National Food and Nutrition Commission

Lusaka, Zambia

National Food and Nutrition Commission

Lusaka, Zambia
SEARCH FILTERS
Time filter
Source Type

Chileshe J.,Tropical Diseases Research Center | Kalungwana N.,Tropical Diseases Research Center | Siamusantu W.,National Food and Nutrition Commission
Journal of Nutrition | Year: 2017

Background: Higher iron stores, defined by serum ferritin (SF) concentration, may increase malaria risk. Objective: We evaluated the association between SF assessed during low malaria season and the risk of malaria during high malaria season, controlling for inflammation. Methods: Data for this prospective study were collected from children aged 4-8 y (n = 745) participating in a biofortified maize efficacy trial in rural Zambia. All malaria cases were treated at baseline (September 2012). We used baseline SF and malaria status indicated by positive microscopy at endline (March 2013) to define exposure and outcome, respectively. Iron status was defined as deficient (corrected or uncorrected SF < 12 or < 15 μg/L, depending on age < 5 or ≥5 y, respectively), moderate (<75 μg/L, excluding deficient), or high (≥75 μg/L). We used a modified Poisson regression to model the risk of malaria in the high transmission seasons (endline) as a function of iron status assessed in the lowmalaria seasons (baseline). Results: We observed an age-dependent, positive dose-response association between ferritin in the low malaria season and malaria incidence during the high malaria season in younger children. In children aged < 6 y (but not older children), we observed a relative increase in malaria risk in the moderate iron status [incidence rate ratio (IRR) with SF: 1.56; 95% CI: 0.64, 3.86; IRR with inflammation-corrected SF: 1.92; 95% CI: 0.75, 4.93] and high iron status (IRR with SF: 2.66; 95% CI: 1.10, 6.43; or IRR with corrected SF: 2.93; 95% CI: 1.17, 7.33) categories compared with the deficient iron status category. The relative increase in malaria risk for children with high iron status was statistically significant only among those with a concurrently normal serum soluble transferrin receptor concentration (<8.3 mg/L; IRR: 1.97; 95% CI: 1.20, 7.37). Conclusions: Iron adequacy in 4- to 8-y-old children in rural Zambia was associated with increased malaria risk. Our findings underscore the need to integrate iron interventions with malaria control programs. This trial was registered at clinicaltrials.gov as NCT01695148. © 2017 American Society for Nutrition.


Talegawkar S.A.,George Washington University | Siamusantu W.,National Food and Nutrition Commission
Food and nutrition bulletin | Year: 2015

BACKGROUND: Detailed dietary intake data in low-income populations are needed for research and program evaluation. However, collection of such data by paper-based 24-hour recall imposes substantial demands for staff time and expertise, training, materials, and data entry.OBJECTIVE: To describe our development and use of a tablet-based 24-hour recall tool for conducting dietary intake surveys in remote settings.METHODS: We designed a 24-hour recall tool using Open Data Kit software on an Android tablet platform. The tool contains a list of local foods, questions on portion size, cooking method, ingredients, and food source and prompts to guide interviewers. We used this tool to interview caregivers on dietary intakes of children participating in an efficacy trial of provitamin A-biofortified maize conducted in Mkushi, a rural district in central Zambia. Participants were children aged 4 to 8 years not yet enrolled in school (n = 938). Dietary intake data were converted to nutrient intakes using local food composition and recipe tables.RESULTS: We developed a tablet-based 24-hour recall tool and used it to collect dietary data among 928 children. The majority of foods consumed were maize, leafy vegetable, or small fish dishes. Median daily energy intake was 6416 kJ (1469 kcal).CONCLUSIONS: Food and nutrient intakes assessed using the tablet-based tool were consistent with those reported in prior research. The tool was easily used by interviewers without prior nutrition training or computing experience. Challenges remain to improve programming, but the tool is an innovation that enables efficient collection of 24-hour recall data in remote settings. © The Author(s) 2015.


Fiedler J.L.,HarvestPlus | Fiedler J.L.,National Food and Nutrition Commission | Mubanga F.,National Food and Nutrition Commission | Siamusantu W.,National Food and Nutrition Commission | And 3 more authors.
Health Policy and Planning | Year: 2014

Child Health Weeks (CHWs) are semi-annual, campaign-style, facility-and outreach-based events that provide a package of high-impact nutrition and health services to under-five children. Since 1999, 30% of the 85 countries that regularly implement campaign-style vitamin A supplementation programmes have transformed their programmes into CHW. Using data drawn from districts' budget, expenditures and salary documents, UNICEF's CHW planning and budgeting tool and a special purposive survey, an economic analysis of the June 2010 CHW's provision of measles, vitamin A and deworming was conducted using activity-based costing combined with an ingredients approach. Total CHW costs were estimated to be US$5.7 million per round. Measles accounted for 57%, deworming 22% and vitamin A 21% of total costs. The cost per child was US$0.46. The additional supplies and personnel required to include measles increased total costs by 42%, but reduced the average costs of providing vitamin A and deworming alone, manifesting economies of scope. The average costs of covering larger, more urban populations was less than the cost of covering smaller, more dispersed populations. Provincial-level costs per child served were determined primarily by the number of service sites, not the number of children treated. Reliance on volunteers to provide 60% of CHW manpower enables expanding coverage, shortening the duration of CHWs and reduces costs by one-third. With costs of $1093 per life saved and $45 per disability-adjusted life-year saved, WHO criteria classify Zambia's CHWs as 'very cost-effective'. The continued need for CHWs is discussed. © 2012 The Author.


PubMed | George Washington University and National Food and Nutrition Commission
Type: Journal Article | Journal: Food and nutrition bulletin | Year: 2016

Detailed dietary intake data in low-income populations are needed for research and program evaluation. However, collection of such data by paper-based 24-hour recall imposes substantial demands for staff time and expertise, training, materials, and data entry.To describe our development and use of a tablet-based 24-hour recall tool for conducting dietary intake surveys in remote settings.We designed a 24-hour recall tool using Open Data Kit software on an Android tablet platform. The tool contains a list of local foods, questions on portion size, cooking method, ingredients, and food source and prompts to guide interviewers. We used this tool to interview caregivers on dietary intakes of children participating in an efficacy trial of provitamin A-biofortified maize conducted in Mkushi, a rural district in central Zambia. Participants were children aged 4 to 8 years not yet enrolled in school (n = 938). Dietary intake data were converted to nutrient intakes using local food composition and recipe tables.We developed a tablet-based 24-hour recall tool and used it to collect dietary data among 928 children. The majority of foods consumed were maize, leafy vegetable, or small fish dishes. Median daily energy intake was 6416 kJ (1469 kcal).Food and nutrient intakes assessed using the tablet-based tool were consistent with those reported in prior research. The tool was easily used by interviewers without prior nutrition training or computing experience. Challenges remain to improve programming, but the tool is an innovation that enables efficient collection of 24-hour recall data in remote settings.


Fiedler J.L.,International Food Policy Research Institute | Lividini K.,International Food Policy Research Institute | Zulu R.,International Center for Tropical Agriculture | Kabaghe G.,National Food and Nutrition Commission | And 2 more authors.
Food and Nutrition Bulletin | Year: 2013

Background. Zambia was a pioneer when it started fortifying sugar with vitamin A in 1998. Micronutrient deficiencies-especially among young children-have changed little over the past decade. In 2008 an initiative to introduce fortified flours was halted when last-hour questions about the program could not be answered. Objective. To provide information about the need, coverage, and impact of alternative fortification portfolio options to help Zambia overcome its fortification impasse. Methods. Using household data from the 2006 Living Conditions Monitoring Survey, apparent micronutrient intake levels and apparent consumption levels of sugar, vegetable oil, wheat flour and maize meal were estimated. The household level data were used to estimate individual intakes by assuming that food was distributed among household members in direct proportion to their share of the household's total adult consumption equivalent. Intake adequacy was measured relative to age- and gender-specific Estimated Average Requirements. Combining information on the industrial structure and estimated fortifiable quantities consumed of each food, and assuming the nutrient content is that specified in official regulations, simulations were conducted of the coverage and impact of 14 fortification portfolios. Results. Maize, the most commonly consumed food, is consumed in a fortifiable form by only 23% of the population. Sugar fortification is estimated to have reduced inadequate intake of vitamin A from 87% to 79%. Introducing oil fortification could reduce the prevalence of inadequate vitamin A intake to 61%, and fortifying roller and breakfast maize meal would further reduce it to 57%, and reduce inadequate iron and zinc intakes by 2.2% and 5.5%, respectively. Implementing WHO flour guidelines would triple the potential iron and zinc impacts. Conclusion. Analysis of LCMS apparent consumption data have helped address important information gaps and provide better understanding of the coverage and impacts of alternative fortification portfolios. © 2013, The Nevin Scrimshaw International Nutrition Foundation.


Fiedler J.L.,International Food Policy Research Institute | Lividini K.,International Food Policy Research Institute | Kabaghe G.,National Food and Nutrition Commission | Zulu R.,International Center for Tropical Agriculture | And 4 more authors.
Food and Nutrition Bulletin | Year: 2013

Background. Since fortification of sugar with vitamin A was mandated in 1998, Zambia's fortification program has not changed, while the country remains plagued by high rates of micronutrient deficiencies. Objective. To provide evidence-based fortification options with the hope of reinvigorating the Zambian fortification program. Methods. Zambia's 2006 Living Conditions Monitoring Survey is used to estimate the apparent intakes of vitamin A, iron, and zinc, as well as the apparent consumption levels and coverage of four fortification vehicles. Fourteen alternative food fortification portfolios are modeled, and their costs, impacts, average cost-effectiveness, and incremental cost-effectiveness are calculated using three alternative impact measures. Results. Alternative impact measures result in different rank orderings of the portfolios. The most costeffective portfolio is vegetable oil, which has a cost per disability-adjusted life-year (DALY) saved ranging from 12% to 25% of that of sugar, depending on the impact measure used. The public health impact of fortified vegetable oil, however, is relatively modest. Additional criteria beyond cost-effectiveness are introduced and used to rank order the portfolios. The size of the public health impact, the total cost, and the incremental cost-effectiveness of phasing in multiple vehicle portfolios over time are analyzed. Conclusions. Assessing fortification portfolios by measuring changes in the prevalence of inadequate intakes underestimates impact. A more sensitive measure, which also takes into account change in the Estimated Average Requirement (EAR) gap, is provided by a dose-response-based approach to estimating the number of DALYs saved. There exist highly cost-effective fortification intervention portfolios with substantial public health impacts and variable price tags that could help improve Zambians' nutrition status. © 2013, The Nevin Scrimshaw International Nutrition Foundation.


Nuss E.T.,University of Wisconsin - Madison | Arscott S.A.,University of Wisconsin - Madison | Bresnahan K.,University of Wisconsin - Madison | Pixley K.V.,Wheat Improvement Center | And 5 more authors.
Food and Nutrition Bulletin | Year: 2012

Background. Vitamin A deficiency is associated with poor health outcomes related to reproduction, growth, vision, and immunity. Biofortification of staple crops is a novel strategy for combating vitamin A deficiency in high-risk populations where staple food intakes are high. African populations are proposed beneficiaries of maize (Zea mays) biofortified with provitamin A carotenoids, often called "orange maize"because of its distinctive deep yellow-orange kernels. The color facilitates ready recognition but presents a cultural challenge to maizeconsuming populations, including those in much of Africa, who traditionally eat white varieties. Objective. This study explores the intake patterns of, as well as adaptation to, traditional foods made with provitamin A-biofortified maize compared with white maize in rural Zambian children 3 to 5 years of age (n = 189) during a 3-month feeding trial. Methods. The subjects were fed a breakfast of maize porridge (sweet mush), a lunch of maize nshima (stiff mush) with various side dishes, and an afternoon snack based on a 6-day rotating menu. The trial was conducted in 2010. The orange maize used in the trial came from three different sources. O1 maize was from the 2009 harvest and was stored in a freezer until use in 2010. O2 maize was also from the 2009 harvest and was stored in a cold room until 2010. O3 ("fresh") maize was from the 2010 harvest and was fed immediately after harvest in week 9 of the study and then stored in a freezer until milling for the final four weeks. Results. Consumption of menu items, except snacks, was influenced by week (p < .0084). The intakes of porridge and nshima made with orange maize equaled those of porridge and nshima made with white maize from week 2 onward. The intakes of porridge and nshima prepared from O1 and O2 did not differ, but intakes became significantly higher when meals made from O3 were introduced (p < .014 for porridge and p ≤ .013 for nshima). Conclusions. These results demonstrate quick adaptation to orange maize, a preference for recently harvested maize, and an optimistic outlook for similar adaptation patterns in other biofortified-maize target countries. ©2012, The United Nations University.


Fiedler J.L.,International Food Policy Research Institute | Afidra R.,Flour Fortification Initiative | Mugambi G.,Ministry of Public Health and Sanitation | Tehinse J.,Independent food and nutrition consultant | And 7 more authors.
Annals of the New York Academy of Sciences | Year: 2014

The economic feasibility of maize flour and maize meal fortification in Kenya, Uganda, and Zambia is assessed using information about the maize milling industry, households' purchases and consumption levels of maize flour, and the incremental cost and estimated price impacts of fortification. Premix costs comprise the overwhelming share of incremental fortification costs and vary by 50% in Kenya and by more than 100% across the three countries. The estimated incremental cost of maize flour fortification per metric ton varies from $3.19 in Zambia to $4.41 in Uganda. Assuming all incremental costs are passed onto the consumer, fortification in Zambia would result in at most a 0.9% increase in the price of maize flour, and would increase annual outlays of the average maize flour-consuming household by 0.2%. The increases for Kenyans and Ugandans would be even less. Although the coverage of maize flour fortification is not likely to be as high as some advocates have predicted, fortification is economically feasible, and would reduce deficiencies of multiple micronutrients, which are significant public health problems in each of these countries. © 2013 New York Academy of Sciences.


PubMed | Johns Hopkins University, Tropical Diseases Research Center and National Food and Nutrition Commission
Type: Journal Article | Journal: The Journal of nutrition | Year: 2016

Impaired dark adaptation is an early functional indicator of vitamin A deficiency that may be prevented by regular dietary intake of foods containing provitamin A carotenoids.We tested the impact of provitamin A carotenoid-biofortified maize consumption (15 g -carotene/g) on dark adaptation in Zambian children.We used a cluster-randomized trial of children aged 4-8 y (n = 1024) in Mkushi District, Zambia, and compared the regular consumption (2 meals/d, 6 d/wk for 6 mo) of biofortified orange maize (OM) to white maize (WM). The primary outcome was the serum retinol response. In a random sample (n = 542), we used a digital pupillometer to test pre- and postintervention responses to graded light stimuli (-2.9 to 0.1 log cd/mAt baseline, 11.7% of the children had serum retinol <0.7 mol/L, 14.4% had impaired dark adaptation (pupillary threshold -1.11 log cd/mThe regular consumption of provitamin A carotenoid-biofortified maize increased pupillary responsiveness among children with marginal or deficient vitamin A status, providing evidence of a functional benefit to consuming this biofortified crop. This trial was registered at clinicaltrials.gov as NCT01695148.


PubMed | Center for Human Nutrition, Tropical Diseases Research Centre, Craft Technologies Inc. and National Food and Nutrition Commission
Type: Journal Article | Journal: The American journal of clinical nutrition | Year: 2016

Vitamin A deficiency remains a nutritional concern in sub-Saharan Africa. Conventionally bred maize hybrids with high provitamin A carotenoid concentrations may have the potential to improve vitamin A status in maize-consuming populations.We evaluated the efficacy of regular provitamin A carotenoid-biofortified orange maizemeal (15 g -carotene/g) consumption in improving vitamin A status and reducing vitamin A deficiency in children.This was a cluster-randomized controlled trial in the rural farming district of Mkushi, Zambia. All 4- to 8-y-old children in an 400-km(2) area were identified and grouped by proximity into clusters of 15-25 children. We randomly assigned clusters to 1) orange maizemeal (n = 25), 2) white maizemeal (n = 25), or 3) a parallel, nonintervention group (n = 14). Children in intervention clusters (n = 1024) received 200 g maizemeal for 6 d/wk over 6 mo; the maizemeal was prepared according to standardized recipes and served in cluster-level kitchens. Staff recorded attendance and leftovers. We collected venous blood before and after the intervention to measure serum retinol, -carotene, C-reactive protein, and 1-acid glycoprotein.Intervention groups were comparable at baseline, and vitamin A status was better than anticipated (12.1% deficient on the basis of serum retinol <0.7 mol/L). Although attendance at meals did not differ (85%), median daily maize intake was higher in white (154 g/d) than in orange (142 g/d) maizemeal clusters. At follow-up, mean serum -carotene was 0.14 mol/L (95% CI: 0.09, 0.20 mol/L) higher in orange maizemeal clusters (P < 0.001), but mean serum retinol (1.00 0.33 mol/L overall) and deficiency prevalence (17.1% overall) did not differ between arms.In this marginally nourished population, regular biofortified maizemeal consumption increased serum -carotene concentrations but did not improve serum retinol. This trial was registered at clinicaltrials.gov as NCT01695148.

Loading National Food and Nutrition Commission collaborators
Loading National Food and Nutrition Commission collaborators