Towards a definition of nutrition research priorities in

TowardsadefinitionofnutritionresearchprioritiesinTanzania

DavidTschirley,TumainiCharles,IsaacMinde,andDavidNyange(MSU/ASPIRES)

withcontributionsfromJoyceKinabo andJohnMsuya (SUA)PresentedattheNutritionResearchStakeholders’Meeting

DaresSalaam,Tanzania21May2018

Background:Foodsystemsandnutrition

ThesisNutritionistheoutcome ofaneconomicand

social/culturalfoodsystem

Itcanbeinfluenced bypoliciesanddirectlyaffected byprogrammaticinterventions

Butwithoutattentiontoandimprovementofthefoodsystem fromwhichitemerges,nutritioncannotbe

sustainablyimproved

FoodSystem(Activities:Prodn,storage,distribution,processing,

packaging,wholesaling,advertising,retailing,consumption)(Outcomes:availability,prices,safety,healthfulness,equity)

FoodSystem(Activities:Prodn,storage,distribution,processing,

packaging,wholesaling,advertising,retailing,consumption)(Outcomes:availability,prices,safety,healthfulness,equity)

Theconsumer’sFoodEnvironment

Urbanization

FoodSystem(Activities:Prodn,storage,distribution,processing,

packaging,wholesaling,advertising,retailing,consumption)(Outcomes:availability,prices,safety,healthfulness,equity)

Theconsumer’sFoodEnvironment

Economicgrowth Globalization

Urbanization

FoodSystem(Activities:Prodn,storage,distribution,processing,

packaging,wholesaling,advertising,retailing,consumption)(Outcomes:availability,prices,safety,healthfulness,equity)

Theconsumer’sFoodEnvironment

Publicpolicy&investment

Economicgrowth Globalization

Urbanization

Publicpolicy&investment

FoodSystem(Activities:Prodn,storage,distribution,processing,

packaging,wholesaling,advertising,retailing,consumption)(Outcomes:availability,prices,safety,healthfulness,equity)

Theconsumer’sFoodEnvironment

Diets

Economicgrowth Globalization

Urbanization

Publicpolicy&investment

FoodSystem(Activities:Prodn,storage,distribution,processing,

packaging,wholesaling,advertising,retailing,consumption)(Outcomes:availability,prices,safety,healthfulness,equity)

Theconsumer’sFoodEnvironment

Diets

Economicgrowth Globalization

Urbanization

Publicpolicy&investment

FoodSystem(Activities:Prodn,storage,distribution,processing,

packaging,wholesaling,advertising,retailing,consumption)(Outcomes:availability,prices,safety,healthfulness,equity)

Theconsumer’sFoodEnvironment

Diets

Nutritionoutcomes

Economicgrowth Globalization

Urbanization

Publicpolicy&investment

FoodSystem(Activities:Prodn,storage,distribution,processing,

packaging,wholesaling,advertising,retailing,consumption)(Outcomes:availability,prices,safety,healthfulness,equity)

Theconsumer’sFoodEnvironment

Diets

Nutritionoutcomes

Economicgrowth Globalization

Urbanization

Publicpolicy&investment

FoodSystem(Activities:Prodn,storage,distribution,processing,

packaging,wholesaling,advertising,retailing,consumption)(Outcomes:availability,prices,safety,healthfulness,equity)

Theconsumer’sFoodEnvironment

Diets

Nutritionoutcomes

Economicgrowth Globalization

Urbanization

FoodSystem(Activities:Prodn,storage,distribution,processing,

packaging,wholesaling,advertising,retailing,consumption)(Outcomes:availability,prices,safety,healthfulness,equity)

Theconsumer’sFoodEnvironment

Diets

Nutritionoutcomes

Publicpolicy&investment

Economicgrowth Globalization

Urbanization

Programmaticinterventionsmustoperate withinthissystem

Theirsuccess willbestronglyaffectedbythesystemTheirdesign mustthereforebebasedonan

understandingofthissystem

Publicpolicy&investment

Foodandnutritionrelated

programmaticinterventions

Foodandnutritionrelated

programmaticinterventionsDiets

Nutritionoutcomes

Economicgrowth Globalization

Urbanization

FoodSystem(Activities:Prodn,storage,distribution,processing,

packaging,wholesaling,advertising,retailing,consumption)(Outcomes:availability,prices,safety,healthfulness,equity)

Theconsumer’sFoodEnvironment

Knowledgeneededintwobroadareas

• Fundamentaldriversinthelocalcontext• Programmaticinterventions

• Givenlocalcontext,howcanprogrammaticinterventionsbedesignedtoachievemaximumsustainableimpactonnutritionaloutcomes?

Technicalnutritionknowledgeneedstofeedinto

both

Knowledgeneededintwobroadareas

• Fundamentaldriversinthelocalcontext• Programmaticinterventions

• Givenlocalcontext,howcanprogrammaticinterventionsbedesignedtoachievemaximumsustainableimpactonnutritionaloutcomes?

Technicalnutritionknowledgeneedstofeedinto

both

Knowledgeneededintwobroadareas

• Fundamentaldriversinthelocalcontext• Programmaticinterventions

• Givenlocalcontext,howcanprogrammaticinterventionsbedesignedtoachievemaximumsustainableimpactonnutritionaloutcomes?

Technicalnutritionknowledgeneedstofeedinto

both

Issues,knowledgegaps,andillustrativeresearchtopics

Issue#1:Stuntingandwasting

• Whatistheissue?• Ratesaredeclining,butarestillhigh• Ratesarehighestinsomeofthemostproductiveareasofthecountry• SouthernHighlands

Issue#1:Stuntingandwasting(cont’d)

• Whatistheknowledgegap?• Whyaregeographicalareaswithhigherfarmlevelproductivitynotseeingbetternutritionaloutcomes?• Whatarethedriversofnutritionaloutcomesathouseholdlevel?Dothesevarybyrural-andurbanareas?

• Possibleresearch• NotetheongoingIFPRIworkusingDHS• UseNPStoexplorethecorrelatesofnutritionaloutcomes

• Whatisthespatialanddemographicdistributionofwastingandstunting?• Whatarethefactors,athh orcommunitylevel,thatmediatetheimpactofanarea’sagriculturalproductiononnutritionoutcomes?

• Whatdoesthisimplyaboutprogrammaticdesign?

Issue#2:Anemia• Whatistheissue?• TheDHSshowsrecentincreasesinanemiaamongwomenandchildren,duetoironandfolicaciddeficiency,evenaswastingandstuntinghavedeclined• Ratesarelowest intheSouthernHighlands,wherewastingandstuntingarehighest

Issue#2:Anemia

• Knowledgegap• Howdothedriversofstuntingandwastingdifferfromthoseforanemia?Whatprogrammaticinterventionswouldbemosteffectiveinsustainablyandcost-effectivelyaddressingtheissue?

• Possibleresearch• Investigatemorecarefullythedistributionofwasting,stunting,andanemiaacrosshouseholds inIringaandNjombe• Spatially(urban,rural)• Demographically(malevs.femaleheads,ageofHHH,education)• Economically(poorcomparedtonon-poor)

• CouldstartwithDHS• Butmightrequireadditionaldatacollection

Issue#3:Foodsafety

• Whatistheissue?• Concernsaboutfoodsafetylikelytoriseas

• HHsrelymoreonmarketsfortheirfood…andmarketinfrastructurecontinuesoftentobedeplorable

• Supplychainsbecomelonger(citiesreachingfurtheroutintoruralareastosourcetheirfood),and

• Theconsumptionofperishableandprocessedfoodsincreases• Moreandmorefoodisconsumedoutsidethehome…andit’spreparationisoftenunderhighlyunhygienicconditions

• Chemical(e.g.mycotoxininmaizeorsunflower)• Microbial(especiallyinperishables)

Issue#3:Foodsafety(cont’d)

• Whatistheknowledgegap?• DolargecompaniesproducesaferprocessedfoodsthanSMEs?

• Regulatoryimplications?• HowprevalentismycotoxininTanzania’svaluechains?Whattypeofconsumerismostexposedtothesetoxins?• Educationalandtestingimplications?

• Howprevalentismicrobialinfection,atlevelsdangeroustohumanhealth,in• Perishablevaluechains?Whichvaluechainsaremostaffected?Where?• Preparedfoodawayfromhome?Whattypesofestablishmentsandwhattypesoffoodaremostrisky?

Issue#3:Foodsafety(cont’d)

• Possibleresearch• Follow-uptheearlierworkonmycotoxininsunflowerwithamoredefinitivestudy.Considermaizeaswell• Estimateburdenofdiseaseanditseconomiccost(DALYs)

• Assessmicrobialcontaminationinfreshproduce,bysourceandend-point• Geographic(urban,peri-urban,rural)• Typeoffarmer(large,medium,small)• Typeofretailoutlet(soko vs.supermarket)

• Assessfoodsafetyinthefood-away-from-homesector• Distinguishingbetweentypesofoutlets

Issue#4:Overweight,obesity,anddietquality

• Whatistheissue?• OverweightandobesityandrelatedNCDsarerisingrapidlyinTanzania

Anddiabetesandhypertensionalsorising

sharply

Source:HLPE

43%offemales,and21%ofmen,overweightorobese

WomenMenWomenMenWomenMenWomenMenOverweightObesitySevereObesity MorbidObesity

Issue#4:Overweight,obesity,anddietquality(cont’d)• Whatistheknowledgegap?• Whatarethedemographic(education,income,gender,age)correlatesofoverweightandobesity?• Whatarethespatialcorrelates?(regional,rural-urban)• Howdovariationsintheconsumer’sfoodenvironment correlatewithoverweightandobesity?• Whatmeasuresofdietqualitybestpredictthelikelihoodofbeingoverweightorobese?• Doesnutritionalknowledgecorrelatewithoverweightandobesity?

Issue#4:Overweight,obesity,anddietquality(cont’d)• Possibleresearch• Quantitativemonitoringovertimeofthefoodenvironment,linkedtochangesinconsumerdietsandtheirattitudes andknowledgerelativetonutrition• communityfoodenvironment:number,type,locationandaccessibilityoffoodoutlets;typeanddensityoffoodadvertising/messaging

• consumerfoodenvironment:availability,cost,andqualityofhealthyandunhealthyfoodoptionswithinoutlets

• Consumerknowledgeandattitudestowardshealthyandunhealthyfoods• Consumerbehavior

• Outlettypesvisited• Foodspurchased

• Outcomesintermsofdietqualityandnutritionalstatus• Originaldatacollectionincitiesofvaryingsizes,andperi-urbanandruralareaslinkedtothosecities

Issue#5:Effectivenessofinterventions

• Whatistheissue?• Aneedforimpactevaluation tobetterunderstandwhatapproachesachieveimpact,andoperationalresearch tounderstandthepathwaysthroughwhichimpactisachieved(ornot)

• Whatistheknowledgegap?• Therehasbeenverylittleimpactevaluationorrigorousoperationalresearchdoneonnutritioninterventionsinthecountry

• Possibleresearch• Acombinationofex-post andex-ante research• Designofinterventionstoallowimpactevaluation• Stakeholderstoidentifykeypriorities

Nowthestakeholdersneedtodefinethepriorities!

- Additionalordifferentkeyissues?- Ifso,defineknowledgegapsandproposeresearch