1
|
Lowe NM. Fortification or biofortification: complimentary strategies or duplication of effort? Proc Nutr Soc 2024:1-10. [PMID: 38197143 DOI: 10.1017/s0029665124000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Micronutrient deficiencies continue to be a global concern, with the most common deficiencies being vitamin A, iron, zinc and B vitamins (folate and B12). Addressing this requires strategies that are scalable and equitable such that they reach all members of a population irrespective of socioeconomic status and geography. Fortification and biofortification offer potential large-scale solutions, however each have strengths and limitations depending on the context, particularly the cultural and political factors that may create barriers or opportunities for effectiveness. Planning how to target scarce resources for maximum impact requires an in-depth knowledge and understanding of local food systems and market dynamics, alongside strong government policy and legislative support. A food fortification programme was launched in Pakistan in 2016, supported by UK Aid and designed to address the high prevalence of vitamin A, iron and zinc deficiency, particularly in women and children. In the same year, the first zinc biofortified variety of wheat, Zincol-2016, was released in Pakistan, supported and developed through the HarvestPlus programme in collaboration with the Pakistan National Agriculture Research Centre. This review explores the challenges faced by fortification and biofortification, initiated independently, (but around the same time) in Pakistan.
Collapse
Affiliation(s)
- Nicola Mary Lowe
- Centre for Global Development, University of Central Lancashire, PrestonPR1 2HE, UK
| |
Collapse
|
2
|
Role of Nutrition Information in Acceptance and Willingness to Pay for Biofortified Cereal Food: Implications for Better Health and Sustainable Diet. Nutrients 2022; 14:nu14163352. [PMID: 36014858 PMCID: PMC9413209 DOI: 10.3390/nu14163352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
A range of nutritional needs are met through the use of fortified farm-based foods. Wheat biorfortification with zinc is such an example where biorfortification is carried out for a crucial element like Zinc. Zinc-biofortified wheat (Zn-wheat) has been officially launched in Pakistan since 2016 but its wide-scale dissemination, adoption and consumption have not taken place till to date. On the other hand, essential nutrients deficiencies have wide-ranging implications for public health especially for children and lactating mothers. This study is undertaken to know the reasons for the slow progression of scaling up of biofortified wheat varieties in Pakistan, people’s awareness about biofortified wheat and to recognize the role of information in acceptance and willingness to pay for this wheat. For this purpose, randomly selected 474 households were interviewed from four districts of Punjab province. They were categorized into four groups based on their exposure to information in real and hypothetical cheap talk (game theory context). Study findings reveal that respondents were ready to pay for fortified wheat if they are aware about nutrient aspects and Zn deficiency. Using Discrete Choice Experiment, the preferences for and factors affecting the willingness to pay for fortified wheat are evaluated. Main factors having positive impact include household head’s education and income, having pregnant women and children <5 years age. It was also found that people having valid information about nutrients of a food would be willing to pay more. The study highlights need for policy focus on educating people about nutritional aspects as well as making available biofortified foods to promote healthy living.
Collapse
|
3
|
Community Perceptions of Zinc Biofortified Flour during an Intervention Study in Pakistan. Nutrients 2022; 14:nu14040817. [PMID: 35215467 PMCID: PMC8876608 DOI: 10.3390/nu14040817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 02/05/2023] Open
Abstract
Zinc-biofortified flour may be a cost-effective approach to improve zinc status of populations in low-resource settings. The success of biofortification programmes is subject to acceptability and uptake by consumers. This study explored community leaders’ and community members’ (n = 72) experiences and attitudes towards the flour provided during a cluster randomised controlled trial of zinc biofortified wheat in rural Pakistan (BiZiFED2). Focus group discussions (n = 12) were conducted and thematic analysis applied using an inductive, semantic, contextualist approach. Five themes were identified: (1) Contribution to food security; (2) Better sensory and baking properties than local flour; (3) Perceived health benefits; (4) Willingness to pay for the flour; and (5) Importance of trusted promoters/suppliers. Although the participants were blind to whether they had received control or biofortified flour, referred to collectively as “study flour”, the results indicated that the study flour performed well in terms of its taste and bread making qualities, with no adverse reports from participants in either arm of the BIZIFED2 RCT. Participants suggested that they would buy the biofortified wheat if this was available at a fair price due to perceived health benefits, reporting positive sensory characteristics and cooking attributes when compared to the flour available in the local markets. Overall, there was a positive reception of the programme and flour among the participants, and members of the community hoped for its continuation and expansion.
Collapse
|
4
|
Chiutsi-Phiri G, Kalimbira AA, Banda L, Nalivata PC, Sanuka M, Kalumikiza Z, Matandika L, Mfutso-Bengo J, Allen E, Ferguson E, Sturgess J, Broadley MR, Langley-Evans S, Millar K, Gashu D, Joy EJM. Preparing for a community-based agriculture-to-nutrition trial in rural Malawi: formative research to assess feasibility and inform design and implementation decisions. Pilot Feasibility Stud 2021; 7:141. [PMID: 34233757 PMCID: PMC8262007 DOI: 10.1186/s40814-021-00877-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/21/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This study reports findings from formative research conducted to assess the feasibility and inform the design and implementation of the Addressing Hidden Hunger with Agronomy (AHHA) trial. The AHHA trial was a randomised, controlled trial conducted in rural Malawi, in which participants were given maize flour biofortified with selenium or control flour not biofortified with selenium for a period of 10 weeks, after which blood samples were taken to measure selenium status. METHODS Formative research was conducted in villages near to the AHHA trial study site 1 year before the planned intervention. A short questionnaire with adult women (n = 50), focus group discussions with male (n groups = 3) and female (n groups = 3) community members, and in-depth key informant interviews (n = 7) were conducted to understand community practices and perceptions. FINDINGS Meals were typically cooked and eaten at home in this community, while participants reported that maize flour would be less readily sold than maize grain - important considerations for the design of the trial. Regarding intervention delivery, we identified potential concerns around effects on fertility, links between blood sampling and witchcraft, and the potential for social stigma if community members considered participants lazy for receiving free flour. Participants reported that involvement of the Malawi government partners including health extension workers would increase trust. INTERPRETATION Following the formative research, the AHHA trial appeared feasible. However, community sensitisation would be essential to address potential fears and concerns; effective sensitisation would support recruitment and treatment adherence, and would protect the safety and wellbeing of participants and researchers. People in positions of authority and trust including village headmen, religious leaders, health and agriculture extension workers, and community care groups should be involved in community sensitisation.
Collapse
Affiliation(s)
- Gabriella Chiutsi-Phiri
- Lilongwe University of Agriculture and Natural Resources, PO BOX 143, Natural Resources College, Lilongwe, Malawi
| | - Alexander A Kalimbira
- Lilongwe University of Agriculture and Natural Resources, PO BOX 219, Bunda College, Lilongwe, Malawi
| | - Leonard Banda
- Lilongwe University of Agriculture and Natural Resources, PO BOX 219, Bunda College, Lilongwe, Malawi
| | - Patson C Nalivata
- Lilongwe University of Agriculture and Natural Resources, PO BOX 219, Bunda College, Lilongwe, Malawi
| | - Marion Sanuka
- Lilongwe University of Agriculture and Natural Resources, PO BOX 143, Natural Resources College, Lilongwe, Malawi
| | - Zione Kalumikiza
- Lilongwe University of Agriculture and Natural Resources, PO BOX 219, Bunda College, Lilongwe, Malawi
| | - Limbanazo Matandika
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Joseph Mfutso-Bengo
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Elizabeth Allen
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Elaine Ferguson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Joanna Sturgess
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Martin R Broadley
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK
| | - Simon Langley-Evans
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK
| | - Kate Millar
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK
| | - Dawd Gashu
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Edward J M Joy
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
| |
Collapse
|
5
|
Rizwan M, Zhu Y, Qing P, Zhang D, Ahmed UI, Xu H, Iqbal MA, Saboor A, Malik AM, Nazir A, Wu X, He P, Tariq A. Factors Determining Consumer Acceptance of Biofortified Food: Case of Zinc-Fortified Wheat in Pakistan's Punjab Province. Front Nutr 2021; 8:647823. [PMID: 34179055 PMCID: PMC8220091 DOI: 10.3389/fnut.2021.647823] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Zinc (Zn) is a fundamental micronutrient required by all living organisms. Zn deficiency among children under 5 years, pregnant, and child-bearing women has been identified in developing countries such as Pakistan. Biofortified crops can increase micronutrient levels and decrease deficiencies. Meanwhile, consumer acceptance is essential, given that genetic alterations can occur during biofortification, resulting in changes in sensory traits and the quality of grains. Therefore, the present study focuses on the determining factors for consumer acceptance of Zn-biofortified wheat., an experimental survey was conducted to achieve the study's objectives. Qualitative and quantitative data were collected and analyzed from 203 respondents in the Punjab province. The results regarding sensory perceptions revealed that people attached great importance to the appearance of the chapati prepared with Zn-biofortified wheat. Therefore, they were willing to purchase Zn-biofortified wheat when asked to choose between the conventional wheat and the Zn-biofortified wheat. Moreover, the probit model illustrates that the level of education in the family and having young children aged under 5 years in the household positively impacted the acceptance of Zn-biofortified wheat among the participants. The findings suggest that there is significant scope for promoting Zn-biofortified wheat in the country. It is also imperative to ensure its availability across various regions so that households with weak purchasing power can buy and address their Zn deficiency. Furthermore, policymakers could introduce reforms targeting business communities for food management, keeping Zn-biofortified wheat in the priority stream.
Collapse
Affiliation(s)
- Muhammad Rizwan
- School of Economics and Management, Yangtze University, Jingzhou, China.,Changjiang River Belt Economic and Development Research Institute, Yangtze University, Jingzhou, China
| | - Yueji Zhu
- Management School of Hainan University, Haikou, China
| | - Ping Qing
- College of Economics and Management, Huazhong Agricultural University, Wuhan, China
| | - Debin Zhang
- College of Public Administration, Huazhong Agricultural University, Wuhan, China
| | - Umar I Ahmed
- Department of Agribusiness and Applied Economics, Muhammad Nawaz Shareef University of Agriculture Multan, Multan, Pakistan
| | - Hui Xu
- School of Economics and Management, Yangtze University, Jingzhou, China
| | - Muhammad A Iqbal
- Institute of Agricultural and Resource Economics, University of Agriculture Faisalabad, Faisalabad, Pakistan.,Department of Economics and Agri. Economics, PMAS Arid Agriculture University, Rawalpindi, Pakistan
| | - Abdul Saboor
- Department of Economics and Agri. Economics, PMAS Arid Agriculture University, Rawalpindi, Pakistan
| | - Arshad M Malik
- Department of Economics and Agri. Economics, PMAS Arid Agriculture University, Rawalpindi, Pakistan
| | - Adnan Nazir
- Department of Agricultural Economics, Sindh Agriculture University Tando Jam, Tando Jam, Pakistan
| | - Xuelian Wu
- School of Economics and Management, Yangtze University, Jingzhou, China
| | - Puming He
- School of Economics and Management, Yangtze University, Jingzhou, China
| | - Azam Tariq
- College of Humanities and Social Sciences, Huazhong Agricultural University, Wuhan, China
| |
Collapse
|
6
|
Abstract
The aim of this review paper is to explore the strategies employed to tackle micronutrient deficiencies with illustrations from field-based experience. Hidden hunger is the presence of multiple micronutrient deficiencies (particularly iron, zinc, iodine and vitamin A), which can occur without a deficit in energy intake as a result of consuming an energy-dense, but nutrient-poor diet. It is estimated that it affects more than two billion people worldwide, particularly in low- and middle-income countries where there is a reliance on low-cost food staples and where the diversity of the diet is limited. Finding a way to improve the nutritional quality of diets for the poorest people is central to meeting the UN sustainable development goals particularly sustainable development goal 2: end hunger, achieve food security and improved nutrition and promote sustainable agriculture. As we pass the midpoint of the UN's Decade for Action on Nutrition, it is timely to reflect on progress towards achieving sustainable development goal 2 and the strategies to reduce hidden hunger. Many low- and middle-income countries are falling behind national nutrition targets, and this has been exacerbated by the COVID-19 pandemic as well as other recent shocks to the global food system which have disproportionately impacted the world's most vulnerable communities. Addressing inequalities within the food system must be central to developing a sustainable, cost-effective strategy for improving food quality that delivers benefit to the seldom heard and marginalised communities.
Collapse
|
7
|
Rehman A, Farooq M, Ullah A, Nadeem F, Im SY, Park SK, Lee DJ. Agronomic Biofortification of Zinc in Pakistan: Status, Benefits, and Constraints. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2020. [DOI: 10.3389/fsufs.2020.591722] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Micronutrient malnutrition (e.g., zinc) is one of the major causes of human disease burden in the developing world. Zinc (Zn) deficiency is highly prevalent in the Pakistani population (22.1%), particularly in women and children (under 5 years) due to low dietary Zn intake. In Pakistan, wheat is the primary staple food and is poor in bioavailable Zn. However, the number of malnourished populations has decreased over the last decade due to multiplied public awareness, accelerated use of Zn fertilizers (particularly in wheat and rice), initiation of several national/international research initiatives focusing on Zn biofortification in staple crops and availability of supplements and Zn fortified meals merchandise, nonetheless a large number of people are facing Zn or other micronutrient deficiencies in the country. There are few reports highlighting the significant increase in daily dietary Zn uptake in population consuming biofortified wheat (Zincol-2016) flour; indicating the positive prospect of biofortification interventions up scaling in lowering the risk of dietary Zn deficiency in rural and marginalized communities. Zinc fertilizer strategy has not only helped in enhancing the grain Zn concentration, but it also helped in improving crop yield with high economic return. In addition, Zn biofortified seeds have exhibited strong inherent ability to withstand abiotic stresses and produce higher grain yield under diverse climatic conditions. However, there are many constraints (soil, environment, genetic diversity, antinutrients concentration, socioeconomic factors etc.) that hinder the success of biofortification interventions. This review highlights the status of Zn deficiency in Pakistan, the success of agronomic and genetic biofortification interventions. It also discusses the economics of agronomic biofortification and cost effectiveness of Zn fertilization in field conditions in Pakistan and the potential of Zn biofortified seeds against abiotic stresses. Furthermore, it also highlights the constraints which limit the sustainability of biofortification interventions.
Collapse
|
8
|
Zaman M, Afridi G, Ohly H, McArdle HJ, Lowe NM. Equitable partnerships in global health research. NATURE FOOD 2020; 1:760-761. [PMID: 37128060 DOI: 10.1038/s43016-020-00201-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Mukhtiar Zaman
- Department of Pulmonology, Rehman Medical Institute, Peshawar, Pakistan
| | | | - Heather Ohly
- UCLan Research Centre for Global Development, University of Central Lancashire, Preston, UK
| | - Harry J McArdle
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Sutton Bonington, UK
| | - Nicola M Lowe
- UCLan Research Centre for Global Development, University of Central Lancashire, Preston, UK.
| |
Collapse
|