects if there is the political will to go in this direction.

Finally, the interface between food, nutrition and health is a complex issue. It depends from where you come from, your education and how you value the importance of good foods and/or health as well as the tradition and culture around food and culinary practices.

For CKi, nutritious food is more than the number of calories or the quantity of macro- (protein, carbohydrate…) and/or micronutrients (minerals and vitamins), it also relates to its social component (eating together, discussing and sharing food), the taste of food, the use of our five senses and finally, the impact that colorful and tasty foods can have on our brain and ultimately on our overall well-being.

Nutrition is a complex phenomenon, like an interactive game where pleasure can play a significant role. Unfortunately, we have lost this dimension in our “super speed” world.

A few years ago, I switched to organic and/or local food because I wanted to reconnect with my roots (French culture around food). The result has been more than positive. I have rediscovered the taste of foods: seasonal fruits and vegetables where I am sure to find the best nutritional value as well as locally produced meat, eggs, cheese and bread. As a result, I am eating less meat and refined carbohydrates but more grains, fruits and vegetables; I also cut completely junk foods. When I am cooking real foods and I am eating good cuisine, I have a lot of pleasure and I feel full not only in my stomach but also in my mind – a great sensation of satiety. I also know that I contribute socially to the sustainability of the global food security. This is also why it is important to eat organic and/or local foods!

Over time, we can expect that unbiased analysis coupled with modern-day science is likely to show with increasing clarity that growing and consuming organic food, especially in conjunction with healthy diets rich in fresh, whole foods and seasonal fruits and vegetables is one of the best health-promotion investments we can make today as individuals, families, and a society.

* In statistics, a meta-analysis refers to methods focused on contrasting and combining results from different studies, in the hope of identifying patterns among study results, sources of disagreement among those results, or other interesting relationships that may come to light in the context of multiple studies.

References:

http://www.ncbi.nlm.nih.gov/pubmed/22944875

http://www.anh-usa.org/new-junk-science-study-dismisses-nutritional-value-of-organic-foods/

http://grist.org/food/organic-food-may-not-have-a-big-nutritional-edge-but-how-much-does-that-matter/

http://www.ncbi.nlm.nih.gov/pubmed/12094634

http://www.ifoam.org/growing_organic/1_arguments_for_oa/environmental_benefits/environmental_benefits_main_page.html

http://www.icrofs.org/pdf/darcofIII/globalorg.pdf

http://www.fao.org/organicag/oa-faq/oa-faq1/en/

http://www.huffingtonpost.com/2012/07/12/chicken-bladder-infection-superbug-uti_n_1668255.html

 

Why millions of people choose to live in urban squalor?

As international development practitioners, we have had many occasions to visit slums in Africa or anywhere in the world. Personally, my more difficult time was in Port-au-Prince and in this specific context; poverty in the countryside has seemed to me almost Arcadian by comparison. The rural poor may lack nutrition, health care, education, and infrastructure but they can farm still in settings that not only are more bucolic, but also represent the condition of most of humanity for most of history.

With life so squalid in urban slums, why would anyone want to move there?

This is an interesting question that Charles Kenny has tried to address in his article “In Praise of Slums” published in the Foreign Policy magazine. In this new blog, we propose to describe and discuss some of his major ideas, highlight the missing aspects, if there are some and finally we will focus on one of our main centers of interest, i.e. the nutrition.

According to Charles Kenny, there are two reasons for choosing to live in urban slums

1- Because slums are better than the alternative

Most people who’ve experienced both rural and urban poverty choose to stay in slums rather than move back to the countryside. That includes hundreds of millions of people in the developing world over the past few decades, including 130 million migrant workers in China alone. They follow a well-trodden path of seeking a better life in the bright lights of the city and in this new century, the probability of living a better life is better than ever. In the case of China, world economic supremacy and extensive industrialization can explain this result. For some African countries that are currently experiencing a sustained economic growth, it can be the same.

2 – Start with the simple reason that most people leave the countryside: money

Everyone is after the same thing…. Prosperity!

Moving to cities makes economic sense. Rich countries are urbanized countries, and rich people are predominantly town and city dwellers.

According to the McKinsey Global Institute, 600 cities worldwide account for 60% of global economic output (http://www.mckinsey.com/insights/mgi/research/urbanization/urban_world). While 600 cities will continue to account for the same share of global GDP in 2025, this group will have a very different membership. Over the next 15 years, the center of gravity of the urban world will move south and, even more decisively, east. By 2025, 136 new cities are expected to enter the top 600, all of them from the developing world and overwhelmingly—100 new cities—from China.

Slum dwellers may be at the bottom of the urban heap, but most are better off than their rural counterparts. In fact, while about half the world’s population is urban, only a quarter of those living on less than a dollar a day live in urban areas. In Brazil, for example, where the word “poor” conjures images of both Rio’s vertiginous favelas and indigenous Amazonian tribes living in rural privation, only 5% of the urban population is classified as extremely poor, compared with 25% of those living in rural areas (http://www.ruralpovertyportal.org/web/rural-poverty-portal/country/home/tags/brazil).

But is it much of a life, eking out an existence in today’s urban squalor!

According to an article published in the New England Journal of Medicine (NEJM), urbanization could be an emerging humanitarian disaster (http://www.nejm.org/doi/full/10.1056/NEJMp0810878).

Why?

Because it grows too fast! To give you an example, the capital of Botswana, Gaborone, will grow from 186,000 to 500,000 inhabitants by 2020. According to United Nations Human Settlements Program (UN-Habitat), all population growth from now on will be in cities: the urban population is projected to grow to 4.9 billion by 2030, increasing by 1.6 billion while the rural population shrinks by 28 million.

According to the NEJM’s article, this transition is happening chaotically, resulting in a disorganized urban landscape. Although many expect urbanization to mean an improved quality of life, this rising tide does not lift all boats, and many poor people are rapidly being absorbed into urban slums. The UN-Habitat reports that 43% of urban residents in developing countries such as Kenya, Brazil, and India and 78% of those in the least-developed countries such as Bangladesh and Haiti live in such slums.

In fact, urbanization could be a health hazard for certain vulnerable populations, and this demographic shift threatens to create a humanitarian disaster. The threat comes both in the form of rising rates of endemic disease such as pulmonary diseases, diabetes and hypertension and a greater potential for epidemics and even pandemics like cholera. Indeed, increasing the population density in cities without proper water supplies and sanitation increases the risk of transmission of communicable diseases.

Countries like Ghana and Ethiopia because of their current and projected economic growth and the will of their governments to reduce the impact of poverty may be able to respond adequately to this demographic shift by offering not only the needed access to health services but also the necessary infrastructures like housing, and water and sanitation. These two countries are among the four African countries that are going to reach some of the MDGs in 2015. Progresses are there! Regrettably, for other countries like Haiti, it may take evermore. Kenya is another example (see below).

But slum living today, for all its failings, is markedly better than it was in Dickens’s time.

According to Charles Kenny, “urban quality of life now involves a lot more actual living. Through most of history, death rates in cities were so high that urban areas only maintained population levels through constant migration from the countryside. In Dickensian Manchester, for instance, the average life expectancy was just 25 years, compared to 45 years in rural Surrey. Across the world today, thanks to vaccines and underground sewage systems, average life expectancies in big cities are considerably higher than those in the countryside; in sub-Saharan Africa, cities with a population over 1 million have had infant mortality rates one-third lower than those in rural areas. In fact, most of today’s urban population growth comes not from waves of villagers moving to the city, but city folks having kids and living longer.”

The comparison with Dickens’s time is quite powerful! Fortunately, conditions are better. It would be interesting to bring another layer of social context and to compare the living conditions of rural populations in developing countries with those of the peasants of Dikens’s time. Have they improved also? Unfortunately, we could not find any pertinent information regarding this specific point.

However, Birchenall showed in his article entitle “Economic Development and the Escape from High Mortality” (http://econ.ucsb.edu/~jabirche/Papers/development.pdf) that while mortality in cities in developed countries during the 20th century declined drastically due to health interventions, mortality in cities started to decline once death rates in rural areas were already declining. In fact, agricultural changes associated with economic development initiated the escape from high mortality and provided the conditions for higher population and higher income in the world. As food availability increased, anthropometric and epidemiological evidences indicate that people in developed countries became taller, heavier, and less susceptible to infectious diseases, especially to diseases in which nutritional status has a definite influence. According to Birchenall, the contribution of per capita income to the world mortality decline from diseases sensitive to nutrition can be as large as 45%. The contribution to the overall mortality decline and to the decline of all infectious diseases is close to 30%.

Access to health, economic development and more importantly good nutrition (quantity as well as quality) were the pillars of the escape from high mortality for the developed countries over the past two centuries. Normally, an historical analysis can show us the appropriate path to follow. Are we observing the same pattern in developing countries? This is an interesting question.

Why are the different elements that can explain a better quality of life?

The latest analyses show ed  that one of the element is a better access to services

Data from surveys across the developing world suggest that poor households in urban areas are more than twice as likely to have piped water as those in rural areas, and they’re nearly four times more likely to have a flush toilet (http://www.prb.org/pdf09/64.2urbanization.pdf).

In India, very poor urban women are about as likely to get prenatal care as the non-poor in rural areas. And in 70% of countries surveyed by MIT economists Abhijit Banerjee and Esther Duflo, school enrollment for girls ages 7 to 12 is higher among the urban poor than the rural poor.

That said, modern slum dwellers – about one-third of the urban population in developing countries — are some of the least likely to get vaccines or be connected to sewage systems (http://www.unhabitat.org/pmss/listItemDetails.aspx?publicationID=1156).

That means ill health in informal settlements is far more widespread than city averages would suggest. In the slums of Nairobi, for example, child mortality rates are more than twice the city average and higher, in fact, than mortality rates in Kenya’s rural areas. But Nairobi’s slums are atypically awful, more an indicator of the Kenyan government’s dysfunction than anything else.

In most developing countries, even the poorest city dwellers do better than the average villager. Banerjee and Duflo (http://economics.mit.edu/files/530) found that, among people living on less than a dollar a day, infant mortality rates in urban areas were lower than rural rates in two-thirds of the countries for which they had data. In India, the death rate for babies in the first month of life is nearly one-quarter lower in urban areas than in rural villages. So significant is the difference in outcomes that population researcher Martin Brockerhoff concludes that “millions of children’s lives may have been saved” in the 1980s alone as the result of mothers worldwide moving to urban areas (http://htc.anu.edu.au/pdfs/Brocker1.pdf). An interesting statement!

But who are the hungry – the rural or the urban population?

According to the latest Food and Agriculture Organization (FAO) statistics, there are 925 million hungry people in the world and 98% of them are in developing countries.  They are distributed like this:

578 million in Asia and the Pacific

239 million in Sub-Saharan Africa

53 million in Latin America and the Caribbean

37 million in the Near East and North Africa

And 19 million in developed countries

Three-quarters of all hungry people live in rural areas, mainly in the villages of Asia and Africa. Tremendously dependent on agriculture for their food, these populations have no alternative source of income or employment. This is critical when there is only one raining season. If the crops production is compromised because of the lack of rain, then the farmers may migrate to cities in their search for employment, swelling the ever-expanding populations of shanty towns in developing countries.

FAO calculates that around half of the world’s hungry people are from smallholder farming communities, surviving off marginal lands prone to natural disasters like drought or flood. Another 20% belong to landless families dependent on farming and about 10% live in communities whose livelihoods depend on herding, fishing or forest resources.

The remaining 20% live in shanty towns on the periphery of the biggest cities in developing countries. Something we need to keep in mind is the fact that the numbers of poor and hungry city dwellers are rising rapidly along with the world’s total urban population. In this context, continued efforts are needed to reduce urban disparities and inequities associated with poverty.

Without any surprise – the more vulnerable are the children and the women!

An estimated 146 million children in developing countries are underweight – the result of acute or chronic hunger (UNICEF, 2009).  All too often, child hunger is inherited: up to 17 million children are born underweight annually, the result of inadequate nutrition before and during pregnancy. Furthermore, if we look specifically the urban situation: research indicates that urban infants suffer growth retardation at an earlier age than their rural counterparts, and that urban children are more likely to have rickets. While the urban diets are often more varied and include higher levels of animal protein and fat, rural diets may be superior in terms of calories and total protein intake. Average food consumption is lower and estimates of undernutrition generally higher in urban areas. However, physical malnutrition in children is markedly worse in the rural population, possibly because urban dwellers, of whatever social group, have lower energy demand than subsistence farmers.

Several associated factors account for nutritional deprivation among slum dwellers. One problem is the inability to adapt to new staples and a new structure of food prices. Food purchases of the urban poor are heavily dependent on competing demand for unavoidable non-food expenditure such as transport to work, housing and remittances to relatives in the countryside. The urban poor seldom have easy access to central markets due to public transport costs and are thus compelled to buy their food in small quantities from local shops at higher prices. They may have little time to prepare food, no suitable space for cooking and no money for fuel. As a result, the poor often rely mainly on small-scale local vendors to prepare meals with little regard for hygiene or food safety. When I was in Port-au-Prince, I saw a gigantic accumulation of white containers in the different canals and rivers that cross the city – demonstrating the importance of the “take-out  system” despite the high level of poverty.

On the other side, women are the world’s primary food producers, yet cultural traditions and social structures often mean women are much more affected by hunger and poverty than men. A mother who is stunted or underweight due to an inadequate diet often give birth to low birth weight children.

According to UNICEF, around 50% of pregnant women in developing countries are iron deficient. Lack of iron means 315,000 women die annually from hemorrhage at childbirth. As a result, women, and in particular expectant and nursing mothers, often need special or increased intake of food.

One major issue in urban undernutrition identified by most UN agencies is that of time constraints on urban women. They are more likely to be household heads, particularly in Latin America, and often lack social support networks found in rural areas. For many low-income female workers who leave home early in the morning and return late at night, bottle feeding of infants has become an absolute necessity. But commercial milk powders are often unhygienically prepared, creating a positive threat to infants’ health. In some urban communities, large scale introduction of bottle feeding has already changed the type and incidence of protein-energy malnutrition. Marasmus, a severe form of protein-energy deficiency, is becoming more frequent among younger children in urban areas. In four Bangkok slums, the prevalence of protein-calorie malnutrition was attributed to failure to breastfeed, early weaning and inadequate artificial feeding.

Slum life remains grim.

HIV prevalence rates are twice as high in urban areas of Zambia as they are in rural areas, for instance, and the story is worse with typhoid in Kenya. Slum residents are also at far greater risk from violence, outdoor air pollution, and traffic accidents than their rural counterparts. And the closer conditions in slum areas get to a state of anarchy mixed with kleptocracy, the more health and welfare outcomes tend to resemble those of Dickensian Manchester.

But all things considered, slum growth is a force for good. It could be an even stronger driver of development if leaders stopped treating slums as a problem to be cleared and started treating them as a population to be serviced, providing access to reliable land titles, security, paved roads, water and sewer lines, schools, and clinics.

As Harvard University economist Edward Glaeser puts it: “slums don’t make people poor — they attract poor people who want to be rich. So let’s help them help themselves”.

Definition: What is a slum?

A slum household is a household that lacks any one of the following five elements:

Access to improved water

Access to improved sanitation

Security of tenure

Durability of housing

Sufficient living area

Resources:

http://www.foreignpolicy.com/articles/2012/08/13/in_praise_of_slums

http://www.mckinsey.com/insights/mgi/research/urbanization/urban_world

http://www.nejm.org/doi/full/10.1056/NEJMp0810878 http://econ.ucsb.edu/~jabirche/Papers/development.pdf

http://www.ifpri.org/publication/why-child-malnutrition-lower-urban-rural-areas-0

http://www.wfp.org/hunger/who-are# http://www.fao.org/hunger/en/

http://whqlibdoc.who.int/publications/2012/9789280646320_eng_full_text.pdf

If you would like to read more interesting articles from Charles Kenny,

go to: http://charleskenny.blogs.com/

Save the child …. Give breast milk!*

The World Breastfeeding Week is celebrated every year (August 1st to 7th) in more than 170 countries to encourage breastfeeding and improve the health of babies around the world. It commemorates the Innocenti Declaration made by WHO and UNICEF policy-makers in August 1990 to protect, promote and support breastfeeding (http://www.unicef.org/programme/breastfeeding/innocenti.htm).

As we all know, the first two years of a child’s life are particularly important, as optimal nutrition during this period will lead to reduced morbidity and mortality, to reduced risk of chronic diseases and to overall better development. Indeed, infant and young child feeding is one key area (or the cornerstone) to improve child survival and promote healthy growth and development.

The situation

Malnutrition is responsible, directly or indirectly for about 33% of deaths among children under five. Well above two thirds of these deaths, often associated with inappropriate feeding practices, occur during the first year of life. In fact, despite compelling evidence that exclusive breastfeeding prevents diseases like diarrhea and pneumonia that kill millions of children every year, global rates of breastfeeding have remained relatively stagnant in the developing world, growing from 32% in 1995 to 39% in 2010 (see map below to get an idea of the level of exclusive breastfeeding per country).

In reality, breastfeeding rates in the developing world have been declining until recently. This decline has been attributed to changing socioeconomic factors and the perception that infant formula is superior to breast milk. To give you a concrete example and according to UNICEF Pacific Representative, Dr. Isiye Ndombi: “In the Pacific, breastfeeding rates dropped for a number of reasons, either because mothers were being integrated into the workforce, were not supported by their spouses or were not making informed decisions about the long-term benefits breastfeeding would bring to their children. Exclusive breastfeeding (i.e breastfeeding from birth to six months) are about 40% in Fiji, Tuvalu and Vanuatu, and 31% in the Republic of Marshall Islands.”

“It’s a global trend”, says Elisbeth Sterken, national director of INFACT Canada, a non-profit agency concerned with issues around breastfeeding (http://www.infactcanada.ca/). The impact of bottle-feeding infants is different culture to culture but the long-term impact would be the same – a high incidence of obesity and metabolic diseases. Why?

For example, “in Western cultures, bottle-fed babies begin life with nutritional deficiencies that may lead to health and obesity issues later in life”, she said.

In fact, it was a real surprise to read in a book entitled “Let them eat junk” that baby formula can contain 60% more sugars than regular milk. In fact, a bottle-fed baby consumes 30,000 more calories over its first eight months than a breast-fed one. That’s the calories equivalent of 120 average chocolate bars. Given how early our tastes are formed, it is not surprising that “several research studies have shown correlations between bottle-feeding and subsequent obesity. And the problem continues in baby foods, against efforts to limits the high level of added sugars.

Is it possible to advocate for an improvement of the nutritious value of baby formula and change the current trend?

The task seems tricky. Lobbying power from food companies is huge! The battle is unequal, something similar to the idea developed by Jean de la Fontaine in one of his poems. What union can there be between a clay pot and an iron pot? Because when they collide against each other, the clay pot will be broken.

Just one example to demonstrate this unequal battle: the Thai introduced a proposal to reduce the levels of sugars in baby foods from the existing maximum of 30% to 10%, as part of the global fight against obesity. The proposal was blocked by the US and the EU, where the world’s largest sugar corporations have their home offices. This is one among other examples of the lobbying power of the sugar companies.

And what happens in the developing countries?

In developing countries the impact is more dramatic”, Sterken said. An estimated 1.5 million formula-fed babies die each year because families in developing countries can’t afford the formula and dilute it, use contaminated water to mix it, can’t properly sterilize bottles, or supplement with sugared tea, thereby depriving their children of nutrition, and introducing deadly bacteria into their food.

Another important problem is related to the high level of urbanization in sub-Saharan Africa.

Slums in sub-Saharan Africa are expanding at a fast rate, and the majority of urban residents now live in slum settlements. And in fact, urban poor settlements or slums present unique challenges with regards to child health and survival.  The slums are characterized by poor environmental sanitation and livelihood conditions. Contrary to the long-held belief that urban residents are advantaged with regards to health outcomes, urban slum dwellers tend to have very poor health indicators. Then it is not a surprise to observe thaturban mothers are less likely than rural ones to breastfeed -and more likely to wean their children early if they do begin. Low rates of breastfeeding may be attributed in part to cultural practices, access to and utilization of health care facilities, a lack of knowledge about the importance of the practice, but more importantly to the reality that poor women in urban settings who work outside the home are often unable to breastfeed.

This is an important point, how can we help women who work in developing countries to act sppropriately?  It is a necessity for them to be able to breastfeed because it is good for their babies but they also need to economically survive. A dilema!

Does malnutrition affect the quality of mother’s milk?

The 2008 Lancet Nutrition Series highlighted the remarkable fact that a non-breastfed child is 14 times more likely to die in the first six months than an exclusively breastfed child. Breast milk meets a baby’s complete nutritional requirements and is one of the best values among investments in child survival as the primary cost is the mother’s nutrition. In this context and knowing the high incidence of food insecurity in the developing countries, it seems important to ask if malnutrition (or poor nutrition) can affect the quality of mother’s milk and compromise the potential benefit of breastfeeding where it is most needed, i.e. the developing countries.

In fact, a review of the literature showed that mild or moderate malnutrition rarely affects the amount or quality of breast milk that a woman produces. The mother’s dietary intake will not generally increase how much breast milk she can produce in a day. Her nutritional status before and during pregnancy are important for milk content, but generally this has only of marginal impact since her body will ensure that the breast milk receives the available vitamins and minerals. If her diet remains inadequate for a long time, the milk may contain fewer vitamins and fats as her own body stores are used up. However, her breast milk continues to be nourishing for her child, and provides anti-infective factors that help to protect the child against infections. No breast milk substitute contains these protective factors.

The response at the micro and macro levels

It’s hard to believe that something as natural, healthy and cost-free as breastfeeding needs to be promoted by health and nutrition specialists. But as World Breastfeeding Week began on Aug. 1, breastfeeding specialists want to draw attention to the many benefits of breastfeeding to mother and baby and curb the trend toward bottle-feeding infants with commercially prepared formula.

In 2002, the WHO and UNICEF have developed a Global Strategy for Infant and Young Child Feeding (http://www.who.int/nutrition/publications/infantfeeding/9241562218/en/), which recommends that infants start breastfeeding within one hour of life, are exclusively breastfed for six months, with timely introduction of adequate, safe and properly fed complementary foods while continuing breastfeeding for up to two years of age or beyond.

Moreover, the WHO and the United Nations Children’s Fund jointly developed a code for marketing infant formula to curb aggressive marketing campaigns, especially in developing countries (http://www.who.int/nutrition/publications/code_english.pdf). However, its impact over the past 30 years has been limited because of a series of alleged violations and boycotts.

What do we need to do to reinforce exclusive breastfeeding globally?

An international governance is needed to step in and replace the voluntary marketing code. It will help to address and correct unethical marketing that could be put in place by makers of breastmilk substitutes.

It is also necessary to develop national policies that support maternity leave, not only in developed, but also in developing countries.

And finally, it is important to work at the community level. One of the strategies could be to train low-income mothers as breastfeeding counselors and assist communities in forming mother-to-mother support groups (something similar to Saving Help Group). This strategy will increase the understanding of the risks of not breastfeeding and finally, it will reinforce the practice of exclusive breastfeeding among mothers.

In fact, if the exclusive breastfeeding rate was increased significantly, as much as 13% of all deaths of children younger than 5 years could be prevented that could represent around 1 million children under five in the developing world each year. Moreover, the promotion of breastfeeding could avert 21.9 million disability adjusted life years (8.6%).

What do we mean by exclusive breastfeeding?

“Exclusive breastfeeding” is defined as giving no other food or drink – not even water – except breast milk. It does, however, allow the infant to receive oral rehydration salts (ORS), drops and syrups (vitamins, minerals and medicines). Breast milk is the ideal food for the healthy growth and development of infants; and it’s also an integral part of the reproductive process with important implications for the health of mothers.

Then, what are the benefits? Just a recap….

Exclusive breastfeeding for six months has many benefits for the infant and the mother, says the WHO. “Chief among these is protection against gastro-intestinal infections which is observed not only in developing but also in industrialized countries. Early initiation of breastfeeding, within one hour of birth, protects the newborn from acquiring infections and reduces newborn mortality. Finally, the risk of mortality due to diarrhea and other infections can increase in infants who are either partially breastfed or not breastfed at all.”

Breast milk is also an important source of energy and nutrients in children 6 to 23 months of age. It can provide one half or more of a child’s energy needs between 6 and 12 months of age, and one third of energy needs between 12 and 24 months. Breast milk is also a critical source of energy and nutrients during illness and reduces mortality among children who are malnourished.

Adults who were breastfed as babies often have lower blood pressure and lower cholesterol, as well as lower rates of overweight, obesity and type-2 diabetes.

Breastfeeding also contributes to the health and well-being of mothers. It reduces the risk of ovarian and breast cancer and helps space pregnancies — exclusive breastfeeding of babies under six months has a hormonal effect which often induces a lack of menstruation. This is a natural (though not fail-safe) method of birth control known as the Lactation Amenorrhea Method.

Moreover and from a sustainable point of view, exclusive breastfeeding contributes both directly and indirectly to sustainable development. Evidence has clearly shown that exclusive breastfeeding for the first six months of a baby’s life not only improves their future growth and educational achievement, but also significantly reduces national health costs and helps prevent chronic malnutrition. Breastfeeding helps to prevent a number of diseases in childhood and later in life. It offers protection from infections, allergies and adult-life chronic conditions like hypertension, diabetes, obesity, cardiovascular diseases and cancer that rob the national budgets of millions of dollars.

Breastfeeding needs to be valued as a benefit which is not only good for babies, mothers, and families, but also as a saving for governments in the long run.

* The theme for this year’s celebration is “Understanding the past, planning the future: Celebrating 10 years of WHO/UNICEF’s Global strategy for Infant and Young Child Feeding”. It has the slogan “Save the Child, Give breast milk”.

Resources:

http://allafrica.com/stories/201208060231.html http://allafrica.com/stories/201207051232.html

http://www.scoop.co.nz/stories/GE1208/S00003/make-breastfeeding-easier-for-mothers-says-unicef.htm

http://www.guelphmercury.com/news/local/article/771868–world-breastfeeding-week-aims-to-promote-benefits-curb-bottle-trends

http://www.unicef.org/nutrition/index_emergencies.html http://helid.digicollection.org/en/d/Js8230e/1.3.1.html

http://www.biomedcentral.com/1471-2458/11/396/

http://www.nbcchicago.com/investigations/series/target-5/target-5-sugar-baby-formula-139339308.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/

http://www.nutraingredients.com/Industry/Infant-formula-marketing-code-has-failed-says-expert

Book: Let them eat junk, how capitalism creates hunger and obesity – Robert Albritton

It is possible to improve food security in Sahel!

Where is located Sahel?

We have all heard about Sahel, but we don’t really know where it is located and how this region is large? Check the map below for more information.

The Sahel (in orange) is the ecoclimatic and biogeographic zone of transition between the Sahara desert (in yellow) in the North and the less arid Savannah (in green) in the South. It stretches across the north of the African continent between the Atlantic Ocean and the Red Sea. The Sahel covers parts of the territory of (from west to east) Senegal, southern part of Mauritania, Mali, southern part of Algeria, Niger, Chad, southern part of Sudan and Eritrea.

What characterizes the Sahel region right now?

The Sahel region suffers from recurrent drought events, temperatures easily crawl into the 100s. Food insecurity, hunger, death are common. Widespread drought, high food prices and poor harvests have put more than 18 million people in a situation of starvation and over a million children at risk of severe malnutrition.

But, despite this dramatic scenario of food insecurity – low rainfall and general food scarcity, some farmers have had a bumper rice yield this year. This surplus rice is no accident.

Is it a miracle?

Not at all! Over the last three years ACDI/VOCA (http://www.acdivoca.org/site/ID/home), an economic development organization, has helped some 10,000 farmers in the northern Segou region of the Sahel region located in Mali to make the transition from semi-nomadic livestock herders to sedentary farmers and landowners through the Alatona Irrigation Project, funded by the Millennium Challenge Account (MCA – an innovative and independent U.S. foreign aid agency that is helping lead the fight against global poverty (http://www.mcc.gov/pages/about).

Like for the majority of the African countries, the inhabitants of this region depend on natural rainfall to grow crops or create viable grazing grounds. For these pastoralists, one year of low rainfall, like last year, could wipe out their animal herds and create a human disaster. Indeed, it can force them to sale their livestock on which they depend for survival at a fraction of their value because it is done in response to a crisis situation. Resettling in a new village and retraining these herders has helped them transition from a subsistence lifestyle into commercial agriculture, resulting in family economic stability and regional food security.

How did they achieve these objectives – family economic stability and regional food security?

Each of the resettled families will receive title to five hectares of irrigated land (which is significantly superior to the average farm size of one hectare that a large majority of the farmers own in Mali), new housing and improved access to fresh water supplies, primary education for children, and health clinics.

Improving the quality of life of the whole family and breaking the intergenerational poverty cycle are important!

Working with local organizations, ACDI/VOCA helps train the new farmers to grow rice with careful irrigation, soil conservation and fertility practices. The farmers are also diversifying and selectively marketing second-season cash crops.

More specifically, ACDI/VOCA is organizing the distribution of agricultural starter kits to ensure success for first-time rice farmers. The kits include oxen, plowing equipment, wagons, fertilizer and certified seed. ACDI/VOCA will also provide kits for a second dry season vegetable crop exclusively for women farmers. In addition to rice, farmers are exploring markets for shallots, potatoes and forage crops for livestock feed.

Perhaps most importantly, these new farmers are learning water management, hydraulic systems, irrigation and drainage techniques as well as the best practices in terms of maintenance of a network of canals.

Access to water, appropriate equipments, technologies, savoir faire and local capacity building for long-lasting outcomes as well as diversification of the production are the keystone of any successful farming project!

As a result, Alatona farmers are producing 5.2 tons per hectare and making on average $1,000 per hectare in a country where average annual incomes are measured at $700 per year.

Everybody thought we herders were incapable of successfully developing the land that the project has given us,” Demba Diallo, a chief of one of the resettled villages remarked. “With all the positive impacts we are seeing, we are organizing ourselves to better overcome defeats.”

This project is designed to go beyond food subsistence and move into agribusiness, where farmers can invest in small threshing machines, de-hulling machines and motorized tractors.

Infrastructure development projects like the Alatona Irrigation Project can help foster food security and alleviate poverty through economic growth. And the components of this winner ticket are replicable through a holistic and integrated approach that needs to include:

A Variety of Services 

It integrates financial services, irrigation development and women’s gardens into its agricultural training program. It fosters sustainability by helping producers form farmer organizations that have market advantage whether buying farm inputs or selling the crops. 

The ownership of the Land for the farmers

The agricultural land in the project is being cultivated under a land title system, which is a first for the region. Now farmers own the land and have incentives to make improvements. As decision-makers, they put in crops the market demands.

 

Challenges still exist for the Alatona Irrigation Project, such as maintaining long-term soil fertility, sustaining the canal infrastructure, transferring know-how to younger generations and coping with the current political instability in Mali.

Sources:

http://www.huffingtonpost.com/anja-tranovich/food-security-solutions-sahel_b_1651153.html

http://www.acdivoca.org/site/ID/maliMCA-ASDA

If you would like to read more of the series of articles published by Huffington post to call attention to the crisis in the Sahel, go to:

http://www.huffingtonpost.com/news/sahel

You will find some really interesting articles….