Jan Low - Biofortification: The First Global Conference / November 9–11, 2010, Washington, D.C., USA

1. Developing Effective Delivery Systems for Biofortified Crops:
Some Thoughts on the Integrated Delivery of
Orange-fleshed Sweetpotato in Sub-Saharan Africa
Jan Low
International Potato Center
9 November 2010

2. The Situation:
Decline in Vitamin A Deficiency among
Children 6-60 months of age not
on track in SSA except for North Africa
Number Rate
(Millions) 1990-2007
1990 2007 2007 ppts/yr
East Africa 43.7 37.5 17,825 -0.36 -0.87
Central Africa 40.8 42.5 9,259 0.10 -0.82
North Africa 32.6 22.4 4,942 -0.60 -0.65
Southern Africa 37.2 25.0 1,530 -0.20 -0.74
West Africa 45.0 40.4 19,163 -0.27 -0.90
Total for Africa 41.4 36.4 52,718 -0.29 -0.83
Rate
required
to meet
MDG
Prevalence
(serum retinol <20 ug/dl)
30 African countries >30% prevalence low serum retinol
UNSCN, 6th Report on World Nutrition Situation (2010), p. 16

3. The Situation, cont.:
1 in 3 persons in SSA (265 million people)
not getting enough to eat daily
19 SSA countries moving in the right direction
14 SSA countries worse hunger than in 1990
 Trends in underweight (children under 5 yrs) not improving
UNSCN, 6th Report on World Nutrition Situation (2010), pp. 90
Projects and programmes that aim to
improve food and nutrition security through increased
yields will be most successful if they are implemented in
tandem with efforts to improve crop and dietary diversity.
Those agriculture interventions that invested broadly in
different types of capital (physical, natural, financial, human
and social) were more likely to improve nutrition outcomes.
Berti, et al. Public Health Nutrition (2004) 7(5), 599-609.

4. The Potential Contribution of Orange-fleshed
Sweetpotato
1. Marginal
change
... VAD
2. Increased
area,
yields,
marketing
... Food
security

5. A Few Sweetpotato Facts
 Grows from sea level to 2300 meters
 Produces on marginal soils (3-12 t/ha)
 Yet responds dramatically to favorable
conditions (40-60 t/ha)
 Women dominant producers in SSA
 Flexible harvesting and planting times
 Dual purpose use: roots & vines
 Vegetatively propagated
 Easy farmer-to-farmer sharing
 Limited "seed" commercialization

6. Overcoming the Conventional Wisdom :
African and Asians will not eat orange-
fleshed sweetpotatoes
 Attempts by AVRDC to introduce them in Asia had failed
 Failure to understand that rejection was due to texture, not
color
 Pilot work in Kenya (1995-97) among 20 women's groups
Sweet potato cultivars with deep
yellow or orange-fleshed roots are
unfortunately rejected in many
developing countries in favor of white
or cream-fleshed types
having little or no provitamin A activity.
The Sweet Potato: an Untapped Food
Resource. Jennifer Wolfe 1992.

7. Key Lessons
From Pilot Work in
Western Kenya:
 Nutrition education
component essential for
increased frequency of
consumption of vitamin A rich
foods by young children
 Orange color accepted, but
preferences differed
--Adults: high dry matter
--Children: low dry matter
 Yellow-fleshed variety had
inadequate beta-carotene
Eat OrangeKARI/CIP/CARE collaboration funded
by ICRW/OMNI/USAID

8. Bosbok
Resisto
Efficacy
studies
 Almost all carotenoids trans-beta-carotene with high
retention when boiled (70-92%)
 120 grams (small root) fed to school children for 5 days a
week for 3 months significantly improved amounts of
Vitamin A stored in the liver
Retention & efficacy studies
established that OFSP is a rich and
bioavailable source of vitamin A
Source: van Jaarsveld et al. 2005 and 2006, MRC-South Africa

9. #1 Access to Beta-Carotene-
Rich Sweetpotato Vines
Buy more Vitamin-A-Rich
Foods & Health Services
INTEGRATED DELIVERY SYSTEM
Increase Young Child
Feeding Frequency &
Diet Diversity
#2 Demand
Creation &
Empowerment
Through
Knowledge
Substitute white-fleshed with
orange fleshed, beta-carotene
rich varieties
Earn
income from
sales
of roots &
processed
products
Produce more Energy &
Beta-Carotene per hectare
Improved agronomic & storage
practices to assure availabilityBEHAVIORAL
CHANGE
Work with
caregivers to
improve feeding
practices AWARENESS
Media
campaign
to increase
demand
#3 Ensure
Sustained
Adoption &
Use through
Market
Development
Sustainably Improve Young
Child Intake of Vitamin A
& Energy
Improved
Vitamin A Status
Increase area
to meet demand

10. Delivery at the Community Level (TSNI)
in Rural MozambiqueCentral Mozambique
Zambézia Province
Design:
 2 yr quasi-experimental design
 Agriculture & nutrition extensionists
based in target areas
 2 Intervention groups: 498 hhs
More intensive: group + home visits
Less intensive: group sessions only
 1 Control group: 243 hhs
 data collection: Jan 2003-Mar 2005
 90% completed study
Funded by the Micronutrient Initiative, Rockefeller Foundation, USAID, & HarvestPlus

11. Did the Intervention Impact the Young Child?
 Median intake vitamin A almost 8 times higher (24 h recall)
 Group sessions sufficient to achieve improved intake
 15% decline in low serum retinol (VAD) due to intervention
Median nutrient intakes yesterday:
non-breastfed children (mean 32 months old)
426
1414
56
1226
0
200
400
600
800
1000
1200
1400
1600
Vitamin A (μg RAE)
P-value=0.00
Energy (kcal)
P-value=0.00
AmountofNutrient
Intervention (n=465)
Control (n=234)
Low et al., Journal of Nutrition 137: 1320-1327, 2007

12. How can we reach larger number of
households cost effectively?
Reaching End Users Project (2006-2009)
in Uganda & Mozambique (HarvestPlus)
 TSNI used direct extensionist to farmer contact:
relatively expensive
 Can the cost be reduced through use of village
level promoters for agriculture & nutrition without
compromising adoption and vitamin A intake
rates?
 How long do we need the community level
nutrition intervention?
More intensive Model: 2 years
Less intensive Model: 1 year
 Short Answer: Yes, can reduce significantly & have
good adoption and intakes with less intensive model

13. What have we learned
about the Integrated
Approach?
Pathway #1: Agriculture
 Agronomically competitive, tasty varieties essential
 Consumer preferences can vary within/between countries
 In areas with short dry seasons (2-3 months), single
massive distributions sufficient for widespread adoption
 In areas with longer dry seasons (4-6 months), need to
establish reliable supply of vines, preferably at
decentralized level
 Trained farmer multipliers with access to water
 Willingness-to-pay exists, but extent depends on market demand
for roots & purchasing power in the community

14. Pathway #2:
Demand Creation
campaign
essential and the
orange color
is an asset
COMMUNITY THEATER
MARKET-BASED
PROMOTIONS & RADIO
COOKING
DEMOS

15. Pathway #2: Demand
Creation at the Community
Level
 Group sessions on nutrition effective for many messages
 Utilization of OFSP, and knowledge of its benefits
 Increase in young child feeding frequency
 Use of other locally available plant sources of vitamin A
 Difficult behaviors to change
 Health-related practices: boiling water
 Addition of small amounts of fat, purchasing practices
 Using promoters results in adoption and use of OFSP, but
fewer additional practices than direct extension contact
 How minimal can we go on the community level intervention?
 How effective is integrating OFSP into broader interventions?

16. Marketing component is longer-term investment
 Need 3-5 years to develop, but most projects are 2-3 yrs
 Invest in educating traders and building consumer demand
 Where significant sweetpotato markets already exist
 Must "break-into" the market against strong existing preference
 Where sweetpotato markets are not well-developed
 Links between farmers and traders need to be facilitated/subsidized
 Processed products liked, but requires sustained supply
 Need to invest in training on fresh storage
 Boiled and mashed superior to dried chips/flour
Pathway #3:
Marketing

17. Next Step:
Building the Evidence for
Linking Agriculture & Nutrition
with Health to Maximize Impact
 Need to minimize loss of vitamin A after intake
 Need for greater investment in women's well-being
 Launched 5 year study in Western Kenya (2009)
[CIP, PATH, CREADIS, ARDAP, Ministries of Health/Ag]
 Can linking OFSP access and nutritional training to existing health
services for pregnant women provide:
1) an incentive to pregnant women to increase health service
utilization?
2) lead to increases in consumption of OFSP and other vitamin A
rich foods by the women and their young infants in a cost-
effective manner?