Preventing and controlling micronutrient malnutrition through food-based actions in South Asian countries¹

A. Hussain

Anwar Hussain is Senior Officer, Nutrition Programmes Service, FAO Food and Nutrition Division.

Worldwide, the largest numbers of people suffering from micronutrient malnutrition live in South Asia. Micronutrient malnutrition, especially vitamin A deficiency (VAD), iodine deficiency disorders (IDD) and iron deficiency anaemia (IDA) are serious public health problems in these countries. It is estimated that about 123 million people in Southeast Asia are at risk of vitamin A deficiency and

1.7 million are affected by xerophthalmia; 486 million are at risk of iodine deficiency and 176 million are affected by goitre; and 616 million are affected by iron deficiency or anaemia (FAO, 1997). The situation in the region is thus grave and unacceptable considering that there are methods available to address these problems effectively.

Of the four methods available for the control of micronutrient malnutrition - diet diversification, food fortification, medicinal supplements and disease control - the first two are food based. Many of the current programmes for the prevention and control of micronutrient malnutrition in the countries of the South Asian Association for Regional Cooperation (SAARC) rely too heavily on health interventions and are not fully exploiting the potential of more sustainable food-based actions. There is now a strong realization that action is urgently needed to promote and strengthen food-based actions for the prevention and control of these deficiencies. The departments of agriculture in SAARC countries, together with other departments such as those concerned with trade and industry and with education, should play a vital part in promoting and implementing these actions along with those of the health sector.

The Food and Nutrition Division of FAO, in collaboration with the International Life Sciences Institute (ILSI), has produced a manual on food-based strategies to prevent micronutrient malnutrition (FAO and ILSI, 1997). It has also developed a popular manual entitled Improving nutrition through home gardening (FAO, 1995). Both of these manuals advocate and promote food-based actions as sustainable and self-reliant ways of preventing micronutrient malnutrition. The manuals have been used in workshops and seminars to identify specific food-based actions to complement ongoing health activities. These actions should be promoted as the most sustainable method of preventing micronutrient malnutrition in the various regions of the world. Since the highest concentration of people with micronutrient malnutrition is in the SAARC countries, it was thought appropriate to start the promotional activities there.

WORKSHOP ON PREVENTION AND CONTROL OF MICRONUTRIENT MALNUTRITION

As a follow-up to the International Conference on Nutrition and the World Food Summit, the Workshop on Prevention and Control of Micronutrient Malnutrition Through Food-Based Actions in the SAARC Countries was held in Dhaka, Bangladesh from 17 to 20 November 1997. The conference was sponsored by FAO in collaboration with the Thrasher Research Fund and the Micronutrient Initiative and organized by the Bangladesh Agricultural Research Council. Official delegates from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka participated, along with representatives of national and international agencies, non-governmental organizations (NGOs) and institutions. The workshop was inaugurated by the Minister for Agriculture and Food of Bangladesh, Matia Chowdhury. Dr C. Gopalan, President of the Nutrition Foundation of India, delivered the keynote address.

Objectives

The workshop participants reviewed the various components of food-based actions and exchanged information on current programmes for the control of micronutrient malnutrition. They suggested ways and means of harmonizing ongoing programmes in other sectors (particularly in health and education) with food-based actions. The lessons learned from the implementation of successful programmes in the region and from other countries in Asia were discussed, and the factors that facilitate or constrain successful implementation of food-based programmes were identified. Ways to improve programme implementation and delivery were discussed. The need to strengthen the capacity of the governments, local communities and the private sector to implement food-based actions was addressed. The participants recommended ways to facilitate Technical Cooperation among Developing Countries (TCDC) in the region for the control of micronutrient malnutrition, to gain support for food-based actions and to establish a network of institutions in the participating countries for future exchange of information and as a base for technical assistance.

Discussion

The workshop discussed ways to improve nutrition through food production at the household level, including home gardening, small animal production and aquaculture. Food processing and preservation, nutrition education and food fortification were taken up as ways to raise micronutrient levels in the diet. Assessment, monitoring, surveillance and evaluation of food-based actions were discussed. Representatives of the World Bank, the United States Agency for International Development (USAID), the Thrasher Research Fund, the Micronutrient Initiative, the Asian Development Bank and the Bangladesh NGOs BRAC (formerly the Bangladesh Rural Advancement Committee) and Proshika discussed ways to attract resources at the community level for food-based actions.

The workshop participants agreed that sustainable food-based solutions are available in the SAARC countries and that actions must be accelerated to ameliorate the serious situation. These efforts would be integral parts of the global programme for control of malnutrition.

Comprehensive approach. The participants agreed that a comprehensive developmental approach including elimination of poverty, increasing food production, improving literacy (particularly of women) and provision of basic services (specifically health, hygiene and welfare) to the vulnerable populations would be required to ameliorate the problem. The workshop participants further recognized that access to safe and nutritious food is a basic right of every human being, and that overall improvement of the total diet of the population should be the goal of any food-based action. Food-based actions are sustainable, cost-effective, income generating and culturally acceptable. They can promote self-reliance and community participation and create partnership among producers, consumers and the food industry.

Farms, not pharmacies. It was noted that the majority of the world's population consumes a wholesome diet and for that reason does not suffer from micronutrient deficiencies. The participants agreed that it is necessary to look to farms and not to pharmacies for the solution of nutritional problems. Food provides a variety of nutrients and related components and their metabolic effects are different from those of a single or multinutrient pill. No cocktail of synthetic nutrients can mimic the beneficial effects of an improved diet.

Multiple strategies. The participants noted that diet diversification, food fortification, medicinal supplementation and public health measures are necessary and may be used in certain situations. Specifically, the medicinal approach is a short-term measure to be used only to correct acute conditions. On the other hand, food-based actions should cover all situations, both acute and chronic. Classifying food-based actions under long-term actions creates a sense of complacency that should be avoided. Food-based actions should be taken at all times and in all situations and must be combined with the medicinal and public health approach when they are implemented. Where possible, actions should be combined to create a synergy between the various options for the control of micronutrient malnutrition in all SAARC countries.

Recommendations

The participants made a number of recommendations to the governments of SAARC countries, NGOs and international organizations working in the field of prevention and control of micronutrient malnutrition.

• Strong initiatives need to be taken to implement the food-based nutrition interventions identified in the National Plans of Action for Nutrition of the respective SAARC countries to improve the nutritional status of
  the population and to ameliorate micronutrient deficiencies.
• Nutrition improvement programmes should be developed as an integral part of national development plans, and an integrated, comprehensive and holistic approach should be used. Food, care and health should be the integrated components of the programme. These programmes should be implemented with the active participation of the people and should be addressed to specific target groups, reviewed periodically and modified to meet the needs of the community.
• The extent, type, prevalence and distribution of malnutrition in SAARC countries should be documented with periodic updates to determine trends and should be kept under continuous surveillance.
• The micronutrient composition of local foods, both raw and cooked, should be determined, with special emphasis on identifying micronutrient-rich traditional foods.
• Institutions within the region that could provide training on various aspects of the problem of micronutrient malnutrition should be identified, and collaboration among institutions within the SAARC countries should be organized for exchange of staff for training in specialized fields.
• Each country should support and promote more initiatives to increase home-level production of micronutrient-rich fruits and vegetables, small animals and fish by the target groups and should support the development of marketing outlets for the sale of surplus production by the target households.
• Home gardening should be promoted more extensively. Efforts should be made to select fruits and vegetables rich in micronutrients. Target populations should have access to high-yielding seeds and other inputs. Governments should support the development of local infrastructure in order to promote home gardening.
• Processing of fruits and vegetables should be encouraged to add value to these products. Simple processing technologies should be adapted to enable women to earn extra income, thus improving their ability to purchase other micronutrient-rich foods. Processing would make it possible to use some of the surplus during the lean season.
• Governments should promote pre- and postharvest technologies and methods to prevent wastage of fruits and vegetables and should provide adequate transportation and marketing outlets for the sale of produce.
• Nutrition education should be an integral part of all nutrition improvement programmes. An integrated and coordinated approach should be employed in the development of nutrition education messages for the public to avoid creating confusion. All available media and methods should be used and messages should be addressed to all target groups - primary, secondary and tertiary - to create a nutrition movement in each country. National universities and institutions should be involved in innovative research, and adverse propaganda by vested interest groups should be neutralized. Dissemination of authentic information collected through systematic scientific studies should be encouraged.
• A directory of institutions working in nutrition in the region should be prepared, and national capacity building - particularly for universities and national institutions of research and information, education and communication (IEC) activities - should be enhanced.
• Training of trainers on IEC techniques and methodologies should be organized in reputable institutions in the SAARC region.
• Nutrition education should be introduced in school curricula as an integral part of instruction.
• The current programme of iron and folate tablet distribution should include deworming and should encourage the regular consumption of citrus fruits to help absorb iron.
• Food-based dietary guidelines should be prepared by all SAARC countries and should encourage the consumption of micronutrient-rich foods, particularly fruits and vegetables.
• All ongoing food-based programmes in SAARC countries should be continuously monitored and kept under surveillance. Success stories should be disseminated for adoption in other countries.
• Fortification of food commonly consumed by the people should be encouraged. Steps should be taken to keep the price of the fortified food within the purchasing capacity of the target groups.
• A regulatory body to enforce quality control of fortified food should be established to prevent fraudulent practices and to protect consumers.
• A subregional network on food-based actions for prevention and control of micronutrient malnutrition should be established to exchange information and technology among the countries. FAO was asked to consider this as a top priority for funding.
• Subregional workshops should be held every one or two years to assess progress in food-based actions in SAARC countries. FAO was asked to seek collaboration with donors for the holding of such workshops.
• A regional consultation on existing, promising or adaptable technologies in the field of food processing and food fortification should be organized in the near future.

¹Adapted from the report of the Workshop on Prevention and Control of Micronutrient Malnutrition Through Food-Based Actions in the SAARC Countries, Dhaka, Bangladesh, 17-20 November 1997.

REFERENCES

FAO. 1995. Improving nutrition through home gardening - a training package for preparing field workers in Southeast Asia. Rome.
FAO. 1997. Human nutrition in the developing world, by M.C. Latham. Rome.
FAO and International Life Sciences Institute (ILSI). 1997. Preventing micronutrient malnutrition: a guide to food-based approaches. A manual for policy makers and programme planners. Washington, DC, USA, ILSI Press.

Summary/Résumé/Resumen