Africa: Integrating Vitamin A with Essential Health Services

Increasingly, countries are adopting Child Health Days or Child Health Weeks to deliver packages of preventive health services to improve child survival. Beginning in 2003 Malawi started to provide vitamin A supplements alongside de-worming for children 1 to 18 years of age, iron supplements, malaria treatment for pregnant women, and re-dipping of bed-nets. African countries from Angola to Zambia are planning to adopt the Child Health Week model from 2005 onwards This will open up the opportunity for fuller and more cost-effective integration of vitamin A supplementation with essential health services.

Improving Diets

Reaching children in remote areas on a regular basis can be difficult. In the long-term if appropriate, affordable and cost-effective ways could be found to improve the diets of young children and their mothers, children would be less vulnerable to the effects of vitamin A deficiency. MI has supported work on two promising food-based approaches in Africa .

Red Palm oil: from Woman to Woman in the Community

Red palm oil is the most concentrated vegetable source of vitamin A. One teaspoon meets the daily requirement of vitamin A for children. Working with several partners, MI supported a program in Burkina Faso to promote locally- extracted red palm oil as a source of vitamin A and as a source of income for women producing and selling it.

The initial two-year program in Sanmatenga province produced impressive improvements in consumption of red palm oil by women and children and in their vitamin A status. Vitamin A deficiency declined from 64% to 32% among women, and from 85% to 62% among young children. Red palm oil promotion (through support to women's groups in production and distribution) now extends to the provinces of Bam, Namentenga, Gourma and Gnagna in addition to Sanmatenga . Altogether, the project extends its benefits to an estimated 1.3 million people.

Burkina Faso 's national micronutrient strategy now includes red palm oil promotion. The way forward envisages an increase in red palm oil production through new plantations and strengthening of the commercial distribution system.

Sweet Potatoes: Making the Change to Orange

Millions of Africans traditionally grow and consume white fleshed sweet potatoes. Orange fleshed sweet potatoes are equally easy to grow, energy-rich crops. In addition they are rich in vitamin A. Thus if more people were to grow and consume the o range-fleshed variety, they could significantly reduce their risk of vitamin A deficiency. However making the change is not straightforward. A project supported by MI and our partners in Zambezia Province in Mozambique involves both informing people of the benefits, and helping them make the switch from one variety to the other. Specifically this has involved:

• developing local markets for orange-fleshed sweet potatoes and products such as orange sweet potato flour and bread;
• ensuring that women farmers have access to drought resistant, high yielding planting material;
• improving local knowledge in nutrition, storage and preparation to make sure that when the food retains high levels of vitamin A after cooking and is eaten by women and young children.

The manufacture of products made from orange-fleshed sweet potatoes has expanded and pão de ouro (Golden Bread) in particular has proven commercially viable in rural village markets. Extending the demand for, manufacture and consumption of other products (juice, biscuits, chips and complementary foods) could further improve the coverage of children under five.