This document summarizes research on delivering nutrition through orange-fleshed sweet potatoes. Key points include: 1) An estimated 32% of African children are vitamin A deficient, which can cause health issues. Orange-fleshed sweet potatoes are a potential solution as they are rich in vitamin A. 2) Early studies from 1995-1997 in Kenya showed orange-fleshed varieties yielded as well as local ones and were liked by consumers. Further research optimized varieties and established their efficacy in improving vitamin A levels. 3) Integrated agriculture-nutrition-market interventions in Mozambique and Uganda significantly increased vitamin A intake and reduced deficiencies, showing the effectiveness of this approach.

1. Delivering Nutrition through
Orange-Fleshed Sweetpotato:
The Growing Evidence Base
Food Nutrition in Eastern & Southern Africa
Nairobi, Kenya
10 September 2012
Jan Low, CIP-SSA

2. An estimated 32% of Africa’s
The Problem children under five years of age
are vitamin A deficient.
Vitamin A deficiency can limit
growth, weaken immunity, cause
xeropthalmia leading to
blindness, and increased risk of
mortality
VAD is caused by inadequate
intakes and loss due to illness
Food-based approaches to
combat VAD address one of
the major underlying causes
but criticized for lack of evidence

3. Orange-fleshed Sweetpotato:
A Potential Contribution to the Solution
 Most varieties in SSA white-fleshed: marginal change
 The Challenge: Will OFSP yield as well as the local variety?
Will consumers like the taste?
What is needed to impact VAD?
Will initial adoption be sustained?

4. Answering these questions
took more than a decade…:
 1st pilot study in Western
Kenya (1995-97)
 Nutrition education
component essential
 Preferences differed
--Adults: high dry matter
--Children: low dry matter
Yellow-fleshed lack sufficient
pro-vitamin A, focus on orange
 Easy to incorporate
sweetpotato weaning foods
into young child diet &
KARI/CIP/CARE collaboration
funded by ICRW/OMNI/USAID improve feeding frequency

5. Efficacy Study Among School Children in
South Africa
Resisto
Bosbok Efficacy
studies
1. Completed in South Africa in 2004
Potential of OFSP 2. Modified relative dose response method
in combating VAD 3. 120 gm. fed to school children for 5 days a
week for 3 months significantly improved
amounts of Vitamin A stored in the liver
van Jaarsveld et al., AJCN 81, 1080-87, 2005.

6. AGRICULTURE NUTRITION MARKETING
Demand Creation
Introduce new source of and Market Development
Vitamin A and Energy: Empowerment for OFSP Roots and
Biofortified OFSP through Processed Products
Knowledge
Mechanisms
1. Create awareness of
Vitamin A problem 1. Link to markets to
1. Substitute white with orange earn income
2. Improve agronomic practices 2. Create awareness of
Vitamin A-rich foods 2. Diversify use through
3. Improve storage practices
3. Empower caregivers development of
to change practices OFSP products
Outcomes
1. Knowledge in local
1. Increased supply of beta-
carotene & energy community
1. Increased household
2. Sustained yields 2. Increased demand for
income for growers
3. Increased supply in Vitamin A-rich foods
2. Sustained OFSP
off-season 3. Increased intake
cultivation over time
Vitamin A & energy
Increased Serum Retinol Levels

7. Integrated (agriculture-nutrition-market)
Intervention at Community Level in Mozambique
 Median intake vitamin A almost 8 times higher (24 h recall)
 OFSP contributed 35% vitamin A intake, 6% of energy intake
 15% decline in prevalence of low serum retinol status
attributable to the intervention
Median nutrient intakes yesterday:
non-breastfed children (mean 32 months old)
1600
1414
1400
1226
1200
Amount of Nutrient
Intervention (n=465)
1000
800 Control (n=234)
600
426
400
200
56
0
Vitamin A (μg RAE) Energy (kcal)
P-value=0.00 P-value=0.00
Low, JW et al., Journal of Nutrition 137: 1320-1327, 2007

8. Building the Orange Brand:
Radio programs and market advertising to
increase awareness of Vitamin A rich
foods & increase demand & combat myths

9. Learned that higher root yielding OFSP has
insufficient vine vigor for drought-prone areas
CANASUMANA RESISTO:
-- Hardier vines, more drought resistant -- Has β-Carotene
--Alternating not agglomerated --More consistent medium
storage roots root size desired in
commercial market

10. Sought funding for a major investment to Breed in
Africa for Africa & to improve the “seed” system...
Breeder Maria Andrade (on 15 new drought-tolerant
right) focused on vine vigor, OFSP varieties were
drought tolerance, and taste… released in February 2011
better yield alone is not
sufficient

11. Reaching End Users (REU): 2007-2009
Mozambique: 14,400 households
144 groups
Uganda: 10,292 Households
392 Groups
Wolfgang H PFEIFFER

12. High adoption rates (>60%) &
positive
outcomes on vitamin A intake among
children and their mothers
(intent to treat figures, include non-
adopters)
Wolfgang H PFEIFFER
(Impact Study led by IFPRI)
Estimated Average Requirements (EAR): satisfy 50% of needs of age group

13. Understanding the costs of using the
integrated approach
 Less intensive (M2) model 30% cheaper to implement
 No significant difference in 2 models on key metrics
 Mozambique (secondary staple):
 Average cost for direct beneficiary: $86
 Marginal cost for direct beneficiary: $36
 Marginal cost if indirect beneficiaries included: $19
 Uganda (staple crop):
 Average cost for direct beneficiary: $56
 Marginal cost for direct beneficiary: $22
 Marginal cost if indirect beneficiaries included: $12
 $15-20 USD for disability life year (DALY) saved

14. Would linking more explicitly to a health intervention
substantially improve Vitamin A status?
0.4
0.35
0.3
Change in 0.25
serum retinol 0.2
0.15
0.1
0.05
0
Baseline Fat + Deworming OFSP OFSP + Fat + Deworming
Treatment group
Mean (± SEM) changes in serum retinol after supplementation
Source: Fasli Jalal et al., Am J Clin Nutr 1998; 68:623-9.

15. Can linking an agricultural intervention and nutritional
training to existing ante-natal care services in Western
Kenya provide an incentive to pregnant women to:
1) increase health service utilization
2) increase consumption of OFSP
and other vitamin A rich foods
by themselves and their
children than existing
health services alone?
3) Will there be a positive impact
on vitamin A status?

16. Conclusions
 OFSP root consumption
can significantly
contribute to improved
vitamin A intake & status
 More research needed on impact of other nutrients
 Still much to learn on:
--effective delivery systems, how to cost-
effectively reach large numbers of households
& HIV/AIDS affected households & communities
(SUN Initiative may provide opportunities)
--storage, extended shelf life, processed product
development (new markets; reach urban consumers)

17. SPHI is a multi-
partner, multi-donor
initiative that seeks
to reduce child
undernutrition and
improve smallholder
incomes in 10 million
African families by
2020 through the
effective production
and expanded use of
sweetpotato.
16 Target Countries
SASHA in 8 countries
Other projects in additional 4 Countries