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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