HarvestPlus Orange Sweet Potatoes in Mozambique

1. HarvestPlusOrange Sweet Potatoes in Mozambique Christina Brumme [Two other Group member names have been removed for confidentiality]

2. Nutrition Sensitive Interventions 2013 Lancet Nutrition Series Underlying determinants of nutrition Complementary sectors Help leverage and accelerate nutrition-specific interventions (Ruel & Alderman, 2013)

3. Nutrition-sensitive vs. Nutrition-specific • Address underlying determinants of nutrition and development • Agriculture & food security • Social safety nets • Women’s empowerment • Schooling • Water, sanitation, hygiene • Family planning • Address immediate determinants of nutrition and development • Dietary diversification • Preconception supplementation • Optimum breastfeeding • Dietary supplementation • Micronutrient supplementation. • Treatment of severe acute malnutrition

4. HarvestPlus HarvestPlusseeks to reduce hidden hunger and provide micronutrients to billions of people directly through the staple foods that they eat. We use a novel process called biofortification to breed higher levels of micronutrients directly into key staple foods.

5. HarvestPlus

6. WhatisBiofortification? Breeding staple food crops with a higher micronutrient content. Milestones: Breeding objectives (micronutrient target concentration) Retention and Bioavailability of micronutrients Farmer adoption rates and intakes

7. Vitamin A deficiency Vitamin A accounts for > 600,000 deaths globally for children < 5 VAD: <0.7 µmol/l Africa:Prevalence of VAD is 42% children 6-59 months Mozambique: Prevalence of VAD is 69% in children 6-59 months Existing Vitamin A interventions High dose capsule twice per year 43% coverage in 2003

8. Orange Sweet Potato White-yellowvarieties • 2ppm beta carotene Orange SweetPotato • 30-200ppm beta carotene • 2.5 times RDA of vitamin A for 4-8year oldchildren(van Jaarsveld et al. 2005)

9. Why Orange SweetPotatoes? (OSP) • High beta carotene levels • 50% of mean daily vitamin A requirement • High consumption in Mozambique • Average consumption 200g/day • Good source of Energy • Drought resistant • Long cultivation season • Accepted by children

10. Mozambique Zambezia province • Main staple crop—maize or cassava • 33% of farmers grow sweet potatoes as seasonal secondary crop • Pilot Effectiveness Study, 2007-2009 • 14,000 households in Zambezia province • 10,000 households in Uganda

11. Partners & Donors

12. Intervention Components Agriculture Demand creation and behavior change Marketing

13. Agriculture • Distribution of vines • Initial: 2kg to farm households at no cost • Continual: 8kg available for purchase • Repeated every year as necessary • Training on best production practices • Avoidance of pests and diseases • Vine conservation between planting seasons • Both men and women were included

14. Demand Creation & Behavior Change • Education • Maternal and child health and nutrition • Targeted to women • Campaign for the general public • Raise awareness about OSP and Vitamin A • Community drama, field-day events • Radio programs

15. Marketing • Training for OSP traders • Urban and rural market development • Distinct market stalls with OSP and information • Not targeted to all growers • Small group of traders • Medium-scale growers • Business owners

16. Implementation • Model 1, Model 2, or Control • Randomized by cluster • Clusters selected based on: • The number of households with children 6-35 months • Access to lowlands • No other agricultural interventions being implemented • Did not participate in previous OSP intervention • Impact evaluation clusters were 5km apart

17. Implementation • Year 1 was the same for Model 1 and 2 • Years 2-3: Model 1 • Refresher training on agriculture and nutrition continued* • Vine distribution continued • Marketing and promotional components continued • Years 2-3: Model 2 • Agriculture and Education components and support did not continue* • Vine distribution continued • Marketing and promotional components continued

18. Implementation • World Visionand Helen Keller International • HarvestPlus staff provided overall coordination • Promoters • Community-based volunteers • Trained by project staff • Provided training and education to participants

19. Effectiveness Evaluation • Nutrition Impact Survey • Participants • Women and children surveyed at baseline and 2-5 years after • At follow-up additional children were surveyed • Baseline: Nov-Dec 2006 • Follow-up: May-June 2009

20. Effectiveness Evaluation • 24-hr Recall • 2 days collected for some • Used the multiple-pass method • Group training for participants • Food Frequency • Common foods • Focus on Vit. A rich foods

21. Effectiveness Evaluation • Anthropometry • Weight, length, height • β-Carotene content • Samples of each farm • Samples of each variety tested for vit. A content after boiling

22. Coverage and Agricultural component • 68% of famers in Mozambique adopted OSP • Adopted = retained OFSP vines for next season • White and yellow sweet potatoes substituted with OSP

23. Increased Intake of OSP • Low et al. (2006), after controlling for inflammation, demonstrated that increase intake of OSP increased serum retinol concentrations • Increased by 0.100 micromole/L • 47-60% increase intake OSP

24. Difference in Proportion of Sweet Potato Intake ***=1% level

25. Increased Intake of OSP • Low et al. (2006), after controlling for inflammation, demonstrated that increase intake of OSP increased serum retinol concentrations • Increased by 0.100 micromole/L • 47-60% increase intake OSP • 47% increase among women • 63% increase among children (6-35 month)

27. Diff. in Retinal Activity Equivalents/Day

29. Model Comparison • Model 1 • Three years of Agricultural training and health and nutrition education (refresher training sessions) • More expensive • Model 2 • One year of Agricultural training and health and nutrition education • Similar OSP adoption and intake between models

30. Cost Implication • Lowest marginal cost and average cost were $17 and $52 per target beneficiary (children 6-59months and mothers) • $15-20 per Disability-Adjusted Life Years (Uganda) • Measure of cost-effectiveness

31. Cost Implication • Advantage of implementing Model 2 • Less expensive • Model 2 can be trimmed down when scale up • Marketing component does not enhance adoption or consumption • Could scale back intensity of demand creation component-nutrition messages had little affect on OSP consumption

32. Strengths Strengths Large-scale effectiveness Many partners Vine conservation Marketing Control group Transparent in sample size and vit. A analysis methods Acceptability

33. Weaknesses Weaknesses Self-report of intake Retinol not measured* Expensive compared to Uganda No discussion of sustainability of vines No discussion of government role Cost non-growers*

34. Future Directions Scaling-up Expand to other countries Others…?

35. Current Activities Currently expanding to: Angola, Kenya, Tanzania, Rwanda, Zambia, Ghana, Nigeria, and others Spillover countries: Burundi, Ethiopia, Ghana, Kenya, Malawi, Mali, Nigeria, Rwanda, South Africa, Tanzania, Zambia, Zimbabwe Sharing knowledge: http://www.sweetpotatoknowledge.org

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41. Thank you!

42. Questions?

43. Resources Hotz, C., Loechl, C., de Brauw, A., Eozenou, P., Gilligan, D., Moursi, M., . . . Meenakshi, J. V. (2012). A large-scale intervention to introduce orange sweet potato in rural Mozambique increases vitamin A intakes among children and women. British Journal of Nutrition, 108(1), 163-176. doi: 10.1017/s0007114511005174 Asare-Marfo, D., Birol, E., Gonzalez, C., Moursi, M., Perez, S., Scharz, J., Zeller, M. (2013). Prioritizing Countries for Biofortification Interventions Using Country-Level Data. HarvestPlus Working Paper, 11. http://www.harvestplus.org/content/vitamin-sweet-potato http://www.sweetpotatoknowledge.org