Issue of June 2014

AFRICAN NUTRITION MATTERS

JUNE 2014 - VOLUME 2 No. 2

Global intiatives to improve nutrition

AFRICAN NUTRITION SOCIETY T H E N E W S L E T T E R

Thematic

SUN movement in the post 2015 agenda (p. 3)

Interviews

Francis Zotor, president of the ANS (p. 5)

LOC president (p. 7)

Scope on the SUN movement

Engaging stakeholders to tackle malnutrition (p.8)

Strengthening capacities in West Africa (p.9)

Experiences of CSO-SUN in Zambia (p.10)

Regional news

MI Forum in Addis Ababa (p.15)

Nutrition research in North Africa (p.16)

West Africa regional instabilities (p.17)

mHealth and Nutrition (p. 18)

The era of MOOCs

Malnutrition e-learning course (p. 3)

2

JUNE 2014 VOLUME 2 No. 2

Editorial Dear Reader,

Welcome to the third edition of African

Nutrition Matters!

It is indeed with great excitement that

this third issue is released to coincide

with the 6th

African Nutrition

Epidemiology Conference (ANEC) to

be held in Accra, Ghana, 21-25 July

2014.

The ANEC conference the only one of

its kind dedicated to scientific discourse

of the African Nutrition Agenda, is this

year hosted by the African Nutrition

Society and the Ghana Nutrition Society

and brings together global leaders in the

nutrition science, research and public

health, non-governmental organizations

and industry to this biennial event.

Indeed this conference is symbolic, as it

marks the official launch of African

Nutrition Matters the official newsletter

of the African Nutrition Society on

African soil. In a symposium to be held

on Monday 21st

July 2014, African

Nutrition Matters readership can

interact with the editorial team, get

copies of this issue and view previously

published issues, participate in

discussions of how this newsletter

comes together and contribute through

suggestions for the newsletters growth.

The theme for this issue of ANM

“Global initiatives to improve nutrition”

opens the discussion on the current

movements globally and their impacts

and effects on nutrition in African

countries. Of particular interest and

focus in this issue is the Scaling up

Nutrition (SUN) movement which has

been adopted by several African

countries. The SUN movement, initiated

in response to the need to scale up

efforts of several countries who lagged

behind in meeting the Millennium

Development Goals (MDG) and in

particularly MDG 1: Eradicate extreme

poverty and hunger. The SUN

movement aims to improve nutrition

through encouraging policy

development and change, program

development with collaboration

between governments and other partners

with shared nutrition goals, and

mobilizing resources to effectively scale

up nutrition, with a core focus on

empowering women. An article by the

SUN secretariat describes the technical

application of the SUN movements’

roadmap.

Several African countries have signed

up and committed to scaling up

nutrition. However, while some

countries have made important

progresses in implementing the SUN

roadmap to reduce child malnutrition,

some are still struggling in

operationalization of the SUN initiatives

because there is a great variability in

African countries readiness and ability

to take on the SUN initiatives. Our

thematic article by Dr. Habiba Hassan-

Wassef from Egypt National Research

Center takes a critical look at the

readiness of African countries realistic

ability to meet the SUN initiatives

goals. Dr. David Nabarro, the SUN

Movement Coordinator gives further

and new insights into the SUN multi-

stakeholder engagements in the News

section.

Our regional news section articles

discuss health in Southern Africa,

Nutrition research in North Africa and

West African regional instabilities:

Consequences for food security. The

partners section includes information on

the Malnutrition eLearning course by

Dr T. Pickup and Dr S. Choi;

strengthening institutional and human

capacities is critical to the

implementation of the nutrition

roadmap in West Africa- Roger

Sodjinou-UNICEF/WAHO West Africa

Nutrition Capacity Development

Initiative and a report on the

Micronutrient Global Forum Addis

Ababa. We continue in this issue to

highlight the work of young researchers

in Spotlight on young African

researchers which features young

Zimbabwean researcher Wisdom Dube.

On this occasion of the 6th

ANEC, we

interviewed the African Nutrition

Society president Dr Francis Zotor and

the Chair of local organizing committee

Professor Stiener-Asiedu who both

highlight the importance of ANEC and

ANS to the West African Region, the

African continent and its Global impact.

We wish you happy reading, and look

forward to meeting you at the African

Nutrition Matters symposium on

Monday 21st July 2014.

Dr Nonsikelelo

Mathe

Co-editor in Chief

Dr Dia Sanou

Co-editor in Chief


Official bulletin of the African Nutrition Society.

VOLUME 2 No. 2; JUNE 2014.

Editors-in-Chief: Dia Sanou (Burkina Faso), Nonsikelelo Mathe (Zimbabwe)

Editorial Board: Mawuli H. Avedzi (Ghana), Robert Fungo (Uganda), Ali Jafri (Morocco), Hanane Labraimi (Morocco), Muniirah Mbabazi (Uganda), Folake Samuel (Nigeria)

Technical Advisory Board: Paul Amuna (Ghana), Francis Zotor (Ghana), Habiba Hassan Wassef (Egypt)

Layout: Ali Jafri

P. O. Box K18, Korle Bu, Accra, Ghana. Phone:+233-244186867; +233-244872410. Fax:+233-2151394

All correspondence should be addressed to the editors by email:

[email protected]

3


Repositioning the SUN Movement in the post 2015

Agenda for Development

Habiba Hassan-Wassef, MD National Research Center, Cairo, Egypt

The SUN Movement in Africa

Launched in September 2010 to help

countries which are lagging behind in

making progress towards the

achievement of the MDG1 (Hunger and

Poverty) the SUN (Scaling Up

Nutrition) Movement[1] soon gained

momentum. To-date thirty five

35[WU1] African countries have joined

the movement and their national food

and nutrition and food security

programmes are benefiting from the

support of development partners and the

United Nations system. Review of the

manner in which the countries

translated the SUN Framework for

Action into programmes to accelerate

the achievement of food and nutrition

goals yielded a rich and varied set of

approaches.

The richness is attributed to the fact that

the SUN initiative provides a guiding

framework that supports national

nutrition plans and programmes

conceived in respect to a particular

context for each respective country. The

variety in the nature of problems and of

the capacity to deal with them, the

manner in which available resources

were utilized, among other local

particularities, have given rise to a

varied range of approaches to improve

the nutritional status of a given

population. It may be opportune at this

point in time to follow up on the

expression, made by some countries, of

the wish to share their successes and

failures with the other SUN Movement

adherents and to learn from their SUN

experience.

While most of the components of the

SUN initiative appear to be addressed in

the country programmes, as for example

the establishment of efficient

coordination mechanisms and a

strengthened interface between national

food security and nutrition programmes;

there was little reference to the interface

with the agro-food industry in its

capacity as a stakeholder in the food

value chain.

Continued relevance of the focus on

early childhood

Scientific evidence of the impact of

undernutrition on infant and child

mortality and its long-term effects on

health and on cognitive and physical

development served as the foundation

for the SUN Initiative Framework for

Action. Much was drawn from the

Lancet [2] 2008 special series on

maternal and child undernutrition which

highlighted the critical importance of

the first 1000 Days of Life (9 months of

pregnancy and the first twenty four

months of life).

The Cost of Hunger in Africa Study [3]

(COHA) provides additional evidence

to justify the importance of addressing

nutrition problems during the critical

early formative stages of an individual’s

life. Results from the investigated

countries (Egypt, Ethiopia, Mauritania,

Swaziland, and Uganda) demonstrate

how the negative consequences of early

undernutrition follow a child in his/her

entire life and gravely affect the

national economy. The focus on

pregnancy and early childhood

continued through the post 2015 debate.

In a revealing and challenging paper,

Mary Young [4] presents the current

convergence of findings in

developmental neurobiology and

psychology, population health, social

science and economics which have

contributed to a phenomenal advance in

understanding the long reach of early

childhood development (ECD). She

reports the recent work of the scientists

who have shown without doubt that

events in early life link with the

development of the brain’s circuitry;

dynamic gene-environment interactions;

programming of the body’s immune,

neurological and endocrine systems; life

trajectories of human development; and

occurrence of chronic diseases in

adulthood. Key findings demonstrate

that coping abilities, cognitive and non-

cognitive competencies, health and the

process of skill formation are strongly

influenced by dynamic interactions

between genes and early life

environments and experiences. Also,

that cognitive, social, emotional and

language competencies are

interdependent and all contribute to the

formation of lifelong capabilities and

that these competencies are developed

during early childhood and are

influenced by good parenting and

nurturing practices.

The SUN Movement can thus put a

break to the progressive depreciation in

the quality of the human capital through

an updated framework that translating

the recent scientific knowledge into

practice while waiting for the

appropriate institutional and policy

reforms. This is of particular

importance in the case of deprived

children living in underserved and poor

4


communities. A new version of the

SUN initiative may thus need to give

more attention to good parenting and

positive care-giving (Bornstein and

Putnick) [5]. According to Young,

efforts will need to be made for creating

the building blocks for universal Early

Childhood Programmes. These include

– inter alia - establishing a population-

based outcome measure; training of

practitioners and caregivers; and

targeted and expanded programmes that

recognize the additive synergistic

effects of combining nutrition and

stimulation. The post 2015 SUN

Framework for Action may thus need to

include innovative approaches that

integrate ECD services and expand

them beyond traditional boundaries.

Importance of investing in Early

Childhood Development

The first few years of a child's life have

a multiplier effect for society. Children

who are well nurtured during this period

tend to do better in school and stand a

greater chance of developing the skills

to compete in the global economy.

Investing in young children is thus an

integral part of human and economic

development. Mary Young explains

that the current understanding of the

neurobiology of early childhood is that

the development of the brain’s

architecture and function in early life

continues to affect health, learning and

behavior all through the life cycle. This

means that what is done or not done in

early childhood has long-term

ramifications for both individuals and

societies. Thus, investing in young

children is regarded as an integral part

of human and economic development

and is a key strategy for the post 2015

sustainable human and economic

development. As the post 2015 Agenda

debate advances, the importance of the

quality of “human capital” justified by

economic evidence and arguments, is

gaining ground. The SUN Movement,

which has the advantage of a head start

in this direction, will need to

incorporate the new evidence and adjust

its strategies and approaches

accordingly.

Nutrition in the post 2015

Development Agenda debate

Building on the successes of the MDGs,

Member States participating in the

global debate led by the UN High Level

Political Forum on Sustainable

Development are creating the

foundation for a new global sustainable

development agenda. An agenda that

will address any unfinished business of

the 2015 MDGs as well as the new

challenges and complexities facing the

world, with sustainable development at

its core and poverty eradication as its

highest priority.

The present list of 17 proposed

Sustainable Development Goals to be

attained by 2030[6] places “ending

hunger, improving nutrition and

promoting of sustainable agriculture” as

the second goal, with “End poverty

everywhere” taking first place. The

nutrition targets[7] proposed by the

United Nations Food and Agriculture

Organization (FAO), the International

Fund for Agricultural Development

(IFAD) and the World Food Programme

(WFP) for the post 2015 Agenda for

Development maintain the focus on

early childhood. The Rio+20 Outcome

Document: “The future we want “[8],

represents its contribution to the 2015

debate. Nutrition, under the title of

“Food security and nutrition and

sustainable agriculture” follows Poverty

Eradication in its list of “Thematic areas

and cross-sectoral issues”. Water and

sanitation closely follow. The document

reaffirms the importance of a

comprehensive vision and the coherence

of integrated multi-sectoral and multi-

partner programmes.

Launched by the UN Secretary General

at the Rio+20 Summit last June 2012,

“The Zero Hunger Challenge” calls for

stepping up efforts to end hunger.“Zero

stunted children under 2 years, no more

malnutrition in pregnancy and early

childhood” is the second of 5 objectives

to be attained by this initiative, which is

expected to remain operational beyond

d 2015.

Aligning with global and continental

initiatives

The SUN Movement calls on countries

to align with and seek critical synergies

from global, regional and local

initiatives. Such initiatives could be

outside the health domain, such as in the

social, agriculture, or education

domains. The most critical of such

programmes is the national poverty

reduction strategy. The health

professionals will need to be able to

identify the benefits and synergies that

can be sought from a given activity or

programme of another sector, especially

for those that are outside the health

domain. The creation of a joint inter-

sectoral planning group at the level of

the national planning authority in one of

the SUN countries made it possible to

guarantee such alignment at the

planning level.

The SUN country programmes must be

capable of identifying ways to draw

benefits and seek synergies from the

global mobilization for eradication of

poverty and sustainable development.

Transparency and the willingness to

share information are some of the

conditions that can facilitate the sharing

of mutual benefits. Alignment with

global programmes such as those for

prevention and control of HIV/AIDS;

chronic non-communicable diseases and

obesity; reduction of maternal and

neonatal mortality; and the integrated

management of childhood illnesses may

appear to be an obvious rational choice.

However, difficulties may arise when

funding sources and supporting UN

system agencies are different. Hence

the importance of the SUN Framework

for Action recommendation for explicit

clear reference to nutrition related

actions/activities in the Country

UNDAF (UN Development Action

Framework) planning document that

details the partners (government, UN

system, as well as development

partner) that will be working together

and/or contributing to the

achievement of a given nutrition

target.

The designation of “2014 Year of

Agriculture and Food Security” by

the 23rd

African Union Summit

meeting held in Malabo last June

reinforces the mobilization of

continental efforts towards achieving

the agriculture and food and nutrition

security goals. A number of the

adopted Summit Declarations are of

direct relevance to food and nutrition

security. There is scope for seeking

potential synergies from some of the

agricultural initiatives and

programmes that could be of direct

benefit to food and nutrition security

at the family level.

Conclusion

With the reaffirmed focus on the

importance of the formative period of

early human the SUN Movement is

right on track for Agenda 2015. The

lessons learned and the experience

gained through implementing the

SUN framework of Action represents

valuable material for fine-tuning the

Framework for Action.

The review of the reports published

online on the country plans and

activities, revealed a wide variation,

in particular in the programme

organization modalities, in the

interface with other sectors, and in

the budgetary arrangements for

financing multi-sectoral, multi-

partner nutrition activities. The issue

of qualified human resources, the

research capacity, and the generation

and management of information are

some of the areas that were identified

to be in need of support. It may be

useful at this stage to assess some of

the innovative activities that were

introduced by some SUN countries,

such as the analysis of nutrition in

public policies or the formulation of

joint (inter-sectoral) indicators.

The overall progress to date made by

the majority of the SUN countries

can only be commended. Now that

we are approaching the new 2015-

2030 Development Agenda it may be

opportune to respond to the wish

expressed by a number of SUN

countries and provide the SUN

countries with the occasion to share

experiences, success stories and

lessons learned. The outcome

represents valuable material that an

updated version of the Framework

for Action can build on.

References

1. Scaling Up Nutrition, A Framework for

Action, 2011

2. The Lancet, “Maternal and Child

Undernutrition,” Special Series, January

2008.

3. AUC and UNECA 2012, “The Cost of

Hunger in Africa: Social and economic

impact of child undernutrition”. Report of

the Seventh meeting of the Committee of

Experts, AU/ECAMEF/EXP/22(VII)

4. Young, Mary 2014, “Addressing and

Mitigating Vulnerability Across the Life

Cycle: The Case for Investing in Early

Childhood”. UNDP Human Development

Report 2014 Occasional Paper

5. Bornstein, M. H., and D. Putnick. 2012.

“Cognitive and Socio-emotional Caregiving

in Developing Countries.” Society for

Research in Child Development 83

(Jan/Feb) (1): 46–61, (cited in Young, M).

6. sustainabledevelopment.un.org/focussdgs.ht

ml

7. www.fao.org/news/story/en/item/219078/ico

de

8. http://www.un.org/en/sustainablefuture/

Interview with Dr. Francis Zotor, president of the

African Nutrition Society

Why was the African Nutrition

Society created?

Since its inception in 2008, the African

Nutrition society (ANS) is a registered

scientific professional body that unifies

African nutrition professionals to

provide a continental professional

scientific forum, promote training,

research, and capacity building for

nutrition as well as contributing to

workforce development to meet Africa's

nutrition and health policy agenda. Our

ultimate goal is to provide a home for

nutritional scientists and other allied

professionals; contribute to programmes

and projects aimed at improving

nutrition in Africa and reducing the

burden of disease. Through our efforts

we hope to promote collegiality and

bring together individuals across Africa

and other parts of the world to work

together towards building and

promoting the nutrition profession and

practice in Africa.

What is unique contribution of

ANS in the continent and in the

global scene?

interviews

http://sustainabledevelopment.un.org/focussdgs.html

http://sustainabledevelopment.un.org/focussdgs.html

http://www.fao.org/news/story/en/item/219078/icode

http://www.fao.org/news/story/en/item/219078/icode

http://www.un.org/en/sustainablefuture/

6


The ANS in its establishment as an

umbrella organisation has among others

come to be seen as an organisation that

has actively been at the forefront of

developing and promoting the nutrition

profession in Africa. Through its

conference, the African Nutritional

Epidemiology Conference (ANEC)

nutritionists across Africa and beyond

the confines of Africa have come to see

the ANS as the organisation to be

associated with. Over the past six years

since the ANS was formed, the

leadership has been in the forefront of

working with sister organisations such

as the Federation of African Nutrition

Societies (FANUS), the International

Union of Nutritional Sciences (IUNS),

the Nutrition Society of Great Britain

and Ireland and the American Society of

Nutrition to work collectively to

promote the ideals of food and

nutritional science on the continent. The

ANS has provided a continental

professional scientific forum (through

its conferences), promoted training (in

partnership with the British Nutrition

Society), capacity building (with

assistance from Unilever, the Nevin

Scrimshaw International Nutrition

Foundation, the IUNS and the Nestle

Foundation) in nutrition and continues

to contribute to workforce development

to meet Africa’s nutrition and health

policy agenda.

What challenges is ANS facing as

an organization?

The foremost challenge the ANS has

found is galvanizing the many

nutritionists of African descent to

proactively work together to find

innovative ways of addressing the

numerous nutritional challenges facing

us as a continent. African nutritionists

need to be more visible and work

together, (as well as share examples of

good practice across sub regions) to

finding solutions to the nutritional

challenges within their own

communities. The ANS is an

association dedicated towards Africa’s

nutrition agenda. We encourage all

nutritionists and those allied to

nutrition to enter into membership with

the ANS so that together we can

provide a voice for nutrition and work

together to address the challenges that

confront us as a continent. The ANS has

a number of projects the organization

would like to initiate amongst other

nutritionists across sub-regions of

Africa, however a key constraint is seed

funding to initiate these projects. It is

the Society’s hope that partnership with

some key multilateral and bilateral

organisations working in Africa would

go a long way to working in sync to

address Africa’s challenges.

What are the priorities for the

next 5 years?

The ANS is due to launch at ANEC VI

a consortium with the British Nutrition

Society, the American Society for

Nutrition, IUNS, and FANUS through a

multi-year investment into an eNutrition

Academy initiative. Nutrition training

and capacity building remain a major

challenge in Africa to provide a

competent workforce to support

national and regional efforts to combat

malnutrition in all its forms. The

continent also requires the necessary

intellectual drive for nutrition research,

policy and practice in countries lacking

in readiness for nutrition actions to

improve the health their people. The

ANS hopes to work in partnership with

its members and its associated

collaborations to advance these set

priorities in the next five years.

Please, comment on the Nairobi

declaration that was made four

years at ANEC IV in Nairobi? How

has ANS worked towards

fulfilling the promises in the

declaration?

The ANS in its 2010 declaration in

Nairobi, Kenya vowed amongst its rank

and file of nutritionists as part of the

health workforce to ensure that training

in nutrition was adequate to meet

standard academic and professional

benchmarks required for competencies

in professional practice. A step in the

right direction certain key members of

the ANS leadership were central in

working within the core group that

brought about the successful initiation

and development of the UN’s Scaling

Up Nutrition (SUN). ANS

representation has been central within

the SUN Civil Society Network group

ever since. To this end in the ANEC V

declaration in South Africa, African

nutritionist urged African leaders to

make scaling up nutrition a priority for

the continent, by joining the Scaling Up

Nutrition Movement and to lead the

way in the fight against hunger and

undernutrition in the continent with the

support of international institutions and

donors countries.

A challenge that remains though to

address in the ANEC IV declaration

relates to skills and professional

competencies that needs to be acquired

in dissemination of research outcomes

to policy and decision makers. This is a

commitment the ANS still has in its

sight.

7


Interview with Professor Matilda Steiner-Asiedu, LOC

chair of the ANEC VI

Who are the members of the

LOC?

The members of the LOC are the

executive committee members and

members of the Nutrition and Dietetic

Association in Ghana, as well as people

in Nutrition related fields who have the

responsibility of finding out and solving

nutrition problems. The LOC has been

in the media throughout last month

informing and sharing ideas on nutrition

issues that confront Ghanaians in

connection with the upcoming

conference. We thank all our media

partners who have given us the

opportunity to do this.

What is the specific theme for

ANEC and why this was

preferred?

The theme for this year’s ANEC is

“Food & Nutrition Security in Africa:

New Challenges and Opportunities for

Sustainability”. This theme was chosen

because nutrition is a national tool for

building a strong economy and

development since healthy people

makes a healthy nation. How do we get

people to be healthy? It is through

eating the right foods in the right

amounts all year round. This borders on

Food and Nutrition security. We are

looking forward to a time when Africa

will be self-sufficient in all food and

nutrition needs. This is where

sustainability comes in. This forum

therefore serves as a good platform to

challenge Africans from all walks of life

to act rather than only talk. Nutrition is

multifaceted; It concerns itself with

issues such as how to get the food from

farm to the table, socio-cultural

contextual factors, eating behaviours

and disease outcomes. All these topics

will be discussed at ANEC.

What are the expectations at the

end of the conference?

At the end of the conference, there

should be the acquisition and transfer of

knowledge regarding some solutions to

nutrition issues pertinent to the

continent. Experiences will be shared

and programmes that have yielded

results elsewhere will be transferred; in

other words “if the wheel has been

invented already why waste time trying

to invent it again”. Participants should

be able to identify and solve some

nutrition problems. Through workshops,

symposia and seminars various nutrition

professional groups will share their new

ideas and innovations to tackle the food

and nutrition security issues confronting

the world. It also is an opportune stage

for young scientists and students to

build their capacity in scientific

reporting and presentation skills

(research).

What are feature activities of the

programme?

Feature activities include the Debate on

Genetically Modified foods /

Genetically Modified Organisms (GM

foods/GMOs)- (Sunday, 20th

July, 2014

at 3:00 pm), Workshop on Scientific

Writing and publication- (Friday, 25th

July, 2014 at 7:30am -10:00am),

various symposia on nutrition issues, as

well as Exhibitions- (21st to 25

th July,

2014) and the presentation of awards to

individuals who have a record of

distinguished services in nutrition.

There will also be the launch of the

electronic Nutrition Academy (eNA), it

is believed that this platform will

enhance training of nutrition

professionals in Africa and

dissemination of latest best practices in

nutrition.

What is the significance to the

Ghanaian nutrition community

of hosting ANEC VI?

ANEC VI means a lot to the Ghanaian

nutrition community because it paves

the way to showcase nutrition in Ghana

and makes it possible for the general

public to know where to get authentic

information on nutrition and diet related

disorders. The meeting also creates the

platform to share knowledge about

Nutrition issues in Africa and to find

common grounds and solutions to

similar problems without reinventing

the wheel especially in this present time

that Africa is facing financial

challenges. Furthermore, since this

meeting is attracting international

audiences and nutritionists across the

globe it provides the right environ to

network with professionals and other

stakeholders in the field of nutrition,

agriculture, food technologist, non-

governmental organizations and the

food industry. Ghana also stands to

benefit since this also enhances our

tourist attraction for those who will be

visiting Ghana.

Professor Matilda Steiner-Asiedu

8


Scaling Up Nutrition Movement: Engaging and inspiring multiple stakeholders to find new ways of

investing together, to tackle malnutrition in all its forms.

David Nabarro Special Representative of the UN Secretary-General for Food Security and Nutrition and SUN Movement

Coordinator.

Scientific articles in the international

medical journal Lancet during 2008

published reviews which confirmed that

women’s and children’s nutrition could

be improved by increasing accesses to a

series of specific services. An editorial

in the journal stated that “nutrition is a

desperately neglected aspect of

maternal, newborn, and child health.

Leadership (for nutrition) is absent,

resources are too few, capacity is

fragile, and emergency response

systems are fragmentary.” The

world’s political leaders increasingly

understood that good nutrition is a vital

driver of equitable development – of

families, societies and nations.

Reflecting this growing interest,

nutrition professionals from more than

100 organizations came together during

2009 and 2010 to develop a Framework

for action to Scale Up Nutrition. This

was released in Washington DC in April

2010: a Road Map for implementing the

Framework, with a focus on the 1000

days between the start of pregnancy and

a child’s second birthday, was presented

at the UN General Assembly in

September 2010. This event triggered

the thousand days partnership –

advocating for action to improve the

nutrition of women and young children

– and the Movement for Scaling Up

Nutrition (SUN). The Movement

focused on scaling up of efforts to

improve nutrition with an approach

spanning across four strategic

processes*. In Africa, the Movement

began with the Minister of Health in

Zambia, who committed Zambia as the

first African country to join the SUN

Movement in December of 2010.

Today, Scaling Up Nutrition in Africa

has grown to become a movement of 34

African countries with thousands of

supporters globally, many of which are

arranged across four networks – the UN

system, civil society, business and

donors. King Letsie III is the African

Union’s Champion for Nutrition

supporting African Nations to commit

resources to their nutrition plans to

allow them to reap the benefits of

investment in nutrition. An additional

19 countries contribute to the

Movement from Asia and Latin

America.

Whilst there are still over 50 million

stunted children in Africa, there is a

sense of optimism across the continent.

SUN countries recognize that

malnutrition poses obstacles to the

development of communities and

economies. As experiences are shared

by SUN countries, it is clear there is

national level leadership coordinating

national, regional and international

efforts.

The leadership at national level has in

many cases ensured that priorities and

programs are designed and implemented

to meet the needs of those in the

country. There is increasing alignment

of financial and technical support to

implement country plans. Governments,

development agencies, foundations,

civil society groups, businesses and the

research community are coming

together to prioritize nutrition – as a

health, education, development, and

economic issue.

Many of these countries are already

starting to show significant

improvements in their levels of under-

nutrition through a combination of

specific nutrition interventions

combined with policies and programs

which are better focused on nutrition

outcomes, i.e. “nutrition sensitive

development”.

As the second International Conference

of Nutrition (ICN2) in Rome, during

November 2014 approaches, countries

are preparing to make the case for

nutrition. The outcome of the

conference will be important. It will

include the policies, institutional

arrangements, investment priorities and

monitoring mechanisms being put in

place by national governments at both

local and national levels. ICN2 is

conveniently timed as the African

Regional Nutrition Strategy (2015 –

2025) is being developed and the

deceleration of African Year of

Agriculture and Food Security.

With two thirds of African states in the

SUN Movement, they are coming

together with supporters. Political

engagement is increasing. Ways of

working for nutrition are being

transformed. Attention is on the future

to ensure that every child receives

proper nourishment so they can grow up

to be healthy and productive and family,

communities and countries can prosper.

*Scaling Up Nutrition (SUN) Movement Strategy

(2012 – 2015).

9


Strengthening institutional and human capacities is

critical to the implementation of the nutrition

roadmap in West Africa

Roger Sodjinou, PhD West African Nutrition Capacity Development Initiative

Great efforts have been made over the

past few years to raise the profile of

nutrition to a high priority in West

Africa(1). There is now strong

momentum to scale up nutrition

interventions and accelerate progress

towards improved nutrition outcomes in

the region. The nutrition landscape in

West Africa has been evolving since

2010 as a result of the launch of new

initiatives aimed at enhancing food and

nutrition security. With the exception of

Cape-Verde, all countries in the West

Africa region are now members of the

Scaling Up Nutrition (SUN) movement

(2). This provides a unique opportunity

for countries in the region to scale-up

nutrition interventions, improve

coordination of nutrition activities,

mobilize resources for nutrition actions

and improve accountability as well as

overall nutrition governance (2). The

Renewed Efforts Against Child Hunger

and undernutrition (REACH), a global

initiative that helps governments to

organize partners around a unified

vision and a common framework for

action to reduce undernutrition (3), has

also gained momentum in five countries

in the region (Ghana, Mali, Mauritania,

Niger and Sierra-Leone). In an attempt

to build resilience to the cyclical food

and nutrition crises in the Sahel belt

region, the European Union and its

partners have also launched the Global

Alliance for Resilience Initiative

(AGIR). Other nutrition-focused

initiatives are also being rolled out to

accelerate progress toward reducing

undernutrition. All these positive

developments are likely to provide the

necessary conditions and accelerate

progress toward the achievement of

nutrition-related goals in the region.

The success and sustainability of these

efforts depend however, on a number of

country-specific factors (4). Adequate

institutional and human capacity to

deliver and scale up nutrition

interventions is one of the factors that

are critical for the advancement of

nutrition (4). There is indeed robust

evidence that lack of capacity is

hindering West African countries from

making progress in nutrition. Our recent

capacity needs assessment has indeed

revealed important gaps in the current

capacity to act in nutrition in West

Africa (5-7). In general, nutrition

programs in West Africa are

characterized by a critical shortage of

skilled human resources, high

dependency on donor resources as a

result of low government investments,

weak logistic and infrastructure

systems, and lack of supervision as well

as coordination of nutrition activities at

lower levels. There is also very little

incentive for nutrition service providers

to stay in service and a lack of clarity in

their roles and responsibilities. Other

challenges include the limited training

capacity to support the expansion of the

nutrition workforce, as a result of a lack

of nutrition training programs. There is

also a lack of harmonization of existing

nutrition curricula and a critical

shortage of nutrition faculty.

Addressing these unmet needs is a

critical step in the implementation of the

regional nutrition roadmap. Under the

auspices of the West African Health

Organization (WAHO), the West Africa

Nutrition Capacity Development

Initiative (WANCDI) has been launched

to bridge the nutrition capacity gap in

the West Africa region. The overall

objective of the initiative is to address

institutional, organizational and human

capacity gaps and provide the needed

support to accelerate progress for

nutrition in West Africa. The key

actions of the initiative include:

Contributing to the development and

expansion of an appropriately skilled

nutrition workforce; Strengthening

capacity at organizational and systemic

levels; Strengthening existing nutrition

training programs and creating a

network of nutrition training

institutions; Development of curricula

that can serve as prototype for pre-

service and in-service nutrition training

and; Creating an enabling environment

for nutrition capacity development.

References

1. Black RE, Victora CG, Walker SP, Bhutta

ZA, Christian P, de Onis M, Ezzati M,

Grantham-McGregor S, Katz J, Martorell R,

Uauy R; Maternal and Child Nutrition Study

Group. Maternal and child undernutrition and

overweight in low-income and middle-

income countries. Lancet 2013;

382(9890):427-51.

2. The Scaling Up Nutrition website. Available

from : URL

http://scalingupnutrition.org/about [Accessed

May 2014].

3. The REACH website. Available from:

URLhttp://www.reachpartnership.org/home

4. UNICEF. Improving child nutrition: the

achievable imperative for global progress.

New York: UNICEF; 2013.

5. Sodjinou R, Fanou N, Deart L, Tchibindat F,

Baker S, Bosu W, Pepping F, Delisle H.

Region-wide assessment of the capacity for

human nutrition training in West Africa:

http://scalingupnutrition.org/about




http://www.reachpartnership.org/home

10


current situation, challenges, and way

forward. Glob Health Action 2014; 7: 23247.

6. Sodjinou R, Fanou N, Deart L, Kupka R,

Tchibindat F, Baker S. Nutrition training in

medical and other health professional schools

in West Africa: the need to improve current

approaches and enhance training

effectiveness (In press, Global Health

Action).

7. Sodjinou R, Fanou N, Deart L, Kupka R,

Tchibindat F, Baker S. A systematic

assessment of the current capacity to act in

nutrition in West Africa: cross-country

similarities and differences (In press, Global

Health Action).

Experiences of the Zambia Civil Society Scaling Up

Nutrition Alliance (CSO-SUN) in the Scaling Up

Nutrition (SUN) movement to advance health and

Development in Zambia

William Chilufya

SUN Country Coordinator, Zambia

Introduction

Malnutrition, especially undernutrition,

remains a serious public health concern

and fundamental threat to the

sustainable economic development for

Zambia. A 2007 Demographic Health

Survey report showed that 45% of

children below five years are stunted,

28% are underweight and 5% are

wasted; while a 2008 national report

showed these proportions as 47%, 28%

and 5% respectively. This means almost

every second child or more than one

million pre-school age children are

stunted in Zambia. The proportion of

exclusive breastfeeding in children

below six months is 51%. Inadequate

dietary intake is reflected in the fact that

37% of children aged 6-23 months

consume a diet of minimal diversity (4

or less food groups). Underlying causes

of malnutrition include inadequate

access to a diverse range of foods,

inadequate care for young children and

mothers, unhealthy environment and

insufficient health services. In addition,

high adult illiteracy (36%) and poverty

(64%) contribute to malnutrition.

Malnutrition is the underlying factor in

the country’s high under-five and infant

mortality rates. The under-five mortality

rate of 119 and infant mortality of 70

per 1000 live births1 are indicative of

Zambia’s developmental challenges.

The 2008 National Nutrition

Surveillance System (NNSS) report

highlighted Zambia’s highest

malnutrition case fatality (40%) in the

Southern Africa Development

Community (SADC) region. In spite of

these high figures, it is just recently that

the profile of nutrition has begun to rise

With the Zambian government’s joining

of the Scaling Up Nutrition (SUN)

Movement in early 2011. Before

Zambia joined the SUN Movement,

fight against malnutrition was perceived

in many spheres to be the domain of the

government and quasi government

institutions, mainly Ministry of Health

(MOH) and Ministry of Agriculture and

Cooperatives (MACO). With Zambia in

the SUN Movement a solid foundation

to advance the nutrition agenda in the

country has been developed through

Multisectoral and Multistakeholder

approaches We are witnessing

Government Sector Ministries come

together such as Community

Development, Water and Sanitation,

Agriculture, Commerce and Trade,

Education, Health and Agriculture. In

addition, stakeholders such as the

Government, Civil Society, Donors and

Private Sector, all implement their

specific roles in support of nutrition.

The CSO-SUN Alliance

The Zambia CSO-SUN Alliance,

established in October 2012, is a

movement of civil society organizations

working to influence policy, financial

and political commitment to raise the

profile of nutrition for national

development. The Alliance mobilizes,

coordinates and builds the capacity of

civil societies to influence national

efforts through constructive dialogue as

well as advocacy with stakeholders -

including the government, donors and

the private sector. The Alliance is also

focused on advocacy and raising

awareness so as to improve the profile

of nutrition among policy makers and

households.

The Alliance’s area of focus is the 1000

most critical day’s period. This is the

window of opportunity from conception

11


until a child’s second birthday, during

which time nutrition has the greatest

impact on saving the lives of children

and mothers. Our vision is to have a

Zambia where every mother and child is

assured of adequate nutrition.

Ten Key Recommendations to

address undernutrition in Zambia

In order to achieve our advocacy

objectives we have adopted 10 key

recommendations refereed to as ‘10 key

Asks’ to addressing undernutrition in

Zambia. These recommendations were

developed in consultation with

Government, the Donor Community

and Civil Society. The

recommendations are improving current

nutrition plans and accelerating progress

towards a Zambia where all children

can achieve their right to adequate

nutrition, and full life potential,

fulfilled. The 10 key recommendations

include:

To build political will to tackle under-

nutrition

Cross-country studies of the

Governance on Nutrition have

highlighted that political will given to

tackling malnutrition is one of the most

critical factors for success in these

efforts. The Alliance has engaged

members of parliament (MPs) to

advocate for effective programs to

tackle under nutrition. Today, Members

of Parliament (MPs) have become

champions for nutrition working with

the Alliance to raise awareness among

our leaders through advocacy.

To address the serious gaps to ensure

adequate human resources at all levels

It is not realistic to expect to address the

crisis of under-nutrition without

urgently increasing the availability of

qualified nutritionists. The crisis of

malnutrition is complex. Addressing it

requires technical competence across

sectors. Presently, Zambia has limited

numbers of trained nutritionists and

dieticians to provide the necessary

guidance in addressing the challenge,

both at policy and program levels

(preventive or curative interventions).

The alliance works to support the new

Nutrition Bachelor of Science and

Masters of Science degrees and further

supports the University of Zambia to

establish a fully functional Nutrition

Department as a crucial element of any

strategy to address human resource gaps

in nutrition

Reform existing programs to increase

their effect on nutrition

In Zambia, there is a heavy reliance on

maize for food resulting in a mono-diet;

high in calories but poor in other

nutrients. In order to reduce

malnutrition rates (and in particular

stunting), a deliberate policy that

supports diversification of agriculture is

necessary; but what is more critical, is

to have a deliberate policy that provides

incentives for livestock production to

allow for promoting increased per

capita animal protein intake in Zambia.

The Alliance advocating for reforming

the Farmer Input Support Programme

(FISP) and the Food Reserve Agency

(FRA) so that they impact more

positively on nutrition.

Ensure effective high-level national

coordination

Malnutrition is a multi-faceted problem,

it requires coordinated action from

multiple sectors of Government,

including Ministry of Health (for curing

those with acute malnutrition), the

Ministry of Community Development,

Mother and Child Health (for promoting

healthy behaviours), the Ministry of

Agriculture (for food security and

production of nutritious foods), the

Ministry of Local Government and

Housing (for ensuring adequate water

and sanitation services, to avoid

frequent illnesses that reduce children’s

abilities to absorb nutrients), not to

mention the Ministry of Finance and

Planning (to ensure adequate funding of

nutrition programmes) and the Disaster

Mitigation and Management Unit in the

Vice-President’s office (to ensure

planning for and mitigation of the

impact of emergencies on food and

nutritional security).

Increase spending to address the

nutrition crisis

Civil Society is advocating for

increased spending to nutrition in order

to effectively implement nutrition

interventions. As at now Nutrition is not

prioritized in terms of funding in lines

Ministries.

Engage civil society as a partner in the

fight against under-nutrition.

Civil Society has the potential to make

Malnutrition problems visible and

improve the scope and quality of service

delivery through research and advocacy.

Civil Society Organizations in Zambia

are influencing and shaping nutrition

policies more effectively because they

directly engage political parties,

government ministers and local

governments, to turn nutrition

campaigns into government policies.

Therefore the Alliance is open to other

stakeholders who wish to use our

platform to raise nutrition awareness

provided they fall under our area of

concern. It is for these reasons that

CSO-SUN Zambia is becoming a

credible source of nutrition information

in Zambia.

Champions of Nutrition

As part of our advocacy efforts, the

Alliance has identified Champions for

Nutrition among the Members of

Parliament (MPs). The MPs have

undergone training in order to further

understand civil society’s issues around

of Nutrition in Zambia. The MPs now

advocate for nutrition in their

parliamentary activities especially in the

House and Committees of Parliament.

Drawing on the success of Nutrition

Champions MPs, the Alliance has taken

strides to identify other traditional

leaders and influential members of the

community as nutrition champions.

Sensitization efforts

As a way of raising the understanding

and appreciation of the 1000 Most

Critical Days Programme, the Alliance

has taken strides to build the capacity of

the media by holding media trainings.

Journalists from both print and

12


electronic have been orientated. Since

the training, we have received an

overwhelming response from the media

as evidenced in the wide coverage of

our activities.

Furthermore, we have partnered with

media houses to do joint media works

on nutrition in Zambia, for example the

Zambia National Broadcasting

Corporation (ZNBC) in producing and

publishing a documentary on

malnutrition, the case for Mumbwa

district. The documentary, entitled “A

Silent Story”, premiered on 12th

December 2013 at the primetime of

18:20hrs on the corporation’s main

television station. The documentary has

since been re-aired cost free on

numerous occasions. Furthermore, “A

Silent Story” has been converted for

online viewing and is available on our

You tube channel. We also partnered

with Millennium Radio among others to

do a six month Nutrition Talk radio

series at no cost to the Alliance.

Through the Nutrition Talks a platform

was created for communities to ask

questions on nutrition by way of

phoning in.

Lessons learned

To advance health and development in

Zambia through improved nutrition, it is

very important that we speak with one

voice and involve multiple stakeholders

in the fight against malnutrition.

Through these efforts the Alliance has

also seen that it is almost impossible to

bring various stakeholders together

without the active participation of the

media. To effectively engage various

stakeholders in the fight against

malnutrition, the Alliance extensively

involves the media through – radio talk

shows, news headlines, newspaper

cuttings, twitter, facebook to mention a

few, thus gaining popularity among

community members and national

leaders. For example, the Alliance, in

collaboration with the Zambia National

Broadcasting Cooperation (ZNBC),

developed a documentary on

Malnutrition, the case of Mumbwa

District central province of Zambia.

This documentary showcases the

extents of malnutrition in the country,

and is continuing to receive attention by

various national leaders and civil

society.

Conclusion

The CSO-SUN Alliance though is a

year old has contributed in a special

way to improving the nutrition situation

in the country through awareness

raising. The problem of malnutrition is

yet to be resolved in Zambia, this entails

stakeholders to continue working

together and recognizing the importance

of each role player. The Alliance’s

diverse means of sensitization and

awareness raising is key to driving the

Scaling Up Nutrition Movement to

advance health and development. It is

critical for Zambia and African

countries in general to note that the

launch of the SUN First 1000 Most

Critical Days Programme will not

remain open indefinitely. The

responsibility falls on all stakeholders to

capitalise on this crucial momentum and

urgently seize upon this opportunity,

before it is lost.

References

1. Grantham-McGregor, S. et al

(2007), ‘Child Development in

Developing Countries: Developing

Potential in the First 5 Years for

Children in Developing Countries’,

The Lancet, Vol. 369, No. 9555: 60-

70.

2. Hoddinott et al., 2008, Effect of a

nutrition intervention during early

childhood on economic productivity

in Guatemalan adults. Lancet 2008;

371: 411–16.

3. National Food and Nutrition

Commission (NFNC). Food and

Nutrition Report, 2008, and

Central Statistical Office, 2009

4. Mejía Acosta, A. and Fanzo, J.,

2012. Fighting Maternal and Child

Malnutrition: Analysing the political

and institutional determinants of

delivering a national multisectoral

response in six countries, IDS/DFID

Further reading:

http://www.ids.ac.uk/files/dmfile/DFID

_ANG_Synthesis_April2012.pdf

Regarding the Zambia study that was

part of the IDS research mentioned

above:

http://www.ids.ac.uk/idspublication/ana

lysing-nutrition-governance-zambia-

country-report

CONTACT

Website: www.csosun.org

Facebook: facebook.com/CSOSUN

Twitter: @CSOSUN

http://www.ids.ac.uk/files/dmfile/DFID_ANG_Synthesis_April2012.pdf

http://www.ids.ac.uk/files/dmfile/DFID_ANG_Synthesis_April2012.pdf

http://www.ids.ac.uk/idspublication/analysing-nutrition-governance-zambia-country-report



http://www.csosun.org/

http://www.facebook.com/CSOSUN

13


Malnutrition eLearning course

Trevor Pickup

Global eHealth International Partnership Lead, Faculty of Medicine, University of Southampton, UK.

Sunhea Choi Global eHealth Education Lead, Faculty of Medicine, University of Southampton, Southampton, UK.

MOOCs and Malnutrition eLearning

The last few years have seen fast

growth of eLearning with the internet

becoming globally accessible and its

potential for training being realised.

There is now a wide range of

educational materials available on the

internet, ranging from short videos on

YouTube to certified eLearning courses.

The most recent trend in this area is

Massive Open Online Courses

(MOOCs), which are offered from

higher education institutions to increase

educational opportunities globally. A

large number of people are taking an

advantage of the offered opportunity by

enrolling on these courses. The

malnutrition eLearning course,

developed by the University of

Southampton (UoS) UK in

collaboration with the International

Malnutrition Task Force (IMTF) to

support health professionals’ capacity

building in the management of

malnutrition, is one of such courses.

Development and field test

Childhood malnutrition continues to be

a major global issue both in terms of

mortality and the developmental and

stunting issues that many experience.

While great progress has been made in

some countries such as Ethiopia, others

are still not seeing the change required

to really impact on this issue. One of the

main reasons is the lack of health

professionals’ capacity in caring for

children with malnutrition. Successful

treatment of children with malnutrition

requires specialist training, but it is not

sufficiently covered in medical training

at most medical schools both in Europe

and across the world. Training for

public health professionals, i.e.

nutritionists, nurses and NGO staff, is

also not easy to access.

In response to this the UoS and IMTF

developed an eLearning course called,

“Caring for infants and children with

severe acute malnutrition”, which can

be freely accessed via the internet. To

evaluate the effectiveness of the course

and the appropriateness of its delivery

in a target context, in December 2010 a

pilot study was conducted in Kampala,

Uganda with 86 in-service and pre-

service health professionals. The results

showed that the participants’ knowledge

of and understanding about malnutrition

and its management using WHO 10

steps improved significantly (1). After

revising the course based on the pilot

study participants’ feedback, it was

launched in summer 2011.

Course dissemination using Social

Media

One of the challenges for eLearning is

the difficulty of bringing the target user

into contact with a particular material

online. The difficulty increases when

the target user is a subset of a global

population and eLearning is not

developed as part of a particular training

programme. Due to the challenge many

high quality eLearning materials,

developed to support education/training

globally, have not become widely

accessed.

Introducing the Malnutrition eLearning

course to the relevant health

professionals in the field, for example

policy makers, educators/trainers, health

workers and students in Africa and

Asia, has proven to be challenging.

Initially, the course had been introduced

to healthcare communities, agencies and

professional bodies through

presentations, exhibitions and

Masterclasses at international events,

but bringing it to the potential users was

slow. From October 2012 and in

response to this challenge, the project

team initiated a Social Media campaign

to directly disseminate the information

about the course to the health

professionals who may benefit from it

but are not possible to reach through

international events. A mixture of

email, LinkedIn, Facebook, newsletters

and YouTube were used for the course

promotion. Messages within LinkedIn

Public Health groups reached a large

number of target user and resulted in a

significant increase in enrolments on the

course. Facebook was used by a

different population but it has also been

effective in making contact with

potential users of the course.

Newsletters were produced regularly

and sent out using a mailing list. People

14


who have used the course and found it

helpful passed on the details to their

colleagues.

Enrolments on the course increased

from 31 people in the 3 months from

July to September 2012, to 896 in the

following quarter. A user survey,

conducted in spring 2012, showed that

LinkedIn was the most effective social

media marketing tool, which has led the

largest number and highest proportion

of the exposed audience to course

enrolment (2, 3). Google Analytics,

used to analyse the sources of referrals,

supported this result.

Course use to date and user feedback

To date (May 2014), over 7,000 people

from 130 countries have used the

course. The users include individual in-

service health professionals who care

for children with malnutrition; teachers

and trainers using the course for their

own knowledge gain or teaching; pre-

service health professionals studying

health science programmes, and field

workers from NGOs. The course is also

being used by a number of institutions

as part of their undergraduate or

postgraduate health science programs.

These include institutions from Ghana

(KNUST, the Catholic University and

Kintampo), Nigeria (Michael Okpara

University of Agriculture), Kenya

(Masinde Muliro University of Science

and Technology and University of

Nairobi), Guatemala (Universidad

Rafael Landivar), Columbia

(Universidad Nacional De Colombia)

and Sri Lanka (University of Columbo).

The user experience with the course has

been very positive, with many being

very pleased with the course design and

content (for more user feedback, go to

www.som.soton.ac.uk/learn/test/nutritio

n/testimonials/). A few selected

comments as follows.

“The course is excellent. I highly

recommend it to those working in child

survival areas. Kudos to the team to

have come up with such an

comprehensive coursework and

brilliantly presented which makes it

completely user friendly”

“Asking if I enjoyed the course is an

understatement. I was impacted and it

has given me new insight and a new

vigour for my career path: malnutrition

and cognitive development in under 5

children.”

“I am so happy with the material and

am confident enough that the course is

very helpful for anyone who has been

engaged in humanitarian programs as

well as all form of nutrition

programming throughout the world!!!”

“Sir I am happy to inform you that I

have finally completed the course and

it’s been confirmed in the My learning. I

am very glad and I know it will help me

a lot in discharging my duties especially

where the survival of the child is

concerned. Thank you and thank you to

all who planned for this very course. I

am grateful.”

Conclusion

MOOCs offer the opportunity for

people around the world to access high

quality training that is relevant to their

situation. When combined with

effective dissemination methods, they

have potential for global capacity

building. An example is the

Malnutrition eLearning course that has

been developed for global capacity

building in malnutrition management

and disseminated using social media

and award schemes. The project is still

at an early stage, but it has

demonstrated potential of MOOCs and

social media as means for global

malnutrition management capacity

building. These methods should be

tested, and when proven effective, be

followed by the nutrition education

community to support the much needed

nutrition capacity building globally.

Info about the course access via

Nutrition Portal

The course is available at:

http://www.som.soton.ac.uk/learn/test/n

utrition and takes about 6-8 hours to

complete. It is appropriate for in-service

and pre-service health professionals,

studying medicine, nursing, nutrition

and allied subjects.

Project team

Chief investigator:

Professor Alan Jackson

Project lead and instructional designer:

Dr Sunhea Choi

Author:

Dr. Reginald Annan

Technical advisor and editor:

Professor Ann Ashworth Hill

Project dissemination:

Trevor Pickup

Design and development:

Faculty of Medicine eLearning team

(Matthew Hammerton, Elizabeth Ault and

George Ke)

References

1. Choi, S., Annan, R.A. and Jackson,

A.A. eLearning as a solution to train

doctors and nurses to manage

malnutrition in children. In: CAPGAN

Conference 2011, 22-23 July 2011,

London, UK. 2011.

2. Choi, S., Annan, R. and Pickup, T.

Malnutrition eLearning and Social

Media joined forces to build global

malnutrition management capacity.

In: AMEE Conference 2013, 24 - 28

August 2013. Prague, Czech Republic.

2013.

3. Pickup, T., Annan, R. and Choi, S.

Malnutrition capacity building

enabled by eLearning and social

media. In: IUNS 20th International

Congress of Nutrition, 15 - 20

September 2013. Granada, Spain.

2013.

http://www.som.soton.ac.uk/learn/test/nutrition/testimonials/




http://www.som.soton.ac.uk/learn/test/nutrition




15


Highlight on the Micronutrient Global Forum, Addis

Ababa, Ethiopia 2014

Aglago Kouassivi Elom, PhD

Unité Mixte de Recherche en Nutrition et Alimentation, URAC 39, Rabat, Morocco.

[email protected]

The micronutrient (MN) Forum, created

since 2006 has been an effective global

meeting where research, innovative

initiatives, and policy for the tackling of

MN deficiencies have been discussed.

After Istanbul in 2007 and Beijing in

2009, the MN Forum chose the African

continent for its third destination. The

2014 meeting took place in Addis

Ababa, Ethiopia from 1st to 6th June.

The choice of Ethiopia remains

symbolic as the country has struggled

with malnutrition over decades.

However, the country set a strong

example to the world by signing a

nutrition strategy in 2011 which

gathered about 10 ministers of health

who committed to put nutrition at the

top of their respective agenda.

The MN Forum 2014 themed ‘Building

bridges’ was declared opened by the

First Lady of Ethiopia, in the presence

of the Minister of Health and Lynnette

Neufeld, the chair of MN Forum.

Presentations were discussed in plenary

and in thematic sessions. The causes

and consequences of MN deficiencies,

and solutions and strategies to improve

micronutrients status worldwide were

covered: iron, iodine, zinc and vitamins.

Life cycle nutrition was also considered

during the Forum, with a paramount

spot on children and pregnant women,

highlighting the importance of the

window of opportunity. It was revealed

from oral presentations and

communications that supplementation

and food fortification was effective in

decreasing MN deficiencies, especially

in developing countries. The session on

Scaling Up Nutrition (SUN) movement

demonstrated the success of the

initiative in many countries, amongst

them Ethiopia. It has been grounded

that commitment from the highest level

of leadership of one’s country is not

only important, but the unique way to

improve sustainable micronutrient

status of a population of a country.

Kenneth Brown from Bill & Melinda

Gates Foundation presented an

innovative tool to optimize the cost-

effectiveness of national micronutrients

deficiency control. Even if the cost of

supplementation and food fortification

are low compared to the advantages,

field workers and logistics, especially

regarding remote areas are still a

challenge to overcome and it is

necessary to consider financial

optimisation issues when setting

programs.

The MN Forum also was a platform to

debate agriculture and food-based

interventions. Often neglected, it is

important to always underline that food

security must be prior to MN debates,

and binding the right to food security

with MN interventions is important for

decisive outcomes. Therefore, success

of corn-soya blend in Cambodia, orange

sweet potato in Africa and increased

intake of animal source foods in some

populations should be a hand push to

combat MN deficiencies. Laboratory

and field approaches for the analysis of

MN, such as dietary assessment and

choice of right biomarkers were

debated. Exclusively, some countries’

specificity, Guatemala as an example,

demonstrated that MN interventions are

becoming alarming because of

supplementation, added to the

mandatory fortification and multiple

voluntary fortifications by the industries

which need the supervision and control

of experts in order to prevent

overconsumption in some cases.

Finally, innovative solutions like

portable kits and the use of geo-

localization to follow the distribution

scheme of supplements and fortified

foods have been presented. During a

session on leadership development, it

came out that many countries need

strong leadership at all levels to back

MN interventions. As a very influential

nutritionist and a leader, Anna Lartey,

the current president of International

Union of Nutritional Sciences (IUNS)

and Director of Nutrition Division at

FAO, shared at the closing ceremony

the keynote address. Invitation was sent

to meet up in Mexico in 2016 for the

next MN Forum and forward the

agenda.

*The author would like to thank his

PhD supervisor Pr Hassan Aguenaou.

He is also delighted to thank the

International Life Sciences Institute

(ILSI) and Dr Geoffy Smith, for the

award presented to him at the MN

Forum.

mailto:[email protected]

16


Nutrition research in North Africa

Ali Jafri, PhD

Ben M’sik Faculty of Sciences , University Hassan II Mohammedia Casablanca

[email protected]

How do we picture the ultimate and

perfect outcome of nutrition research?

Probably eradicating hunger, feeding

the world, winning the fight against

malnutrition, etc. Those aren’t

unreachable perspectives since nutrition

research has literally allowed mankind

to reach for the stars (1). It is no

surprise that research holds an

important place in nutrition strategies.

The world had come to realize -a bit late

perhaps- that if we were to succeed in

our struggle against chronic diseases,

this success is most likely to come

through nutrition.

If we compare nutrition research in

North African countries based on their

scientific production, we would find

that most of them are in relatively low

positions in agricultural and biological

sciences (Egypt: 42, Tunisia: 48,

Morocco: 64, Algeria: 77, Sudan: 82,

Libya: 136, Mauritania: 161) though

three of them are in the Top 10 of

scientific production on the continental

level (data source: Scopus).

Comparing the evolution of the annual

scientific production in these countries

(figure 1) we notice that in 2003-2004

research in Egypt and Tunisia witnessed

a weakening in the nutrition-related

fields, scientific production has nearly

tripled in Egypt and quadrupled in

Tunisia between 2004 and 2011, but

even before, data shows that more

papers were already being published

from Egypt, which might be due to the

fact that there substantially more

scientific journals published in English

than there is in French -assuming the

fact that scholars from the Maghreb

region tend to publish in francophone

journals- but, that doesn't explain the

scientific surge in Tunisia following

2004.

The fact is that nutrition trainings and

research in both Egypt and Tunisia are

much more developed and were long

organized in order to meet the

requirements and challenges these

countries are facing. For the complexity

of the epidemiologic situation in North

Africa (2) is in need of thorough

understanding that can only be brought

through organized research. Most (if not

all) North African countries didn't have

a proper nutrition strategy until a few

years ago (3).

Now, the region is headed towards

meeting the objectives of the World

Health Organization’s regional nutrition

strategy (3) which aims to improve the

nutritional status of the populations

mainly by focusing on the political

engagement in setting up policies which

would ensure decreasing undernutrition,

NCDs and food insecurities. This

strategy requires an important

governmental commitment in order to

meet these objectives and have the

expected success, unfortunately, the

unstable political situation in a number

of the region countries has added an

extra challenge to the picture. We can

only hope that they recover quickly

from that setback.

References

1. Lane HW, Bourland C, Barrett A, Heer M,

Smith SM. The role of nutritional research in

the success of human space flight. Adv Nutr.

2013 Jan 1;4(5):521–3.

2. Labraimi H, Jafri A. Nutrition challenges in

North African countries. African Nutrition

Matters. Accra; 2013 Sep;16–7.

3. WHO-EMRO. Document technique

EM/RC57/4: Stratégie régionale sur la nutrition

2010-2019. Cairo; 2010.

Figure 1. Scientific production in four countries from North Africa (in number of scientific papers per year). Data source: Scopus.

mailto:[email protected]

17


West Africa regional instabilities: Consequences for

food security

Hayford Mawuli Avedzi University of Alberta, Canada

Folake Samuel, PhD

Department of Human Nutrition, University of Ibadan, Nigeria

Food security is said to exist when all

people at all times have physical and

economic access to sufficient, safe and

nutritious food for a healthy and active

life. Thus when there is food and

nutrition security people’s diets are

adequate in both quality and quantity,

providing the required amounts of

energy, macronutrients (carbohydrates,

protein, fats) and micronutrients

(vitamins, minerals, electrolytes) and

the nutritional needs of special groups

such as infants and young children are

met. However, instabilities including

armed conflicts, one-sided violence,

draught, epidemics, and economic

crisis, which affect the “physical and

economic access” to food impact

heavily on food and nutrition security.

This has profound effects on people's

nutritional health and lives by

increasing acute malnutrition, morbidity

and mortality.

Between 1990 and 2003, major armed

conflicts occurred in 17 African

countries. While West Africa has taken

important steps to consolidate peace and

democratic governance after these

conflicts, the gains are increasingly

being endangered by new threats and

challenges. In recent times, thousands

of defenceless Nigerian citizens,

particularly in the northern part of the

country have been killed, maimed and

displaced due to growing insurgency

and sectarian violence by the group

known as Boko Haram. The continuous

spate of bombings and killings of

innocent citizens, which began in 2009,

has resulted in a state of civil insecurity

in Nigeria coupled with political and

socioeconomic crises that bedevil the

oil and human resource rich nation.

Between February and March 2014,

three West African nations: Guinea,

Liberia and Sierra Leone witnessed the

world's biggest Ebola Virus Disease

(EVD) outbreak that killed hundreds of

people and threatens regional and global

public health security. In addition to the

loss of lives, the EVD outbreak, which

is characterized by an intense

community spread, is having negative

economic effect on the affected nations

as foreign workers are leaving, flights

are being cancelled and businesses are

recording low sales. EVD, which

remains the deadliest outbreak to date,

has no cure spreads through contact

with an infected person's bodily fluids.

Corruption, poor political leadership

and economic policies have culminated

in free-fall of the Ghanaian Cedi in

addition to increasing inflation.

Consequently, food and nutrition

security of low-income households is

endangered as food prices have risen up

to levels that they can barely afford due

to higher costs of living. This situation

is not too different in most of the West

African nations where corruption, poor

governance is commonplace.

Draughts, floods and pests due to

changes in the world's climate is

affecting many West Africa nations

leading to major shifts in food

production, and availability. The sub-

region is extremely vulnerable to

climate change because its agriculture is

essentially rain-fed. Almost every

country in the region has experienced a

year-by-year reduction in rainfall.

Displacement of farmers from the land

due to civil insecurity and collapse of

public safety; disruption of the

agricultural cycle and destruction of

food stocks and harvests by

environmental factors such as draughts,

floods or fire; and the interference in the

food market caused by poor governance

and economic crisis within the territory

of a country culminate in the disruption

and total collapse of food supply

networks and marketing systems of

affected populations. Disruption or

collapse of food supply ultimately result

shortages that drive prices up to levels

which low-income households cannot

afford.

Provision of emergency food aid to

populations experiencing these

instabilities and food insecurity is an

important short-term response to

ameliorate the plights of affected

populations. However, the sub-region,

and most of Africa must come together

to find lasting solutions to these

challenges.

18


References

An Introduction to the Basic Concepts

of Food Security.

http://www.fao.org/docrep/013/al936e/a

l936e00.pdf

Declaration on the political situation in

West Africa, Abuja, 8th

August 2012,

West African Civil Society Forum

(WACSOF).

http://www.responsibilitytoprotect.org/P

osition%20Statement%20by%20WACS

OF.pdf

West Africa, United Nations

Department of Political Affairs

http://www.un.org/wcm/content/site/un

dpa/main/activities_by_region/africa/we

st_africa

Special Ministerial Meeting on Ebola

Virus Disease in West Africa Accra,

Ghana, 2 - 3 July 2014

http://www.afro.who.int/en/clusters-a-

programmes/dpc/epidemic-a-pandemic-

alert-and-response/epr-highlights/4187-

special-ministerial-meeting-ebola-accra-

2-3-july-2014.html

Outbreak of Ebola in Guinea, Liberia,

and Sierra Leone:

http://www.cdc.gov/vhf/ebola/outbreaks

/guinea/

Climate change in West Africa - the risk

to food security and biodiversity.OFEDI

and GRAIN, 2009.

http://www.grain.org/article/entries/775

-climate-change-in-west-africa-the-risk-

to-food-security-and-biodiversity

mHealth and Nutrition: opportunities for health

promotion and nutrition messaging in Southern Africa

Nonsikelelo Mathe, PhD University of Alberta, Canada

There are more mobile phone

subscriptions in Sub Saharan African

(SSA) than in the USA or the European

Union. It is anticipated that by 2017

there will be approximately 1.12 billion

mobile phone subscribers in SSA [1].

The penetration of mobile phones, in

SSA, is estimated to be 63% in 2013

and may reach more than 70% by

2015[2]. These figures imply that

people living in SSA countries are more

connected than ever before, and

potentially have greater access to

information through mobile phones and

other mobile devices. Moreover, the

wide penetration of mobile phones has

the potential to reach large numbers of

people living in resource-limited

settings.

Mobile health or mHealth describes the

use of mobile devices to support public

health and medicine. This includes the

use of short messaging service (SMS),

wireless data transmission, voice

calling, and smartphone applications to

transmit health-related information [3].

The Global Observatory for eHealth

(GOe) defined mHealth as “Medical

and public health practice supported by

mobile devices, such as mobile phones,

patient monitoring devices, personal

digital assistants (PDAs), and other

wireless devices”.

mHealth has the potential to offer

solutions to healthcare workers

including nutritionists and dietitians, to

maximize their impact and efficiency,

especially where access to healthcare

personnel is limited, as in most rural

areas in SSA [4]. Mobile phones have

been used in health education

interventions using text messaging to

address risk factors for non-

communicable diseases in developed

countries [5]. Although most research in

mHealth has been in high income

countries with advanced mobile

information infrastructure, increasingly

a number of mHealth interventions are

being developed and applied to disease

prevention and control in more

resource-limited contexts [4]. Two

examples from Southern African

countries include:

http://www.fao.org/docrep/013/al936e/al936e00.pdf

http://www.fao.org/docrep/013/al936e/al936e00.pdf

http://www.responsibilitytoprotect.org/Position%20Statement%20by%20WACSOF.pdf





http://www.un.org/wcm/content/site/undpa/main/activities_by_region/africa/west_africa





http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/epr-highlights/4187-special-ministerial-meeting-ebola-accra-2-3-july-2014.html





http://www.cdc.gov/vhf/ebola/outbreaks/guinea/




http://www.grain.org/article/entries/775-climate-change-in-west-africa-the-risk-to-food-security-and-biodiversity





In a study in Zambia, a system

operated by nurses in a public sector

cervical cancer prevention program

was used. After taking photographs

of a suspicious cervical lesion with a

mobile phone, nurses in remote

settings sent images electronically to

an expert consultant for review as

well as an SMS message notifying

the consultant to review the images.

The consultant and nurse were able

to communicate via mobile phone

while viewing the images

simultaneously [6].

A South African study involved peer

support for adult women living with

diabetes via mHealth. A series of

educational group sessions

addressing lifestyle improvements

were offered to women living with

diabetes and each was assigned a

“text message buddy” to assist with

lifestyle changes via SMS. After the

sessions, the women were asked

health questions via daily text

messages [7].

Although there is a paucity of

information on the application of

mobile phones and technology in the

context of nutrition in Africa,

elsewhere, mHealth initiatives that

include nutrition have been used in

for health promotion, nutrition

messaging and surveillance. Indeed,

there remains some skepticism and

myths about mHealth [8] and more

research in the context of mHealth in

Africa is needed. However, the

potential influence and impact of

mobile technologies in nutrition

surveillance, monitoring and

evaluation, data gathering and

nutrition interventions is immense.

References

1. International Technology Union

(2013) The World in 2013: ICT Facts

and Figures, World Health

Organization. Geneva

2. Deloitte, Sub-Saharan Africa

Mobile Observatory 2012, 2012.

3. World Health Organization

(2011), mHealth: new horizons for

health through mobile technologies,

2011, World Health Organization.

Geneva

4. Betjeman, T.J., S.E. Soghoian, and

M.P. Foran, (2013) mHealth in Sub-

Saharan Africa. Int J Telemed Appl

p. 482324.

5. Cole-Lewis, H. and T. Kershaw,

(2010) Text messaging as a tool for

behavior change in disease

prevention and management.

Epidemiol Rev, 32(1): p. 56-69.

6. Parham, G.P., et al., (2010) eC3--a

modern telecommunications matrix

for cervical cancer prevention in

Zambia. J Low Genit Tract Dis,

14(3): p. 167-73.

7. Rotheram-Borus, M.J., et al.,

(2012) Diabetes buddies: peer

support through a mobile phone

buddy system. Diabetes Educ, 38(3):

p. 357-65.

8. Biesdorf, S., Niedermann, F.,

(2014) Healthcare’s digital future, in

Mckinsey and Company Insights and

Publications, Mckinsey and

Company.

20


Spotlight on Wisdom G. Dube

Where are you based?

Centre of Excellence for Nutrition,

Potchefstroom, North-West University,

SA

Where are you from?

Zimbabwe

What area of research are you

working in?

I have a growing interest in infant and

young child nutrition research. My

interest is particularly in the area of

“Implementation research”. I would

define my area of research as the

“Bridge linking programming and

research for communities”.

Tell us a little bit about the projects

you are involved in currently?

I am currently the Principal Investigator

for the UNICEF funded project “Infant

and young child feeding training in

Zimbabwe: Analysis and

Recommendations”. This resulted in the

following publication:

Wisdom G. Dube, Thokozile Ncube

(2012). Frontline experiences of

Community Infant and Young Child

Feeding in Zimbabwe. Field

Exchange, Issue No 43, July 2012. p95.

http://fex.ennonline.net/43/frontline

Another project I have been involved in

is “The Functioning and Sustainability

of a School Health Programme in Binga

District, Matabeleland North” in

Zimbabwe, where I work as the project

co-ordinator.

What are your thoughts about global

movements “such as the Scaling Up

Nutrition” and its relevance to young

nutrition researchers such as

yourself?

I would like to comment on the efforts

of the SUNRAY (Sustainable Nutrition

Research for Africa in years to come)

project. This project initiated an agenda

for prioritization of Nutrition research

particularly in Africa. The project was

one of the awarded projects by the

European Commission with the aim of

helping establish research priorities,

strengthening commitment, and

identifying resource needs, synergies

and co-ordinated research efforts on a

European and global level towards

tackling malnutrition

(http://sunrayafrica.co.za). I was

nominated to contribute to the

consultative effort of the SUNRAY in

2012 and this nomination came due to

my active nutrition-research

contributions in Zimbabwe also coupled

by my previous participation in the

ANLP (African Nutrition Leadership

Program,

http://www.africanutritionleadership.org

/ ). l would like to emphasize on the

importance of this growing movement

to any young nutrition researcher. In a

nutshell the project has identified a

number of factors which are particularly

relevant to nutrition research. The

factors include improved interaction and

problem-driven research, capacity

building priority, cross-African

collaborations. Further information

about this important movement can be

found on the website:

http://sunrayafrica.co.za

In relation to the SUN movement, in

2010, l attended a high level meeting on

“Lessons for the Scaling up Nutrition

(SUN) movement”. The purpose of this

meeting was to exchange and learn

lessons from African and Asian

countries, particularly to set an

exchange platform for the SUN

movement approaches from the

different countries, a detailed report is

found on:

(http://www.ennonline.net/pool/files/ife/

cmam-conference-report.pdf).

I was invited to attend the meeting and

represent the government of Zimbabwe

and this came due to my contributions

to nutrition frontline work, l was doing

with the Ministry of Health, Nutrition

department of Zimbabwe. It might have

been a long time since lessons have

been learnt on the SUN, l still believe as

young nutrition researchers there is

need for continued learning from the

experiences of this great advocacy

movement for nutrition action. As a

lesson from the meeting and a

challenge, l look back to a comment

made by David Nabarro about the SUN

saying “The way-forward(in 2010) was

rather not clear and required skilful

approach towards achieving change”. I

also leave this challenge to all young

nutrition-researchers particularly in

Africa to apply ourselves skillfully and

tactfully towards achieving change and

positive nutrition outcomes among the

communities.

References

Email: [email protected]

Linkedin:

za.linkedin.com/pub/wisdom-

dube/31/5a7/169/

Recent achievement (publication of

paper, abstract accepted, conference

attendance, awards, etc.)

Recent Publications:

1.Dube WG, Makoni T, Nyadzayo T.K,

Covic M.N., A strategy to scale-up

Vitamin A supplementation in a remote

rural region in Zimbabwe, South-

African Journal of Child-




http://sunrayafrica.co.za/

http://www.africanutritionleadership.org/







http://www.ennonline.net/pool/files/ife/cmam-conference-report.pdf



http://za.linkedin.com/pub/wisdom-dube/31/5a7/169/




21


Health(SAJCH),Vol 8.No 2, 2014.

http://sajch.org.za/index.php/SAJCH/art

icle/view/618/520

2. Dube WG. Nutrition and Economic

growth in South Africa: A co-

integration approach model, Journal of

Economic studies (JES) (Accepted &

Forthcoming), 2014. http://mpra.ub.uni-

muenchen.de/id/eprint/52950

Abstracts Accepted:

1. "Progress in elimination of iodine

deficiency disorders in Zimbabwe- A

program coverage". Micronutrient

Forum, Ethiopia, 2014.

2. "Weight-for-age charts and Z-scores

developed for 10-15 year old

adolescents in north-west province

South Africa: the HIV/AIDS context":

20th

International AIDS conference

Melbourne Australia, 2014.

Announcements

African Nutrition Matters Symposium: processes, challenges, opportunities and the way forward 21 July 2014 – Accra, Ghana (Parallel symposium at ANEC VI. Venue: Osei Tutu)

1:00-2:00 PM.

Building Healthy Global Food Systems: A New imperative for Public Health: Ground-breaking Food Policy

Conference. September 8-9, 2014 – Oxford, UK.

http://www.wphna.org/Oxford2014/

25th Congress of the Nutrition Society of South Africa and the13th Congress of the Association for Dietetics

in South Africa. September 16-19, 2014 - Boksburg, South Africa.

http://www.nutritioncongress.co.za/index.php/component/content/category/2-uncategorised

Third World Congress of Public Health Nutrition 9-12 November 2014 - Las Palmas de Gran, Spain.

http://www.nutrition2014.org/

International Nutrition Conference (ICN2) organized by FAO and WHO 19 – 21 November 2014 – Rome, Italy.

http://www.fao.org/about/meetings/icn2/en/

African Nutrition Matters is the official bulletin of the African Nutrition Society.

http://sajch.org.za/index.php/SAJCH/article/view/618/520




http://mpra.ub.uni-muenchen.de/id/eprint/52950

http://mpra.ub.uni-muenchen.de/id/eprint/52950

http://www.wphna.org/Oxford2014/

http://www.nutritioncongress.co.za/index.php/component/content/category/2-uncategorised

http://www.nutrition2014.org/

http://www.fao.org/about/meetings/icn2/en/

Issue of June 2014

Documents

Transcript of Issue of June 2014