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Food and Nutrition Bulletin. 2001; 22(4):357-360.Vitamin A deficiency is a major public health problem in Africa, especially in the Sahelian countries. It occurs mainly in young children and women of childbearing age. Inadequate intake of vitamin A is the main cause of the deficiency. The main animal sources of vitamin A are liver, eggs, milk, and milk products. They contain 25 to 8,235 retinol equivalents (RE)/100 g of edible portion. Even though these sources are rich in highly bioavailable vitamin A, their consumption among the population is still low. Plant foods rich in provitamin A represent more than 80% of the total food intake of vitamin A because of their low cost, high availability, and diversity. Fruits, roots, tubers, and leafy vegetables are the main providers of provitamin A carotenoids. Because of their availability and affordability, green leafy vegetables are consumed largely by the poor populations, but their provitamin A activity has been proven to be less than previously assumed. Among fruits, mangoes constitute an important seasonal source of vitamin A. Yellow or orange sweet potatoes are rich in provitamin A. Red palm oil has a high concentration of provitamin A carotenoids (500-700 ppm/100 g). Extension of new varieties with a high content of bioavailable provitamin A and locally adapted education and counseling on the handling and storage of provitamin A sources can significantly increase the vitamin A intake of vulnerable people. The Food and Agriculture Organization has implemented projects in several African countries to increase production and promote consumption of locally produced or available vitamin A-rich foods. The focus has been on women as the principal food producers and behavioral change agents. Adoption of food- and agriculture-based strategies as the best, appropriate, efficient, and long-term solution should be the focus of African efforts to improve nutrition. Food sources of vitamin A and provitamin A are plentiful in Africa. Food-consumption practices, food habits, and cultural aspects represent essential factors to be taken into account for successful implementation of these approaches. (author's)
Planning a national food-based strategy for sustainable control of vitamin A deficiency in Ghana: Steps toward transition from supplementation.
Food and Nutrition Bulletin. 2001; 22(4):361-365.In an effort to control the high prevalence of vitamin A deficiency in Ghana, which studies have shown to be of public health significance, a number of interventions are being pursued. Periodic, massive-dose supplementation strategy, developed as a short-term life-saving intervention, is currently under way, either as part of the polio eradication program or combined with the existing health delivery system, schools, or community-based infrastructures. This has been successfully accomplished, and therefore the stage is set for the design and implementation of a long-term, sustainable solution. This is important in order to make the transition from a subsidized periodic capsule-distribution effort to a more sustainable food-based intervention, which could supply other vital nutrients as well as vitamin A in the diet. This report describes a proposal for a food-based strategy against a backdrop of low consumption in spite of the relatively high availability of some vitamin A-rich foods in most parts of Ghana. The aim is to improve vitamin A status of vulnerable groups through increased production, availability, and consumption of vitamin A-rich foods. The proposal is therefore to undertake a range of food-based interventions that will include horticultural interventions that aim to increase production and availability of vitamin A-rich foods, such as dark-green leafy vegetables and orange-colored fruits and vegetables and tubers in the diet of Ghanaian households. There will also be a comprehensive behavior change and communication strategy, to raise awareness of the causes and consequences of vitamin A deficiency and the need for consumption of adequate vitamin A-rich foods at the household level. Further emphasis will be placed on efforts to promote consumption of red palm oil, since this oil is generally available and not subjected to acute seasonal shortages. A phased community-based program will be implemented in four districts during the next three years, with the aim of applying lessons learned to the rest of the country. The monitoring framework will cover the planning process, provision of services, utilization of services, and coverage of target groups. These dietary approaches offer long-term sustainable options for improving the quality of family diets and overcoming vitamin A deficiency. (author's)
Enhancing vitamin A intake in young children in western Kenya: Orange-fleshed sweet potatoes and women farmers can serve as key entry points.
Food and Nutrition Bulletin. 2001; 22(4):376-387.In western Kenya, where vitamin A deficiency is common and the white sweet potato is an important secondary staple, orange-fleshed sweet potatoes were introduced and their consumption was promoted, along with other vitamin A-rich foods. Ten women's groups grew a number of varieties of sweet potato on group plots in on-farm trials. Five of the groups also received an intervention consisting of nutritional education, individual counseling, and participatory rapid appraisal techniques to promote vitamin A consumption, while the other five formed the control group that received no additional promotion. Changes in consumption of children under five years of age were assessed before and after a one-year intervention period using the Helen Keller International food-frequency method. Varieties were tested for yield, agronomic performance, taste and appearance, and dry matter content. They were also assessed for ß-carotene content in the forms of boiled and mashed puree, sweet potato flour, and processed products. Children in the intervention group consumed vitamin A-rich foods almost twice as frequently as control children (93% more), especially orange-fleshed sweet potatoes, mangoes, dark-green leafy vegetables, butter, and eggs. The yields of orange-fleshed sweet potatoes were at least twice those of white sweet potatoes, as were the taste and appearance ratings. The dry matter content of the varieties exceeded 25%, except for one that was preferred as a weaning food. ß-Carotene values were high enough that one cup of boiled and mashed sweet potato fed daily to children of weaning age would alone meet their requirement of vitamin A, even using the higher 12:1 ß-carotene:retinol conversion. Orange-fleshed sweet potatoes produced and prepared by women farmers can serve as a key food-based entry point for reducing vitamin A deficiency. (author's)
Experience of World Vision Ethiopia Micronutrient Program in promoting the production of vitamin A-rich foods.
Food and Nutrition Bulletin. 2001; 22(4):366-369.Deficiencies of micronutrients are major health problems in Ethiopia. According to a national survey conducted by the former Ethiopian Nutrition Institute in 1985, the prevalence of Bitot's spots exceeded 1%, and low serum vitamin A levels were found in 16% of preschool children. In a 1997 baseline study by World Vision Ethiopia, the prevalence of Bitot's spots was 6.4% and 7.5% in preschool-children and schoolchildren, respectively. In October 1998, World Vision Ethiopia launched a comprehensive Micronutrient Program with the goal of improving the micronutrient and health status of mothers and children. Promoting the production of vitamin A-rich foods was adopted as one of the strategies to reduce vitamin A deficiency in the target population. Intensive nutritional education was given in the project areas, focusing on community leaders, women's groups, teachers, and students. Vegetable seeds and hand tools were made available for demonstration purposes, and production of vitamin A-rich foods (dark-green leafy vegetables, carrot, beet root, cabbage, and kale) was started in community demonstration plots and schools. Community members began replicating vegetable gardens at the household level. In areas where the climate is suitable, production of vitamin A-rich fruits, such as mango, papaya, and avocado, was also demonstrated to the communities. Seedlings grown in community plots were distributed to households. At the end of the second year (1999), 11,708 backyard gardens, 275 school gardens, and 77 community gardens had developed with the full participation of the community. In addition to improved micronutrient status, vegetable production contributed to household food security and income generation of the community. Our experience shows that production of vitamin A-rich vegetables is well accepted by the community. It is sustainable and cost-effective. The challenge ahead is the need to develop local vegetable seed production, since the availability and cost of imported seeds are a hindrance, particularly for very poor community members. A food-based approach, and particularly production of vitamin A-rich vegetables and fruits, should be the mainstay in designing a sustainable micronutrient program in poor developing countries. (author's)
Marketing of red palm oil as a food source of vitamin A in Burkina Faso: A pilot project involving women's groups.
Food and Nutrition Bulletin. 2001; 22(4):388-394.Consumption of red palm oil for its provitamin A activity could extend to nonproducing areas of Africa. To assess the impact of red palm oil introduction, vitamin A status was measured in a random sample of mother-child pairs in the pilot areas. This paper describes the marketing approach, the evaluation design, and results after one year. Red palm oil purchased in southern Burkina Faso is retailed in the north-central pilot area by women's groups. At onset, serum retinol was low in 66% of children and 43% of mothers. After one year, 94% of mothers reported liking red palm oil, 71% had purchased it, and 32% had consumed some in the last week. The rates of risk of inadequate vitamin A intake declined by one-third. Prior to scaling-up, the main challenges ahead are positioning red palm oil as a food supplement rather than a cooking oil, and determining whether the increased demand can be met by local production without undue pressure on prices. (author's)