To prevent stunting that blights the developing world … a better understanding of what nutrition means in the context of human development, an integrated approach and a strong leadership are needed (Part 3)

Addressing the issue of stunting or chronic undernutrition, resulting in growth retardation, is currently a big issue because it affects dramatically children’s development and compromised irremediably their future professional life.

As announced last week by the EU Commissioner for development, Andris Piebalgs: “Undernutrition is the biggest threat to people’s health in the developing world, causing at least one third of all child deaths, and a fifth of mothers. This shocking and shameful reality calls for an improved, global and decisive response. The EU is firmly committed to reduce by 7 million the number of stunted children by 2025. Increased international mobilization is vital. That’s why, today, I am also calling on other major donors and development actors to join us in this global movement and make their own commitments.”  

 When I decided to embark in this journey, I didn’t know that I would spend days reading articles, analyzing, pondering the pro and con… My personal objective was to be able to put together different pieces of the puzzle to really understand how we can impact poverty through preventing stunting and as a result, ensuring a dignified future for everyone.  One of my lesson learnt is the fact that we need to change our mindset … Access to food is not only based on quantity (calories) but it is more importantly based on quality (micronutrients for sure, but also macronutrients) when nutrition becomes the corner stone of global health and food security. This change in mindset is the future of sustainable human development not only in the developing world but also in the developed countries.

This article will review different aspects to help us to better understand the issue of stunting (and its adverse outcomes) not only in children but also in women. A short stature can predict more than one dimension of the potential impact that malnutrition can have on human being — it is why it is so critical to address this issue appropriately.

 stunting-in-children_50291a07a181b

The current situation – a decrease of the incidence of stunting, yes but not for everyone:

The children who are suffering from stunting (short stature) may look normal but their brain development and immune systems most certainly are not. Stunting is much more common than underweight (low weight-for-age) or wasting (low weight-for-height), affecting globally in 2010 about 171 million or 27% of children aged 0–5 years.

 The good news … Worldwide, the prevalence of childhood stunting has decreased and will continue to decrease as shown in the figure below:

 graph 1

 (Adapted from Maternal and Child Nutrition (2011), 7 (Suppl. 3), pp. 5–18)

Trends in stunting follow different patterns in developing and developed countries. While the prevalence of stunting in developed countries has been stable at 6% since 1990 and is expected to remain at this level, developing countries have experienced a decrease from 44.4% in 1990 to 29.2% in 2010. The prediction is that this decreasing tendency will continue and will reach a prevalence of 23.7% in 2020.

 Africa vs Asia – not the same story:

graph 2

  (Adapted from Maternal and Child Nutrition (2011), 7 (Suppl. 3), pp. 5–18)

 

In Africa, given population growth, the result presented above has translated into increasing numbers of stunted children (from 45 million in 1990 to 60 million in 2010). In contrast, Asia has showed a dramatic decrease and this declining trend will continue, reaching a total number of stunted children in Asia (68 million) similar to the number in Africa (64 million) in 2020. In Latin America both the prevalence and number of affected children were much lower than in Africa and Asia (14 % or 7 million in 2010) and they are expected to continue decreasing in the coming decade). Data in Oceania remain scarce and thus trend modeling is not possible. However, individual countries like Papua New Guinea show high rates of stunting (44 % in 2005).

 figure 9 article 3

 

There is a great variation in rates of childhood stunting among countries. The figure above maps countries according to their latest national stunting prevalence estimation. Extremely high rates appear in countries like Afghanistan, Yemen, Guatemala, Burundi, Madagascar, Malawi and Ethiopia, with levels closed to or above 50 % in most recent surveys. Other countries of sub-Saharan Africa, South-central and South-eastern Asia also present high to medium stunting rates.

 

The causes – inadequate dietary intake but also disease like infection and diarrhea:

The causes and etiology of stunting are the result of multiple circumstances and determinants. To schematize, the immediate determinants refer to inadequate dietary intake and disease. The underlying determinants include food insecurity, inappropriate care practices and an unsafe environment including access to water and hygiene, inadequate health services and air pollution. A new determinant that has received a lot of attention over the past few years is mother-infant interaction (maternal nutrition and stores at birth, and behavioral interactions). All these circumstances result in increased vulnerability to shocks and long term stresses.

 figure 3 article 3

 

 (Sphere project – http://www.sphereproject.org/)

 

In actual fact, the determinants of undernutrition are rooted in poverty and involve interactions between social, political, demographic, and societal conditions. Over the past decade, It became important to go beyond the traditional concept of food security (access, availability, stability and utilization of food) and recognizes that the nutritional status is dependent on a wide and multi-sectoral array of factors. It is why the international community has starting to introduce the concept of nutrition security because …

 A household can achieve nutrition security only when it has secure access to food coupled with a sanitary environment, adequate health services, and knowledgeable care to ensure a healthy life for all household members.

But it is important to remind that stunting is a complex issue. The causes and etiology of stunting are much less understood than are its timing and consequences. In particular, there is little understanding of why and how stunting occurs extensively in environments that are poor, but not desperately so, and in environments that seem to be improving (India is the good example). In a population, an individual child can become stunted or not. In addition, some populations are much more stunted than others. This means that an understanding of why and how children become stunted is needed at both the individual and ecological levels.

 

The consequences – a dramatic long term impact that affects human capital:

The consequences of becoming and remaining stunted are increased risk of morbidity, mortality, delays in cognitive (ability to think and understand) and physical development, and decreased work capacity. Actually, it is well documented that impaired mental and physical development has long-term negative consequences on both micro and macro levels, reducing human and overall economic development. The economic cost of undernutrition has been estimated at 2 to 8 % of Gross Domestic Product (GDP).  

Moreover, children who have suffered of malnutrition (stunting) during their childhood are also at higher risk of suffering from chronic diseases (such as diabetes and cardiovascular disease) in adulthood. As highlighted in one of the latest Lancet Series “The global burden of diseases study 2010“: fewer children are dying every year (big progress), but more young and middle-aged adults are dying and suffering from disease and injury, as non-communicable diseases (cancer and heart disease) that become the dominant causes of death and disability worldwide: 54% of disability-adjusted life years worldwide were caused by non communicable disease in 2010, compared with only 43% in 1990.

 

The vicious inter-generational cycle of malnutrition = the inter-generational transmission of  poverty:

Although a child may not be classified as ‘stunted’ until 2–3 years of age, the process of becoming stunted typically begins in utero. The result – a very short height – usually reflects the persistent, cumulative effects of poor nutrition and other deficits that often span across several generations (see figure below).

 figure 1 artice 3

 

Poor nutrition often starts in utero and extends, particularly for girls and women, well into adolescent and adult life, and extends over to the next generations. The infants with low body weight, who suffered intrauterine growth retardation, and born undernourished, are at higher risk of dying in the neonatal period or later infancy. If they survive, they are unlikely to significantly catch up on this lost growth later and are more likely to experience a variety of developmental deficits. In fact, an infant with low body weight at birth (which is strongly correlated with birth length) is thus more likely to be underweight or stunted in early life.

Actually, stunting can be found at many levels in society. In Bangladesh, for example, stunting in children less than 5 years of age was found in one-fourth of the richest households [National Institute of Population Research and Training (NIPORT), 2009]. In developing countries, stunting is more prevalent than underweight (low weight for age, 20%) or wasting (low weight for height, 10%), possibly because height gain is even more sensitive to dietary quality than is weight gain.

Stunted height is a dreadful marker of multiple deprivations regarding food intake, care and play, clean water, good sanitation and health care. As a result, stunting is an important indicator of child well-being and is considered as a marker of endemic poverty.

To summarize, it is important to remember that small size at birth and childhood stunting are linked with:

  • short adult stature,
  • reduced lean body mass,
  • less schooling,
  • diminished intellectual functioning,
  • reduced earnings, and
  • lower birth weight of infants born to women who themselves had been stunted as children

 These outcomes have long-term impact if not addressed appropriately.

The figure below presents the % of low infant birthweight. The highest % is observed in 3 of the countries where we also observe a high incidence of short maternal stature, i.e. Afganistan, Yemen and Ethiopia. Sub-Sahara Africa (and specifically the Sahel region) and South East Asia are the regions where we observe the higher prevalence of low infant birth weight and stunting (see world map on prevalence of stunting above). 

 figure 10 article 3

 

The importance of maternal malnutrition (short stature and/or low body weight) – a key issue in the context of sustainable human development:

We now all agree that adult height in women reflects a cumulative outcome measure of environmental exposures from fetal to adult life encompassing nutritional, infectious, socio-cultural, and economic influences that can be transmit to the next generation through the inter-generational cycle of malnutrition. In this context, investing in women can have an astonishing impact!

Maternal undernutrition, embodied by short stature and a low body mass index (BMI), is highly prevalent in many developing countries. Short stature (<145 cm) affects more than 10% of women of reproductive age across South Central Asia and Latin America, but only 1% to 2% in sub-Saharan Africa, whereas a low BMI (<18.5) is found among 20% or more women in sub-Saharan Africa and South Central Asia but not in Latin America.

It was really interesting to go through the scientific publications & international agency reports to better understand this issue. More I was reading about this issue, more I was conscious of what are the overwhelming consequences of maternal chronic undernutrition in the context of child and maternal health, and how it is crucial to invest in women nutrition, health, education and empowerment. Let me to put together some numbers, facts and of course, maps/graphs to help us to better understand the problem. 

Because the consequences of maternal malnutrition (mortality and morbidity) in the context of pregnancy are dramatic…

Both indicators (short stature and low BMI) can predict adverse pregnancy outcomes. However, only

  • Maternal height is a strong predictor of birth size, and
  • It is inversely associated with risks of child mortality, underweight, stunting, and wasting

From a clinical point of view, short maternal stature can restrict uterine blood flow and growth of the uterus, placenta and fetus. Intrauterine growth restriction (IUGR) is associated with many adverse fetal and neonatal outcomes like chronic fetal distress or fetal death. Moreover, short maternal stature is consistently associated with an elevated risk of perinatal mortality (stillbirths and deaths during the first 7 days after birth), mostly related to obstructed labor resulting from a narrower pelvis in short women. In a hospital based study in Nigeria, obstructed labor accounted for 53% of perinatal mortality that is largely the result of birth asphyxia.

The world map below shows the cause of under 5 mortality for the World Health Organization region. Neonatal causes of death (the yellow part of the disk) represent more than 40% of all causes of death in all the regions, except Africa (brown color).

figure 5 article 3 

Globally, birth asphyxia accounts for 23% of the four million neonatal deaths each year. An estimated one million children who survive birth asphyxia live with chronic neuro-developmental disorders, including cerebral palsy, mental retardation and learning disabilities (World Health Organization 2005).

 Interestingly, the effect of short maternal stature on child mortality is comparable to the effect of having no education or being in the poorest 20% of households.

Moreover, short maternal stature because of the risk of disparity in size between the baby’s head and the mother’s pelvis increases also the risk of maternal mortality and short and long-term disability. The consequences of obstructed labor include injury to the birth passage, postpartum hemorrhage, rupture of the uterus, genital sepsis or fistula, leading to urinary dribbling or incontinence (see the documentary: A walk to beautiful – http://ww3.tvo.org/video/162183/walk-beautiful). In the worst case scenario, obstructed labor can lead to maternal death, mostly because of ruptured uterus or puerperal sepsis.

 figure 7 article 3

 

 Causes of maternal death (World Health Organization – 2008)

The percentages of maternal mortality attributable to obstructed labor (grey color) are 4% in Africa, 9% in Asia and 13% in Latin America and the Caribbean. Mothers who survive but have long-term disability due to complications such as fistula experience social, economic, emotional and psychological consequences that have an enormous impact on maternal health and well-being.

Finally, lower birthweight (which is strongly correlated with birth length) and undernutrition in childhood are risk factors for high glucose concentrations, blood pressure and harmful lipid profiles in adulthood. The “developmental origins of health and disease”  (or Barker) hypothesis hypothesizes that the intrauterine and early post-natal environment can modify expression of the fetal genome and lead to lifelong alterations in metabolic, endocrine and cardiovascular function. In this case, it is likely that the process of stunting is harmful and not necessarily short stature itself.

 figure 8 article 3

  

Let me to put some perspective because the numbers talk by themselves….

Compared with the highest maternal height category of more than 160 cm, women with short stature (<145 cm) have an approximately 40% higher risk of any of their offspring dying, after adjusting for confounders.

A similar analysis revealed risks of stunting and underweight in offspring to be 2-fold greater among short mothers, whereas that of wasting was only 17% higher.

However, with every 1-cm increase in height, the relative and absolute risk of each of the adverse outcomes listed above (i.e. child mortality, underweight, stunting, and wasting) can be significantly decreased.

 

The “window of opportunity” for improvement – yes, it is possible to change things:

During fetal life and the first 2 years after birth (the famous 1000 days), nutritional requirements to support rapid growth and development are very high.

Envision! … 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. A costly process! 

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, with demanding nutrient requirements. Immune-system and brain-synapse development are particularly vulnerable. As a result, any disturbance of this frantic activity leaves a terrible mark.

In this context chronic malnutrition can have a dramatic impact. Then, let me discuss the importance of nutrition for both immune-system and brain-synapse development. We will take the opportunity to highlight the importance of diversified nutrition (macro as well as micronutrients intake) in the context of “in 1000 days you can change the future” (http://www.thousanddays.org/).

 

In the case of brain-synapse development, which nutrients are important?

Growth factors, but also nutrients regulate brain development during fetal and early postnatal life. The developing brain between 24 and 42 wk of gestation is particularly vulnerable to nutritional insults because of rapid neurologic processes, including synapse formation and myelination. All nutrients are important for neuronal and glial cell growth and development, but some appear to have greater effects during the late fetal and neonatal life. These include protein, iron, zinc, selenium, iodine, folate, vitamin A, choline, and long-chain polyunsaturated fatty acids. The effect of nutrient deficiency or supplementation on the developing brain is a function of the brain’s requirement at a specific time for a nutrient in specific metabolic pathways and structural components. For example, during late fetal and early neonatal life, regions such as the hippocampus, and the visual and auditory cortices are undergoing rapid development characterized by the morphogenesis and synaptogenesis that make them functional. In this case, protein-energy and long-chain polyunsaturated fatty acids are important.

For any given region, early nutritional insults have a greater effect on cell proliferation, thereby affecting cell number. Later nutritional insults affect differentiation, including size, complexity, and in the case of neurons, synaptogenesis and dendritic arborization (the neuronal circuit that permits to send information).

All nutrients are important for brain development, but some appear to have a particularly large effect on developing brain circuits during the last trimester and early neonatal period as shown in the table below:

Important nutrients during late fetal and neonatal brain development

(Adapted from Am J Clin Nutr February 2007 vol. 85 no. 2 614S-620S)

 

Nutrient

Brain requirement for the nutrient

Predominant brain area or activity affected by deficiency

Protein-energy

Cell proliferation, cell differentiation

Synaptogenesis

Global

Cortex

Iron

Myelin

Neuronal and glial energy metabolism

White matter

Hippocampal-frontal

Zinc

DNA synthesis

Autonomic nervous system

Copper

Neurotransmitter synthesis, neuronal and glial energy metabolism, antioxidant activity

Cerebellum

Long-chain polyunsaturated fatty acids

Synaptogenesis

Myelin

Eye

Cortex

Choline

Neurotransmitter synthesis

Myelin synthesis

Global

White matter

 

Breast feeding is the best food in this context…

The potential mechanisms through which breastfeeding may improve cognitive development relate both to the composition of breast milk and to the experience of breastfeeding. Breast milk contains a suite of nutrients, growth factors, and hormones that are important for brain development, including critical building blocks such as docosahexaenoic acid (DHA – fish oil) and choline. In addition, the physical act of breastfeeding may promote the quality of the mother-infant relationship and enhance mother-infant interaction, which are important for cognitive and socioemotional development. For instance, cognitive effects of nutritional deficiencies (as measured by the mental development index of Bayley Scales) are more severe for children living in homes where there is less stimulation compared to homes with higher levels of stimulation.

When compared to formula, human milk provides all the essential n-6 and n-3 PUFA like linoleic acid and alpha-linolenic acid, as well as their longer-chain more-unsaturated metabolites, including arachidonic acid and DHA that support the growth and development of the breast-fed infant. In fact, the role of DHA in infant nutrition is of particular importance because DHA is accumulated specifically in the membrane lipids of the brain and retina, where it is important to visual and neural function. In this context, it is crucial to ensure an adequate maternal dietary lipids and DHA intake if this is the only source of essential fatty acids for infant development both before and after birth to minimize the risk of low infant neural system maturation.

In this case, investing in programs that focus on exclusive breast feeding during the first 6 months, that will continued along with appropriate complementary foods up to two years of age as well as increased access to nutritious food for breastfeeding mothers makes sense because these strategies will pay back…

In the case of immune-system development, which nutrients are important?

Immune cells and organs rapidly proliferate in the first trimester of pregnancy. Early cells undergo progressive waves of maturation, some unique to the fetal period, as they build the capacity to recognize and adapt defenses to specific pathogens. Although the immune system is qualitatively complete at birth (but still immature), exposures to colonizing commensal bacteria, environmental antigens, bioactive dietary substances, and potential pathogens during infancy and early childhood are essential for expansion and priming of adaptive cell populations. These critical periods of development are highly vulnerable to insult, which may permanently alter immune defenses.

Moreover, the ability of the immune system to prevent infection and disease is strongly influenced by nutritional status of the host. In fact, malnutrition is the most common cause of immunodeficiency in the world. Nutrient deficiencies can cause immunosuppression and dysregulation of immune responses. Because nutritional status can modulate the actions of the immune system, the sciences of nutrition and immunology are tightly linked.

 Impact of maternal malnutrition in infant immune system development:

The impact of maternal protein-calorie malnutrition (PCM) on neonatal vulnerability to infectious disease is well known. Much of the damage to neonatal host defense occurs through impact on the developing immune system, especially the thymus, often called the barometer of nutrition. In this context, malnourished children have lower levels of thymulin* and deficient T-cell development.

Micronutrient imbalance or deficiency in the mother in the absence of PCM can alter the program of immune development in the infant. The strongest evidence for micronutrient programming effects comes from studies of vitamin A deficiency. In fact, vitamin A is required for the homing of T cells into the gastrointestinal tract and promotion of antigen-specific regulatory T cells development.

Impact of malnutrition in infant:

PCM primarily affects cell-mediated immunity (increased phagocyte activity, cytotoxic T cells activation and cytokine release) rather than humoral immunity (antibody response). In particular, PCM leads to atrophy of the thymus, the organ that produces T cells, which reduces the number of circulating T cells and decreases the effectiveness of the memory response to antigens. Additionally, PEM compromises the integrity of mucosal barriers, thereby increasing susceptibility to infections of the respiratory, gastrointestinal, and urinary tracts. PCM often occurs in combination with deficiencies in essential micronutrients, especially vitamin A, zinc, copper, selenium, and magnesium.

The good news is that the effects of PCM are reversible by refeeding. Renutrition studies in children showed that innate immune functions and adaptive lymphocyte proliferative response improve in parallel with growth. Treatment of severely malnourished infants has shown that after refeeding, previously deficient phagocytosis, microbicidal activity, chemotaxis, and cell proliferation indices normalized along with anthropometric gains.

Micronutrient deficiencies are a major complication of PCM and promote infectious processes. Oxidative stress is worsened in infection if micronutrients are deficient. Vitamin A, β-carotene, folic acid, vitamin B12, vitamin C, riboflavin, iron, zinc, and selenium have immunomodulating functions and influence both the susceptibility of the host to infectious diseases and the course and outcome of these diseases. For example, vitamin A deficiency impairs mucosal barriers and diminishes the function of neutrophils, macrophages, and NK cells.

And again …Breast feeding is the best food in this context…

Human milk provides virtually all the protein, sugar, and fat baby needs to be healthy. It also enhances the immature immunologic system of the neonate and strengthens host defense mechanisms against infective and other foreign agents. Some mechanisms that explain active stimulation of the infant’s immune system by breastfeeding are the bioactive factors in human milk such as hormones, growth factors and colony stimulating factors, as well as specific nutrients like lactoferrin, one of the most abundant proteins in human milk, nucleotides, complex sugars and long-chain polyunsaturated fatty acids.

 

To conclude…

Simply providing an adequate food supply likely would not be enough to keep kids growing well. Researchers said that common childhood incidents in the developing world, such as a high burden of early childhood infections (acute diarrhea and infection with a parasite), compound the problem. Both diarrhea and parasites can lead to malnutrition—and vice versa—so the path to well-nourished, healthy children is not quite as simple as making sure that their families have enough food.

To have an impact on stunting levels, nutrition-sensitive interventions (bringing quality and not only quantity) and promotion of adequate nutrition practices need to be targeted to women during pregnancy and to children from birth to 24 months of age. In addition, communities require increased income among the poor, improved food security, sanitation and water supplies as well as better public health education and health care availability. Investment in these changes in the near term should pay off later in improved earning power and an easier ascent out of poverty, which in turn should also lead to better health for the generations to come.

Moreover, tackling undernutrition will require solutions to be developed with the integration of the food security, livelihoods, health, care practices and nutrition sectors. Yet, the linkages between the different sectors are complex and are increasingly under scrutiny as experience has shown that each sector tended to operate in separate spheres.

Malnutrition is often said to be no one’s responsibility but everyone’s business. We must make it everybody’s responsibility. Leaders are needed if we want to make the legacy of the first 1,000 days last forever.

Let move in this direction all together…

 

* A zinc-dependent thymic hormone that regulates the differentiation of the immature thymocyte subpopulation and the function of mature T and natural killer cells and also functions as a transmitter between the neuroendocrine and immune systems

 

References:

http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf

http://onlinelibrary.wiley.com/doi/10.1111/j.1740-8709.2011.00349.x/pdf

http://www.who.int/nutgrowthdb/publications/Stunting1990_2011.pdf

http://www.prb.org/Publications/PolicyBriefs/HealthyMothersandHealthyNewbornsTheVitalLink.aspx?p=1

http://journals.cambridge.org/download.php?file=%2FPHN%2FPHN15_01%2FS1368980011001315a.pdf&code=9388ad17651c06a950aadfcbedad50cd

http://www.guardian.co.uk/commentisfree/2013/mar/13/undernutrition-invisible-killer-children

http://ajcn.nutrition.org/content/85/2/614S.full

http://satvenandmer.hirezz.com/pdf/dha/Nutrition%20and%20Cognitive%20Development%20.pdf

http://journals.cambridge.org/download.php?file=%2FPNS%2FPNS66_03%2FS0029665107005666a.pdf&code=3d8f0f9371eabfc67ed3eff3d6c22b2f

http://advances.nutrition.org/content/2/5/377.full

http://images.abbottnutrition.com/ANHI2010/MEDIA/Cunningham_Rundles_112th%20ANRC.pdf

http://www.jacionline.org/article/S0091-6749(05)01274-1/fulltext

http://listas.exa.unne.edu.ar/bioquimica/inmunoclinica/documentos/protection_neonate.pdf

http://thousanddays.org/wp-content/uploads/2013/03/Technical-Brief-4-Nutrition-and-brain-development-in-early-life-2.pdf

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

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

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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

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/

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….

Developing World Has Less Than 5 Percent Chance of Meeting UN Child Hunger Target

A new study published in The Lancet suggests that developing countries as a whole have a less than 5% chance of meeting the UN’s Millennium Development Goal (MDG) target for the reduction of child malnutrition by 2015(http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60647-3/fulltext#article_upsell). The Article analyses trends in the weight and height (two simple indicators that can permit to define if the malnutrition is chronic or acute) of more than 7•7 million children worldwide between 1985 and 2011 in 141 countries. They also looked how levels are likely to change if current trends continue.  It is the first large-scale study to provide a detailed examination of trends in children’s weight and growth in all developing countries.

Why this study is important?

The phenomenon of hunger does not only weigh on the individual, it also imposes a crushing economic burden on the developing world as economists estimate that every child whose physical and mental development is stunted by hunger and malnutrition stands to lose 5-10 percent in lifetime earnings. Moreover, 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. In fact, optimal breastfeeding and complementary feeding practices are so critical that they can save the lives of 1.5 million children under five every year.

Progresses are made …..

Professor Majid Ezzati, from the School of Public Health at Imperial College London, UK, and the article’s senior author, said: “Our analysis shows that the developing world as a whole has made considerable progress towards reducing child malnutrition, but there are still far too many children who don’t receive sufficient nutritious foods or who lose nutrients due to repeated sickness. Severe challenges lie ahead.”

To summarize the key results

• 61 of these 141 countries have likely a 50—100% chance to achieve the target – particularly in some parts of Asia and Latin America.

• The prevalence of moderate-and-severe stunting (insufficient growth in height for their age) declined from 47•2% to 29•9% and underweight from 30•1% to 19•4% between 1985 and 2011 in developing countries as a whole.

• In 2011, over 300 million children were mildly to severely stunted and over 250 million mildly to severely underweight, with 17 countries – mainly in sub-Saharan Africa and Oceania – seemingly undergoing no improvement in the number of children who are underweight or restricted in growth.

• Undernutrition worsened in sub-Saharan Africa from 1985 until the late 1990s, when height and weight scores began to improve. The deterioration may have been due to economic shocks, structural adjustment, and trade policy reforms in the region in the 1980s and 1990s. In Ivory Coast and Niger, nutritional status was measurably worse in 2011 than it had been in 1985.

• South Asia, the region with the worst nutritional status in 1985, has improved considerably, but undernutrition is still a major issue. About one half of the world’s underweight children live in South Asia, mostly in India.

• China has undergone the largest improvement in children’s height over the last 25 years, with Latin America and the Caribbean region also experiencing significant improvements in this area. The authors suggest that, in many of these countries, the improvements seen are down to overall improvements in the populations’ nutrition, rather than specific interventions targeting children at high risk.

• Some countries in Latin America, such as Chile, now have almost no undernutrition. The proportion of underweight children almost halved per decade in Brazil.

What’s next?

The statistics presented in this article suggest that in most countries, the improvements are due to population-wide improvements in nutrition, rather than interventions targeting high-risk children.

Moreover, according to Professor Ezzati, “There is evidence that child nutrition is best improved through equitable economic growth, investment in policies that help smallholder farmers and increase agricultural productivity, and primary care and food programs targeted at the poor. We mustn’t allow the global economic crisis and rising food prices to cause inequalities to increase, or cut back on investments in nutrition and healthcare.”

To continue in the same direction – strategies that can contribute to the improvement of the overall nutritional status of children:

In a book entitled “Just Give the Money to the Poor, The Development Revolution from the Global South”, the authors showed through a specific example that equitable economic growth at the community level permits  a population-wide nutritional improvement, among other social and economic improvements.  

In  this book, the authors discussed a new strategy – direct cash transfers (CTs). These are regular payments by the state directly to poor people, similar to welfare in developed countries.  The authors showed that this strategy can have a significant social and economic impact. CTs are affordable and the recipients use the money well and do not waste it. As a result, cash grants are an efficient way to directly reduce current poverty, and they have the potential to prevent future poverty by facilitating economic growth and promoting human development.

Something that perhaps you don’t know! And we didn’t know before reading this book.

45 countries in the Global South now give CTs to more than 110 million families. Every program is different, from universal child benefits in Mongolia to pensions in Africa to family grants in Latin America. Some grants are tiny – only $3 a month – whereas others give families more than $100 a month; some cover more than one-third of the population, and others aim only for the very poorest. The size of public spending varies from 0.1% of GDP to 4%, although most programs fall in the range of 0.4% to 1.5%.

What are the outputs/outcomes of this kind of program?

  • Social protection and security for the young, old, disabled
  • Development and economic growth – CTs give poor people the security they need to invest in higher risk/return options like new crops, or migrating in search of work
  • Breaking intergenerational poverty by ensuring children are better nourished and educated than their parents
  • Rights and equity – reducing income inequality and promoting the status of women

To give you a concrete example on how this strategy can impact the life of people

The villagers of Otjivero village (a very destitute rural community) in Namibia have received each month the equivalent of 15 US$ as part of a pilot study to evaluate the socio-economic impact of direct cash transfer.

One of the first and immediate results was the creation of a whole range of economic activities in this small village.

After two years, the program team that managed this pilot study was able to report:

• A decrease of the number of people living below the poverty line from 76 to 37%

• Less than 10% of the children were malnourished – before the experiment, almost half of children were malnourished

• 90% have finished their education – before, they were only 60%

• And crime has dropped

This pilot study has also shown that CT has an impact not only on production but also on demand. In Africa, the purchasing power is usually centered in a few centers, forcing people to leave the countryside to cities, where slums eventually spread. The CT allows rural to grow, it creates local markets and allows people to be self-sufficient.

When you know that you will recieve each month some cash to support your family, this brings some sort of financial security. This kind of initiative helps to ensure that the basic needs for the family are covered but also helps to invest in the future. It creates the first step to equitable economic growth.

Something to meditate! 

Sources:

http://www.redorbit.com/news/health/1112650992/developing-world-has-less-than-5-percent-chance-of-meeting-un-child-hunger-target/

http://www.exchangemagazine.com/morningpost/2012/week27/Thursday/12070507.htm

http://www.oxfamblogs.org/fp2p/?p=2547

http://www.courrierinternational.com/article/2010/04/29/les-miracles-du-revenu-minimum-garanti