1. Project GCP/BGD/037/MUL
National Food Policy Capacity Strengthening Programme (NFPCSP)
  Training Workshop on
FOOD SECURITY CONCEPTS, BASIC FACTS & MEASUREMENT ISSUES
25 June – 07 July, 2011
Topic: Analytical Approaches for Food security
Sub-topic 2c : Analytics 3: Food Utilization Lecture : Food Utilization/Nutrition By
Mohammad Abdul Mannan, PhD
Nutrition Advisor, NFPCSP-FAO
Distinguished participants, good afternoon,
I shall present my topic on food utilization or nutrition today.

2. Outline of the presentation
Background
Conceptual framework
Nutrition and health status
Food consumption and nutrition situation
Seasonality and disaster
Linkage with different sectors
Concluding
Way forward

3. Food security – An evolving concept
In the 50s and 60s: Food security = self sufficiency in major staples
After World Food Conference of 1974:Food Security = Access to sufficient food
World Food Summit of 1996:“Food security exists when all people, at all times, have physical and economic access tosufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life”.
Food Security is part of Nutrition Security
The concept of Nutrition security — ensuring access to food that is nutritious as well as sufficient — is increasingly being used to stress the importance of the quality of food for people of all ages
All the acceptable definitions of food security in use imply nutrition but only in the sense that
Household FS means that if the household’s food are consumed according to the dietary
requirements of all household members their dietary/nutritional needs will be met; Nutrition security requires simultaneously ‘food’, ‘health’ and ‘care’. So, there is no way to
achieve nutrition security without FS at household level. FS must include ‘food safety; FS and NS are closely interrelated and may appear in a vicious cycle, but at a different
magnitude, according to the context. For instance, where infectious diseases are the
prevailing cause of malnutrition, the addition of more food is not effective, or, vice versa, a
further investment in the health sector does not help, if food insecure was the fundamental
problem

4. What is Nutrition?
Nutrition is the science and practice of consuming and utilizing foods. It is the study of nutrients in food, how the body uses nutrients, and the relationship between diet, health and disease.

5. Why nutrition is important?
Foundation to development contributing to MDG’s
Economic benefit
LBW perpetuates the intergenerational cycle of undernutrition and disease
Economic growth alone unlikely to yield Nutrition results

6. Conceptual framework for analyzing the causes of malnutrition
death & disability
Outcomes
Immediate causes
Inadequate
dietary intake
Disease
Each of the underlying causes are necessary to prevent malnutrition – alone are insufficient to ensure adequate nutritional status.
Underlying causes at household / family level
Insufficient access to FOOD
Inadequate maternal & child CARE practices
Poor water, sanitation & inadequate HEALTH services
Quantity and quality of actual resources –
human, economic & organisational - and the way they are controlled
Basic causes at societal level
Potential resources: environment, technology, people
UNICEF

7. The food and agriculture sector and nutrition Narrowing the “nutrition gap” the gap between what foods are available and what foods are needed for a healthy diet
Diets are often low in quantity, quality and variety
(hunger and micro-nutrient deficiencies)
Increased production of staple foods is not sufficient
Need to ensure local availability and access of the right mix of foods in all seasons
Consumers must be informed
Collaboration must be established with : (a) social protection programmes to support the poorest and (b) with health & multi sectors/programmes

8. The WFS goal of halving the number of undernourished people in the world by 2015 threatens to be out of reach. FAO’s most recent estimates put the number of hungry people at 925 million in 2008 versus 842 million in , the baseline period for the World Food Summit (WFS) and Millennium Development Goals (MDGs). The majority of the world’s undernourished live in developing countries; 2/3 live in just 7 countries (BGD, Democratic Republic of Congo, Ethiopia, India, Indonesia and Pakistan) and over 40% live in China and India alone. Projections for 2010 indicate that the number of undernourished people will decline in the developing regions although with a different pace; the region with most undernourished continues to be Asia and the Pacific, but with a decline of 12% from 658 M in 2009 to 578 M in 2010.
Source: FAO, 2010

9. Undernourishment: FAO estimates
Proportion of undernourished population remains the largest in South Asia
Between and ,prevalence of undernourished decreased in Bangladesh by 11%, the largest decline in South Asia
Country
Undernourished
(millions) in in
Proportion (%) of population undernourished
Proportion (%) of population undernourished
Bangladesh
44.4
41.7 38 27
India
172.4
237.7 20 21
Nepal
4.2
4.5 16
Pakistan
29.6
43.4 25 26
Sri Lanka
4.8
3.8 28 19
Total South Asia
255.4
331.1 22
The situation in selected S Asia countries shows that the % decline of undernourishment in the last 15 years has been satisfactory in Bangladesh, Nepal and better in Sri Lanka but this is not the situation in India and Pakistan.
Source: SOFI ,2010

10. CONTEXT : Bangladesh continues to have the highest Cer DES - 80%

11. Undernourishment trends

12. FOOD CONSUMPTION SITUATION
Significant + correlations between DES Cer% and child MN rates
FAO recommends maximum contribution of DES from cereals (DES Cer % ) as 60% for good health and nutrition; higher than 60% DES Cer makes the diet imbalanced; population habitually consuming relatively high amounts of cereals are likely to suffer from MN; regression analysis on data from 29 countries between dietary indicators and prevalence of stunting, wasting and UW was done; significant correlations were seen between DES Cer % and child MN rates in the region
Source: Authors' own calculation from FAO RAP 2007

13. RELATIONSHIPS WITHIN THE FS FRAMEWORK
The definition of FS emphasizes availability, accessibility and utilization of food; the inclusion of utilization underlines that nutrition security is more than food security; This figure illustrates the relationship among the categorical elements within the conceptual framework of FS; 2 determinants influence the framework. Physical determinants influence the food flow :availability, accessibility and utilization; availability is achieved if adequate and safe food is ready to have at people’s disposal; access is ensured when all HHs have sufficient resources to obtain appropriate foods (through production, purchase or donation) for a nutritious diet. Adequate utilization refers to the ability of the human body to ingest and metabolize food; nutritious and safe diets, an adequate biological and social environment, proper health care to avoid disease ensure utilization of food. In most cases utilization is discussed only from the biological perspective, however, food has also an imp social role keeping flys and communities together; in times of fis, this role fns can be achieved only when sufficient culturally adapted food is available within the hh and communities to meet their biological and social needs; Stability is a temporal determinant of FS and affects all 3 physical determinants; includes factors of seasonality and disaster situations

14. Nutritional and health status
This ‘vicious cycle’ is known as the “malnutrition-infection cycle”:
INADEQUATE DIETARY INTAKE
Weight loss, growth faltering and reduced immunity, which lower the body’s ability to resist infection.
leads to
this causes
this results in
Loss of appetite, malabsorption of nutrients, altered metabolism and increased nutrient needs.
Longer, more severe and more frequent disease episodes.
leads to

15. Nutritional and health status
Nutrition and health are closely linked:
NUTRITIONAL STATUS
disease contributes to malnutrition
HEALTH STATUS
while malnutrition makes an individual more susceptible to disease.
This can eventually lead to severe malnutrition and death.

16. FOOD CONSUMPTION SITUATION
Increase in consumption of vegetables by 20% (157g); potato by 50% (63g)
Increase in vegetable consumption by 20%: 157 g /d which is still lower than the WHO/FAO norm; steady increase in consumption of potato (62g); milk consumption is low; all foods have increased with remarkable increases in vegetables and potatoes; massive horticulture production and consumption strategies in the country
Source: Adapted from BBS-HES/HIES,

17. FOOD CONSUMPTION SITUATION
DEI Cer % decreased from 80 % to 73 % in the last 10 years
FAO recommendation contribution of cereals to DEI optimally 60%
Prospects by 2020
In Bangladesh, the contribution of cereals (mainly rice) to total dietary energy consumption is unacceptably high, especially in rural areas. This is a result of various factors, including high availability, cheaper prices, but also old-age dietary habits and cultural practices. DES from cereals in Bangladeshi diet was as high as 79.6 in the early nineties, decreasing only marginally to 72.9 in The dietary imbalance is much more pronounced in rural areas, with the DES from cereals reaching 75.2%, against 66.7% in urban areas. One will note, however, that the decrease in the ratio has been slower in urban compared to rural areas.
Inadequate but also highly imbalanced energy supply is one of the important factors leading underweight and stunting in young children and CED in adults. In particular, the dietary supply of micronutrients - rich foods like fruits and vegetables is far from adequate, making the population, particularly children and women, highly vulnerable to micronutrient deficiencies, particularly vitamin A deficiency night blindness and iron deficiency anemia.
The current daily per capita total energy intake is derived from a consumption of a total food amount of g/d of which cereals contribute to g (16.55 oz). Taking an average energy content of 3.48 kcal/g cereal, the total energy supply from cereals in the Bangladesh diet is 1633 kcal/d which is 73% of the total dietary energy consumed.
Source: Authors’ own calculations

18. Some hygiene and sanitation indicators for selected countries in SE Asia show a mixed picture; on the whole the population with access to improved (adequate) sanitation is much lower than the population having access to improved (safe) water; Bangladesh appears to be better in comparison to even Thailand; however, the situation in Thailand, Bhutan, Sri Lanka comparatively better than the other countries; Nepal and India need to make progress
Source: WHO SEARO, 2007

19. Source of hazards in the food chain
Industrial emissions and effluents
Landfills
Vehicle emission
Agricultural
practices
Livestock
Crops
Seafood
Processing
Cooking
Crops and animals may be exposed to toxic substances due to envionmental contamination of water, air and soil. In addition, agrochemicals, such as pesticides, are widely used in most countries. Food can also be contaminated during processing, handling, storage, and preparation. Long-term, low-level exposure to some chemical contaminants is associated with serious disease, including neurological damage, birth defects and cancer. Although rare, acute exposures to chemicals through food have resulted in large-scale outbreaks, in some cases with irreversible health damage and enormous economic costs. Regular, accurate information on food contamination is essential to reduce its occurrence and protect public health.
Storage
Retail
Distribution

20. The source of drinking water is important for good health
The source of drinking water is important for good health. About 97% households get drinking water from improved source. The urban HHs have the better opportunity of drinking water from improved sources than the rural HHs. Besides, the higher % of urban HHs are habituated in appropriate water treatment (boiling, etc) prior to drinking than the rural HHs.

21. Population Pyramid - Bangladesh

22. Health services Health services delivery includes-
Maternal, Neonatal and Child Health
Communicable disease control
TB and Leprosy control
HIV/AIDS prevention and control
Non communicable disease control including
Emergency preparedness programme and climate change,
Hospital based emergency obstretic care,
Health education and promotion,
Hospital services at upazila, district, and tertiary level, and
Alternative medical care.

23. NUTRITION SITUATION
% Decline in BMI (< 18.5) in women over the last decade 53 % to 26%
Emerging concern of double burden- prevalence of overweight (BMI > 23)

25. Stunting and Underweight
Indicators for under five children remain alarming despite improvements
Nutrition outcomes highly susceptible to variability of food prices
UW rate had quite steadily decreased from 64 % in 1999 to 42% in 2007; this was followed by a slight increase in 2007 (for UW) and in 2008 and 2009 for stunting. This is attributed to the impacts of the price hike notably as chronic undernutrition and the reversal of the gains made over the past decade.

26. NUTRITION SITUATION
3 fold increase in % of UW among 6-12 month infants
Faulty weaning and feeding behaviour along with infectious disease are critical factors

27. Vitamin A supplementation

28. NUTRITION SITUATION
Night blindness almost non existent, prevalence below 0.1% in 2006;
Attributed to blend of actions VAC distribution with EPI and food based
strategies
VAD is still high, 30% among women and children
BGD has achieved commendable success in bringing down some of the common problems of MNM namely VAD and IDD; XN which was prevalent to the extent of 4.1 % in the 1960s is now non existent. The main actions behind this success have been two pronged :blend of VAC , EPI and national scale home gardening programmes.
Source: HKI, 2006

31. NUTRITION SITUATION Source :Yusuf et al, 2008
Success due to USI initiated in ; marked annual decline of 3.48%;
Physiological iodine deficiency still exists around 36%
Source :Yusuf et al, 2008

32. Diabetes is becoming a serious health concern in BGD; Between 2004 to 2008, the proportion of people suffering from diabetes increased from 4% to 7%; considering the country’s average population growth of around 1.6% the increase is even more marked in absolute terms: from 5.3 to 10.2 M people.

33. Comparing 10 varieties, analysis at DU, BRRI and BIRDEM showed that effect of rice on BSL differs widely between varieties. Following the introduction and promotion of HYV, BGD has seen a remarkable increase in production of rice; howeevr in , 66% of the total boro rice cropped area; 29 % of total rice cropped area for was dedicated to the production of 2 rice varieties; varieties that do not lead to high bsl rises were limited to only 4% of the total rice cropped area

34. JACKFRUIT RIPENING, BHALUKA, MYMENSINGH
Food safety in horticulture :
Bangladesh Results- Survey (fruit ripening)
Bangladesh is seen to be facing typical problems of using synthetic chemicals in accelerating ripening of climacteric fruits such as mango, banana, papaya, tomato and jackfruit; in the case of jackfruit chemical ripening is used (Ripen -15) is sprayed over the fruit by the bepari and wholesalers; the chemical spray is then followed by fruit piercing; as a result the chemicals directly penetrate the fruit which causes quick rpiening but poses danger of leaving chemical residues higher than MRLs that are to the detriment of consumer health ; the shelf life of chemically ripenied fruits is also very short due to faster rot as compared to those ripened by conventional methods, the post harvest loss of JF in the marketing channel is also v high; jackfruit piercer gets 25 paisa per fruit pierced; everyday around 200 JF are pierced by each piercer (Baluka, Mymensingh)
JACKFRUIT RIPENING, BHALUKA, MYMENSINGH
Source: Hassan et al,2010, BAU

35. Consumers’ perception on quality and safety
Consumers’ willingness to pay
more for purchasing safe fruits
and vegetables
Consumer’s willingness to pay more for purchasing safe fruits and vegetables: while it was noted that consumers were aware of the harmful effects they were willing to pay up to 20% more as compared to the usual payment for safe fruits and vegetables; they were however reluctant to pay more than 20%; a little more than a third were willing to pay 10 % more ; this would have implications with regard to marketing of quality and safe produce; only 20% more money could be spent for marekting as compared to the usual price for a particular commodity for the entire supply chain

36. Framework on access to education, credit, and health care

37. From farm to table, table to farm: a new agricultural paradigm (Rouse and Davis, 2004)

38. An example of a small mixed orchard intercropped with vegetables
AGRICULTURE-NUTRITION LINKAGES
Horticulture technology models from DAE show a wide range and quantity of fruits
Can be produced over a 10 year period at HH level
Fruits rich in vitamins and minerals; contribute to food security and dietary diversity
An example of a small mixed orchard intercropped with vegetables
Source: DAE, MoA: GoB/FAO/UNDP Integrated Horticulture and Nutrition Development (BGD/97/041)

39. AGRICULTURE-NUTRITION LINKAGES
Vitamin A supply from fruits/HH/d and per capita noted to be adequate
Provides substantial part of the RDA for micronutrients at HH and individual levels
Papaya and drumstick leaves : furnish 97% of the RDA for Vitamin A
Source: Report on Food based Nutrition Strategies for Bangladesh, Integrated Horticulture and Nutrition Development Project,
FAO/GoB/UNDP,

40. DESIRABLE DIETARY PATTERN
Current national average cereal intake 469 g/person/d (rice 449g) contributing to 70% DEI as against the optimal FAO/WHO norm of 55% -60%
Need to reduce cereal intake and increase non-cereal foods
Need to increase calorie intake
Source: FPMU, MoFDM, MoA, MoH&FW, NFPCSP Expert Consultation, August 2007

41. DESIRABLE DIETARY PATTERN
Desirable food basket total energy intake set at 2350 kcal and % energy from cereals proposed at 55%; absolute terms 375 g(350 g rice + 25g wheat & other cereals) some 77 g less than present intake (rice low by 90g and wheat up by 13g)
Source: FPMU, MoFDM, MoA, MoH&FW, NFPCSP Expert Consultation, August 2007

42. Thresholds for assessing nutritional status in emergency situation
Severity of malnutrition
Prevalence of wasting
(% below median – 2SD)
Mean weight for height Z-score
Acceptable
< 5%
> -0.40
Poor
5–9%
-0.40 to -0.69
Serious
10–14%
-0.70 to -0.99
Critical
> 15%
< -1.00
Starting point for interpretation, rather than the sole basis…
Thresholds vary

43. Adaptation of Health sector: Community action for malnutrition amidst climate change
Climate change through nutrition intervention and mainstreaming nutrition consideration in food, agriculture and health sectors:
Increase vector borne diseases like malaria and dengue fever due to global warming and climate change
Increase depletion of nutrients, minerals and reserves due to diarrhoea – because of increased flooding and drainage congestion
Increase heat strokes –further aggravated by shortages of drinking water
Increase malnutrition, morbidity, mortality suffering and loss of productivity
Reduce the capacity of individuals to adapt to climate change
Actions needed
Review evidence of relationship among nutrition, health and climate change
Establish community based nutrition program
Deliver integrated package of health and nutrition
Home gardening, poultry rearing, fisheries development
Food storage and processing technologies
Population planning at community level

44. Feeding programmes: decision making frameworks
Food availability at household level <2100 kcal/day
Unsatisfactory situation: improve general rations
Malnutrition rate 15% or more or 10-14% with aggravating factors
Serious situation:
General rations, supplementary feeding for all members of vulnerable groups, therapeutic feeding
Malnutrition rate 10-14% or
5-9% with aggravating factors
Risky situation:
No general rations, but supplementary feeding targeted to malnourished individuals, therapeutic feeding for severely malnourished
Malnutrition rate under 10% with no aggravating factors
Acceptable situation:
No need for population interventions
Attention to malnourished individuals through regular community services

45. Malnutrition and Mortality – can we review rates in order to diagnose food crises, health crises and famines that kill?

46. The Country Investment Plan
Responding to L’Aquila Initiative and in line with the 5 Rome Principles, the CIP was Approved on 14 June 2010 following the Bangladesh Food Security Forum.
Translates the policy frameworks in a comprehensive set of 12 priority investment programmes and aims at
convergence and alignment of domestic and external funding
mobilizing additional resources:
Bangladesh qualified as first Asian country receiving a grant under the Global for US $ 52.5 million
The revised CIP, based on extensive consultation, incorporates over 400 projects of which 146 ongoing (for US$ billion) and 262 in pipeline (for US$ billion of which US$ billion are priority). 46

47. Concluding Remarks
Bangladesh is an exemplary case of a consistent long term effort to put in place a comprehensive policy framework for food security and nutrition
HPNSDP is ready for implementation
This framework provides a platform for
Dialogue among government, civil society and development partners
Alignment, coordination and harmonization of interventions
Within the FS framework, CIP is the tool for prioritizing, enhancing effectiveness and scaling up food security investments
Food security is critical to nutrition security – ensuring access to safe and nutritious food – emphasis on quality of food
A conducive institutional setting and continued commitment of all partners are needed to sustain the implementation and monitoring process in the medium/long term

48. Way Forward
Global/regional/national commitment to mobilize the necessary resources to address the problem decisively.
Improve capacity building and awareness raising on food and nutrition security at household level
Integrate /strengthen nutritional considerations into agriculture, food and health policies and interventions to improve food security and nutrition
Establishing information and surveillance systems that are critical for developing evidence-based food security and nutrition policies.
Sustain involvement of multiple actors – strengthen/establish community based and national mechanisms for nutrition

49. THANK YOU FOR YOUR KIND ATTENTION !