Malnutrition continues to be an obstacle for economic growth and human well-being in many African countries. Despite a high level of commitment, many countries in Africa are not on track to achieve the nutrition-related Millennium development goals by 2015, such as halving child nutrition, reducing child mortality, and improving maternal health. An IFPRI Policy Note highlights some of the factors which inhibit the reduction of malnutrition, mainly due to a lack of political commitment. The cross-sectorial nature of nutrition with linkages to health, agriculture, education, infrastructure, and social development complicates planning processes. Another report indicates that nutrition is not prioritized because policymakers view it as an outcome from, rather than an input into, human development.
It is estimated that one – third of the world’s population are affected by deficiencies of one or several micronutrients. The most prevalent deficiencies are: anemia and iron deficiency affecting 1.6 billion people; iodine deficiency with 1.9 billion people at risk; and vitamin A deficiency affecting 190 million children under 5 years of age (WHO 2004; WHO 2008; WHO 2009). Deficiencies of zinc, folate, and B-vitamins are also prevalent but the extent is less well known. Low intakes and/or low bioavailability of micronutrients from monotonous plant based diets lead to micronutrient deficiencies often in the most vulnerable population groups such as women and young children. Micronutrient malnutrition causes reduced physical and cognitive development of children and increased morbidity and mortality in children and adults.
Cost of Hunger in Africa
Today, there are more stunted children in Africa than 20 years ago. 69 % to 82 % of all cases of child undernutrition are not properly treated. Most of the health costs associated with undernutrition occurs before the child turns one.
Between 7 % – 16 % of repetitions in school are associated with stunting. Stunted children achieve 0.2 years to 1.2 years less in school education. 8 % to 28 % of all child mortality is associated with undernutrition. Child mortality associated with undernutrition has reduced national workforces by 67 % of working-age populations suffered from stunting as children. Undernourished children are at higher risk for anaemia, diarrhoea, fever and respiratory infections. These additional cases of illness are costly to the health system and families. Undernourished children are at higher risk of dying.
Stunted children are at higher risk for repeating grades in school and dropping out of school. Additional instances of grade repetitions are costly to the education system and families.
If a child dropped out of school early and is working in he or she may be less productive, particularly in the non-manual labour market. If he or she is engaged in manual labour he/she has reduced physical capacity and tends to be less productive. People who are absent from the workforce due to undernutrition-related child mortalities represent lost economic productivity.
Control and prevention strategies
Strategies to prevent and control micronutrient malnutrition aim at increasing the micronutrient intake by dietary diversification, supplementation, fortification and Bio-fortification. These approaches should be regarded as complementary with their relative importance depending on local conditions and specific requirements.
Dietary diversification aims at adding micronutrient dense foods, such as animal source foods, fruits and vegetables to diets based on staple food crops. The major constraints to dietary diversification are the availability and accessibility of micronutrient dense foods, especially in poorer settings as well as the need for behavior change and education.
Supplementation is the provision of relative large doses of micronutrients in form of pills or syrup to treat or prevent deficiencies. The most common supplementation programs include the provision of iron and folate to pregnant women and vitamin A for young children. Expensive supply and poor compliance are the major limitations of this strategy.
Fortification of foods with micronutrients is a preventive strategy which has been successfully used in many countries including well known programs such as salt fortification with iodine and wheat flour fortification with iron and folate. Guidelines to plan and implement efficient programs are available (WHO and FAO 2006). A major drawback of food fortification is that rural populations with limited access to processed foods can often not be reached. For these populations living predominantly on staple food crops Bio-fortification is a promising approach.
Bio-fortification is the process of increasing the level and/or bioavailability of essential nutrients in edible parts of crops by conventional plant breeding or transgenic techniques. Conventional breeding has been the primary approach to enhance staple food crops with iron, zinc and provitamin A carotenoids. Rice, wheat, maize, pearl millet, the common bean, sweet potato and cassava are the main targeted crops of HarvestPlus, the CGIAR’s (Consultative Group on International Agricultural Research) Bio-fortification Challenge program (Pfeiffer and McClafferty 2007; Bouis and Welch 2010). Three prerequisites have been identified to make Bio-fortification successful: i) a bio-fortified crop must be high yielding and profitable to the farmer; ii) the bio-fortified crop must be shown to be efficacious and effective reducing micronutrient malnutrition in target populations, and iii) the bio-fortified crop must be acceptable to farmers and consumers in target regions (Hotz and McClafferty 2007).
For bio fortified crops to be efficacious and effective, not only the enhanced concentration of the micronutrients in the edible part of the crop is important, but also the bioavailability of the micronutrients. In addition, the effect of food processing and preparation on micronutrient concentration and bioavailability needs to be considered.
Linking Nutrition to Agriculture: Nutrition sensitive interventions
Nutrition by nature is a multifaceted, multisectoral issue. Interventions from a variety of sectors should contribute to sustainable improvements in nutrition. Direct interventions improving nutrition are mostly found in the Health domain and Indirect interventions contributing to improved nutritional outcomes can be found in the domains of Agriculture, Economic development, Social development, Social protection, Education, Women and Gender Affairs, Water and Sanitation, etc.
Nutrition sensitive interventions address the underlying causes of malnutrition, while nutrition specific interventions address the direct causes. Nutrition sensitive interventions are never typically in themselves a sufficient intervention to remedy malnutrition.
• Increasing (staple) food production, increasing food availability, lowering food prices
• Diversification of agricultural production
• Micronutrient-rich crops
• Crops/varieties with reduced anti-nutritional factors
• Animal derived foods with higher bio-availability of micronutrients
• Plant breeding for elevated levels of micronutrients (bio-fortification)
Post-harvest processing and food processing
• Reducing food losses
• Extending shelf life
• Increasing food availability
• Adding value
• Maintaining (micro-)nutrients
• Reducing anti-nutritional factors
Recent Development in Ethiopia
Special attention to fight malnutrition is given by policy makers and non-government organizations in as a recent development. Different kinds of intervention including media campaign on feeding children and mothers, nutrition education, nutrition specific interventions to affected population and nutrition sensitive agriculture are materialized.
To make nutritional poor agricultural commodity modified for better nourishment bio fortified crops like orange flesh sweet potato and quality protein maize are promoted to the farming community. In addition to diversification of household produced by giving special intervention to agricultural enterprise which has ignored in previous agricultural development and extension programs mainly backyard agriculture as a source of nutritionally dense green leafy vegetables.
The way forward
Food insecurity and malnutrition is a cumulative effect of previous miss matched development interventions of decades and Even if some efforts made in recent development for giving attention to mainstream a nutrition sensitive agriculture and nutrition sensitive agricultural value chain development is needed. More initiative and programs should be developed so find a social viable and sustainable solution for the multi-dimensional problem of malnutrition in Ethiopia.