Hello, my name is Shannon King and I am working with Sight and Life as an intern while completing my Masters of Science in Public Health with a focus in human nutrition at Johns Hopkins Bloomberg School of Public Health.
The Assignment in India
During the late summer of 2017, I spent 2 months in India where I was working with our local partner, Karuna Trust, to conduct research on the implementation of the PATH “Feeding the Future through Fortified Rice Program”. Within this intervention Sight and Life has designed three school-based nutrition and WASH strategies to develop healthy eating habits while improving hygiene and sanitation behaviours. The intervention uses peer role modeling and cues to action; games and helper crews; and problem-based learning within the school environment to promote behaviour and attitude change.
The study required visiting 50 schools in four different areas of Karnataka in order to understand how the program is being implemented. Our observations allowed for us to examine to what extent each school had executed program activities- such as having soap available for the students, and how the program materials are being used around the school. Further, in-depth discussions with the implementing teachers provided detailed descriptions of how the program is being used and their experiences thus far.
Impact of my Experience
Overall, it was an incredible experience allowing me to engage first-hand in the entire research process from protocol design, to ethics review, data collection, and data analysis. As a graduate student, I have had the opportunity to work on studies in the past; however, this was the first time I have been given ownership of a study and the ability to work on it from initiation to conclusion. It has been very rewarding to work through each step of the process and overcome all the associated challenges and roadblocks.
During my time in the field, I found it fascinating to see a wide range of implementation processes used in the schools despite the fact that each school was provided with the same program materials and instructions. As researchers, a better understanding of the factors influencing implementation allows us to develop programs in a manner that will optimize delivery.
While the research did not involve any formal data collection from the school children, I will always cherish the moments I was able to engage and play with them. The opportunities were few and far between, however, at one school we arrived early and the teachers were having lunch so the facilitators and myself played one of the nutrition and WASH games with the children. Despite needing a translator to help facilitate the process, it was an hour filled with laughter and joy. It was also an incredible opportunity to see the program in action and how much the children were enjoying to learn.
Working through Barriers
The biggest challenge, and the most eye-opening experience of the trip, was working as a young female researcher. In several different contexts and settings, comments and suggestions made by females were treated less seriously than those put forward by males. Or sometimes women’s opinions were simply ignored, and it was eye-opening and aggravating to experience. Witnessing an individual’s esteem being judged primarily on their gender and seniority is quite the contrast to a working environment where your capabilities are judged primarily on your education, experiences and work ethic. It provided me with an even stronger appreciation of the efforts made to promote gender equality. India has an incredible, young female population with the potential to be strong leaders and change-makers, if given the opportunity.
Lastly, this experience highlighted the need for implementation research to better understand how the nutrition community can optimize the delivery of nutrition interventions rather than purely conducting before-and-after data collection to assess the success of a program. I look forward to sharing the results with both project partners, in the hopes of allowing for mid-course corrections to improve program implementation, and sharing the findings with the greater research community to help build the literature base of implementation research in nutrition.
Enjoy this gallery of pictures showcasing my visit to Indian schools.
Photo credits: Prachi Katre
Cracking the Egg Potential
Working to Reduce Child Stunting and Improve Rural Livelihoods
Saskia Osendarp, PhD/OsendarpNutrition/Child Investment Fund Foundation
Most Recent, Perspectives
Eggs are among “nature’s first foods”, designed to holistically support early life and development. They are among the richest sources of essential amino acids, protein, choline, and long- chain fatty acids (DHA). They are also an important source of some vitamins and minerals, including vitamin A, B2, B5, B12, selenium, phosphorous and zinc, and contain other bioactive factors. In a symposium chaired by Chessa Lutter from RTI International and the University of Maryland School of Public Health and Saul Morris from the Global Alliance for Improved Nutrition (GAIN), and sponsored by the Child Investment Fund Foundation (CIFF) at the International Congress of Nutrition (ICN 2017) in Buenos Aires, the potential of eggs to improve child nutrition and rural livelihoods was debated.
The Science Behind the Egg
For a full-packed symposium hall, Lora Iannotti from Washington University, presented findings from the Lulun Project, a randomized controlled trial in Ecuador, where eggs were given to children 6 to 9 months of age. After only 6 months, linear growth was improved and stunting was reduced by 47% in the group receiving eggs – an effect larger than those of any other complementary feeding interventions to date. The trial also showed significant improvements in concentrations of biomarkers associated with cognitive development including choline, betaine, methionine and DHA. Currently, a replication study is on its way in Malawi that also includes assessments of child development.
In rural Ghana, poultry-based income generation activities embedded in an integrated agricultural and nutrition education intervention also led to improved egg consumption, dietary diversity and linear growth among young children. Dr Grace Marquis from McGill University presented the preliminary results of this intervention, in which households with infants up to 12 months of age received multiple agricultural and infant feeding interventions, including education and training on poultry, home gardens and beekeeping. Dr Marquis and her team are currently working with district partners on the sustainability of the intervention by helping women form farmer associations, opening opportunities for access to credit from the local rural bank, and strengthening technical assistance from government health and agriculture extension services.
Creation of demand and overcoming social and cultural taboos preventing mothers and caregivers from giving eggs can be major barriers to overcome when promoting the use of eggs for young child feeding. A key element of the previously described RCT in Ecuador — an intensive social marketing strategy — was described by Carlos Andres Gallegos Riofrío of Washington University. The project was branded as “Lulun”, which translates into ‘egg’ in the local indigenous language, and symbolically tied the practice of giving eggs to young children with indigenous worldviews. The strategy followed a structured process targeting all the six P’s in successful marketing: people, product, place, price, promotion and policy change. Creating a successful brand, brand loyalty and empowerment of mothers and caregivers to take decisions on their child feeding were critical for the successful and continued behavior change and central to the success of the study in improving egg consumption and child growth.
Availability of Eggs
To make eggs available and affordable to low-income households, small holder poultry business models need to be viable. Klaus Kraemer of Sight and Life presented the findings from a scoping study in Kenya, Ethiopia, Malawi and India demonstrating the potential of four types of business models to be viable at-scale:
(1) Micro-Financing institutions that provide a small credit to underserved poultry entrepreneurs coupled with peer group support, technical, and business skill training. Such credit helps backyard poultry farmers set-up and operate micro-enterprises.
(2) The Out-Grower Model: a partnership between smallholder poultry farmers and commercial players to improve the productivity of hens.
(3) In the Enterprise Development Model, an established local input supplier organizes smallholder farmers into groups and helps them invest in mid-size poultry enterprises. With relevant training, market support and funding, they manage businesses that not only generate profits, but also succeed in improving the availability of high quality eggs in their community.
(4) The One-Stop Hub Model is a distribution and aggregation platform tailored for a rural environment. It is a combination of the above three models, and goes one-step further by providing a marketing channel for eggs to be accessible even in hard-to-reach rural areas.
All of these models were successful and in some contexts even hugely profitable. In Malawi, for instance, women farmers in the Enterprise Development Model, can each earn an average income of US$1130 per year!
Finally, Emily Lloyd of the One Acre Fund demonstrated the importance of rigorous piloting before moving to scale to tackle issues with selection of the most appropriate chicken-breed in a particular setting, appropriate housing and vaccinations of chickens to prevent spread of poultry-related infectious diseases in the participating households, as well as distribution and financing challenges.
In a lively discussion, some important suggestions were raised by the audience. These included the potential to improve egg consumption in other vulnerable target-groups, in particular pregnant and lactating women, the need for behavioral change strategies and other interventions to prevent the spread of poultry-related infectious disease to the household, concerns about allergies, considerations of equity when rolling-out poultry business models and how to improve sustainability when these programs and interventions are further scaled-up.
Saul Morris, GAIN’s Director for Policy and Planning, concluded that the potential of egg and poultry interventions to impact child’s nutrition and improve rural livelihoods is ‘egg-citing’ and has been underexplored and appreciated. The symposium clearly demonstrated that together, interventions to improve young child egg intake and household and community egg production could radically reduce the global prevalence of stunting and improve livelihoods of the rural poor. The next challenge will be to bring these interventions to scale, and fulfill the promise that by 2020, 10 million eggs will be delivered to young children annually, as a key component of complementary feeding.
Theobald’s expounds upon the SBN’s vision for more businesses to responsibly leverage consumer insight and data in their production of nutritious foods, particularly for low-income consumers, and its hopes that businesses will develop marketing and communications approaches making nutrition more exciting, relevant and aspirational to the consumer.
“One third of the world’s population is consuming a poor diet, the world is facing a huge public health and economic challenge,” notes Theobald. “Improving the diets of more than two billion people requires, among other things, engaging food businesses to improve the nutritional content of foods and make nutritious foods more desirable. To reach the ‘bottom of the pyramid’, food businesses need to develop a deep understanding of low-income consumers and their food purchase decisions.”
A bit of background information, the Scaling Up Nutrition (SUN) Movement was established in 2010 and supports national leadership and collective action to scale up nutrition. The SBN is one of four global networks that support SUN countries, along with the United Nations (UN), civil society and donor networks. It is convened by GAIN and the UN World Food Programme (WFP), but is also further supported by an advisory group comprising senior business leaders. The SBN advocates for and supports business investment in nutrition in order to help reduce all forms of malnutrition through innovation and responsible and sustainable initiatives, actions and operations.
The SBN’s wider remit is to facilitate partnerships and linkages with organizations that provide technical assistance, business development support and access to finance, in order to support business to better address malnutrition in all forms. As such, where possible, SBN undertakes and/or collates consumer and market research and shares findings with its business members at the national level.
In this interview, Theobald shares how SBN advocates and supports businesses to act on the issue surrounding malnutrition. The SBN’s Global Coordinator, Jonathan Tench; Uduak Igbeka, the Team Lead of SBN Nigeria, which is convened by GAIN; and Ralf Siwiti, Programme Manager, SBN Zambia, which is convened by the WFP also contributed to the Q&A session.
Sight and Life (SAL): Tell us a little bit about your background, and how you got involved in Scaling-Up Nutrition Network.
Hannah Theobald (HT): I’m a BSc and PhD qualified nutritionist, and have spent the majority of my career working as a nutritionist in the private sector, mainly focusing on emerging markets. In the last few roles within business I was involved in more corporate social responsibility (CSR) work. I’d been thinking about working in international development for some time so, when the opportunity arose, I took it. I had been aware of and inspired by the work of GAIN and the SUN Business Network for a while. Working on the SBN has been a great way of utilizing my nutrition and business background for social good and sustainable nutrition improvement.
Uduak Igbeka (UI): My background is in agricultural economics. I have been working at GAIN for six years now, focusing on regulatory agencies in industry on a food fortification program before the opportunity to join the SBN team presented itself. It was quite a natural fit, seeing as I had been working closely with business in Nigeria already. I found the opportunity to engage with businesses beyond the food sector exceptionally exciting.
Ralf Siwiti (RS): I am a marketer at heart. My career has taken me from managing relationships in sales to developing marketing communications campaigns for large multinationals in the food industry, as well as non-profit campaigns. My journey with the SUN Movement began with participation as a representative of a well-known consumer goods company at the launch of the SUN Business Network in Zambia in November 2014. Five months later, I was at the helm of this budding project, which has now developed into one of the most successful SUN country networks working to generate private sector investment in nutrition. I am currently leading SBN Zambia into its next phase, which will see it directing focus on making nutrition aspirational for consumers in Zambia.
SAL: What are the SBN’s main objectives?
HT: As the world’s only dedicated, global platform for business and nutrition, we have three main objectives. First, to mobilize business to contribute to reducing malnutrition in all forms. Secondly, we aim to make nutrition more aspirational, accessible, affordable – and available to the consumer. Finally, we are building the case for greater business engagement in nutrition amongst all stakeholders. We achieve this with the support of more than 400 members, which includes both multinational and national companies that are committed to improving nutrition throughout the world.
SAL: How do other stakeholders, who are part of the SUN network, perceive consumer research?
UI: In Nigeria, the research that was shared with business was commissioned by the Bill & Melinda Gates Foundation, and was originally intended for civil society and shared with them in the first instance. Because formative research is a big part of development, it is perceived that this type of research would help in shaping the development of more nutritious product for target populations in Nigeria.
RS: In Zambia, most stakeholders in the SUN network hold a positive view of consumer research and insight, as undertaken by the national SBN. The country has a widespread lack of data, including that on consumers. As a result, most sectors are eager to learn of the availability of usable data. Consumer insights form an increasingly powerful tool in terms of the implementation of programmes, particularly those relating to behaviour change communications (BCC).
SAL: What challenges are you faced with, to have others − both in and out of the SUN network − accept consumer research and apply the work?
Jonathan Tench (JT): Businesses face two common challenges when it comes to scaling up investment and action on nutrition. First, investment in nutrition is seen to be too expensive – returns on investment can be low if scale is also low and this can be seen as risky by business and investors alike. Second, there is little demand for nutrition at present, especially from low-income consumers, so it is hard for companies to make a case for investing more, as they don’t see a market. There’s also quite a poor understanding of what we mean by nutrition, which in part explains the low demand for nutritious foods. It’s important to do more to raise consumer awareness; we have to educate both consumers and businesses about nutrition.
There are lots of ways that companies globally address this issue, alone or as part of public-private partnerships, for example around consumer behavior change. We want to encourage more of that type of action and partnership. Businesses can take other actions to raise awareness of and demand for nutritious foods, such as employing social marketing techniques where consumers are taught about the benefits of nutrition. Companies are often very good at marketing aspiration and employ a huge range of marketing strategies, so we’d be keen for businesses to employ these skills to make nutrition more aspirational and desirable.
RS: The use of the term consumer can sometimes be interpreted as an attempt to commercially exploit the vulnerable. It is often important to highlight the fact that vulnerable people, or so-called beneficiaries of development programmes, are still capable of making choices. The choices they make can be a huge factor in attempts to support them and this is sometimes ignored in development programmes. The sensitization of stakeholders is important in relation to the need, use, and application of consumer insights as, by the nature of most development work, the consumer is often seen as a beneficiary who is vulnerable and must be protected.
UI: Businesses in Nigeria have found the information very useful for identifying product development opportunities. They find the information most useful where a business opportunity also addresses a public health need. Having access to market data through SBN provides access to a resource that many SMEs cannot afford. It helps stimulate innovation, and helps business better understand the consumer.
SAL: What do you find most exciting and challenging in your work − and what do you hope to see in future?
HT: As a nutritionist from a private sector background, the need to understand the consumer well has been instilled in me. Before joining GAIN and the SBN, I therefore had an understanding of how consumer insight worked and the important role that it plays in product development and communication. It was very important for the network to get involved in this in order to help the Network develop effective consumer awareness campaigns and support business to deliver sustainable nutrition solutions. For example, in Tanzania, we didn’t understand the level of awareness of food fortification. Now that we do, we have a good understanding of consumer’s beliefs and knowledge it will be a lot easier to tailor messages around fortification.
Introducing Vitamin B7
What are the Benefits of this Water-soluable Vitamin?
Look at the ingredients in cosmetic products and you may be surprised to see that vitamin B7 or biotin is a key component! Thanks to vitamin B7’s role in a multitude of cellular reactions, particularly interactions keeping your hair, finger nails, and skin healthy, it is often recommended for strengthening hair and nails. Vitamin B7 is involved in metabolism as a coenzyme that transfers carbon dioxide, an important step in breaking down food including carbohydrates, fats and proteins into energy. This role is critical.
The Primary Sources of Vitamin B7
Vitamin B7 can be found in: vegetables; cereals; nuts such as almonds, walnuts, peanuts; yeast; and soybeans. It is also sourced from animal products such as eggs, milk, liver, and kidney or synthesized by intestinal bacteria.
Bioavailability of Vitamin B7
In foods, biotin is found as the free form or bound to dietary proteins. The bioavailability of biotin depends on the ability of protein enzymes in the stomach to convert protein-bound biotin to free biotin. Biotin is not sensitive to light, heat, or humidity.
Risks Related to Inadequate or Excess Intake of Vitamin B7
Experts have yet to quantify the amount of biotin in natural foods. Deficiency due to lack of dietary intake is rare in healthy populations. Symptoms of deficiency include general fatigue, nausea, neurological problems, poor skin, and hair quality. No adverse effects have been reported with excessive intakes of biotin.
Find more information on vitamins and micronutrient deficiencies though our partner, Vitamin Angels or download our complete vitamin and mineral guide here. Here is a delicious way to incorporate biotin into your diet – enjoy!
Banana and Walnut Loaf*
100g softened butter plus a little extra for greasing
140g caster sugar
1 beaten egg
225g plain flour
2 tsp baking powder
4 very ripe bananas
85g chopped walnuts
Pre-heat the oven to 180C (fan) and 160C (gas). Grease a 2lb loaf tin with some butter and line the base with baking parchment, and then grease this as well.
In a large bowl, mix the butter, sugar, and egg together and then slowly mix in flour and baking powder. Peel, then mash the bananas. Now mix everything together, including the nuts. Pour the mixture into the tin and bake for 1 hour, or until a skewer comes out clean. Allow the cake to cool on a wire rack before removing from the loaf tin. The loaf can now be wrapped tightly in cling film and kept for up to 2 days, or frozen for up to 1 month. Defrost and warm through before serving. Serve in thick slices topped with vanilla ice cream and drizzled with a little chocolate sauce for a dessert.
While looking at diet and cardiovascular disease risk many of us immediately consider our saturated fat intake however Vitamin B6 should not be overlooked. Together with folate and vitamin B12, vitamin B6 is required for maintenance of normal blood homocysteine levels. Raised homocysteine is a risk factor for cardiovascular disease.
Vitamin B6, comprises 3 forms: pyridoxine, pyridoxal and pyridoxamine. All three forms of B6 can be converted to the coenzyme PLP. Vitamin B6 in its coenzyme form is involved in more than 100 enzyme reactions, many concerned with protein metabolism.
Along with its central role in the metabolism of amino acids (protein), it is fair to say that Vitamin B6 is required for the majority of biological reactions in our body including neurotransmitter synthesis, red blood cell formation and metabolism and transport of iron.
Vitamin B6 is stored in muscle tissue.
The Primary Sources of Vitamin B6
There are many good sources of vitamin B6, including chicken, liver (cattle, pig), fish (salmon, tuna) from animals.
In addition, chickpeas, maize and whole grain cereals, green leafy vegetables, bananas, potatoes and other starchy vegetables are ideal sources from fruits and vegetables. Vitamin B6 can also be found in nuts and chickpeas.
Bioavailability of Vitamin B6
If consuming a mixed diet, the bioavailability of vitamin B6 is about 75%. Vitamin B6 is destroyed by heat but it remains stable during storage.
Risks Related to Inadequate or Excess Intake of Vitamin B6
Deficiency of vitamin B6 alone is uncommon; usually it occurs in combination with a deficit in other B-vitamins. Individuals at risk for poor intakes are alcoholics and those taking tuberculosis medication. Signs of vitamin B6 deficiency include microcytic anemia due to inadequate synthesis of hemoglobin, depression, nerve problems, and irritability. No adverse events have been observed with high intakes of vitamin B6 (from food or supplements).
Find more information on vitamins and micronutrient deficiencies though our partner, Vitamin Angels or download our complete vitamin and mineral guide here.
Incorporate vitamin B6 into your next dinner with this delicious recipe below.
Remove the wish bone and keep for the stock. Season the cavity of the chicken with salt and freshly ground pepper and stuff a sprig of tarragon inside. Chop the remaining tarragon and mix with two-thirds of the butter. Smear the remaining butter over the breast of the chicken, place breast side down in a casserole and allow it to brown over a gentle heat. Turn the chicken breast-side up and smear the tarragon butter over the breast and legs. Season with salt and freshly ground pepper. Cover the casserole and cook in a moderate oven for 13-12 hours.
(To test if the chicken is cooked, pierce the flesh between the breast and thigh. This is the last place to cook, so if there is no trace of pink here and if the juices are clear the chicken is certainly cooked.) Remove to a carving dish and allow to rest for 10-15 minutes before carving.
Spoon the surplus fat from the juices, add a little freshly chopped tarragon, add in the cream and stock if using* boil up the sauce until it thickens slightly. Alternatively bring the liquid to the boil, whisk in just enough roux to thicken the sauce to a light coating consistency. Taste and correct seasoning.
Carve the chicken into 4 or 6 helpings, each person should have a portion of white and brown meat. Arrange on a serving dish, nap with the sauce and serve.
Vitamin B2, like all B vitamins, has an important role in producing energy for the body. Vitamin B2, commonly referred to as riboflavin, helps the body convert food, such as carbohydrates, into fuel or glucose, which provides us with energy. It also aids the body in metabolizing fats and proteins.
Additionally, riboflavin acts as an antioxidant to fight the damaging particles in the body known as free radicals. These free radicals can impair cells and DNA, which may contribute to the aging process as well as the development of a number of health conditions, such as heart disease and cancer. Antioxidants, such as riboflavin, have a potential health benefit by fighting free radicals and preventing some of the damage they may cause.
Vitamin B2 also helps the body change vitamin B6 and folate into useful forms. Moreover, it is important for growth, reproduction, and plays a role in vision.
The Primary Sources of Vitamin B2
Vitamin B2 is found in animal products such as offal (liver, kidneys, heart), eggs, meat, milk, yogurt, and cheeses while other sources include whole grain cereals, dark green leafy vegetables, and brewer’s yeast.
Bioavailability of Vitamin B2
Vitamin B2 from foods is highly available; bile salts, which are released when we consume fats, increase the rate of absorption of vitamin B2. Vitamin B2 is sensitive to light but remains stable under heat and refrigeration. The milling process reduces the content of vitamin B2 in cereal grains.
Risks Related to Inadequate Intake of Vitamin B2
Individuals whose food intake relies primarily on refined cereals from the elderly and chronic dieters to individuals who exclude milk products from their diet are at risk for inadequate intakes. Vitamin B2 requirements are increased during periods of strong growth, such as in pregnancy and lactation. Vitamin B2 deficiency co-occurs with other nutrient deficiencies and it may precipitate deficiencies in vitamin B6 and niacin. People with cardiovascular disease, diabetes or cancer are at risk for vitamin B2 deficiency.
Additional information on vitamins and micronutrient deficiencies is available though our partner, Vitamin Angels or download our complete vitamin and mineral guide here.
Enjoy this recipe for your next dinner…
Liver and Bacon Sauté with Potatoes*
400g new potato
2 tbsp olive oil
4 spring onions trimmed and cut into 2-3 pieces on the diagonal
4 rashers of unsmoked bacon cut into pieces
1 tbsp plain flour
1 tsp paprika
155g lamb’s liver, sliced into thin stripes
150ml hot vegetable stock
4 tbsp creme fraiche
Start by cutting the potatoes in half and simmer in salted water for 12-15 minutes. Drain and set aside. Next, heat the oil in a wok and add the potatoes. Fry them for 4-5 minutes over a high heat until browned and crispy. Remove from the pan and set aside.
Then tip the spring onions and bacon into the pan and stir and sizzle for 3-4 minutes or until the bacon gets crispy. Meanwhile, season the flour with paprika, a little salt and plenty of black pepper and use the mixture to coat the liver.
Stir the liver into the pan and cook for 2-3 minutes. Toss in the potatoes and quickly reheat. Remove everything from the pan and divide between 2 plates. Keep warm.
For the finishing touches, quickly pour the hot vegetable stock into the pan and scrape all the crispy bits up from the bottom. Let it bubble for 1-2 minutes, then pour around the liver and potatoes. Serve each portion topped with creme Fraiche and a sprinkling of paprika.
One often hears the term ‘it’s a matter of life and death’ but this is literally the case for Vitamin K! Vitamin K, also known as phylloquinone or menaquinone, has a vital role in blood clotting and thus also supports wound healing.
More than a dozen different proteins and the mineral calcium are involved in making a blood clot. Vitamin K is essential for the activation of several of these proteins. When any of the blood clotting factors is lacking, hemorrhagic disease (uncontrolled bleeding) results. Vitamin K also participates in the metabolism of bone proteins, most notably osteocalcin. Without vitamin K, osteocalcin cannot bind to the minerals that normally form bones, resulting in poor bone mineralization.
Storage and primary sources of vitamin K
Vitamin K is stored in the liver. Vitamin K is found in plant foods as phylloquinone (K1). Bacteria in the lower intestine can synthesize vitamin K as menaquinone (K2), which is absorbed by the body.
Sources of phylloquinone are green leafy vegetables (i.e., parsley, spinach, collard greens, and salad greens), cabbage, and vegetables oils (soybean, canola, olive). Menaquinones are also found in fermented foods such as fermented cheese, curds, and natto (fermented soybeans).
Bioavailability of vitamin K
Absorption of vitamin K from food sources is about 20%, and dietary fat enhances absorption.
Risks related to inadequate or excess intake of vitamin K
Deficiency of Vitamin K is rare as it is widely available from the diet and is also provided by gut bacteria. Thus, deficiency is generally secondary to conditions such as malabsorption or impaired gut synthesis. However, there is growing interest in the role of vitamin K in optimising bone health. Supplementation with vitamin K has been found to be beneficial for improving bone density among adults with osteoporosis because it drives synthesis of a special protein called matrix Gla protein.
Vitamin K is poorly transferred via the placenta and is not found in significant quantities in breast milk, so newborn infants are especially at risk for bleeding. This innate vitamin K deficiency is treated with intramuscular injection or oral administration of phylloquinone. Supplementation with vitamin K has been found to be beneficial for improving bone density among adults with osteoporosis because it drives synthesis of a special protein called matrix Gla protein.
Additional information on vitamins and micronutrient deficiencies is available though our partner, Vitamin Angels or download our complete vitamin and mineral guide here.
Here is an easy way to incorporated vitamin K into your next meal.
Spinach, aubergine and chickpea curry*
1kg fresh spinach
2 tbsp olive oil
2 medium red onions, chopped
200g tinned chickpeas, drained and rinsed
2 garlic cloves, finely chopped
2 fresh hot green chillies, halved and thinly sliced, seeds included
1 tbsp coriander seeds, ground
1 tbsp cumin seeds
1 large aubergine, approx. 400g/14oz, cut into 2cm (3/4in) dice
400g tinned chopped tomatoes
Cook the spinach in boiling water for two minutes, then cool it under cold running water and squeeze gently to remove most of the liquid. Place in a food processor and chop the spinach to a coarse purée. Meanwhile, heat half the olive oil in a large pan and cook the onion, chickpeas, garlic, chilli and spices for five minutes over a medium heat. Next, add the remaining olive oil and the aubergine to the pan. Cook for ten minutes, stirring often, until the aubergine is colored. Then add the tomatoes and a pinch of salt. Cover the pan, lower the heat and simmer for 15 minutes until the aubergine is soft. Stir in the spinach purée and serve.
At age 17, Ms Cheril has just won a place on the prestigious and highly competitive Bachelor in Journalism course at Maasai Mara University, in Narok, Kenya.
When Sight and Life spoke with Ms. Cheril, she said that, above all, her experience with RWG has made her passionate about working with the poorest of the poor, and about giving a voice to the voiceless.
Sight and Life magazine (SAL): Please explain the foundation of the Ramala Women Group.
Munters Cheril (MC): Kofi Annan, a Ghanaian diplomat, wrote “study after study has taught us that there is no tool for development more effective than the empowerment of women”. RWG is that tool for the development of women, households, families and communities in Kenya and the world. In 2000, RWG was founded by seven people who were touched by the ever-growing atrocities of poverty in all forms; the rampant abuse of vulnerable women, youths, and children’s inalienable rights; the high prevalence of malnutrition and micronutrients deficiencies (hidden hunger) among children; the effects of HIV/AIDS; and poor living condition among vulnerable communities.
This community-based organisation (CBO) is dedicated to fighting poverty by enhancing, fostering, promoting, and strengthening psychosocial and economic opportunities for women and children in underserved, vulnerable, and marginalized communities in Migori and neighboring counties in Kenya.
RWG envisages a prosperous, resilient, and improved quality of life for households in underprivileged communities and an increased proactive involvement of women in holistic developmental initiatives at local, regional, national, and international levels. The group is committed to enhancing households’ socio-economic opportunities by providing hope, restoring, and promoting women’s pride – not only in Kenya, but also throughout the world. This should enable women to be self-reliant and self-sufficient, with households and communities, which are empowered to prioritize and respond proactively and in a timely fashion to their needs.
SAL: What are RWG’s overall goals and core values?
MC: The organization’s overall mission is to enhance, foster, promote, and strengthen households’ socio-economic opportunities for sustainable development. RWG seeks to harness locally available resources and materials and put them into effective, efficient, constructive, and meaningful use. It aims to partner with likeminded groups or organizations in order to prepare the impoverished communities to be conscious of their challenges, and respond intelligently to the same with the noble goal of improving their living conditions and thus mitigating poverty within households, families, and communities.
RWG endeavors to increase access to secure and sustainable dignified livelihoods and economic opportunities, through integrated and participatory community development, capacity building, advocacy, and socio-economic empowerment.
It sees development as a process, not as an end: ‘to develop is to become not to have.’ Community proactive involvement is the only sure vehicle through which the process of development can be achieved.
The group would like, insofar as it is possible, to achieve households’ prosperity and resilience. It encourages proactive and transformative community involvement in support of effective and efficient project design, policy formulation, and implementation of applied programs aimed at mitigating poverty in all forms among rural households, families, and communities.
SAL: Why is it a women’s group, and how successful has it been to date?
MC: In Kenya, women represent over 72 percent of those living on less than 2 USD per day. Women suffer inequitably from the chronic effects of poor nutrition, insufficient healthcare, and limited educational opportunity. Women contribute to 67 percent of the world’s work and receive less than 10 percent of the pay. They spend 90 percent of their income on their families, while men typically spend less than 35 percent alone. In addition, women who contribute to family finances have greater decision-making power resulting in better nutrition, health, and education for their children. When family needs are met, women are more likely to then invest in their communities.
In sixteen years, RWG membership has grown to 983 (based on 2016 figures). Sight and Life has supported the group’s initiatives, with the aim of improving the welfare of children by mitigating the dangers associated with vitamin A deficiencies, since 2001 and by 2006 the focus was scaled up to include deficiencies of micronutrients and other vital vitamins. Through this initiative and partnership, over 60,000 children and 25,000 women respectively have benefited directly from Sight and Life’s support. Additionally, it is believed that over 0.72 million people have benefited indirectly.
SAL: What is your personal experience with RWG?
MC: As a vulnerable child in 2003, I was recruited and enrolled into RWG’s Food and Nutrition program due to my nutrition and health conditions. By the time I was taken in by RWG, through the actions of a social worker, I was four years old, severely malnourished, and on the brink of death.
As a result of proper food and a nutrition intervention implemented by RWG with the support of Sight and Life, my holistic (intellectual and volitional) health significantly improved. I became more active and playful. I was then enrolled into a pre-school program at Rongo Baptist Kindergarten by RWG where my self-esteem improved and I became more confident than ever before. This impressed my teachers who encouraged me to take part in school functions. In church, my public speaking and presentation skills improved too, I sang in the children’s choir.
SAL: How many MixMeTM packets/meals did you receive? And until what age did you go?
MC: Through the program I took foods enriched with MixMeTM powder provided by Sight and Life on a daily basis from the first day I was enrolled into the program by RWG. I was on MixMeTM for over four years and I stopped in 2007 when I was seven years old.
Today, I am a RWG volunteer. My main role is to visit households and schools introducing people to the values of proper nutrition and micronutrients and the dangers associated with deficiencies of the same. My ambition is to educate the masses on nutrition and micronutrients by sharing information and educating children, households, and communities. As a journalist, I hope to focus on the welfare of women and children by sharing their stories and finding how their livelihoods can be improved for the better.
SAL: How did RWG help in other ways?
MC: I was enrolled into a pre-school program at Rongo Baptist Kindergarten by RWG, where I started my schooling. The group supported me through my elementary and high school education until the fourth form. A group of women with big hearts paid my school fees and provided the things I needed during high school. After that, they said they could not continue to support me through my college education as they were supporting other children through their primary and high school education. To date, the group is still supporting me.
As a way of reciprocating the hope and promise of a bright future they have given to me, I have dedicated my voluntary service to the group. I wish to contribute significantly towards the welfare of women and vulnerable children. My hope is that I can help restore someone’s hope as Sight and Life through RWG restored mine seventeen years ago. I want to put a smile on someone’s face as Sight and Life through RWG did for me. The group has been with me through thick and thin and I have committed myself to giving back to the community and the group in any way I can.
I am seeking partners such as Sight and Life to help me walk my talk. Through my journalistic skills, I am confident that I will be able to do it through collaboration with likeminded partners.
SAL: Why did you choose journalism for your studies?
MC: Henry Anatole Grunwald, an Austrian-born American journalist and diplomat perhaps best known for his position as managing editor of TIME magazine and editor in chief of Time, Inc., said:
“Journalism can never be silent: that is its greatest virtue and its greatest fault. It must speak, and speak immediately, while the echoes of wonder, the claims of triumph and the signs of horror are still in the air.”
There is, quite simply, always a need for journalists in our world and in our communities, especially now, where it seems a sad, negative event occurs daily. Journalists are passionate about sharing stories, and provide citizens with the information they need to make the best possible informed decisions about their lives, their communities, their societies, and their governments.
I am extremely passionate about working with destitute communities, providing educational opportunities for vulnerable children, and underserved and marginalized communities. I have always loved writing. I have always loved reading what others write. I love how people can sometimes feel how someone else feels by reading their stories.
Studying journalism will give me a chance to build important skills, such as researching, writing, interviewing, and thinking critically and creatively. I will be able to learn about people and their communities, and suggest the best possible action plan for improving people’s living conditions. As a journalist, I am to be a voice to the voiceless, so that those who are in power can hear silent voices through the stories I share.
Ever wondered why leading cosmetic companies add Vitamin E to their products? One very good reason is that Vitamin E acts as a powerful antioxidant protecting our cells against oxidative damage from free radicals thus maintaining healthy skin.
Vitamin E, also know as α-Tocopherol, is a group of eight lipid-soluble compounds synthesised by plants, tocopherols and tocotrienols. α-Tocopherol accounts for 90% of the vitamin E in human tissues and acts as an antioxidant (i.e., stops the chain reaction of free radicals producing more free radicals). Vitamin E protects cell membranes, proteins, and DNA from oxidation and thereby contributes to cellular health.
Sources of Vitamin E and Storage
Vitamin E is stored in the liver and is safe even at high intakes. Vitamin E in the α-tocopherol form is found in edible vegetable oils, especially wheat germ, and sunflower and rapeseed oil. Other good sources of vitamin E are leafy green vegetables (i.e., spinach, chard), nuts (almonds, peanuts) and nut spreads, avocados, sunflower seeds, mango and kiwifruit.
One of the best source of vitamin E is almonds while leafy green vegetables such as spinach and Swiss chard are popular as well. Other excellent sources include animal products like cheese and eggs or plant oils.
Bioavailability of Vitamin E
Vitamin E is a fat-soluble nutrient. As such, absorption of this vitamin is enhanced in the presence of fat in a meal. Risks related to inadequate or excess intake of vitamin E Individuals whose diets consist mostly of starchy staples – with inconsistent intake of edible oils or other vegetable sources of vitamin E – are at a higher risk of inadequate vitamin E intake.
Deficiency of Vitamin E
Vitamin E deficiency is not common. When deficiency of Vitamin E is present it leads to red blood cell breakage and nerve damage. Recent studies from Bangladesh link low vitamin E blood levels to an increased risk of miscarriage. In other studies vitamin E supplementation has been successfully used for the treatment of non-alcoholic fatty liver disease, a condition widespread in overweight and obese people. Excessive intake of vitamin E from food is very rare.
Additional information on vitamins and micronutrient deficiencies is available though our partner, Vitamin Angels or download our complete vitamin and mineral guide here.
Here is a healthy recipe to incorporate vitamin E into your breakfast.
1 Tablespoon lemon or lime juice
4 Slices whole grain toast
Salt and pepper to tast
First, mash the avocado, lemon or lime juice and pinch of salt together and set aside. Next, fry the eggs in a pan over medium heat and toast the whole grain bread. Then spread the avocado mixture evenly on the toast and place the fried egg on top. Season with salt and pepper to your liking or get creative with hot sauce, cheese, cilantro or other herbs.
Yes, it’s true our exposure to sunlight, given the right season and enough time in the sun, has an important role in determining our Vitamin D status. With the help of sunlight, vitamin D is synthesized by the body from a precursor derived from cholesterol. Vitamin D exists as either vitamin D2 (ergocalciferol) or vitamin D3 (cholecalciferol). The active from of vitamin D is actually a hormone that targets organs – most notably the intestines, kidneys, and bones. In the intestine, vitamin D is involved in the absorption of calcium and phosphorus. In the bone, it assists in the absorption of calcium and phosphorus, helping bones grow denser and stronger as they absorb and deposit these minerals.
Why is Vitamin D Important?
One of the main roles of vitamin D is to facilitate the absorption of calcium and phosphorus. Consequently, a vitamin D deficiency creates a calcium deficiency, with significant consequences to bone health. Among children and adolescents, it may cause rickets and adversely affect peak bone mass. In adults, vitamin D deficiency increases the risk of osteomalacia and osteoporosis.
Sources of Vitamin D
Sunlight – exposure to ultraviolet B (UVB) rays is necessary for the body to synthesize vitamin D from the precursor in the skin. It’s not known exactly how much time is needed in the sun to make enough vitamin D to meet the body’s requirements. This is because there are a number of factors that can affect how vitamin D is made, such as your skin colour or how much skin you have exposed
Natural food sources of vitamin D include red meat, liver, egg yolks, and oily fish such as salmon, sardines, herring, mackerel and fresh tuna. A selection of fortified foods from fat spreads and choice breakfast cereals may be available at the market.
Bioavailability of Vitamin D
There is very little information on the bioavailability of vitamin D. It is assumed that the food matrix has little effect on absorption. Bioavailability also varies among individuals and depends on the level of circulating vitamin-D-binding protein.
What Influences our Vitamin D Status?
Inadequate exposure to sunlight is the primary risk factor for poor vitamin D status. The use of sunscreen, higher levels of melanin in skin (i.e., dark skin), skin coverings (clothes, veils), and time of day are factors that decrease exposure to UVB rays. The distance from the equator is also a factor for UVB exposure; people living in latitudes above or below 40 degrees from the equator will be unable to form vitamin D from the skin precursor during the winter months.
Breast milk is a poor source of vitamin D. Children who are exclusively breastfed and have no or little sun exposure require vitamin D supplements to meet requirements.
Remember! While sunlight is important for our vitamin D levels be careful not to burn in the sun. Take care to cover up or protect your skin with sunscreen before your skin starts to turn red or burn.
Download our complete vitamin and mineral guide here.
Here is a recipe to easily incorporate Vitamin D rich foods in your diet!
Method 1. Heat the grill. Place the potatoes in a pan of water, bring to the boil, cover and cook for 12-15 mins until tender. Drain and leave to steam-dry, then mash. Meanwhile, season the salmon and grill for 5-6 mins until just cooked. Cool for a few mins, then break into large flakes.
2. Mix the potato, ketchup, mustard, zest, herbs and some seasoning. Lightly mix in the salmon, taking care not to break it up too much. Shape into 4 large fish cakes.
3. Put the flour, egg and breadcrumbs in 3 shallow dishes. Dip the cakes into the flour, dust off any excess, then dip in the egg, and finally coat in breadcrumbs. Heat the oil in a large pan. Fry the cakes over a medium-low heat for 3-4 mins each side until deep golden and heated through. Serve with salad and lemon wedges.
Edward (Ted) Fischer is Professor of Anthropology and Director of the Center for Latin American Studies and the Institute for Coffee Studies at Vanderbilt University. Prof Fischer is also the founder of Maní+, a social enterprise in Guatemala that develops and produces locally-sourced complementary foods to fight malnutrition, and serves as an advisor to the World Health Organization on Wellbeing and the Cultural Contexts of Health.
Prof Fischer posits that food is about much more than macro- and micronutrients, arguing that it is instead intimately linked to identity and social relations in his article, ‘Beyond Nutrition: Eating, Innovation, and Cultures of Possibility’ published in the Sight and Life magazine. In his opinion, food is an integral part of our identity, and any attempts to change diets need to take this into account. The composition also explains why culture should not be seen as an obstacle to health, but as a source of potential. In addition, he says that public health and nutritional interventions should work with, rather than against, this dynamism, and beneficiaries should be treated as clients, customers, and collaborators, and as sources of inspiration and innovation, as well as mouths to feed.
Here at Sight and Life we had an opportunity to talk with Prof Fischer and discuss his continual fascination with the Maya way of life. During our interview, he shared how it led to a realization that, far from being a hindrance, culture is an aid to improving nutrition.
Sight and Life (SAL): What inspired your passion for the topic of eating, innovation, and the cultures of possibility?
Prof Edward Fischer (EF): As a cultural anthropologist, I have spent the better part of my life and career (the last 25 years) working with the Maya people of highland Guatemala. I have cumulatively lived and worked there for several years, I visit several times a year, and I have deep personal as well as professional ties. Maya culture and traditions are endlessly fascinating to me, and I have spent countless hours in the fields of maize, beans, and squash and around the hearth watching women make tortillas and slow-cook black beans. Maya families tend to have a close sense of kinship and community; while most Maya are very poor in material and economic terms, they have a richness of social ties that we have lost.
The beauty of Maya culture is in contrast to their history of colonization, marginalization, and violence. Half the population of Guatemala is Maya, and yet they are largely excluded from national economic and political life. There is also still the palpable legacy of the violence of the 1970s and 1980s, when Maya communities were intentionally targeted for extermination by the US-backed military.
SAL: How do you explore this through your research?
EF: My work looks at these paradoxes: How the Maya adapt and co-opt the globalized economy for their own ends (by growing broccoli for export to the US, for example), and how we can understand wellbeing in the context of material poverty.
When I was in graduate school, we learned that the Maya were especially short because of some local evolutionary adaptation or a genetic bottleneck. If you have ever been to Guatemala, you will have noted the heights: Maya men average just 1.59 meters (5.21 feet) and Maya women 1.47 meters (4.82 feet). They were thought to be the ‘pygmies of Central America.’ However, research by anthropologist Barry Bogin has shown that this is not genetic; the difference in height is virtually all nutritional and environmental.
I saw in development programs a lot of distribution of imported malnutrition products, which struck me as odd and counterproductive in a predominately agricultural country, with a majority of those suffering from malnutrition being rural farmers. For that reason, I started looking into malnutrition, and how to develop something locally that would support farmers.
SAL: Were there any unexpected findings?
EF: We discovered a number of surprising things. First, there is an epidemic of early childhood malnutrition, but also of adolescent and adult obesity: This is the dual burden of malnutrition. Thus, it is very important that interventions be targeted at specific at-risk children within families.
Second, I was surprised to see, behind the scenes of the malnutrition world, that well-intentioned humanitarian workers often saw Maya culture as a problem, not something to be celebrated and nourished. Many want to “overcome” traditional beliefs to get people to eat well in specific ways (such as a certain number of calories, the amount of protein, and so on).
In view of that, I wrote this article largely as a response — to show how culture can be used to improve nutrition, and that it is more than an obstacle. Also, to underline the important subjective, affective, and emotional aspects to food that are real and important (even if they are not measured in neat numbers of grams or RDA), and that we who are fighting malnutrition need to engage, rather than fight.
SAL: Did your work present any unexpected challenges?
EF: Fieldwork in difficult places always presents an endless string of challenges, logistical, cultural, and intellectual. This is even more so when doing interventions. As we were developing the Mani+ project in Guatemala, we encountered one obstacle after another, not least in the food science of developing a new product. The peanut oils interact with plastics in ways I could not anticipate. Packaging solids and liquids is straightforward, but getting pastes into little sachets is almost impossible because of the consistency. Therefore, when students ask what being a successful social entrepreneur requires, I tell them that it takes naïve optimism. I saw a problem with malnutrition in Guatemala, and what I thought was a relatively simple solution. Had I known all of the reasons my ‘relatively simple’ solution was not so simple, all of the reasons that it should not work, I probably would not have started. However, I was naively optimistic. Hence, when the problems started coming, I dealt with them one by one as they arose, thinking each one would be the last one to solve and then we would end up with our product. However, had I know at the start the string of obstacles we would face, I would not have begun.
In addition, taking culture seriously means working in local languages and local communities. In Guatemala alone, there are 23 Mayan languages spoken. The easy fix is to do all programming in Spanish, the country’s official language. That works fine in urban areas, but in the rural villages, where malnutrition is most prevalent, many do not speak Spanish well and women are the least likely to speak Spanish in Maya communities. Therefore, we have had to go through the hard work of translating materials, and training native speakers to do educational sessions with our program. It is not easy, but it makes all the difference.
Here is a photo gallery of typical Mayan meals captured during Ted Fischer’s time in Guatemala:
Why Ethnographic Research?
Insight behind gathering research data from a cultural perspective
Dr Eva C Monterrosa is the senior scientific manager at Sight and Life and the co-author, with Prof Gretel H Pelto, graduate professor at Cornell University, Ithaca, of “The Mother-Child Food Relationship in the Study of Infant and Young Child Feeding Practices”, published in the ‘Focus on Food Culture’ edition of Sight and Life magazine. This article shines a light on how biology and culture come together at the level of the diet by reviewing infant and young child feeding (IYCF) practices. Far from ‘story-telling’, Dr Monterrosa says research that incorporates a cultural perspective achieves two objectives: First, to generate explanatory frameworks that help us understand and generate hypotheses about health behaviors; and, second, to design programs to improve behaviors.
When we spoke with Dr Monterrosa about how she came to this topic of research, she had some stimulating answers:
Sight and Life magazine (SAL): Why did you choose this topic – what inspired it?
Eva Monterrosa (EM): In my opinion, public health nutrition research design is focused on getting the results we want – often at the expense of understanding ‘how’ results were achieved. But it is precisely the ‘how’ (or the ‘black box’) that can help us design programs that achieve our goals. A successful outcome in one setting might not lead to success when it is replicated in a different context. By context, I don’t just mean a different country. Even replication in the the same type of institution, such as a hospital or clinic, can be a challenge. In essence, we must understand the context to know what factors are driving our results, and how to adapt interventions to fit our context. Ethnographic research gives us the tools to do this.
SAL: What challenges do you face when doing this type of research?
EM: I think my greatest challenge is people telling me, often not in a nice way, that my research is ‘story telling’, or worse yet saying that what I do is ‘not research’. This however, speaks to another predisposition in nutrition science: That research is only valid if it uses a randomized trial design , or uses complex statistical procedures. Don’t get me wrong – I can hold my weight when it comes to running a complex analysis of longitudinal data, but I understand this work’s limitations. Moreover, when you deal with food and eating habits, these are complex social phenomena that cannot be reducible simply to numbers.
In the research Prof Pelto and I share in the article, we use ethnographic methods, such as observations, interviews, and other cognitive elicitation techniques, including free listing, and card-sorting exercises. The selection of the methods is always guided by a research question. One must skillfully apply interviewing techniques, including careful wording of questions and precise ordering to reduce reporting bias. Lastly, a rigorous analysis of the text data is necessary to elicit solid insights based on the data.
SAL:What has been the most surprising result or outcome from your research?
EM: When study participants ask clarifying questions – their questions lead to all sorts of wonderful discoveries. I recall from my Mexico work that I asked one of my first participants: ‘What meals do you prepare at home?’ And she asked, ‘Meals for whom? My family or my children?’ and this was an unexpected answer that led to a wonderful discovery of child-appropriate meals, which added another dimension to our data analysis. We went from just describing complementary feeding practices to understanding how mothers and children inhabit the same ‘eating space’. It was fascinating!
SAL:Why is applied ethnographic research for nutrition science important?
EM: Two pieces are featured in this issue of Sight and Life magazine, because I want our readers to understand the explanatory power of ethnographic methods, and how this work can help their scientific inquiries or programs. It is not about the biological perspective versus the cultural perspective. That is counterproductive. We need a holistic view of nutrition science.
SAL:Do you think people will listen?
EM: I hope so! Prof Pelto developed the biocultural framework in the late 1970s as a framework to examine the different domains that in interaction determine dietary and eating practices. Today, there is a new generation of scientists seeking to address the complexity of eating practices. We are seeing a rise in training on mixed-method designs, excellent research question(s), solid training in ethnographic methods, and the analytical procedures to elucidate patterns in the data.
SAL: How is your research used?
EM: Much of the work that we do is used to develop programs. A lot of the nutrition research that draws on the biological perspective has an impact on the policy sphere, for example, in helping to set recommendations of vitamin A or calcium. As for the ‘how’ to develop programs for administering vitamin A or calcium? That is a whole different research phase, but it is the space that our research inhabits.
Announcing the NEW sightandlife.org
Check out the features & information now available
Our redesigned website is now equipped with enhanced navigation and functionality for an improved user experience and a robust blog full of engaging posts.
The design and large visual elements of the website are visually pleasing while the original content is valuable for the audiences within the nutrition sector. Created with the user experience in mind, the site boasts many new features to help users quickly and easily navigate the site to find relevant information.
We invite you to explore the new attributes highlighted below:
About Us: Learn more about Sight and Life and our dedication to eradicating all forms of malnutrition in this section through our vision and strategy that is being carried out by our talented leadership team and board members. Additionally, this page tells the story of our history starting in 1986, with an original goal to be at the forefront of global efforts to improve vitamin A nutrition, to today serving as a nutrition think tank.
Our Work: Take a look at Sight and Life’s projects around the world and more specifically in Africa, Asia, and South America. This interactive page shares each of our projects which are divided into categories including research, advocacy, public health, humanitarian, or social business. We have established a distinguished alliance consisting of academia, research partners, and funders working collectively to eliminate all forms of malnutrition. Together, we discover and implement sustainable solutions, grounded on solid scientific evidence, to improve the lives of those in most need.
News: The latest happenings in the nutrition atmosphere, from newly released reports and guidelines to important announcements, will be posted and keep our readers up-to-date.
Blog: Visit the blog to find insightful and scientific posts relating to nutrition. Keep tabs on this page as we will continue rolling out new and original posts including interesting perspectives from nutrition thought leaders and interviews with select authors fromm the latest issue of the Sight and Life magazine.
Resources: Sight and Life provides a range of educational materials on malnutrition issues. This section is filled with the current, and past editions dating back to 2005, of the Sight and Life magazine and supplements along with our highly sought after infographics. In addition, we have books, brochures, and documentaries to support the information needs of health workers, scientists, representatives of governmental/non-governmental agencies, and the media.
Dr Klaus Kraemer, Sight and Life's Managing Director
Sight and Life was a major sponsor of the first Central Eurasian Nutrition Forum (CENF), which was held in Ulaanbaatar, Mongolia from June 7 to 9, 2017. The three-day forum was hosted by the Mongolian Ministry of Health and the Mongolian Ministry of Food, Agriculture & Light Industry, Standing Committee on Social Policy, Education, Culture and Science of Mongolia, and was excellently organized by the Mongolian Health Initiative (MHI). CENF 2017 builds on a workshop at the Radcliffe Institute for Advanced Study at Harvard University, which took place in October 2016 and was organized by Radcliffe Institute Fellow Dr. Ganmaa Davaasambuu.
Dr. Ganmaa (as she is known by her Mongolian fellow citizens) is a long-time collaborator with Sight and Life in assessing the micronutrient situation in Mongolia, and is the founder of the MHI, which has conducted a nationwide micronutrient survey among Mongolian adults. The forum was attended by about 200 representatives from the government (ministers and members of parliament), academia (domestic and international), the private sector, and technical partners such as GAIN, UNICEF, FFI, FAO, WHO and Sight and Life
MHI created a first-class dramaturgy, taking the forum to the relevant political decision-makers. The first day took place in the Ministry of Health, the second in the Ministry of Food, Agriculture & Light Industry, and the last day in the Mongolian Parliament. The organizers kept me very busy not only with a presentation entitled “Central Eurasia’s Position in the Global Nutrition Ecosystem”, but also as a panelist and moderator, and invited me to provide the closing remarks on day one, right after my midnight arrival in Ulaanbaatar.
A Look at the Mongolian Diet
Mongolia has made major progress in terms of reducing stunting and low birth-weight over the last two decades. However, Mongolians still face significant deficiencies in micronutrients, particularly vitamins A, D, C, B1, B2, B6, and folate, as well as rising rates of overweight and obesity, and related non-communicable diseases.
Mongolia is a typical example of the so-called double burden of malnutrition, viz. concurrent under- and over nutrition. The diet is dominated by flour, meat, and dairy products, with very poor fruit and vegetable consumption, and is high in salt, sugar, and saturated and trans fats. According to FAO statistics, Mongolia is the country with the second-highest levels of meat consumption, the eleventh-highest levels of milk consumption, and the ninth-lowest levels of fruit and vegetable consumption and the third-lowest levels of seafood consumption per capita. The poor dietary diversity (see Graph 1) explains much of the malnutrition situation in the country. Moreover, the latitude (Ulaanbaatar is 47°6′ N) only allows for vitamin D production in the skin during the few summer months and, due to the high altitude (a large part of the country is over 1,000 m above sea-level), the cold requires warm clothes covering the skin.
Still, the high prevalence of vitamin D and A deficiency came as a surprise to me, because of the high levels of consumption of dairy, which is usually a good source for these vitamins. This may be due to the production system: The majority of Mongolian milk is produced by pastoralists dependent on arid grassland (the Mongolian Steppe and the Gobi Desert) yielding dry pasture with a low provitamin A carotenoid content, and the livestock suffers from the same limited vitamin D synthesis as do humans. (When I sent a picture of what I called the Mongolian grassland to the Sight and Life team, the immediate question was, “Where is the grass?”) Milk production ceases in the winter due to the limited availability of feed, and milk consumption becomes even more dependent on imports, which are primarily supplied to the urban area.
Stunting prevalence is moderate, at 10.8%, but is a public health concern, with 20% in Western Mongolia reflecting significant inequalities in the country. Another matter of concern is the declining breastfeeding rate. This was at 57% in 2005, and at only 47% in 2013, which is below the World Health Assembly (WHA) target of 50%.
Progress in Mongolia
But there is very good news! Since the workshop at Harvard last October, there has been significant progress. Today, the Mongolian Parliament has a fortification working committee, and a draft fortification law, which is considering wheat flour, milk, and vegetable oil for fortification. However, I would hope that fortification becomes mandatory, and that there is scope for other staples to be considered.
Next steps include the passing of the fortification bill in Fall by parliament, the establishment of comprehensive fortification standards, and investment in laboratory capacity to ensure that foods are adequately fortified.
Impressions from CENF 2017
I believe that the CENF provides an excellent platform for developing the nutritional agenda, not only in Mongolia, but also across Central Eurasia, recognizing that food fortification is a cost-effective strategy for tackling the ailments from micronutrient deficiencies throughout the region.
My personal takeaway from the CENF is that it requires vision, passion, scientific evidence, and inspirational leadership to make a difference, and that Mongolia has two great female leaders in Dr. Ganmaa and Dr. Undraa, Member of the Hural (Parliament) of Mongolia, both of whom champion the mitigation of micronutrient malnutrition in their home country. The 2018 forum will be organized in Tajijikstan and will continue the discussions regarding the nutritional priorities for the Central Eurasian region.
Download the declaration for further details here.
Take a look at a few moments from CENF 2017 captured by Mr. Gerelbadrakh.