ACC Network on Rural Development and Food Security

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Posted 12 November 1998

Theme: Preventing micronutrient malnutrition: the food-based strategy

prepared by the FAO Food and Nutrition Division (ESN)

The problem

Micronutrient malnutrition, that is, deficiencies of vitamins and minerals, constitutes the most widespread form of malnutrition in the world. Such deficiencies affect both the rich and the poor, with women and children being particularly vulnerable. More than two billion people in the world suffer from various micronutrient deficiencies. Deficiencies of vitamin A, iron and iodine can lead to serious health problems, including blindness, mental retardation, reduced resistance to infectious disease and, in some cases, death, and are currently receiving major public health attention. However, these deficiencies are only three of several of concern. For example, low intakes of calcium and vitamin D, zinc, folate and vitamin C are increasingly recognised as impairing the health of large segments of many populations. Taken together, these dietary deficiencies are debilitating to individuals, households, communities and nations and are associated with unnecessary and unacceptable loss of human potential and productivity.

Unlike other impediments of social and economic development, these deficiencies can be reduced with relatively small investments. The technology is available to address many of them, but they persist for a variety of reasons, including the insufficient awareness of policymakers regarding the importance of addressing them and insufficient understanding by programme planners of the strategies available to combat them. In many instances, there is also a problem with relying on short-term measures of control without addressing their root causes.

The food-based approach

Actions to promote consumption through expanding and diversifying the production, processing, and preservation of micronutrient-rich foods, coupled with a strong nutrition education initiative, is the core of the FAO micronutrient programme. The components of the programme include: i) direct assistance to member countries in the design and implementation of field projects to increase the production, availability and consumption of micronutrient-rich foods; and ii) advocacy and policy advice through publications, workshops and nutrition education.

Direct assistance to member countries

Fruits, vegetables, large and small livestock, poultry and fish are all good sources of micronutrients. Efforts to diversify and improve the production, processing and preservation of fruits and vegetables and expand small animal, poultry and fish production can all contribute to better household food security and the availability and consumption of micronutrient-rich foods. Animals are generally excellent sources of biologically-available micronutrients, but are often costly and beyond the reach of poor communities, the worst sufferers of micronutrient malnutrition. Commonly, fruits and vegetables are the cheapest micronutrient-rich food sources and thus are within the economic possibilities of the poor. The FAO Food and Nutrition Division (ESN), in collaboration with the Horticultural Crops Group of the Plant Production and Protection Division (AGP), vigorously promotes home gardening for improved production and consumption of fruits and vegetables. For example, as a part of the UN Ten Year Prevention of Vitamin A Deficiency Programme (VAD), FAO assisted 17 member countries and implemented 25 projects, including 15 in Africa, 9 in Asia and one in the Near East to develop sustainable approaches to overcoming problems of VAD. Promotion of home gardening was at the heart of these projects. In addition, AGP, as part of its core programme, promotes the commercial production of fruits and vegetables.

Evaluation of these and other FAO-implemented projects clearly demonstrates and confirms the beneficial impact of fruit and vegetable production in improving the vitamin A status of project beneficiaries, particularly when the production activities are coupled with nutrition education. The beneficiary households increased consumption of fruits and vegetables, diversified and improved the quality of their diets and enhanced household income through the sale of surplus produce. These projects also contributed to the expanded availability of fruits and vegetables in the local markets. Women and children particularly benefited from these projects as taboos and superstitions declined and consumption of fruits and vegetables improved. Mothers fed more vegetables and fruits to their young children, thus substantially improving consumption of carotene-rich foods by young children. For example, in one project in the Purlieu District of West Bengal, India, the incidence of bigot's spots, an early sign of vitamin A deficiency, was almost eliminated in a period of 18 months through the promotion of home gardening coupled with nutrition education of the public. In Vietnam, a much larger and integrated project including a component of animal production also produced similar results.

By addressing micronutrient concerns within a broader context of the overall improvement of household food security and nutrition, ESN has supported the development of community-based nutrition programmes and projects. For example, the currently operated project, "Improving Household Food Security and Nutrition in the Luapula Valley, Zambia", was formulated on the basis of an in-depth participatory appraisal carried out by an interdisciplinary team of experts in nutrition, health, agriculture, gender, education and communication. The emphasis was to develop a comprehensive and innovative approach which will enable the communities to have access to an adequate diet all year round and thus improve their food security and nutrition, including micronutrient status.

Advocacy and policy advice

To advocate and promote the concept of a food-based approach as the most sustainable method for the control and prevention of micronutrient malnutrition, ESN has produced a number of publications, policy briefs, technical manuals and resource books for various levels of audiences and has also convened a number of consultations and workshops. Some examples follow:

ESN and the International Life Sciences Institute (ILSI) have published a two-volume manual for policymakers and programme planners entitled, "Preventing Micronutrient Malnutrition. A Guide to Food-based Approaches", which illustrates the wide array of food-based approaches available to overcome micronutrient malnutrition. It identifies factors hindering their implementation and attempts to assist policymakers in overcoming these constraints by providing guidance for programme planning. It also describes various technical and programme considerations for actions in various fields, such as agriculture, education and communication to assist programme planners and managers implement more effectively food-based activities.

Home gardening is often an effective means of combating household food insecurity and malnutrition. It is especially helpful in alleviating micronutrient deficiencies. ESN has developed a training manual entitled, "Improving Nutrition through Home Gardening. A Training Package for Preparing Field Workers in Southeast Asia". This training package was developed and field tested in Indonesia for the instruction of agricultural extension, home economics and community development staff working with households and communities in Southeast Asia to promote home food production for better nutrition. It is a practical tool for field workers, which integrates food production and nutrition issues and provides a comprehensive set of information materials for trainers, field staff and farmers. It aims to provide field staff with the technical, extension and planning skills necessary to help rural households identify problems and opportunities for improving home food production and to attain better nutrition for the entire family. It is proving to be very useful and has been adapted for use in field programmes in Vietnam, Bhutan, India and the Maldives. It is currently being adapted for Sub-Saharan Africa and Latin America in French, English and Spanish versions, respectively.

Nutrition education is also an important means for promoting the consumption of micronutrient-rich foods as an integral component of a varied, safe and adequate diet. FAO promotes a food-based approach, adapted to specific cultural contexts, to nutrition education. This approach recognises the social significance as well as the nutritional value of food and stresses the multiple benefits derived from enjoying a variety of foods. It encourages people to consider their total diets in relation to their preferences, individual lifestyles, physiological requirements and physical activity levels. To provide dietary guidance to the public, ESN has produced a set of materials, "Get the Best from Your Food", which promotes four basic messages on which national nutritionists and educators can build. They are: Enjoy a variety of foods; Eat to meet your needs; Protect the quality and safety of your food; and Keep active and stay fit. These materials have been adapted and translated in approximately twenty languages. The Food and Nutrition Division has also produced a technical guide on "Social Communication in Nutrition: A Methodology for Intervention", and an Expert Consultation Report, "Nutrition Education for the Public", which is complemented by a comprehensive set of background papers that provide additional information for implementing effective nutrition education programmes.

Food fortification

FAO recognises that the fortification of food, that is adding micronutrients to processed foods, can, in certain situations, be an important component of food-based approaches. To provide guidance and promote appropriate food fortification technology, FAO convened an Expert Consultation on Food Fortification Technology in 1995. The recommendations concerning the use of appropriate technologies, the means of promoting sustainability, the adequacy of quality controls to assure safety, and the areas identified as needing further research have been widely disseminated. The Codex Alimentarius Commission has also prepared guidelines for governments to use on the addition of essential nutrients to foods and is continuing to examine the nutritional and labeling implications of food fortification. The Codex standard for food-grade salt contains specific provisions for iodisation.

Capacity building

ESN has sponsored a number of national and international workshops in Asia and Africa to promote food-based approaches. These workshops were attended by experts from member countries who reviewed the current status of micronutrient malnutrition in their countries and regions, assessed the impact of ongoing programmes, and discussed ways and means of strengthening food-based action as a complement to other programmes. For example, a workshop on Improving Food Supplies and Nutrition through Household and Village-level Processing and Preservation of Fruits and Vegetables was held in Harare, Zimbabwe, in 1996. This workshop discussed the role of preservation of fruits and vegetables in improving food supplies, promotion of appropriate technologies and mechanisms of inter-country collaboration and information exchange. A workshop on the Prevention and Control of Micronutrient Malnutrition through Food-based Actions in SAARC Countries was held in Dhaka, Bangladesh, in 1997. It reviewed the need for strengthening food-based actions in SAARC countries, made a number of recommendations for collaboration and provided guidance for further programme development.

FAO's food-based action programme is a comprehensive, sustainable and long-term action programme for the control and prevention of micronutrient malnutrition. It is intended to contribute to the improvement of the total diet and overall nutritional status of all people at all times. Additional information on FAO's micronutrient activities may be obtained from the Director,
Food and Nutrition Division,
Food and Agriculture Organization (FAO),
Viale delle Terme di Caracalla, 00100 Rome, Italy;
E-mail: nutrition@fao.org.

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