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RAP PUBLICATION 2007/05

FOOD-BASED NUTRITION STRATEGIESIN BANGLADESH

Experience of integrated horticulture andnutrition development

Lalita Bhattacharjee, Sanjib Kumar Saha & Biplab K. Nandiin collaboration with the

Project Team

Department of Agricultural ExtensionMinistry of Agriculture

The People’s Republic of Bangladesh

Food and Agriculture Organization of the United NationsRegional Office for Asia and the Pacific

Bangkok, 2007

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For copies write to: Biplab K. NandiSenior Food and Nutrition OfficerFood and Agriculture Organization of theUnited Nations, Regional Office for Asia and the Pacific39 Phra Atit RoadBangkok 10200, ThailandE-mail: [email protected]

FAO 2007

The designations employed and the presentation of material in thisinformation product do not imply the expression of any opinionwhatsoever on the part of the Food and Agriculture Organization ofthe United Nations concerning the legal status of any country,territory, city or area or of its authorities, or concerning thedelimitation of its frontiers or boundaries.

All rights reserved. Reproduction and dissemination of material in thisinformation product for educational or other non-commercial purposesare authorized without any prior written permission from the copyrightholders provided the source is fully acknowledged. Reproduction ofmaterial in this information product for resale or other commercialpurposes is prohibited without written permission of the copyrightholders. Applications for such permission, with a statement of thepurpose and extent of the reproduction, should be addressed to SeniorFood and Nutrition Officer, Food and Agriculture Organization of theUnited Nations, Regional Office for Asia and the Pacific, 39 Phra AtitRoad, Bangkok 10200, Thailand.

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Foreword

Food-based intervention strategies to improve nutritional standards of rural communities inthe developing world play a key role in poverty reduction efforts. The nutritional level ofa community is an important indicator of its socio-economic status and, accordingly, nutritionand food-based interventions have high priority in development programmes and projects.

The Food and Agriculture Organization of the United Nations (FAO) has focused attention onworld hunger through major initiatives such as the International Conference on Nutrition (ICN),World Food Summit (WFS), WFS: five years later and the International Alliance Against Hunger(IAAH). These resulted in commitments by governments to address global food insecurity andmalnutrition. The United Nations Millennium Declaration of 2000 and the UN MillenniumDevelopment Goals (MDGs) too have made food and nutrition a cornerstone of development.

Horticulture-based food such as fruits, vegetables and nuts is important for the daily diet,providing essential micronutrients, fibre, vegetable proteins and other bio-functionalcomponents. FAO is implementing horticulture-based field operations and normative activitiesincluding field projects to improve household food security and nutritional levels in LatinAmerica, the Caribbean, Africa, the Middle East and Asia. Technical assistance is being providedto national governments and relevant stakeholders for improved planning, targeting andmonitoring of food security programmes. In collaboration with the People’s Republic ofBangladesh, the FAO Regional Office for Asia and the Pacific undertook an initiative to promotenutrition based on horticultural food.

This report is an account of the nutrition component of the Integrated Horticulture andNutrition Development Project (BGD/97/041) funded by the United Nations DevelopmentProgramme (UNDP) and the Government of Bangladesh (GoB), with FAO as the technicalagency. The five-year project commenced in 2001 and was implemented under NationalExecution (NEX) arrangements by the Ministry of Agriculture (MOA). A significant projectoutcome was the development of a community-based nutrition programme which has led tomajor improvements in the nutritional knowledge, skills and technologies of rural communities.A dietary impact assessment found substantially higher energy, protein and micronutrientintake among households covered by the project as compared to non-project households.

The project offered valuable lessons in using horticulture-based nutrition development strategiesto improve food security and nutritional standards in other developing countries in the region,particularly in South and Southeast Asia. I trust this document will be a useful contribution toFAO’s collaborative activities in horticulture and nutrition towards household food security andnutritional improvement in the Asia-Pacific region.

He ChangchuiAssistant Director-General andFAO Regional Representative for Asia and the Pacific

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Acknowledgements

The authors gratefully acknowledge the support and contribution of the Integrated Horticultureand Nutrition Development Project team members, in particular National Project Director, A.K.Rashid Uddin Ahmed and National Project Coordinator, A.B. Siddiqui. They also express theirsincere thanks to the FAO Representation in Bangladesh, especially Programme Officer, SayedurRahmanin and the then FAO Representative in Bangladesh Bui Thi Lan. Also acknowledgedis the support of United Nations Development Programme (UNDP) Bangladesh ProgrammeOfficers Mamunul H. Khan and Ayshanie M. Labe.

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Table of contents

Page

Foreword ........................................................................................................................................ iii

Acknowledgements ..................................................................................................................... iv

Abbreviations ............................................................................................................................... vii

Executive summary ..................................................................................................................... ix

1. Introduction ........................................................................................................................... 11.1. Nutrition situation in Bangladesh............................................................................. 1

1.1.1. Dietary pattern ................................................................................................. 11.1.2. Nutritional status ............................................................................................. 2

1.2. Contribution of horticultural produce to human nutrition .................................. 3

2. Development and immediate objective .......................................................................... 4

3. The nutrition education strategy ...................................................................................... 53.1. Components .................................................................................................................. 53.2. Nutrition outputs ......................................................................................................... 53.3. Targeting for nutrition education .............................................................................. 53.4. Location of the project ................................................................................................ 63.5. Implementation strategy ............................................................................................. 6

3.5.1. Social mobilization .......................................................................................... 6

4. Development of community-based nutrition education programmes ..................... 84.1. Capacity building through training .......................................................................... 84.2. Participatory nutrition activity .................................................................................. 10

5. Nutrition information, education and communication ............................................... 135.1. Training tools and materials ...................................................................................... 135.2. Dissemination and effectiveness of NIEC materials .............................................. 14

6. Recipe development ............................................................................................................ 166.1. Acceptability ................................................................................................................. 166.2. Nutritional contribution of recipes ........................................................................... 186.3. Food preparation techniques and cooking tips ...................................................... 23

7. Nutrition improvement through agroprocessing .......................................................... 247.1. Preservation of fruits and vegetables by drying and frying technologies ......... 267.2. Preservation of vegetables and fruits by pickling and preparation of chutneys 267.3. Preservation of juices and juice-based products .................................................... 267.4. Semi-processing of fruits and vegetables ................................................................ 267.5. Preservation of horticultural produce by sugar concentration ............................ 26

8. Improving storage and preservation ................................................................................ 27

9. Linking nutrition with horticulture ................................................................................. 289.1. Horticultural production and consumption ............................................................ 289.2. Horticultural production and nutrition availability .............................................. 289.3. Fruit production and micronutrient supply ............................................................ 30

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10. School Nutrition Programme (SNP) ................................................................................ 3310.1. Planning the School Nutrition Programme ........................................................... 3310.2. Coverage and programme........................................................................................ 3310.3. Resources and responsibilities ................................................................................. 3410.4. Promotion of micronutrient-rich vegetables and fruits ...................................... 3410.5. Nutrition education programme ............................................................................. 3510.6. Evaluation ................................................................................................................... 3610.7. Assessing institutional arrangements ..................................................................... 38

11. Dietary impact assessment ................................................................................................. 4311.1. Comparison of landless project and non-project households ............................ 4311.2. Hygiene and nutrition .............................................................................................. 4311.3. Food security .............................................................................................................. 4411.4. Preparation, cooking and preservation practices ................................................. 4511.5. Habitual food combinations .................................................................................... 4611.6. Preservation of fruits and vegetables at home ..................................................... 4611.7. Methods of household food preservation ............................................................. 4611.8. Consumption of winter and summer vegetables ................................................. 4611.9. Consumption of salads ............................................................................................. 4711.10. Consumption of fresh spices, lemon and sour fruit ............................................ 4711.11. Frequency of consumption of leafy and yellow-orange vegetables and fruits 4711.12. Frequency of consumption of sour fruits and vegetables .................................. 4811.13. Consumption of animal food ................................................................................... 4911.14. Consumption of fats, oils and iodized salt ........................................................... 4911.15. Infant feeding practices............................................................................................. 5011.16. Nutrient intake ........................................................................................................... 51

12. Community-based assessment and impact of nutrition programmes ...................... 5512.1. Farmers’ seminars ...................................................................................................... 5512.2. SWOC/T analysis ...................................................................................................... 5812.3. Observation and lessons learned ............................................................................ 60

13. Establishing and fostering linkages ................................................................................ 62

14. Policy implications .............................................................................................................. 6414.1. Nutrition-oriented horticulture diversification ..................................................... 6414.2. Implications for nutrition and health ..................................................................... 6514.3. School nutrition .......................................................................................................... 6514.4. Institutionalizing the community nutrition education programme.................. 6614.5. Food safety implications ........................................................................................... 6614.6. Strengthening links with food and nutrition policy ............................................ 6714.7. Mainstreaming food-based nutrition approaches or programmes ................... 67

15. Lessons learned .................................................................................................................... 68

Table of contents (continued)

Page

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Abbreviations

BNNC Bangladesh National Nutrition Council

DAE Department of Agricultural ExtensionDAM Department of Agricultural MarketingDLS Department of Livestock Services

FAO Food and Agriculture Organization of the United Nations

GoB Government of Bangladesh

HDTC Horticulture Development and Training CentreHRDB Human Resource Development BoardHKI Helen Keller InternationalHNPSP Health, Nutrition and Population Sector Programme

IHNDP Integrated Horticulture and Nutrition Development ProjectICDDR, B International Center for Diarrhoeal Diseases Research, BangladeshINFS Institute of Nutrition and Food Science

MOA Ministry of AgricultureMOE Ministry of Education

NAC National Advisory CommitteeNNP National Nutrition Programme

OIC Officer in Charge

SAAO Sub Assistant Agriculture OfficerSHPDE Senior Horticulture Programme Development ExpertSMS Subject Matter SpecialistSMO Subject Matter OfficerSNP School Nutrition ProgrammeSPFS Special Programme for Food Security

UNDP United Nations Development Programme

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EXECUTIVE SUMMARY

The overall objective of the Integrated Horticulture and Nutrition Development Project(IHNDP), Bangladesh was to improve the efficiency of the horticultural system and associatedsupport services in the project areas using modern technologies to ensure food and nutritionalsecurity. The central aim was to create conditions for diversified food production forconsumption by providing rural farmers with necessary knowledge, technology and skills tomake nutritious food available to their community and improve household dietary quality.

An immediate objective of the project was to “increase the nutritional awareness among thebeneficiaries and develop a comprehensive food-based nutrition programme to reducemalnutrition in the target groups comprising mainly women and children”. The nutritioncomponent of the project aimed to diversify the food habits of the target groups by promotingconsumption of horticulture-based food as a sustainable solution to the problem ofmicronutrient malnutrition. Food preparation and dietary practices were improved at thehousehold and community level while strengthening prevalent nutritional practices that werebeneficial.

The project’s Nutrition Education Strategy set up community-based nutrition educationprogrammes to create nutritional awareness among various groups such as women, farmers andschoolchildren. Mass media educational messages and programmes on the advantages ofconsuming vegetables and fruit were developed and disseminated.

Vegetable and fruit consumption in project areas has increased while programmes on foodintake methods and young child feeding have promoted changes in nutritional behaviouramong children. Nutritional improvement also resulted from simple agro-processingtechnologies such as dehydration, pickling, bottling, pulping and preparing preserves andrelishes from a variety of vegetables and fruits. This built synergies between nutrition and foodprocessing by reducing micronutrient losses, increasing shelf life, supplementing daily nutrientintake and adding value to some products.

Food consumption surveys found project households consuming between 46 to 64per cent ofvegetables and fruits produced in home gardens while 9 to 20 percent of the produce was sold.This was significantly higher than among non-project households. Project intervention improvedconsumption of leafy, yellow and orange vegetables such as carrot and yellow pumpkin as wellas vitamin C-rich fruits in project households. Over 60 percent of project households startedcomplementary feeding with infants between five to seven months old along with breastfeeding as compared to only a third of non-project households.

Substantially higher intakes of energy, protein and micronutrients were noted among projecthouseholds compared to non-project households even after adjustments for differences in farmsizes in the two categories. In the former, there were significantly higher intakes of iron by adultwomen; vitamin A by children, adolescent girls and adult women; vitamin C by children andadult women; and calcium among adolescent girls. Case studies show families eating at leasttwo types of vegetables and a fruit every day and women or mothers using correct foodpreparation procedures.

Participatory nutrition education activities show the project strengthening nutritional knowledgewith a growing number of women including horticultural food recipes in their diets. Asignificantly larger number of project households were washing vegetables before cutting, using

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coriander leaves for cooking and eating fresh carrots, tomatoes, lemons or sour fruit, and greenchili in daily meals. The diets of project households also appeared more diversified than thoseof non-project households.

Evaluations of the School Nutrition Programme show definite improvement in the children’snutritional knowledge. According to quarterly food frequency data, over three-fourths of thechildren eat leafy vegetables at least every other day while about half the children have fruittwo to three times per week. Nutrition gardens are being established in the schools andproviding practical and experimental learning opportunities to both children and the schoolsystem. There has been active participation by the teachers, children and the schoolmanagement. A child-to-family approach is being strengthened by which children share schoolnutrition education experiences with parents and the community.

The dietary assessment also illustrates how proper collection of semi- and quantitative data cancombine with practical experience and technical expertise to provide a sound basis fora nutrition education programme. Recognizing that nutritional well-being is a key componentand contributor to the UN Millennium Development Goals (MDGs), there is a need to considerconsolidation of efforts to combat non-income poverty and related undernutrition issues.

Although adapted to the conditions of Bangladesh, the project, by successfully integratinghorticulture-based diversification of food production with improvement of household andcommunity nutritional standards, has shown its wider regional applicability, particularly inSouth and Southeast Asia.

The IHNDP’s food-based nutrition component can be part of national agricultural extension andnutrition programmes implemented by the agriculture and health ministries. The SchoolNutrition Programme can also be included in multi-sectoral programmes of ministries ofeducation, agriculture and health. This practical food-based nutrition model and approach canbe considered for integration into the broader framework of agricultural policies and povertyreduction strategies.

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1. INTRODUCTION

Horticulture-based food varieties, namely fruit, vegetables and nuts, are important for the dailydiet as these contain micronutrients, fibre, vegetable proteins and bio-functional components.Consumption of fruits and vegetables is vital for a diversified and nutritious diet. Increasingdietary diversification is the most important factor in providing a wide range of micronutrientsand this requires an adequate supply, access to and consumption of a variety of foods. However,food surveys1 show continuing low consumption of fruits and vegetables in many regions ofthe developing world.

Horticultural interventions combined with extensive nutrition education offer a long-term,food-based strategy to control and eliminate micronutrient malnutrition. Horticulturalproduction, relatively easy for unskilled people, can play an important role in povertyalleviation programmes and food security initiatives, providing work and income opportunities.

Fruits and vegetables can be produced on a small scale to meet a substantial part of dietarynutrient needs at the household and community level, health centres, refugee camps and relatedsituations. Global demand for horticultural produce is expected to grow with population, risingstandards of living and awareness of the health benefits of fruit and vegetables. Dietary patternswill also change with the expected increase in per capita consumption of fruits and vegetables.Developing countries may find new opportunities for trade in fruits and vegetables, offeringa comparative advantage in the context of globalization.

The Food and Agriculture Organization of the United Nations (FAO) is implementinghorticulture-based programmes through field operations and normative activities. A variety ofdirect interventions are being implemented through field projects to improve nutrition levelsand household food security in Latin America, the Caribbean, Africa, the Middle East and Asia.

The Integrated Horticulture and Nutrition Development Project (BGD/97/041), funded by theUnited Nations Development Programme (UNDP) and the Government of Bangladesh (GoB),was implemented by the Ministry of Agriculture (MOA) with the Department of AgriculturalExtension (DAE) as the Government Executing Agency. The project demonstrated and validatedthe use of food-based strategies to promote food and nutritional security.

By its nature, the project was technology driven, with an emphasis on “training anddemonstration” at the horticulture development and training centres (HDTCs) as well as villagesites. A total of 31 400 men and women benefited directly from the training, including marginal,landless and women farmers, homestead owners, school teachers, adolescent schoolchildren,unemployed rural youth and NGOs. The project supported the formation of small, relativelyhomogeneous farmers’ groups in the project villages to act as a critical mass for technologytransfer. This was seen as central to the project’s grassroots intervention strategy.

1.1. Nutrition situation in Bangladesh

1.1.1. Dietary pattern

Cereals, largely rice, are the main food in Bangladesh. Nearly two-thirds of the daily dietconsists of rice, some vegetables, a little amount of pulses and small quantities of fish if and

1 FAO. (2002). World agriculture towards 2015/2030. Summary report. Rome, Food and Agriculture Organization ofthe United Nations.

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when available. Milk, milk products and meat are consumed only occasionally and in verysmall amounts. Fruit consumption is seasonal and includes mainly papaya and banana whichare cultivated round the year. The dietary intake of cooking oil and fat is meagre. The typicalrural diet in Bangladesh is, reportedly, not well balanced.2

Traditional dietary habits often do not meet good nutritional requirements, with a preferencefor polished rice and leafy vegetables of poor nutritional quality. In addition, cultural normsdictate a better diet for males over females with the male head of the household getting the bestmeal portions. Persistent poverty, inadequate nutrition information and gender inequity causepervasive malnutrition among women, especially pregnant women and lactating mothers.

While food habits vary at regional and even individual household levels, in general, foodpreparation methods result in significant nutrient loss. Minerals and vitamins, especiallyB-complex vitamins are lost (40 percent of thiamine and niacin) even during the washing of ricebefore cooking. Boiling rice and then discarding the water results in even more nutrient losses.The manner of washing and cooking vegetables leads to considerable loss of vitamin C andB-complex vitamins.

Household food consumption studies3 show that cereals make up the largest share (62 percent)of the diet, followed by non-leafy vegetables, roots and tubers, which together comprise morethan four-fifths of the rural people’s total diet. Protein and micronutrient-rich foods like fish,meat, eggs, milk, milk products, fats and oils account for less than 10 percent of the ruralperson’s diet, and the consumption of vegetables and fruits is declining steadily.

Rural consumption of leafy and non-leafy vegetables has remained more or less the same overthe past two decades after increasing over the preceding 30 years. Fruit consumption hasdeclined in rural areas after more than doubling in the 1970s. With an average national percapita consumption of 23 g of leafy vegetables, 89 g of non-leafy vegetables and 14 g of fruit,the average Bangladeshi eats a total of 126 g of fruit and vegetables daily. This is far below theminimum daily consumption of 400 g of vegetables and fruit recommended by FAO and theWorld Health Organization (WHO).4

1.1.2. Nutritional status

Despite considerable improvement in the national rural health status, the nutritional well-beingof rural people continues to be neglected.5 Children and women in Bangladesh suffer from highlevels of malnutrition and micronutrient deficiencies such as low birth weight (LBW),undernutrition (underweight, stunting and wasting), vitamin A deficiency, iodine-deficiencydisorders (IDD) and iron-deficiency anaemia (IDA). At the same time, new health problemsrelated to over-nutrition such as obesity are emerging.

Maternal undernutrition (body mass index less than 18.5 kg/m2) in non-pregnant women inthe country, while declining from 54 percent in 1996–1997 to 38 percent in 2003, is still veryhigh. Undernutrition, both before and during pregnancy, causes intrauterine growth

2 Jahan, K. & Hossain, M. 1998. Nature and extent of malnutrition in Bangladesh, Bangladesh National Nutrition Survey,1995–1998. Dhaka, Institute of Nutrition and Food Science, Dhaka University, Bangladesh.

3 Bangladesh National Nutrition Survey (1995–1996).4 FAO/WHO. 2003. Diet, nutrition and the prevention of chronic diseases. Report of a joint FAO/WHO. Expert

Consultation. WHO Technical Report Series 916. Geneva. World Health Organization.5 World Bank. 2005. Maintaining Momentum to 2015? An impact evaluation of interventions to improve maternal and

child health and nutrition in Bangladesh. Washington, The World Bank.6 Bangladesh Demographic and Health Survey, 2000.7 Helen Keller International/IPHN, 2004.

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retardation and is one of the major reasons for the high LBW (36 percent) prevalence in thecountry.

Low birth weight is more common among adolescent mothers. Marriage at very young age hasserious consequences for pregnancy, future survival, health, growth and development. Whencombined with positive energy balance (adequate energy intake) in later life, LBW increases therisk of obesity, diabetes, high blood pressure and coronary heart disease. Between 1990 and2004, underweight levels among children fell from 67 to 48 percent and child stunting fell from66 to 43 percent,8, 9 but the levels are still unacceptably high.

The consumption of vitamin A-rich foods is still low, suggesting that the underlying causes ofvitamin A deficiency require further attention. The diets of pregnant women in low-incomegroups are deficient not only in micronutrients but also in energy. Anaemia is a severe publichealth problem affecting pre-school children (49 percent) and pregnant women (47 percent), anda moderate public health problem among non-pregnant women (33 percent) and adolescents(29 percent).10 Anaemia caused by iron deficiency impairs the growth and learning ability ofchildren, lowers resistance to infectious diseases and increases the risk of maternal death andLBW. Children are malnourished by inadequate dietary intake or infectious diseases.

The underlying causes include (i) household food insecurity resulting from inability to growor purchase a nutritionally adequate amount and variety of food; (ii) lack of dietary diversity;(iii) inadequate maternal and child care due to inappropriate hygiene, health and nutrition;(iv) low rates of exclusive breast feeding; (v) inadequate access to quality health services;(vi) poor environmental hygiene and sanitation along with low levels of income and maternalformal education. Malnutrition early in life has long-lasting and negative effects on overallgrowth, morbidity, cognitive development, educational attainment and adult productivity.11

Because of this, the nutritional status of children, particularly below five years of age, is seenas one of the most sensitive indicators of a country’s vulnerability to food insecurity and overallsocio-economic development. Women of child-bearing age are also highly vulnerable tonutritional deficiencies because of increased need for food and nutrients during pregnancy andlactation.

1.2. Contribution of horticultural produce to human nutrition

Most people have a mixed diet of plant and animal food. Potatoes also form an important partof the diet being an important source of energy. Root and tuber crops together with bananascan supplement a cereal or rice-based staple diet. Starch is the main component of root andtuber crops, and plantain and green bananas. Oils and fats, also a source of energy, occur onlyin small amounts in fresh produce except for coconut and avocado.12 Most fresh fruits containsimple sugar ranging between 50 to 100 kcal per 100 g.

Proteins are essential to the building and repair of muscles and organs and are needed inincreasing amounts by growing children. Although fresh horticulture produce has low proteincontent, on a dry weight basis, some food types such as beans have between 15 and 20 percentof protein.

8 BBS. 1989/90. Child Nutrition Surveys. Dhaka, Bangladesh Bureau of Statistics.9 Bangladesh Demographic and Health Survey 2004.

10 Bangladesh Bureau of Statistics/United Nations Children’s Fund, 2004.11 UNICEF, 1998.12 Coconut has 40 percent fat and avocados, 15–25 percent oil.

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Small amounts of micronutrients (minerals and vitamins) are needed for good health along withenergy food and protein. Sodium, potassium, iron, calcium, phosphorus and many traceelements are essential for the body. Vegetables, especially leafy, have significant amounts ofcalcium, iron and some other minerals including vitamins A and C. Vitamins are vital in thecontrol of body chemical reactions. Fresh horticultural produce also has large amounts of fibreor “roughage” which, although indigestible, plays an important part in digestion. A diet withhigh fibre content reduces susceptibility to disease.

Inadequate consumption of fruits and vegetables is estimated to cause about 31 percent ofischaemic heart disease and 11 percent of strokes worldwide.13 Overall, it is estimated that upto 2.7 million lives could be saved every year with a sufficient increase in fruit and vegetableconsumption. Dietary diversification through horticultural food intake and supported bynutrition education is, therefore, seen as a sustainable approach to fighting micronutrientmalnutrition.

2. DEVELOPMENT AND IMMEDIATE OBJECTIVE

The overall development objective of IHNDP was to enhance food security and food nutritionlevels. For this, a multi-pronged strategy was used including:

❖ improving efficiency of the horticultural production system and associated supportservices;

❖ application of modern technologies and diversified cropping patterns to boostproductivity and incomes of small farmers in a sustainable manner;

❖ promoting conditions to ensure that households have sufficient access to fruits andvegetables at affordable prices;

❖ providing households necessary knowledge and skills to prepare and consume thesefoods to complement their diet, particularly targeting poor women farmers; and

❖ developing a comprehensive food-based nutrition programme to reduce malnutritionin the target groups comprising mainly women and children.

13 WHO. 2002. World Health Report. Reducing risks, promoting healthy life. Geneva, World Health Organization.

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3. THE NUTRITION EDUCATION STRATEGY

The project’s nutrition component aimed to diversify food habits of the target groups andpromote horticultural food consumption as a sustainable remedy for malnutrition. This wasdone by improving food preparation and dietary practices at household and community level,and strengthening prevalent nutritionally beneficial methods.

3.1. Components

The main components of the Nutrition Education Strategy were:

(a) development of community-based nutrition education programmes to createnutritional awareness among various groups such women (farmers) andschoolchildren;

(b) mass media educational messages and programmes on the advantages ofincorporating vegetables and fruits in the diet;

(c) promotion of behavioural change related to food intake and feeding of youngchildren; and

(d) development of food-based nutrition programmes to encourage intake of vegetableand fruit as part of the strategic nutrition interventions.

3.2. Nutrition outputs

The two nutrition outputs of the project were:

❖ community-based nutrition education programmes established to create awarenessamong schoolchildren, household women and elders; and

❖ programmes on food based nutrition initiated to encourage consumption ofhorticultural commodities and allied products as a nutrition intervention strategy.

The following success criteria or indicators provided benchmarks for the nutrition strategy:

❖ increased per capita consumption of fruits, vegetables and spices through availabilityat affordable prices;

❖ a better balanced diet incorporating more vegetables and fruits; improvement in thenutritional status of children, women and elders;

❖ behavioural change towards use of new food recipes incorporating fruits, vegetablesand spices;

❖ better child weaning food formulations incorporating cereal, fruit pulp, and mashedvegetables; and

❖ reduction in vitamin and iron deficiencies; improvement in child growth rates andoverall socio-economic status through increased productivity and literacy.

3.3. Targeting for nutrition education

The project specifically targeted the landless, marginal and small farmers from selected villagessurrounding the 15 HDTCs of the project which were deliberately located in areas of highpotential for horticultural development. The term “landless” in Bangladesh does not necessarily

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mean being entirely without land and a household in this category can have up to 0.49 acres(approx 2 000 sq m) (see Table 1).

The main beneficiaries of the project included landless women horticulture farmers from fiveto seven villages within the vicinity of the HDTCs. The project also provided support to otherpeople in the community associated with horticultural production and disposal.

The target beneficiaries of nutrition education included:

(a) landless, marginal and small farmers, especially disadvantaged and impoverishedwomen

(b) adolescent schoolgirls

(c) NGO women farmers and workers

(d) district officers and Upazila level staff

(e) rural schoolteachers

3.4. Location of the project

Fifteen HDTCs14 of the Department of Agricultural Extension and four to five villages withinthe vicinity of the HDTC area were covered by the project (Figure 1).

3.5. Implementation strategy

Project activities were planned, administered and coordinated from the project headquarters atDAE. Khamarbari, Dhaka. The HDTC officers were responsible for implementation of all projectactivities at field level. The Assistant Horticulture Officers, Agriculture Overseers, Sub AssistantAgriculture Officers and other staff assisted the HDTC officers and were closely engaged in theday-to-day implementation of field-level activities.

3.5.1. Social mobilization

A group approach was adopted to provide extension services to the farmers under the project,in keeping with the key principle of DAE’s approach to working with groups. This offered theopportunity for a more effective use of extension resources for problem identification andsolution, sharing of information and a cost-effective choice of extension methodology.

The groups were formed with the participation of the landless, marginal and small farmers,particularly disadvantaged and impoverished women engaged in horticultural production. Of

Table 1. Landholding criteria used for classification of farmers in project

Classification Land area (acres)

Landless <0.50Marginal 0.50 to 0.99Small 1.00 to 2.49

2.37 acre = 1 ha

14 Gaital (Kishoreganj), Kewatkhali (Mymensingh), Jamalpur Sadar, Burirhat (Rangpur), Natore Sadar, Tebunia(Pabna), Baradi (Meherpur), Kallayanpur (Chapai Nawabganj), Rajbari Sadar, Daulatpur (Khulna), Rahmatpur(Barisal), Pachgachia (Feni), Ramgarh (Khagrachari), Banarupa (Rangmati) and Balaghat (Bandarban).

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the total farmer beneficiaries targeted, 48 percent were landless, 41 percent were marginal and11 percent were small farmers. Each group was managed by a three-member committee. A totalof 1 292 groups were formed with 17 802 farmers, 14 657 of them being women (82 percent).

Figure 1. Map of Bangladesh showing Project Locations

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4. DEVELOPMENT OF COMMUNITY-BASED NUTRITIONEDUCATION PROGRAMMES

Training of various levels of functionaries for community nutrition programmes was animportant tool in implementing and promoting the nutrition programme.

4.1. Capacity building through training

Three types of training courses were designed and offered to develop a critical mass of humanresources to be both trainers and practitioners. Training of Trainer (TOT) courses on food-basednutrition strategies were conducted for DAE officers like HDTC in-charges, horticulture subjectmatter specialists (SMSs), Upazila Agriculture Officers (UAOs), Agriculture Extension Officers(AEOs) and instructors of Agricultural Training Institutes (ATIs). In-service training courses onnutrition and food processing were offered to Sub Assistant Agriculture Officers (SAAOs),Horticulture Overseers (HOs) and NGO officials.

While focusing on key food-based nutrition topics, the training aimed to sensitize HDTC andblock-level officers to the use of horticultural food-based strategies for addressing malnutritionand promote appropriate dietary use of home grown horticultural produce among farmers.

In particular, technical inputs for horticulture-based food preparation and household-levelprocessing were given through practical training at the HDTCs as well as in the field. Gapsidentified in understanding practical food-based solutions to nutrition problems were also

Table 2. Nutrition training for various levels of functionaries

Training course Functionary Main objective

Food-based HDTC officers, Sensitization on food-based strategies to address malnutritionnutrition Sub Assistant and promote appropriate dietary use of locally available/strategies Agriculture Officers, home-grown horticultural produce.

SMS, SMOFood-based Schoolteachers Strengthen and provide updates on nutrition throughoutnutrition the life span and promote food-based activities usingstrategies horticultural produce and other foods to increase vegetable

and fruit consumption among adolescent girls; promotesimple household-level food preparation and processingtechniques for nutrition and food security.

Nutrition and Sub Assistant Increase nutritional awareness and promote food-basedhousehold food Agriculture Officers, activities using horticultural produce to reduce malnutrition;processing Horticulture promote simple household-level food processing techniques

Overseers for long-term use and nutrition.Community Women farmers Provide complementary feeding guidelines and preparechild caring; use horticulture-based complementary food.of horticultural,complementaryfoodFamily health Women farmers Give basic information on importance of a balanced dietand nutrition along with use of horticultural crops; demonstrate correct

cooking methods to reduce nutrient losses, appropriate foodcombinations for improved nutritive value, and personaland food hygiene practices.

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addressed during the training. This helped to update and build upon their nutrition knowledgeand skills, which would enable them to appropriately implement the nutrition programme inthe field.

Nutrition curricula were developed for courses for all three levels of functionaries includingHDTC officers, Subject Matter Specialists in horticulture, SAAOs and HOs (see Table 2). Thiswas done by the project’s National Nutrition Education Specialist in collaboration with otherNational Experts and in close partnership with BANHRDB, a nodal nutrition training institutionof the DAE. One TOT for HDTC officers and two in-service training programmes wereconducted (see Table 3).

Table 3. Training coverage for district level officials

Target groupTOT on food-based nutrition In-service training on food

strategies processing and nutrition

Horticulturist, Assistant Horticulturist, 118 –Horticulture Development Officer,Assistant Horticulture DevelopmentOfficer, Agriculture Officer, SubjectMatter Specialist, Crop ProtectionSpecialist, etc.Sub Assistant Agriculture Officers, – 30Horticulture OverseersTotal 118 30Grand total 148

Nutrition training courses were provided to men and women farmers under the project as wellas NGO women farmers. Overseas study tours were also organized for DAE officials andwomen farmers, besides in-country study tours for farmers, farmers’ rallies, field day,exhibitions, workshops and seminars. A total of 8 390 farmers were trained in various nutritioncourses (Figure 2).

Figure 2. Farmers training in nutrition

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4.2. Participatory nutrition activity (PNA)

Participatory nutrition activities (PNA) activities were organized to assess the effectiveness andimpact of the Nutrition Education Programme in promoting nutrition awareness and correctnutritional behaviour. The main PNA outcome was mobilization of farmers for independent

Box 1. PNA strategies with thefarmers

❖ Bringing farmers together in aninteractive discussion.

❖ Reviewing responses on knowledgegained through training anddemonstrations.

❖ Eliciting farmers’ views and ideason the importance of horticulturalfood.

❖ Farmers’ concept of food groups,cooking methods and preparation.

❖ Conduct of field-level games andcooking competitions.

initiatives to improve their food and dietary patternand enhance consumption of vegetables and fruits(Box 1).

Some responses and outcomes related to the PNAare given in Table 4. The two games used with thegroup included: (a) food vocabulary and (b) foodsorting. Farmers too interest and participatedactively in the games, grouping food typesaccording to combinations habitually used in homerecipes. These included rice and pulse for khichuri,puffed rice and jaggery for breakfast, spinach andpotato in shak bhaji, sweet pumpkin and onion forbhaji, tomato and cucumber as salad.

This was used as the basis for working out a varietyof nutritious food combinations which werediscussed with the group. This contributed to their

understanding of correct food groupings that ensure dietary diversity and improve nutritionalquality. For example, a combination of spinach, pulse or fish, potato and tomato was suggestedto prepare bhaji instead of using only spinach and potato. The farmers also cited variousexamples, generating a wide choice of culturally suitable food combinations for nutritiousrecipes.

Hands-on-explorer (locally available) methods used to facilitate the demonstrations showencouraging results. Brain-storming sessions with women farmers on the use of common leafyvegetables and habitual food combinations, basic questions on handling, preparation andcooking of vegetables, reveal big gains in nutritional knowledge. All the women now reportedlywash vegetables thoroughly before cutting to prevent loss of vitamins. The women pointed outthat they were using many project recipes and had increased consumption of vegetables sincejoining project activities.

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Table 4. Game on fruits and vegetables

FruitReason for Discussion

VegetableReason for

Discussion pointslisting points preference

Papaya Grown in Rich source of Sweet Like it, All yellow and orangehome garden vitamin A pumpkin popular in coloured vegetables are(HG), popular diet a good source ofin diet; vitamin Avitamin A-rich

Blackberry Available Good source of Ridge gourd Like it, Adds bulk and varietyvitamin C, and available in to diet, used in “mixedminerals like summer vegetable soup” showniron in food preparation

demonstrationMango Grown in HG Good source of Lau shak Seasonal Rich in iron, vitamin A;

vitamin A (gourd) availability and good for eyesightgrown in HG;fruit and leavesused to makefood; tenderbottle gourdpeels used forbhaji andchutneys;combined withfish, potato,onion andotheringredients

Apple Like it and Not grown, Cauliflower Like it, Provides bulk, variety,a good fruit have to buy; available in minerals and vitamins

nutrition winterreturns notcommensuratewith moneyspent

Litchi Grown Cabbage Eaten in season Good source ofvitamin A, fresh cabbagehas vitamin C

Banana Available Good source of Lal shak Grown in HG, Good source ofenergy (local green) popular in diet vitamin A, iron, calcium

and folic acid (good forblood building)

Guava Grown in HG Vitamin C-rich; Data shak Prepare dish Good source of mineralspreferred to (stem and vitaminsapple amaranth)

Grapes Good fruit Vitamin C-rich, Potol Not prepared Gives variety and bulkbut not grown (local oftenin HG nor vegetable)easily available

Oranges Good fruit Good source of Palang shak Eat often Good source ofvitamin C, (spinach) vitamin A, iron, calciumhave to buy and folic acid (good for

blood building)

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Table 4. Game on fruits and vegetables (continued)

FruitReason for Discussion

VegetableReason for

Discussion pointslisting points preference

Coconut Know about it Field beans Eat in season Gives some protein,used in many recipes,including soup

Kamranga Grown in HG Good source of Kolmi shak Eat Good source of(Star fruit) vitamin C (local green) occasionally vitamin A, iron, calcium

and folic acid (good forblood building)

Atapal Know about it Good source of Kochu shak Eat as bhorta Excellent source of(custard apple) vitamins and (local green) (steamed or vitamin A, iron, calcium

minerals broiled, and folic acid (good formashed, spiced blood building)preparation)

Pomegranate Know about it Good source of Drumstick Know about it Excellent source ofvitamins and leaves vitamin A, iron, calciumminerals and folic acid (good for

blood building)

Nashpati (Pear) Know about it Good source of Tomato Eat in season, Good source ofvitamins and added to dal in vitamin C and has someminerals winter vitamin A

Pomelo Grows in Good source of – – –Bangladesh vitamin C

Anaaras Know about it Good source of – – –(pineapple) vitamins and

minerals

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5. NUTRITION INFORMATION, EDUCATION ANDCOMMUNICATION

As part of the nutrition information, education and communication (NIEC) developmentprocess, a number of advocacy materials were prepared, printed and distributed to projectbeneficiaries and other stakeholders. This was done in collaboration with stakeholders atnational, district and community levels taking into account farmers’ needs as well assuggestions from project staff and management.

5.1. Training tools and materials

Appropriate training tools and materials were developed and tested through participatoryeducation methods with community collaboration to ensure their applicability and effectiveness.The NIEC tools and materials utilized the participatory process for nutrition education activitiesfor the farmers’ training, demonstration and school nutrition programme (see Table 5).

Table 5. NIEC materials

Education tools Theme Target users Language

Training manual Food-based nutrition District officers and EnglishSub Assistant AgricultureOfficers

Nutrition extension booklet Vegetables and fruits for District, upazila and English,better nutrition extension personnel Bangla

Farmers’ training notes Family health and nutrition Farmers EnglishRecipe booklet Vegetables, fruit and Extension personnel, Bangla,

spice-based recipes practitioners, farmers EnglishBooklets Correct cooking and Extension personnel & Bangla

combinations of vegetables farmersand fruits

Pictorial recipe extension Horticulture-based recipes Extension personnel & Englishfolder for better nutrition farmers, schoolteachers

and studentsComplementary food Horticulture-based Extension personnel, Bangla

complementary food for mothers, farmers,better nutrition care-takers, adolescent girls

Posters on nutritive Comparative nutrient Extension personnel, Banglavalue of vegetables composition of fruits farmers, schoolteachers,

studentsSchool nutrition diary Nutrition messages and School students Bangla

planningSchool nutrition Nutrition for the adolescent Schoolteachers and HDTC Banglatransparencies (Food groups; officers

Food Pyramid)Festoons for display at Nutritional importance of Farmers, extension BanglaHDTCs vegetables and fruits personnel

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5.2. Dissemination and effectiveness of NIEC materials

Positive feedback was obtained on the value of NIEC materials from users including tenfield-level functionaries15 and 30 farmers in four HDTC-covered villages (see Table 6).

Table 6. Field responses on NIEC materials

Type of material Target user Response

Booklets (Bangla) SAAO, farmers Informative, useful for training, user-friendly;❖ Correct cooking and literate women farmers asked for more copies

combinations of vegetables Literate mothers of small children found itand fruits very useful and referred to it; requested more

❖ Use of vegetables and fruits in copiescomplementary foods

Brochure (Bangla) HDTC officers, Useful in training; should have larger print❖ Vegetables and fruits to SAAO size and more pictures and graphics

reduce malnutritionFlip Chart (Bangla) Farmers, SAAO Very useful for training and demonstration;❖ Preparation of horticulture- clear messages and greatly demanded by

based complementary food mothers and young childrenPosters (Bangla) Farmers, SAAO Very useful for training and demonstration;❖ Nutritious fruits ‘Foods and Fruits and Vegetables for Healthy-❖ Foods for healthy blood Blood’ posters have valuable information; can❖ Fruits and vegetables for also be calendar-type visual aid; ‘Nutritious

healthy blood fruits’ poster needs more pictures of different❖ Nutritive value of fruits

vegetables❖ Nutritive value of fruitsSchool nutrition modules and Rural school Very useful, well-accepted by teachers; highlytransparencies (Bangla) students practical; recipes much appreciated; constant❖ Nutrition and diet for requests by schools for copies

adolescentsPictorial recipe flip file (English) HDTC officers, Well-accepted by HTDC officers, SAAO,❖ Horticulture-based recipes for SAAO, teachers, schoolteachers; logical sequence of recipes;

better nutrition students useful concept of quantities and measures;farmers and teachers showed interest in colourpictures; schools and HDTCs asked for copies

Recipe book (Bangla) HDTC officers, Practical recipes that can be easily made at❖ Horticulture-based recipes for SAAO, home; acceptable; farmers and teachers showed

better nutrition teachers much interest in colour photographs; requestsfor copies

Booklet (English) HDTC officers, Very informative, practical, easy to understand;❖ Vegetables and fruits for teachers, policy- demand for more copies; need for Bangla

better nutrition makers, national translationstakeholders

15 Including HDTC officers and Sub Assistant Agriculture Officer from Feni, Kishoreganj, Natore and Barisal.

15

The HDTC officers indicated that the NIEC materials had helped strengthen training for betterdelivery and easy understanding of the participants. It had also been very handy at householdand family levels because of the practical utility of these materials. The Sub AssistantAgriculture Officers and Horticulture Overseers reported that the materials provided user-friendly information linking functions of nutrients through food as well as horticulture-basedfood, and highlighted ways to increase their consumption.

Many farmers asked for additional NIEC materials to give to their neighbouring householdsand other community members. Schoolteachers, members of the school management involvedin the SNP and students also asked for the school nutrition modules for their guidance.

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6. RECIPE DEVELOPMENT

The development of recipes was an important part of the Nutrition Education Strategy. The useof horticultural produce added variety, nutrient density and acceptability to the foodpreparations. Focus group discussions at field sites16 identified household preferences and food

Box 2. Grouping of recipes

1. Soups

2. Children’s snacks ( 1–6 years)

3. Vegetable-based complementary food

4. Snacks

5. Main meal dishes

6. Salads

7. Beverages using fruits

8. Recipes based on seldom used partsof vegetables and fruits

9. Spice-based recipes – chutneys andchutney powders

10. Preservation of vegetables, fruits andspices

11. Dehydrated vegetables – carrot, bittergourd, okra, green leafy vegetables

12. Pickle

13. Chutney and preserves

types. Responses were obtained from 41 womenfarmers in selected villages in different HDTCson (a) common household cooking methods; (b)common recipes; and (c) knowledge and use ofvegetables. These were used in recipedevelopment.

A set of 55 horticultural produce-based recipeswere developed including soups, children’ssnacks, complementary food, main meals,salads, fruit-based beverages, preparations fromseldom used vegetable and fruit portions,mushrooms, coconut, spices, besides fruit,vegetable and spice preservation (Box 2).

The recipes, adapted to local cultural practicesand tastes were used to promote consumptionof micronutrient-rich vegetables and fruits.Traditional practices that were nutritionallybeneficial like roasting and grinding wereemphasized. Preservation methods such asfermentation, pickling and drying were used todemonstrate the role of household conservationpractices in food security and nutrition.

6.1. Acceptability

The acceptability of the recipes was assessed by community-based trials involving districtofficials and farmers in selected areas, using a five-point score.17 The sum of all attributes wasused to calculate overall acceptability (see Table 7).

The average acceptability for all recipes was 87 percent among district-level participants(non-farmers) and 92 percent among farmers. The community-based acceptability trial foundthat, in general, sobuj bhath and soup were rated the best. Drumstick leaves omelette had a scoreof 98, but this was attributed to the use of eggs which are generally liked by all households andchildren.

There were regional differences in acceptability with northern districts like Natore andChapainawabganj preferring drumstick leaves-based recipes. Older women farmers preferredsobuj ruti, everyone liked soup and sobuj bhath, and adolescent boys and girls preferred mixedvegetable salad. Both adults and adolescents liked sobuj bhath and mixed vegetable pitha. Allparticipants were keen to learn more recipes.

16 Jamalpur, Mymensingh, Feni, Pabna and Kishorganj.17 Mymensingh, Jamalpur, Kishoreganj, Pabna, Feni, Barisal, Khulna, Rangmati, Khagrachari.

17

The mean acceptability scores of the recipe groups are given in Figure 3. On average, main mealdishes (sobuj bhath, sobuj ruti), soups, preparations from drumstick leaves such as omelette,pakura (deep fried in batter) and bhorta (steamed or broiled then mashed and spiced) andmushroom-based recipes were rated more than 90 percent by the farmers.

Table 7. Acceptability scores of recipes promoted by project

Recipe Acceptability score %

District18 level Farmer19 level

Mixed vegetable soup 89 90Mixed vegetable beans soup 90 92Mixed vegetable chicken soup 93 95Mixed vegetable meat soup 89 94Mixed vegetable fish soup 80 89Sobuj bhath 90 95Sobuj ruti 82 90Drumstick leaves omelette 80 98Drumstick leaves pakura 82 92Drumstick leaves bhorta 60 85Sweet pumpkin coconut halwa 87 90Coconut egg vegetable curry 82 88Mixed vegetable egg salad 90 90Mixed vegetable beans salad 88 89Colocasia leaves pitha 80 85Mixed vegetable20 pitha (hoppers) 90 92Mushroom chop 90 90Mushroom omelette 88 91Fruit21 based complementary food 89 90Carrot based complementary food 91 92Vegetable22 based complementary food 88 88Average score 87 92

Figure 3. Mean acceptability score of IHNDP recipes (%)

18 HDTC officers, SMS, BS and overseers19 Farmers20 Spinach and carrot21 Papaya, banana or mango22 Sweet pumpkin

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Although soup was very popular, the slightly higher score for sobuj bhath and sobuj ruti isattributed to the greater cultural acceptability of rice in the Bangladeshi diet. A combination ofcereals with pulses and vegetables as in bhath and ruti is readily acceptable, easy to make andgives a sense of satisfaction and fullness to the farmer and her family members. Salads andcomplementary food varieties scored 90 percent while snacks and coconut-based recipes hadscores of 89 percent.

6.2. Nutritional contribution of recipes

The nutritive values of the recipes, including energy, protein, fat, vitamin A (beta carotene), iron,calcium, and vitamin C, are based on the Indian Food Composition Tables23 and the HKI Tablesof Nutrient Composition of Bangladeshi Foods.24 The use of sour fruits like Indian gooseberry(amloki), tomato, lemon and tamarind with leafy vegetables, increases absorption of iron.

6.2.1. Soups

Mixed vegetable soup is a nutritious preparation of leafy yellow-orange and root vegetableswith gourd, cereal (flour), egg, lemon, fresh and dry spices, and oil. Leafy vegetables addmicronutrients like beta carotene (vitamin A), folic acid, iron and calcium, while yellow-orangevegetables provide beta carotene (vitamin A). Potatoes, flour and oil give energy while lemonand green chilli add vitamin C and some beta carotene to the dish. Generally, all vegetablesused have minerals like sodium and potassium. A small amount of egg adds good qualityprotein, thickness and palatability. Oil helps absorption of vitamin A from leafy, yellow andorange vegetables such as carrot, yellow pumpkin and yellow sweet potato grown in homegardens or available in village markets.

The recipe demonstrates correct cooking practices such as cleaning and washing leafyvegetables before cutting, cutting into large pieces, placing vegetables in boiling water andcooking for minimum time. A mixed vegetable soup is a packaged source of nutrients andfluids, adding bulk and fibre to the diet. It can be a meal in itself or supplement rice, ruti ortraditional bread for the main lunch, dinner, mid-morning or mid-evening meal.

23 NIN/ICMR. 1996. Nutritive Value of Indian Foods. Hyderabad, India/New Delhi, National Institute of Nutrition/Indian Council of Medical Research.

24 INFS/WFP. 1988. HKI Tables of Nutrient Composition of Bangladeshi Foods. Dhaka, Institute of Nutrition and FoodScience, Dhaka University/World Food Programme.

25 NIN/ICMR. 1998. Nutrient requirements and recommended dietary allowances for Indians. Hyderabad, India/New Delhi, National Institute of Nutrition/Indian Council of Medical Research.

Table 8. Nutritive value of soup recipes/serving basis

RecipeEnergy Protein Beta carotene Iron(kcal) (g) (µg) (mg)

Mixed vegetable soup 287 10.0 2 634 4.0Mixed vegetable beans soup 200 9.0 1 600 3.0Mixed vegetable chicken soup 308 12.0 2 834 7.0Mixed vegetable meat soup 310 13.0 2 834 8.0Mixed vegetable fish soup 298 12.0 2 834 7.0

A serving of soup is estimated to provide much more beta carotene than the recommendeddietary allowance (RDA)25 for vitamin A and about one-sixth of the RDA for iron fora moderately working woman (see Table 8).

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6.2.2. Main meal dishes

Sobuj bhath is a nutritious main meal of cereals, pulse or beans, leafy vegetables, egg, tomatoes,fresh or dry spices and oil. Leafy vegetables like spinach and drumstick have beta carotene(vitamin A), iron, calcium and folic acid, while tomato adds beta carotene and vitamin C(See Table 9). Rice and oil give energy while pulses or beans and egg are a source of proteinand energy. Eggs have some protein, vitamin A and riboflavin. Adding egg and oil promotesabsorption of vitamin A from leafy vegetables and tomato.

Table 9. Nutritive value of main meal dishes/serving basis

RecipeEnergy Protein Fat Beta carotene Iron(kcal) (g) (g) (µg) (mg)

Sobuj bhath 420 14.0 7 2 120 5.0Sobuj ruti 325 10.1 7 4 720 4.0

Leafy vegetables like spinach or drumstick and tomato are grown in home gardens andavailable in local markets. Fresh coriander contains vitamins A and C while spices such asginger, garlic and green chilli provide taste, some vitamins and minerals. The recipe shows howdifferent food combinations in appropriate amounts (cereal + pulses or beans + egg + tomato+ oil) can improve dietary variety and nutrient availability. It also demonstrates correct cookingmethods such as cooking rice in just enough water (by absorption method) to ensure retentionof B-complex vitamins.

A “meal-in-a dish” recipe, sobuj bhath can be a main meal and a packed school lunch.A culturally appropriate adaptation of the popular khichuri (rice and pulse) by adding spinachand other food types, the green rice topped with red tomatoes reminds children and farmersof the national flag, encouraging them to eat green leafy vegetables and fresh tomato. A servingof sobuj bhath has more than twice the RDA for vitamin A, a part of the RDA for iron and a littleless than one-fourth of the RDA26 and one-third of the RDA for protein.

Sobuj ruti is a nutritious main meal or breakfast dish of cereals, pulse flour, leafy vegetables,potato (in proportions of 3:1:2:2) and fresh spices like coriander leaves and green chilli. Leafyvegetables have vitamin A, iron, calcium and folic acid, potato has energy and bulk whilechickpea and wheat flour add protein. Oil or fat helps in absorption of vitamin A from leafyvegetables. A culturally appropriate adaptation of the popular ruti by addition of spinach,drumstick or any leafy vegetable, it can be a nutritious packed school lunch, a main meal orbreakfast item.

A serving of sobuj ruti has twice the RDA for vitamin A and a part of the RDA for iron. It alsofurnishes a little less than a fourth of the RDA27 and a fifth of the RDA for protein.

6.2.3. Drumstick leaves-based recipes and snacks

Drumstick leaves bhorta is a good source of energy and micronutrients. Drumstick leaves, locallyknown as sajna or moringa oleifera, are an excellent source of vitamin A, riboflavin, folic acid,vitamin C, calcium, iron and protein. (see Table 10).

26 RDA for energy for moderate working Indian female is 2 225 kcal; RDA for protein is 50 g.27 RDA for energy for a moderate working Indian female is 2 225 kcal; for protein is 50 g.

20

Drumstick leaves combined with potato, onion, fresh and dry spices and fresh mustard oil havea taste that is highly relished in the Bangla diet. The nutritional quality of a dish can beimproved by combining drumstick leaves with cereals and pulses.

Drumstick leaves have very high contents of beta carotene, calcium and iron (almost eight tonine times that of spinach and amaranth), and only half the quantity of drumstick leaves wereused in the recipes. Recipes using drumstick leaves provide vitamin A much above the RDAand a substantial part of the RDA for calcium and iron.

6.2.4. Coconut-based recipes

Several households in the coastal regions of Khulna, Barisal and Feni in Bangladesh havecoconut trees. Coconut contains 35 to 65 percent fat and is a rich source of dietary energyproviding 444 kcal per 100 g on a fresh weight basis.

It can be combined with sweet pumpkin or sweet potato, chickpea and jaggery to make a halwawhich is an energy-and-nutrient-dense dessert. This offers energy from the sweet pumpkin orsweet potato, protein, niacin and some iron from the chickpea, while jaggery provides energyand some iron (see Table 11).

Table 10. Nutritive value of snacks and side dishes/serving basis


Drumstick leaves omelette 237 10.0 8.0 2 568 4.0Drumstick leaves pakura 450 12.0 8.0 2 900 5.0Drumstick leaves bhorta 220 5.3 5.0 6 147Colocasia leaves pitha 213 15.0 6.0 5 290 16.0Mixed vegetable28 pitha (hoppers) 532 15.0 6.0 – –

Table 11. Nutritive value of coconut-based recipes/serving basis


Sweet pumpkin coconut halwa 377 5.0 16 965 7.6Coconut egg vegetable curry 550 14.1 30 4 697 3.0

28 Spinach and carrot

Roasted chickpea can be ground into flour to improve its digestibility and fortify the ingredientsblended in the recipe. Sweet pumpkin and yellow-coloured sweet potato locally known askamola sundari, are an inexpensive and relatively easily available source of beta-carotene.

The fat in the coconut helps in the absorption of beta carotene from the sweet pumpkin or sweetpotato. The market value of sweet pumpkin can be considerably increased by processing it intosweet pumpkin coconut bars. Sweet pumpkin-coconut halwa can be a dessert or dish betweenmeals filling dietary nutrient gaps among vulnerable groups such as adolescents and pregnantor lactating women. One serving provides about half of the RDA for vitamin A, a little less thana fourth of the daily energy requirement and a third of the RDA for iron.

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Coconut egg curry is rich in energy with all nutrients except ascorbic acid. Egg protein has thehighest quality among all dietary proteins; it also provides riboflavin and vitamin A. Vegetableslike carrot, tomato and sweet pumpkin provide vitamin A while potato and coconut giveenergy, and beans add protein with some iron. Coriander leaves add both beta carotene andvitamin C to the dish. Eggs are easily available to most rural households with poultry whilevegetables can be grown in home gardens.

A serving of coconut egg curry contains 590 kcal which is about one-third of the daily RDA forenergy and protein, twice the RDA of vitamin A, and a part of the daily RDA for iron.

6.2.5. Salads

A salad of vegetables, beans, potato and egg is a good source of micronutrients (vitamins Aand C), protein and energy. Since most vegetables are used in fresh and uncooked form, theyserve as good sources of vitamin C. Cabbage, carrot, tomato and egg provide vitamin A whilegreen papaya, radish and cucumber add bulk and variety to the diet.

A lemon dressing adds vitamin C which enhances the absorption of iron from plant sources.Cumin powder in the dressing provides some calcium. The amount of vegetables, potato andegg in the salad make it a packaged source of nutrients and a meal-in-dish. A serving of mixedvegetable egg salad or mixed vegetable beans salad provides much more than the RDA forvitamin C, in addition to nearly the full RDA for vitamin A and other nutrients (see Table 12).

Table 12. Nutritive value of salad recipes/serving basis

RecipeEnergy Protein Beta carotene Iron Vitamin C(kcal) (g) (µg) (mg) (mg)

Mixed vegetable egg salad 270 6.0 1 867 3.0 58Mixed vegetable beans salad 130 6.0 2 010 5.0 52

6.2.6. Mushroom-based recipes

Mushrooms are a low-calorie food having less than 30 kcal/100 g with traces of sugar and nocholesterol. Almost free from fat (0.2 g/100 g) mushrooms are highly suitable for overweightpeople. The low fat content of between 2 to 8 percent is rich in linoleic acid, an essential fattyacid important for growth and cell integrity. Mushrooms contain specific hypocholesterolemicsubstances. Free of fat and cholesterol, and rich in linoleic acid, mushrooms are a healthy foodchoice for patients of heart disease. Free of starch and with very low sugar content, mushroomscan be called the “delight of the diabetic”.

Table 13. Energy and protein content of mushroom-based recipes per serving

Recipe Energy (kcal) Protein (g)

Mushroom chop 250 4.0Mushroom omelette 160 8.0

Combined with beans, vegetables, eggs, and other staple food ingredients, mushrooms enhancethe meal’s nutritional quality. They can be used with fish, chicken or meat as part of food-to-food enrichment.

22

A serving of mushroom chops or mushroom omelette has moderate amounts of energy, smallamounts of protein and forms a satisfying meal. Mushrooms have good quality protein,improving the nutritional quality of vegetable-based diets.

6.2.7. Complementary food (CF)

Complementary feeding supplements breast feeding to meet the nutrient needs of infantsstarting from the age of six months up till about two years. Complementary food must haveadequate energy, protein and micronutrients.

Cereals (grains), pulses and nuts in proportions of 4:1:1 were used to prepare a nutrient-densecomplementary food mix (CFM), Mix A for infants and small children. Roasted grains andnuts reduce bulk and are a concentrated source of nutrients. Dehydrated carrot powder isa concentrated source of beta carotene. The two powders can be mixed for food-to-foodenrichment.

The consistency of the CF gruel makes it easy for child feeding. The two mixes are nutritious,easy to prepare and household processing methods such as roasting and grinding make itpossible to store the CFM for long periods.

Kept in a clean and dry container at room temperature, Mix A has a shelf life of up to twomonths while carrot powder (Mix B) can be kept for up to three months in a dark glasscontainer at room temperature in a clean and cool place, protected from light. The two mixturescan be prepared at household level using easily available food materials.

Table 14. Nutritive value of complementary food per serving


Fruit29-based 300 13.0 7.0 995 5.0complementary foodCarrot-based 364 13.0 7.0 6 460 5.0complementary foodVegetable30-based 240 13.0 7.0 2 333 4.0complementary food

One serving of carrot-based CF contains a little less than a third of the RDA for energy,31 aroundthree-fourths of the RDA for protein and over five times the RDA for beta carotene. Other CFvariations provide substantial amounts of nutrients, furnishing part of their RDA.

Studies elsewhere in Asia show that rice, mung bean, sesame and carrot are the mostacceptable gruel formulation in terms of sensory quality attributes. It also had significantlyhigher levels of protein, minerals and energy value than the RDA.33 Carrot-based gruels wereintended to supplement the child’s main diet and supplied one-third of the RDA. It isencouraging to note that the project results are in keeping with findings from studies elsewhere.

29 Papaya, banana or mango30 Sweet pumpkin31 RDA for energy and beta carotene for infants of 6–12 months age is 1 000 kcal and 1 200 µg.32 Naikare, S.M. & Mabesa, R.C. 1993. Processing of supplementary food prepared from rice-mungo-sesame-carrot

blends. J Food Sci. Technol, 30(6): 451–453.33 Florentino, R.F. 1990. Food Composition Tables. Manila, Food and Nutrition Research Institute, Philippines.

32

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6.3. Food preparation techniques and cooking tips

Developing the competence and skills of the farmers to promote horticulture-based food in theirdiets has been a key component of the nutrition programme. Demonstrations were held on:

(a) preparation of horticulture-based foods;

(b) processing and preparation of horticulture-based complementary foods.

Specific technologies were developed and transferred to the field emphasizing the use ofmicronutrient-rich vegetables that are locally available and their combinations with othervegetables and staple food ingredients. Cooking methods to promote maximum retention of thenutritive value along with hygienic handling of vegetables and food were also demonstrated.

Methods to improve the bioavailability of some key micronutrients such as iron in vegetableswere emphasised with combinations of sour or vitamin C-rich fruits and vegetables, along withappropriate processing techniques. These food technologies have been well accepted and arenow practiced by the farmers. An impact assessment of food preparation demonstrationsas validated through a change in farmers’ practices has been discussed later (See 13.0“Community-based assessment and impact of nutrition programmes”).

Cooking partially destroys vitamins C and B1. Raw fruits and vegetables are particularlyvaluable sources of these vitamins provided they are grown and handled hygienically. Peelingof vegetables and fruits can cause significant loss of nutritive value and this was consideredwhile developing the recipes34 for the Nutrition Education Programme. As the water used forcooking vegetables or fruit contains dissolved minerals and trace elements, the nutritioneducation programme recommended that this should not be thrown out but used in soups orfor preparing other food.

34 For mixed vegetable soup, vegetables were washed well and cut into large pieces; peeling of vegetables likepotato and carrot was not suggested in order to retain the nutritive value.

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7. NUTRITION IMPROVEMENT THROUGHAGROPROCESSING

As part of the nutrition improvement strategy through agroprocessing, a wide range ofprocessed foods were developed and promoted35 at household and community levels. Simpletechnologies for dehydration, pickling, bottling, pulping and preparing preserves and relishesfrom a variety of vegetables and fruits were promoted.

This developed synergies between nutrition and food processing, especially by reducingmicronutrient losses, increasing shelf life, meeting part of the daily requirement of nutrients andvalue addition for some products (see Table 15). The technologies were brought to rural projectsites in different districts of the country and have been well accepted by project beneficiaries.

Table 15. Products, main technologies and nutrients provided

Product Technologies usedMain nutrients Approximate

provided shelf life

Fermented cucumber Salting, fermentation followed Potassium, B-complex 6 monthsby addition of spices, oil and vinegar vitamins

Mixed vegetable pickles Slicing, curing in oil, salt, spices and Vitamins A & C, 6 months(cauliflower, carrot, acetic acid B-complex vitamins,peas, pointed gourd, and potassiumgreen chillies, etc.)

Fermented cabbage Shredding, salting and lactic acid Vitamins C, B-complex, 3 monthsfermentation potassium

Dehydrated cabbage Shredding, blanching, sun drying and Vitamins C, B-complex, 3 monthspacking in plastic-polythene (PP) pouches potassium

Dehydrated vegetables Shredding, blanching, sun drying and Vitamins A, B-complex, 4–6 months(bitter gourd, okra, packing in PP pouches potassiumsweet gourd, etc.)

Fermented vegetables Steeping mixture of vegetables in 3 percent B-complex vitamins, 2 months(cucumber, ridge gourd, salt solution, 0.8 percent acetic acid and potassiumpointed gourd, 0.2 percent KMSsweet gourd)

Bottled tomato Preserving tomato pieces in own juice; Vitamins A, B-complex, 3 monthsfilling, exhausting, closing and sterilizing potassiumin boiling water

Tomato ketchup Pulp extraction, adding salt, sugar and Vitamin A, energy 6 monthsspices, bottling

Tomato pulp Pulp extraction, adding salt, sugar and Vitamin A, energy 6 monthsspices, bottling

Papaya morobba Slicing, hardening unripe papaya, drying, Vitamin A, potassium, 6 months(preserve) adding sugar and citric acid, packing in energy

cellophane.

Ash gourd preserve Cutting, slicing, hardening by lime Energy, potassium 6 monthswater dip, impregnation with sugar,packing in PP pouch/plastic/glasscontainer

35 Information based on discussions with Dr Amiruzamman, National Food Processing Expert and Mission Reportof INES (November 2004).

25

Mango leather Pulp extraction, heating, adding lime juice, Vitamin A, potassium 4 monthssugar, KMS, spreading and sun dryingpulp on stainless tray; PP sheet packing

Mango slices in sugar Using up to 40º Bx sugar, sterilizing in Vitamin A , potassium 4–6 monthssyrup boiling waterUnripe mangoes as Using oil salt, spices and acetic acid Energy, vitamin A, 4 monthssemi-processed product potassiumMango pickle Using oil, salt, spices and acetic acid Energy, vitamin A, 6 months

potassiumDehydrated Flattening by dehydration in solar drier, Energy, potassium 2 monthsbanana packing in PP pouchesFried banana chips Slicing, soaking in lemon juice water, Energy, potassium 2 months

removal of adhering water, frying in oil,sprinkling spice mixture, packaging

Pineapple squash Juice extraction, measurement of TSS and Energy, potassium 6 monthsacidity, formulation of juice contents likesugar, incorporation of pectin andcitric acid, and KMS

Guava jelly Juice extraction, straining, measurement of Energy, potassium 6–8 monthsTSS, formulation of initial mix with sugar,incorporation of pectin and citric acid,cooking to desired consistency and packing

Carrot pickle Blanching, salt impregnation, packing Vitamins A, C and 6 monthswith vinegar potassium

Carrot pickle Use of salt, spices, sugar and oil Vitamins A, C and 6 monthspotassium

Lemon and green Preparing and cooking raw materials in Vitamin C, potassium 6 monthschilli pickle mustard oil to desired consistency with

addition of spices, salt, sugar andacetic acid

Lemon squash and Extraction of lemon juice, concentration Energy, potassium 6 monthsdrink with sugar, pasteurization by hot filling

in sterile bottlesHog plum pickle Use of salt, sugar, spices, vinegar and oil Energy, potassium 6 monthsTamarind chutney Pulp extraction, mixing with sugar, salt, Energy, potassium, iron 6 months

spices, mustard oil at specific stages,sodium benzoate as preservative,store in glass bottles

Olive pickle and Use of salt, sugar, spices and oil Energy, potassium, 6 monthschutney vitamin CBer (local plum) Pulping, mixed with sugar, salt, spices, Energy, potassium, 4 monthschutney mustard, vinegar and oil vitamin CBer tamarind chutney Pulping, crushing, dried ber fruit in Energy, potassium, 4 months

definite ratio, cooking mixture to desired vitamin Cconsistency with permitted level ofpreservatives, packing in sterile containers

Star fruit pickle Use of oil, salt, spices, sugar, acetic acid Energy, potassium, 6 monthsand mustard oil vitamin C

Green chillies and Use of oil, salt, spices, sugar, acetic acid Potassium, 6 monthsgarlic pickle and mustard oil vitamins C, A

Table 15. Products, main technologies and nutrients provided (continued)

Product Technologies usedMain nutrients Approximate

provided shelf life

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7.1. Preservation of fruits and vegetables by drying and frying technologies

The reduction or removal of the moisture content of vegetables and fruits is an importantprinciple in drying and frying technologies. This involves removal of water from vegetables byeither sun-drying or using a dryer.

Dark green leafy vegetables and yellow-orange vegetables should be cleaned, washed andspread on a clean sheet for drying in the sun. When completely dried, these should bepowdered coarsely by rubbing with the hand and stored in air-tight containers. These can beused when a fresh supply is not available.

Drying technologies provide a concentrated source of nutrients such as protein and thiamin inthe case of dried beans, vitamin A as beta carotene in carrot powder, energy in banana chips,vitamin A and calcium in coriander leaves, and vitamin A, calcium and iron in spinach.

While some of these methods are traditionally used, the project emphasized pre-treatment likeblanching, trimming, slicing, and sanitary and hygienic methods during and after drying.

7.2. Preservation of vegetables and fruits by pickling and preparation of chutneys

Pickling is a traditional preservation technique involving salting and acidification of preparedfruits and vegetables. A variety of common vegetables and fruits along with less commonvegetables were pickled, including brinjals, green chillies, mixed vegetables, radish and garlic.

Considerable value can be added to all vegetables through processing into pickles or chutneys.Chutneys were made from ber, olives, tamarind, hog plum and chalta.36 Pickles and chutneysprovide vitamin A (as beta carotene), some vitamin C and potassium. They can be useful dietaryenhancers, increasing the bioavailability of micronutrients such as iron in the meal. Oil and saltare major preservative ingredients in pickles and add energy and sodium to the diet. Thisshould be kept in mind in the preparation of calorie and salt-restricted diets.

7.3. Preservation of juices and juice-based products

Fresh juice and juice-based beverages, prepared by extracting the juice and concentration withsugar, are refreshing high energy drinks. Fruits also contain potassium and offer vitality andhealth benefits.

Tomato juice and tomato-based products provide vitamin A as beta carotene and lycopene, animportant carotenoid with nutritional health benefits for healthy vision, prevention ofdegenerative heart disease and certain types of cancers. The project developed and promotedpineapple, lemon, mango and tomato juice and juice-based products.

7.4. Semi-processing of fruits and vegetables

Steeping vegetables in brine, juice extraction and use of sugar were the main principles followedin the preparation methods. Salted and fermented vegetables offer the additional benefit ofB-complex vitamins, and all products have the advantages of preservation, long-term access andsupplementing household nutrition.

7.5. Preservation of horticultural produce by sugar concentration

Extraction of fruit juice and concentration with sugar were the main principles used inpreparation of jams, jellies, marmalades and preserves. Such products provide energy and addsome potassium to the diet (see Table 15).

36 Bael

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8. IMPROVING STORAGE AND PRESERVATION

The keeping and preparation of fresh produce affects nutritional value in several ways. Drymatter (energy supply) is reduced with time as living processes within the produce use upstored food reserves. Vitamin C content decreases with time and little may remain after two orthree days.

37 TCP/IND FAO Pilot Project on Prevention and Elimination of Micronutrient Malnutrition in DharmapuriDistrict, Tamil Nadu, India (2000–2002).

As part of the strategy to promote their consumption,storage and preservation technologies for vegetables andfruits were developed by the National Post-harvest Expertusing available technologies. Various low-cost methods forstoring vegetables and fruits were searched elsewhere inAsia.37

As a result, a low-cost earthen pot (Figure 4) was developedunder the post-harvest component of the project.

The simple storage method using a big pot, a smaller innerpot and a lid, includes (i) filling water in the outer layer(big pot), (ii) putting produce in the inner pot and (iii)placing the small pot into the bigger one and covering withthe lid.

The inside of the smaller pot cools due to evaporation of thewater and the temperature inside the pot is 5–6ºC comparedto the ambient temperature outside during a dry hot day.

Storage trials with pointed gourd were conducted by theNational Post-harvest Expert. Figures 5, 6 and 7 show thestatus of pointed gourd samples (control and experimental)after one, four and five days of storage at room temperaturein the earthen pot. The experimental samples are on the leftside and the control samples on the right. The samplesstored in the earthen pot retained freshness compared tothose kept outside which had shrivelled.

Figure 4. Low-cost earthencooling pot

Figure 5. Storage at day 1

Figure 6. Storage at day 4 Figure 7. Storage at day 5

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9. LINKING NUTRITION WITH HORTICULTURE

The nutritional status and, to a great extent, the health of a community depends on access toa sufficient quantity and variety of agricultural food. Expanding and improving household-integrated horticulture production systems to promote nutrition and address changes in rurallivelihoods were, therefore, important project outputs. Major strides were made in integratingnutrition in the project mainstream, with high-density mixed fruit orchards and multi-bedvegetable systems resulting in positive nutrition outcomes. More has to be done to implementthe practical aspects, particularly of mixed fruit orchards but a good start has been made.

9.1. Horticultural production and consumption

The nutrition component was dovetailed into the total food chain starting from group andindividual homestead garden production, including procurement from local markets, todomestic processing for home meal preparation. The links between the horticulture andnutrition component and the related activities were strengthened in collaboration with theSenior Horticulture Programme Development Expert and the Fruit and Vegetable Experts.

A variety of micronutrient-rich vegetables and fruits have been promoted through thehorticulture production component of the project. These include leafy vegetables like Indianspinach and stem amaranth, carrot, country beans, red pumpkin, tomato, broccoli, garden peas,okra, onions and green chillies.

9.2. Horticultural production and nutrition availability

Vegetable garden-based production of improved vegetable varieties was an important projectactivity. The nutritional contribution of the vegetables produced in farm and homestead gardenswas assessed using summer and winter vegetable yield information38 in demonstration plotsat 15 HDTC locations and discussions with the Vegetable Production Expert.

The yield availability per person was calculated using an average of six persons per household.Table 16 shows average yields of winter and summer vegetables at HDTC and farm levels. Thedaily average household and per capita availability of vegetables from the group garden andthe per capita daily micronutrient supply are also given.

Sweet pumpkin, sweet potato, kang kong and broccoli were promoted. The HorticultureCropping Systems Expert has recommended promotion of other vegetables such as squashes,taro, amaranthus and Indian spinach. Kang kong is a nutritious leafy vegetable well known tothe farmers and can be grown almost round the year with a good yield.

Broccoli was also well received by the farmers. More nutritious than cauliflower, broccoliis a good source of vitamin A and other carotenoids such as lutein and xeaxanthin withmarked nutritional benefits. One hundred grams of broccoli provides 700 µg of beta carotene,and 1 900 µg of lutein + xeaxanthin.39 Broccoli is also a good source of vitamin C, with 100 gproviding 109 mg. The National Research Council Committee on Diet, Nutrition and Cancerrecommends increased consumption of Brassica genus vegetables as a preventive measureagainst cancer.

38 Data from Dr S.M. Monowar Hossain’s Report (2004) on vegetable yield during winter 2002–2003.39 Mangels. 1993. Carotenoid content of fruits and vegetables: an evaluation of analytical data. J Am Diet Assoc.,

93: 284, 1993.

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Yellow sweet potato was promoted as a source of beta carotene (1 810 µg/100 g40). It also addsenergy and bulk to the diet. Low-costing sweet potato can be processed into high-value sweetpotato coconut bars and this was promoted by the project along with sweet pumpkin-coconutbar and halwa in the coastal regions of Barisal, Feni and Khulna.

The daily per capita availability of vegetables from the group garden was estimated to be about201 g. The National Plan of Action for Nutrition (NPAN)41 recommends increasing the daily percapita vegetable consumption from the present level of 72 g to 215 g. Special efforts are beingmade at the national level in the 5th Five Year Plan (1997–2002) for year-round production ofmajor fruits and vegetables using appropriate technology. The Integrated Horticulture andNutrition Development Project promoted the NPAN objective by increasing the supply ofmicronutrient-rich vegetables to reduce micronutrient malnutrition.

Among winter vegetables, carrot has the most vitamin A as beta carotene (3 230 µg) followedby tomato (708 µg) per capita. Tomato is one of the most common vegetables and nutritionallyvaluable because of its high content of vitamins A and C. It is also a primary source of lycopene(a carotenoid) and its consumption has significant association with low risk levels of digestivetract and prostrate cancers.42 Garden peas are not a good source of vitamin A but providedietary protein, especially when dried.

Table 16. Horticultural produce43 and nutrition availability from group garden

Average yield/season44 Micronutrient45 supply/P/d

Vegetable All Per Farm Per HH/d Per P/d Vit. A as Vit. C Iron CaHDTCs (kg) (g) (g) BC (µg) (mg) (mg) (mg)

(kg) N = 75 N = 6

WINTERTomato 61.00 53.00 706 117 708 32 0.70 58Pea 6.80 5.5046 183 30 25 3 0.45 6Carrot 30.80 24.5047 533 88 5 168 3 0.88 64

SUMMERIndian spinach 68.00 55.00 366 61 1 704 52 6.00 120Okra 30.00 27.00 300 50 26 7 0.70 10Stem amaranth 39.00 32.0048 266 44 2 208 4 0.70 104

HH/d: household/day; P/d: person/day; Vit.: vitamin; BC: beta carotene; Ca: calcium

40 Gopalan, C. 2004. Nutritive Value of Indian Foods (Reprint). Hyderabad, India/New Delhi, National Institute ofNutrition/Indian Council of Medical Research.

41 National Plan of Action for Nutrition 2000, Bangladesh.42 Singh. J. 2001. Vegetable Crops: Nutritional Security. New Delhi, Indian Council of Agricultural Research.43 Data adapted from Monowar Hossain (2003) Assignment Report.44 5 months, actual period of availability 2 1/2 months.45 Gopalan, C. 2004. Nutritive value of Indian Foods. Hyderabad, India/New Delhi, National Institute of Nutrition/

Indian Council of Medical Research.46 Available for 1 month only.47 Available for 1 1/2 months only.48 Yield from 65 farms.

Among summer vegetables, stem amaranth (data shak) has maximum vitamin A (2 208 µg betacarotene), calcium (104 mg) and a little iron per capita. Indian spinach, on the other hand,is a packaged source of micronutrients including vitamin A (1 704 µg beta carotene), calcium(120 mg) and iron (6.0 mg) per capita.

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Contribution to Recommended Dietary Allowance (RDA)

Tomatoes are a good source of vitamin C, providing 80 percent of the RDA and a little overone-fourth of the RDA for vitamin A as beta carotene. Carrot is an excellent source ofvitamin A and contributes twice the amount of the RDA (215 percent). Indian spinach providesnearly three-fourths of the RDA for vitamin A, and more than the RDA for vitamin C(130 percent). Stem amaranth also has adequate vitamin contributing to 92 percent of the RDAfor beta carotene and about one-fourth of the RDA for calcium (see Table 17).

Table 17. Micronutrient contribution of vegetables as percentage of RDA49

Per HH Per P/d Vit. A RDA50 Vit. C RDA51 Iron RDA52 Ca RDA53

Vegetable (g) mg (BC) µg % mg % mg % mg %(N = 6)

Tomato 706 117 708 29 32 80 0.70 2.3 58 15Pea 183 30 25 1 3 8 0.45 2.0 6 2Carrot 533 88 5 168 215 3 8 0.88 4.0 64 16Indian 366 61 1 704 71 52 130 6.00 20.0 120 30spinachOkra 300 50 26 1 7 18 0.70 2.3 10 3Stem 266 44 2 208 92 4 10 0.70 2.3 104 26amaranth

HH: household; P/d: person/day; Vit: vitamin; BC: beta carotene; Ca: calcium

Nutrition education played an important role in supporting the vegetable productionprogramme. The food preparation demonstrations encouraged women farmers to cookhorticulture-based nutritious food for household consumption. The excess yield is sold,providing some income. Encouraging women farmers and their households to eat more fruitsand vegetables has been central to the project’s nutrition education strategy.

9.3. Fruit production and micronutrient supply

Several yellow, orange-coloured and vitamin C-rich fruits were promoted by the project.Yellow and deep orange-coloured fruits are a good source of beta carotene, the plant source ofvitamin A, providing a wide range of carotenoids as well as phytonutrients and fibre thatimpart protective attributes to the human body.

Recent research54 shows that regular consumption of a variety of vegetables and fruits cansubstantially reduce the risk of non-communicable ailments such as cardiac disease, diabetesmellitus, degenerative eye disease and certain types of cancer.55

49 Recommended dietary allowance50 RDA for vitamin A is 2 400 µg (beta carotene) or 600 µg retinol51 RDA for vitamin C is 40 mg52 RDA for iron is 30 mg53 RDA for calcium is 400 mg54 FAO/WHO. 2003. Diet, nutrition and the prevention of chronic diseases. Report of a joint Expert Consultation. Geneva,

World Health Organization, Technical Report Series 916.55 IARC. 2003. Handbook on fruit and vegetable consumption and cancer prevention. Washington, DC, International

Agency for Research on Cancer.

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A wide range and quantity of fruits rich in micronutrients (vitamin A, vitamin C, potassium,iron) can be produced over a ten-year period (see Table 18), contributing to both micronutrientfood security and dietary diversity.

The estimated total fruit availability per person per day of 155 g is much higher than the currentconsumption of 34 g per person per day.

Figures 8 and 9 show that from the first year itself, the daily vitamin A supply56 (beta carotene)from fruits is adequate for meeting each household’s and each person’s micronutrient needs.

The recommended beta carotene dietary allowance57 for an adult is 2 400 µg. Papaya anddrumstick leaves alone can furnish 97 percent of the RDA for beta carotene. Both can provide

Table 18. Estimated production of fruits over a ten-year period/day/household (g)

SpeciesNo. Year Year Year Year Year Year Year Year Year Year

Totaltrees 1 2 3 4 5 6 7 8 9 10

Mango 2 0 0 40 160 300 438 570 570 570 570 3.24Jackfruit 2 0 0 0 0 0 164 300 438 570 570 2.21Drumstick 5 60 130 200 270 270 270 270 270 270 270 2.32Guava 6 40 410 410 270 190 136 80 80 80 80 1.79Papaya 8 240 190 0 0 0 0 0 0 0 0 438Banana 6 330 410 130 50 50 50 50 50 50 50 1.28Hog plum 6 100 270 410 270 240 210 191 164 164 164 2.21Lime 4 50 210 210 160 130 100 109 109 109 109 1.34Lemon 2 20 210 210 160 130 100 109 109 109 109 1.31Custard apple 2 0 0 100 100 80 50 20 0 0 0 383Carambola 4 40 410 410 540 680 820 958 1.09 1.09 1.09 7.0Acerola 2 50 80 100 136 136 136 136 136 136 136 1.2Pineapple 204 0 750 270 0 0 0 0 0 0 0 1.0Total 934 2.83 2.34 1.89 1.97 2.24 2.54 2.76 2.90 3.06 23.5

56 In terms vitamin A availability, the bioavailability factor used for beta carotene is: 1 mcg beta carotene = 0.25 mcgretinol.

57 Recommended dietary allowance for Indians (1992), Indian Council of Medical Research.

Figure 8. Daily vitamin A supply/household (µg)

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nearly twice the RDA in the second year. In subsequent years, mango and drumstick leaf willprovide more than three times the RDA.

The daily per capita household and person supply of vitamin C from guava, papaya, lemon andhog plum over a ten-year period is shown in Table 19. The RDA for vitamin C is 40 mg andthe four fruits can furnish over three times this. Only two of these fruits can meet the RDA forvitamin C.

Figure 9. Daily vitamin A supply per person (µg)

Table 19. Vitamin C from guava, papaya, lemon, hog plum over a ten-year period

YearVitamin C/HH/d (mg) Vitamin C/P/d (mg) RDA %

G Pa L H G Pa L H G Pa L H

1 85 137 13 92 14 23 2 15 35 58 5 38 136

2 869 108 132 248 145 18 22 41 362 45 55 103 103

3 869 132 377 145 22 63 362 55 157 574

4 572 101 248 95 17 41 237 43 103 383

5 403 82 220 67 14 37 168 35 93 296

6 288 63 193 48 11 32 120 28 80 228

7 170 75 176 28 13 29 70 33 73 176

8 170 75 151 28 13 25 70 33 63 166

9 170 75 151 28 13 25 70 33 63 166

10 170 75 151 28 13 25 70 33 63 166

G: guava; Pa: papaya; H: hog plum; L: lemonHH/d: household/dayP/d: person/dayRDA: recommended dietary allowance

TotalRDA %

It is interesting that just one slice of guava of about 20 g can provide the RDA for vitamin Cas 100 g of guava contains 212 mg of vitamin C.

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10. SCHOOL NUTRITION PROGRAMME

The School Nutrition Programme (SNP) encouraged schools to make use of the synergiesbetween horticulture and nutrition education to teach adolescent girls the importance of eatingvegetables and fruits.

The SNP was implemented in 30 schools, reaching out to 1 800 adolescent girls from Grades VIIIand IX in the project areas. Developed jointly by the national project coordinator, nutrition andhorticulture experts in collaboration with the school management, the programme wasfacilitated by the HDTC under the technical supervision of the National Nutrition Consultant.

10.1. Planning the School Nutrition Programme

The preliminary results of the IHNDP baseline survey58 found most families had minimalmonthly income and a low consumption of micronutrient-rich food, vegetables and fruits. Thechildren’s nutritional status was presumably poor.

Meetings with the management of three schools59 were held in December 2003 to explorepossible collaboration between IHNDP and the schools for the proposed SNP. Basic informationwas collected including the school’s name, location, whether co-educational or not, grade levels,inclusion of nutrition in home economics curriculum, food varieties in children’s lunch orsnacks, whether there was a home garden in the area, water supply availability, and area of theschool garden.

The school management recognized the importance of correct food habits and good nutritionboth as a subject for education and for nutritional improvement of students leading in turn toimproved educational performance. A school nutrition education strategy was planned inkeeping with the science and home economics curriculum.

The main objectives of the School Nutrition Programme were to: (a) create nutritional awarenessamong high school students and (b) promote inclusion of a variety of micronutrient-richhorticultural food in the daily diet.

10.2. Coverage and programme

The criteria for selection of schools included request for this, the school management’scommitment, having a high school and science department, a minimum of 60 female studentsin the eighth and ninth grades, location within the project area, a minimum land area of3 decimal60 for the nutrition garden, and access to water. Thirty high schools were covered bythe School Nutrition Programme, including two schools in every HDTC area, with a total of1 800 girl students between Grades VIII and IX and in the age group of 13 to 15 years.

A one-year programme was launched with nutrition education and school gardening activities.Nutrition education included lecture-cum-food preparation demonstrations to build/strengthenexisting nutrition knowledge through hands-on food preparation activities. The schoolgardening activities set up a demonstration nutrition garden in the school and a peer nutrition

58 Draft Final Report on Baseline Survey (2002) Integrated Horticulture and Nutrition Development Project,FAO-DAE-Kranti Associates.

59 Kishoreganj, Jamalpur and Feni60 237 decimals = 1 ha

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promotion programme was also implemented. High school students were assignedresponsibility for sensitizing middle school students to nutrition, using an each-one-teach-oneapproach.

Each high school student identified a schoolmate not covered by the SNP and arranged to meether at least once in 15 days to teach the basics of nutrition and diet recipes. A set of recipe sheetswere given to the student “teacher”. This was done on a voluntary or extra-mural basis by thestudents.

10.3. Resources and responsibilities

The HDTCs signed a memorandum of understanding (MOU) with the respective SchoolManagement Committee (SMC) to set up the garden and to conduct the nutrition education andfood preparation demonstration programmes. The schoolteachers were very cooperative and thegirls participated actively in the nutrition programmes. Seeds and planting material wasprovided to the school for setting up of the garden. The school had responsibility for preparingthe field, seed sowing and maintaining the garden, including fencing.

Students had to work in the garden under the supervision of the agriculture teacher incollaboration with the Sub Assistant Agriculture Officer or Agriculture Overseer from theHDTC. The National Nutrition Education Specialist provided necessary guidelines forestablishment and management of the vegetable garden in close consultation with relevantvegetable, fruit or spice specialist. A list of selected micronutrient-rich vegetables and fruits wasproposed by the nutrition experts in collaboration with the project management as well as thevegetable and fruit specialists.

Nutrition gardens were established in 15 high schools in the project area to demonstrateyear-round production of vegetables, fruits and fresh spices. The size of the model schoolnutrition garden was approximately 1.3 decimal (8 m x 6.5 m) with four raised beds. Thetechnical guidelines for the model garden specify vegetable cultivation round the year by bednumber and cropping sequence.

Altogether, 14 vegetables, fruits and spices were selected for the school nutrition gardensestablished in the schools’ premises during the second quarter of 2004. Funds were alsoprovided to the HDTCs for food preparation demonstrations for adolescent school girls inGrades VIII and IX. Tiffin boxes were supplied to 60 girls in each school to bring their lunchand as a motivational reward for participation in the SNP.

10.4. Promotion of micronutrient-rich vegetables and fruits

The vegetables grown and promoted through the nutrition garden included red amaranth,Indian spinach, kang kong, stem amaranth, early spinach, green onion, black colocasia, okra,yard long beans, country beans, French beans, carrot, broccoli and summer radish. Guava andpapaya were also promoted.

The micronutrient-rich vegetables were selected on the basis of nutritional value, culturalacceptability, seasonal availability and ease of cultivation in the school garden. The gardenproduce was primarily intended to be consumed by the participating students. The school wasallowed to sell part of the produce and use the income for buying seeds and gardenmaintenance.

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10.5. Nutrition education programme

The technical curriculum included theory and practical modules covering two sessions. Eachsession lasted three hours from 2 p.m. to 5 p.m.

Theory modules

Module I Module II

Basic food groups and their functions Nutrition and diet in adolescence

Nutritive value of vegetables and Nutritional requirements offruits adolescents

Appropriate food combinations and Planning the adolescent’s dietcorrect cooking methods

A number of recipes were demonstrated for a balanced meal for adolescent girls, includingmixed vegetable-egg soup, sobuj bhath, sobuj ruti, and mixed vegetable and egg salad. Eachrecipe provided between 400 to 500 kcal and 10 to 15 g protein, meeting about one-fourth ofthe daily recommended dietary allowance for an adolescent girl.

10.5.1. Lessons learned from the nutrition education programme

It was observed that 44 percent of students had learned about food groups and food quantitiesto meet dietary nutrient requirements and participated actively in the discussion session.Twenty eight percent students had a very clear understanding of the recipes, learning how toprepare them. They could explain the importance of vegetables and fruits in the daily diet,though only 5 percent were able to explain the importance of nutrition gardens. In most cases,they were only told how to establish and maintain the garden (Figure 10).

Figure 10. Lessons learned in daily life

10.5.2. Application of learning in daily life

Some 44 percent of students felt they would be able to teach their family, friends andneighbours what they had learned from the school nutrition education programme. When askedabout applying this knowledge in their daily life, 37 percent responded positively (Figure 11).

36

Some believed that they would establish nutrition garden in their homestead which wouldserve as a regular source of vegetables for their family’s nutrition.

10.5.3. Constraints

Students mentioned a wide range of potential constraints with 31 percent of the view that theirfamily might ignore them and not help in applying what they had learned.

About 20 percent of students noted the lack of vegetables in their homestead affecting theirregular consumption of vegetables. Avoidance of home gardening by family members,considering home gardening extra work and social conservativeness making women reluctantto work outside the house were the most common constraints listed by the students.

They also mentioned their parents’ reluctance to accept new ideas and technologies. Anotherreason was that being young girls, their suggestions would not be taken seriously. In thecountry’s male-dominated society, women are traditionally denied importance in familydecision-making. Despite being young adolescents, the students said they would try to findways to overcome the constraints (see Table 20).

Figure 11. Application of learning in daily life

Table 20. Overcoming constraints

Ways of overcoming constraintsRespondents

%

Convince family members by highlighting importance of nutrition 32Take help of friends in applying lessons learned 16Take help of HDTC 20Establish nutrition garden with parental support 20No response 12

10.6. Evaluation

An evaluation, three months after project implementation found that students had learned thefollowing lessons from the school nutrition education programme.

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10.6.1. Frequency of vegetable consumption

Nearly three-fourths of the children were seen having leafy vegetables at least every other day.This is noteworthy and suggestive of the inclination of the students towards frequentconsumption of vegetables. Nineteen percent of students ate vegetables more than three timesa week and 7 percent between two to three days in a week (Figure 12).

Figure 12. Frequency of consumption of vegetables by students

While it is known that rural communities in Bangladesh usually have some leafy vegetables inthe daily meal, the students were found to be eating two to three types of vegetables every dayafter the start of the nutrition education programme.

10.6.2. Frequency of fruit consumption

Much less fruits were eaten than vegetables with only 7 percent of students eating fruits daily,22 percent having fruits more than three days a week and 60 percent two or three days a week(Figure 13). Eleven percent of students gave no response because they may not have eaten anyfruit in the previous 15 days.

It was reported that fruits were more expensive than leafy vegetables and many households didnot have a home garden so fruits were not readily available. Students spoke of the need to havea home garden. Local fruit varieties such as guava, mango and papaya which are rich inmicronutrients like vitamins C and A are cultivated in the school garden.

Figure 13. Frequency of fruit consumption by students

Frequency of vegetables taken

Frequency of the fruits taken

38

Most rural households in Bangladesh are too poor to buy fruits in the market for dailyconsumption. But local fruits like the Indian gooseberry, hog plum and jujube are often eaten,especially by children, though this depends on the season and availability.

10.6.3. Recipe preparation in households

The school nutrition programme also influenced recipe preparation in households. It wasencouraging to find that 88 percent of students reported they were preparing at home recipeslearned during the nutrition education. Nearly half the students (44 percent) prepared therecipes twice during the three-month period after learning how to do so in the nutritioneducation programme.

Twenty nine percent of students prepared the recipes on one occasion and 17 percent did sothrice during the period. Only 7 percent made the food preparations four times and 2 percentprepared the recipes five times. A number of factors were found to have influenced homepreparation of the recipes, mainly the consent and cooperation of parents, especially mothers.In some cases, the raw materials needed were not available due to the lack of a home gardenand the family being too poor to buy in the market.

10.6.4. Peer education

Almost all students (94 percent) took part in peer education activities, teaching school friendswhat they had learned in the nutrition education programme. Six percent of the students couldnot do so as they could not find friends to teach. Students reported that the main informationgiven and skills transferred to them were the importance of eating vegetables and fruits dailyand preparation techniques for sobuj ruti, mixed vegetables soup and sobuj bhath. Between 18to 28 percent of students had carried out these activities.

The information and skills transferred by students to their peers were mostly about preparationof recipes learned in the nutrition education programme. This indicates understanding andacceptance of the practical rather than theoretical aspects of the programme. However, it alsohighlights that practical learning opportunities must be promoted as part of the agriculture andhome economics curriculum.

10.7. Assessing institutional arrangements

The school nutrition programme was assessed for its relevance in introducing horticulture andnutrition-linked school learning as well as practical experience in nutritional improvementamong the students through production and consumption of horticulture-based food. For this,responses were obtained from the school principal and management committee, schoolteachers,students and parents of children covered by the SNP.

10.7.1. Response of School Management Committee and teachers

The School Management Committee (SMC) including the principal, trust members, seniorteachers and some elected parent representatives, expressed satisfaction with the SNP. Overall,they found the programme concept and activities highly useful and attributed this to the directrelation of the messages to the schoolchildren’s health as well as their involvement in practicalagricultural activities.

The programme duration in all the schools ranged from 2 to 15 months. Nutrition educationsessions were conducted by schoolteachers in collaboration with the HDTC officers and project

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nutrition experts. About 90 percent of the schools set up school gardens and the rest committedto establish school gardens within two months. The schools mentioned that the nutritionprogramme was an excellent means of fulfilling their social responsibility.

10.7.2. Constraints

A number of reasons were listed by the School Management Committee for not setting up theschool garden (see Table 21).

Table 21. Constraints to setting up school garden

Problems

School lacked boundary wallNo protection from pests and animalsSchool playground used for school games/physical activitiesSchool playground used for zonal sports and annual fairLack of funds to set up school gardenInability to look after school garden after school hours/vacation

10.7.3. Role and responsibilities as seen by School Management Committee

The principal and his team agreed that they had an important role in the programme. A verbalnotification was given to one of the schools under the Secondary Education DevelopmentProject through the Ministry of Education to establish a nutrition garden in rural schools. TheSMC pointed out that the school nutrition programme initiated by the project and the visit ofthe team was very timely as it coincided with their plans to take up the activity which was alsorecommended by the Ministry of Education. They thanked the project for initiating the processand agreed to ensure protection of the school garden by the school’s full-time security staff.

The SMC agreed to explore the possibility of involving parents in the nutrition programmeduring the monthly parent-teacher meetings. The management committee also said it wouldlook for opportunities of linking up with NGOs to continue and strengthen the nutritionprogramme. Many schools were conducting extra-mural activities such as awareness buildingon social issues, gender violence and fire fighting training in collaboration with NGOs such asBRAC and Songjog.

The SMC agreed to intensify implementation of the nutrition programme as part of practicalcurricular functions and learning activities. Some teachers wanted the nutrition programme tocover all students and not only adolescent girls. The SMC confirmed that students would bemobilized to work on home gardening and food preparation activities under the supervisionof the agriculture and home economics teachers. The management also requested periodicguidance and monitoring from the project.

10.7.4. Participation of students, parents and community

Experience shows that school gardening and nutrition education are more effective andsustainable if these involve the entire school and are linked to activities which engage parentsand the community. Establishing school gardens without parental involvement can give rise totension within communities. Parents send their children to school to learn to read and write andoften do not accept ruralization of the school curriculum.61

61 FAO. 2004. School Garden Concept Note: Improving Child Nutrition and Education through the promotion of SchoolGarden Programmes, SPFS. Rome, Food and Agriculture Organization of the United Nations.

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10.7.5. Students’ responses

Group discussions involving a sample62 of participating students from one of the schools wereconducted by the National Nutrition Education Specialist and the International NutritionEducation Specialist in collaboration with the school management. Responses were elicited fromSMC representatives as appropriate. Three-fourths of the students said they liked the nutritioneducation programme very much while 15 percent liked it partially. Five percent of the studentsdid not attend the nutrition education classes and could not provide responses but said theyliked the programme and had been told by their peers that it was good. Another 5 percentstudents could not give any response (see Table 22).

Table 22. Student preference ratings on NEP

Preference Percentage

Very much 75Partially 15Like but could not participate 5Do not like 0No response 5

10.7.6. Reasons for students liking NEP

All students found the nutrition lessons highly useful, helping them understand a healthy diet,how to use different food varieties and prevent nutrient losses through proper cooking methods.Some recipes and cooking methods taught were said to be different from those used in thestudents’ homes. They had passed on the nutrition knowledge learned in school to their parentsand their mothers had adopted correct practices such as washing vegetables before cutting,cutting vegetables into larger pieces and putting vegetables in boiling water.

10.7.7. Queries on nutrition education programme to students

Students were asked about the number of times the recipes they had learned in school wereprepared in their homes. Random questions on what they had learned in the nutrition classesproduced the following responses:

❖ mixed vegetable soup provides vitamins and minerals

❖ vitamins are present in vegetables and fruits

❖ leafy vegetables contain calcium

❖ how to preserve vitamins and minerals❖ 250 g of vegetables should be eaten every day

10.7.8. Home practice by students

Of the 40 students interviewed, two were preparing at home, the recipes learned during thepreceding one month while ten students did so occasionally. No student had brought lunch ortiffin to school on the day of the group discussion. Some students went home for lunch whileothers did not eat anything the entire day and ate only upon returning home. Only 20 studentshad a home garden.

62 School-based evaluation at Rajbari covering 40 students.

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10.7.9. Parents’ responses

Parents were interviewed about the school nutrition programme, 63 percent of them beingmothers. It was heartening to see that the students had passed on much of the nutritioneducation information to their parents (see Table 23).

Table 23. Responses of parents on SNP

NE information given by children to parents: Responses by parents Percentage

Nutrition education is being given in the class; knowledge of nutrients and 25their health valueNutritious food preparations as part of practical lessons 25Eating adequate vegetables and fruits makes us health, with no need to visit the doctor 12We prepared soup in the class; provided complete recipe 12Leafy and other vegetables essential for health and need to be taken regularly 12Prepared mixed vegetable meat soup 14Total 100

10.7.10. Responsibilities to be taken up by parents

All parents who came for the meeting had home gardens. They were asked for their views andto suggest roles they could play in the school nutrition programme. All volunteered to keepa watch on and maintain the school garden during school holidays.

Among parents, 63 percent volunteered to assist in the large-scale soup preparation for studentsregularly. Some were members of the school management committee and agreed to get thecooperation of other parents through the SMC. The parents also committed to provide dailylunch for their children consisting of a ruti, vegetable, an egg and a fruit (see Table 24).

Table 24. Parental responsibilities identified

Assistance Percentage63

Voluntary labour in school garden (by rotation) 100Providing local expertise and advice 45Providing possible land use 12Assistance in preparing recipes from school produce for students 63Follow up participation of other parents 25Commit to send school lunch/snack for children 74 64

A benefit of gardening-linked nutrition education is the active role played by schoolchildren inproviding food for themselves and in involving parents in the learning process. It must bereiterated that schools offer the most efficient way of reaching out to large sections of the localpopulation, including young people, school personnel, families and other community members.

63 Percentages include multiple responses.64 The rest said their children came home for lunch as they lived very close to the school.

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Schools can take nutrition information and technologies to the wider community, playinga leading social role through advocacy of policies and services to promote nutrition.65 Nutritioneducation is particularly beneficial for girls as nutritional status has a major impact onpregnancy, lactation and child nourishment.

The SNP needs to be consolidated and expanded, encompassing both nutrition education andschool gardening for sustainable nutritional gains. Central to this is promoting horticulture-based dietary and micronutrient improvement among adolescent girls who are future mothersand other beneficiaries such as young people through the school system and community.

65 WHO. 1996. Status of School Health. Geneva, World Health Organization.

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11. DIETARY IMPACT ASSESSMENT

A key assessment indicator for food-based nutrition intervention programmes is the nutritionalstatus of beneficiaries after the project’s implementation. The IHNDP promoted nutritionalawareness among and improved nutritional knowledge levels of the beneficiaries.66 Theevaluation tried to assess if the project helped improve nutritional levels through increasedconsumption of horticulture-based food. It was also considered essential to identify the factorsinfluencing dietary intake.

For this, a food consumption and dietary assessment survey was conducted among project andnon-project beneficiaries in collaboration with the Institute of Nutrition and Food Science,Dhaka University (INFS) between April and October 2004.

11.1. Comparison of landless project and non-project households

The assessment covered 474 project and 90 non-project households. Among project households,21 percent were from hill regions and 79 percent from the plains. Thirty two percent of theproject households covered by the assessment were landless, 40 percent were marginallandholders and 28 percent were small landholders. Of the 90 non-project households surveyed,30 lived in the Kishoreganj, 30 in Rajbari and 30 in Barisal. For comparability with projecthouseholds, the non-project households were selected from among landless households (withless than 50 decimal67 of cultivable land) in rural areas at least three miles from the project andwith no NGO presence. Both project and non-project households did not differ significantly inmean family size and income.

The majority of project households (62 percent) lived in houses with tin walls and roof,25 percent had brick houses and 13 percent lived in mud or straw houses. In comparison,89 percent of non-project households lived in tin houses, 4 percent had brick abodes and7 percent, mud or straw houses.

There was significant difference in house construction by project and non-project households.68

Almost all project households were trained and attended project demonstrations on production,preparation and preservation of horticultural foods, and were provided planting materials andnutrition counselling. Some also received micro-grants and other project services.

11.2. Hygiene and nutrition

Clean water and a hygienic environment are important determinants of household health andnutrition. Ninety six percent of project households drank water from tube-wells and the restfrom ponds, ring wells, rivers and canals. Almost all (99 percent) non-project households dranktube well water. There was no significant difference in the drinking water sources of project andnon-project households.69 Seventy eight percent of project households used tube well water forcooking and washing and the rest obtained it from other sources, compared to 86 and14 percent respectively among non-project households. There was no significant difference inthe cooking and washing water sources of project and non-project households.70

66 Mid Term Evaluation Report, 2003.67 237 decimal = 1 ha68 Pearson Chi-square test (p = 0.00)69 Pearson Chi-square test (p = 0.1)70 Pearson Chi-square test (p = 0.1)

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11.3. Food security

Eight percent of landless households covered by the project were food-deficit throughout theyear, 43 percent sometimes faced food shortage, another 43 percent were neither deficit norsurplus in food, and the remaining 6 percent had more food than their needs. A higher levelof food insecurity was observed among landless households not covered by the project with 19,40, 33 and 8 percent respectively facing degrees of food insufficiency or adequacy in the sameorder as the project households.71

11.3.1. Field crops grown by households

Rice and vegetables were common field crops, pulses being cultivated less by project as wellas non-project households. While 75 and 79 percent respectively of project households grew riceand vegetables, this was done by 83 and 59 percent of non-project households. Spices werecultivated by 31 percent of project households, fruits by 23 percent and pulses by 2 percent.Among non-project households, 21, 17 and 2 percent respectively cultivated spices, fruits andpulses.

Project households farmed cereals on 96 decimal, vegetables on 18 decimal, fruits on 11 decimal,spices on 4 decimal and pulses on 1 decimal. This compared to 32, 3, 2, 2 and less than1 decimal respectively for these crops by non-project households. The differences werestatistically significant for cereals72 and vegetables73 but insignificant for other crops.74

Horticultural crops have relatively higher value and an annual yield potential of up to 50 kgper square metre depending on the crop and technology used. An indicator of the project’spositive impact on production was the large number of households adopting garden cultivation.

11.3.2. Food access and availability among landless households

As seen above, very few project-covered landless households were food-deficit or food-surplusthroughout the year. The large majority either faced a shortage of food sometimes or alwayshad adequate food. There was a significant difference with the food security situation oflandless households not covered by the project, nearly one-fifth of them being food-deficitthroughout the year, but a slightly larger proportion were food surplus compared to projecthouseholds.

11.3.3. Horticultural production by season

The availability of land for individual home gardens varied from 0.50 to 0.99 acres75 in projectareas, resulting in a variety of horticultural produce in winter and summer. On average,households harvested 128 kg of produce in winter and 108 kg in summer (see Table 25). Thistranslates into 1.42 and 1.20 kg of horticultural produce per day in the two seasons, with anestimated per capita availability of 284 g in winter and 216 g in summer. This was an importantachievement of the project.

71 Pearson Chi-square test (p = 0.00)72 Pearson Chi-square test (p = 0.00)73 Pearson Chi-square test (p = 0.00)74 Pearson Chi-square test (p >0.05)75 2.37 acre = 1 ha

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The per capita availability of horticultural produce in Bangladesh is 87 g against the dailyrecommended intake of 400 g of fruits and vegetables excluding potatoes and other starchytubers, for prevention of chronic ailments such as heart disease, cancer, diabetes and obesity.76

11.4. Preparation, cooking and preservation practices

A significantly larger proportion of project households (72 percent) washed vegetables beforecutting compared to only 26 percent among non-project households. Likewise, 80 percent ofproject households had fresh carrot, tomato, other vegetables, lemon or some sour fruit andgreen chili in daily meals and used coriander leaves in cooking. The corresponding dietaryconsumption percentages were significantly lower for non-project households. While 78 percentproject households preserved vegetables using pickling as a method, only 47 percent ofnon-project households did so.

11.4.1. Frequency of preparation of daily meals

Twenty two percent of landless households covered by the project cooked meals once a day,57 percent did so twice daily and the rest prepared more than two times a day. Thecorresponding figures for non-project landless households were 19, 69 and 12 percentrespectively showing no significant difference in this regard between the two categories ofhouseholds.77

11.4.2. Food handling practices

While 72 percent of landless families in project areas washed vegetables before cutting,24 percent did so after cutting and 4 percent did both. The corresponding numbers fornon-project landless households were 26, 69 and 5 percent respectively, showing a significantdifference which confirmed the study’s overall findings.78

11.4.3. Reasons for washing vegetables before cutting

Six percent of project households washed vegetables before cutting because the family did notobject or on instruction from family elders. This being usual family practice was the reasongiven by 42 percent households while 51 percent said it was more convenient. In non-projecthouseholds, the corresponding proportions were 22, 25 and 42 percent respectively, showinga significant difference in the reasons given by the two categories of households.79

Table 25. Horticultural produce by season

Horticultural produceSeason (kg)

Winter Summer

Fruit 162 105Leafy vegetables 78 140Non-leafy vegetables 235 79Spices 36 –

Average 128 108

76 FAO/WHO. 2003. Diet, Nutrition and the Prevention of Chronic Diseases. Report of a Joint WHO/FAO Consultation.Geneva, World Health Organization.

77 Pearson Chi-square test (p = 0.10)78 Pearson Chi-square test (p = 0.00)79 Pearson Chi-square test (p = 0.00)

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11.5. Habitual food combinations

Sixty five percent of project households habitually ate rice, salt and chili, 79 percent had rice,pulse soup and vegetables, 91 percent ate rice, fish and dark green leafy vegetables, and59 percent had rice, beef or chicken. Similar food combinations were noted among 79, 70, 84and 37 percent respectively of non-project households.

11.6. Preservation of fruits and vegetables at home

Only 54 percent of landless households in project areas and 18 percent of landless families innon-project areas preserved fruits and vegetables at home, showing significant difference infood preservation practices.80

Among project households, 58 percent preserved mango, 32 percent preserved jujube and24 percent preserved Indian olives, compared to 26, 8 and 9 percent respectively by non-projecthouseholds. Between 10 to 17 percent of project households preserved tamarind, cabbage andbroad beans, while 2 to 9 percent preserved other fruits and vegetables.

11.7. Methods of household food preservation

Seventy eight percent of project households used salt, spices and oil to pickle food while69 percent dried in the sun, compared to 47 and 74 percent respectively in non-projecthouseholds. Sugar was used for preservation by 28 percent of project households but by noneof the non-project households.

The project developed prevalent food preparation and processing methods to preserve nutritivevalue and retain the benefits of fruits and vegetables in composite traditional food varieties.

Project households prepared several recipes including those learned in the project while somewere based on the technologies learned.

Table 26. Consumption of vegetables and fruits by landless households

Horticulture produceSeason (kg)

Winter Summer

Fruits 77 60Leafy vegetables 28 35Non-leafy vegetables 71 24Spices 15Average 48 40

80 Pearson Chi-square test (p = 0.00)

11.8. Consumption of winter and summer vegetables

The average household consumption of vegetables was 48 kg in winter and 40 kg in summer(see Table 26) with per capita consumption of 53.3 and 43 g in winter and summer respectively.However, this was much less than the minimum quantity of vegetables recommended fora nutritious diet.

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11.9. Consumption of salads

Raw vegetables were also eaten with 80 percent of project households having fresh carrot, alleating fresh cucumber, 76 percent having raw onion, 74 percent fresh radish, 98 percent eatinguncooked tomato and 12 percent having fresh green chili. Among non-project households, thecorresponding figures were 54, 91, 67, 66, 97 and 18 percent respectively. A small proportion ofproject households and none of the non-project households ate raw lettuce and red beetroot.

11.10. Consumption of fresh spices, lemon and sour fruit

Only 69 percent of landless households in project areas and 62 percent of landless families innon-project areas used coriander leaves in daily cooking showing a significant difference in thisregard between the two household categories.81 Only 45 percent of project households ate lemonor other sour fruit every day compared to 16 percent among non-project households, revealinga significant difference.82 There was also a marked difference in the daily consumption of greenchilli among project and non-project households who were landless, with only 72 percent of theformer and 57 percent of the latter, doing so.83

Fresh coriander and green chilli are excellent sources of beta carotene and vitamin C and theirconsumption was promoted through various recipes taught by the nutrition educationprogramme. Sour lemon also has vitamin C and is a dietary enhancer, improving thebioavailability of micronutrients such as iron in a meal.

11.11. Frequency of consumption of leafy and yellow-orange vegetables and fruits

Among landless project households, only 1 percent did not eat leafy vegetables at all, 51 percentdid one to three days per week and 48 percent four to seven days a week, compared to 12, 65and 23 percent respectively among non-project landless households. The significant difference84

in the consumption of leafy vegetables by the two household categories confirmed the overallfindings of the study (Figure 14).

Figure 14. Leafy vegetable consumption by landless households

While 26 percent of landless households in project areas did not eat yellow-orange vegetablesat all, 67 percent ate one to three days a week and 7 percent four to seven days a week,compared to 48, 49 and 3 percent respectively among non-project landless households (Figure 15).

81 Pearson Chi-square test (p = 0.00)82 Pearson Chi-square test (p = 0.00)83 Pearson Chi-square test (p = 0.01)84 Pearson Chi-square test (p = 0.00)

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The significant difference85 between project and non-project landless households in the weeklyconsumption of yellow and orange vegetables confirms the overall findings of the study.

Six percent of landless households in project areas did not eat yellow and orange fruits,76 percent did one to three days per week and 17 percent ate four to seven days a week,compared to 47, 47 and 6 percent respectively among landless households not covered by theproject. The significant difference86 between project and non-project landless households in thefrequency of weekly consumption of yellow and orange fruits confirms the overall findings ofthe study (Figure 16).

Figure 15. Yellow and orange vegetable consumption by landless households

Figure 16. Yellow and orange fruit consumption by landless households

11.12. Frequency of consumption of sour fruits and vegetables

Two percent of landless households covered by the project did not eat sour fruits andvegetables, 48 percent did one to three days a week and 49 percent ate four to seven days perweek, compared to 8, 64 and 29 percent respectively among landless households not coveredby the project. Less than 1 percent of the project households did not eat fruits rich invitamin C, 99 percent ate such fruits one to three days a week and 1 percent did so four toseven days per week, compared to 10, 90 and 0 percent respectively among the non-projecthouseholds, showing significant difference.87

85 Pearson Chi-square test (p = 0.00)86 Pearson Chi-square test (p = 0.00)87 Pearson Chi-square test (p = 0.00)

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11.13. Consumption of animal food

Less than 1 percent of the project households did not eat fish, meat, egg or milk, 95 percent didone to three days a week and 4 percent ate such food four to seven days per week, comparedto 9, 84 and 7 percent respectively of non-project households (Figure 17), showing significantdifference.88

Figure 17. Fish, meat, egg and milk consumption by landless households

Animal food is one of the best sources of micronutrients, but vegetables and fruits are often theonly affordable micronutrient sources for poor households. The production of fruits andvegetables by the project ensured the households direct access to important micronutrients thatmay not have been readily available to them or within their economic reach.

The experience89 of other home gardening programmes in Bangladesh shows that householdswith well-developed home gardens eat non-cereal food rich in micronutrients, more frequentlythan other households. This includes high-quality food such as dal (lentils) and animal productsthat can be purchased with the income from the garden. This is confirmed by the current study.

11.14. Consumption of fats, oils and iodized salt

Only 2 percent of project households did not add fat or oil to their diet, no one consumed thisfor less than four days per week and 97 percent did for four to seven days every week. Allnon-project households had fat or oil four to seven days per week. No significant difference wasnoted between project and non-project households in the weekly consumption of fats and oils.90

While 9 percent of project-covered households did not eat iodized salt, no one consumed it forless than four days a week and 91 percent did 4 to 7 days a week, compared to 13, 0, and87 percent respectively for non-project households, pointing to no significant difference91

between project and non-project households in the consumption of iodized salt.

88 Pearson Chi-square test (p = 0.00)89 Talukedar, A. 2000. Increasing the production and consumption of vitamin A-rich fruits and vegetables: Lessons

learned in taking the Bangladesh homestead gardening programme to a national scale. Food and Nutrition Bulletin,21: 165–172.

90 Pearson Chi-square test (p = 0.12)91 Pearson Chi-square test (p = 0.12)

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11.15. Infant feeding practices

In 13 percent of project households, breastfeeding of infants was practised till less than12 months of age, while 34 percent of households did so till the infant was 12 to 24 months old,and 53 percent of households continued breastfeeding beyond 24 months. In comparison,breastfeeding was practised for less than 12 months, till 12 to 24 months and beyond 24 monthsby 7, 21 and 72 percent respectively of non-project households. There was no significantdifference in the infant feeding practices of the two categories of households.92

11.15.1. Initiation of complementary feeding

Six months after birth, breast milk alone cannot meet the infant’s energy and micronutrientneeds and complementary feeding should begin. Between 6 and 24 months of age, the child ishighly vulnerable to nutritional deficiency. Malnutrition, as measured by growth retardationusually peaks between one and two years of age. During this period, the child needs frequentintake of age-appropriate and energy-dense food besides continued breastfeeding. Withdecreasing consumption of breast milk by the growing child, complementary feeding must meeta greater part of the energy needs.

Children aged between 6 and 24 months and older, require sufficient protein andmicronutrients93 as well as energy for growth and proper metabolic functioning of the body.They need daily or frequent feeding of small quantities of vitamin-rich fruits and vegetables,meat, poultry or fish, fat, wholegrain cereals and iodized salt.

Sixteen percent of project-covered landless households began complementary feeding for thelast child at less than five months of age, 59 percent did so when the child was between fiveto seven months old and 25 percent after seven months of age (Figure 18). This compared to15, 38 and 46 percent respectively among non-project landless households (Figure 18), showingsignificant difference between the two types of households in the initiation of complementaryfeeding.94

Figure 18. Initiation of complementary feeding by landless households

92 Pearson Chi-square test (p = 0.10)93 Golden, M.H.N. 1995. Specific deficiencies versus growth failure: Type I and Type II nutrients. SCN News,

No. 12.94 Pearson Chi-square test (p = 0.10)

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11.15.2. Complementary food varieties

Yellow and orange fruits, eggs, meat and fish, khichuri (made from rice and pulses) and suji95

(diluted wheat soup) were typical complementary foods for children in both project andnon-project households. Among project households, yellow and orange fruits were used by77 percent, eggs, meat and fish by 66 percent, khichuri by 59 percent and suji by 59 percenthouseholds respectively as complementary food compared to 58, 44, 40 and 28 percentrespectively among non-project households. Diluted milk, biscuits and potatoes were othercommon complementary food items.

Slightly more than half of project households gave complementary food to children, comparedto between 25 and 40 percent of non-project households. Formula food, boiled, puffed orpressed rice, leafy and non-leafy vegetables were less frequently used for complementary food.

11.16. Nutrient intake

Infants, older children, adolescent girls and adult women in landless project households hadhigher per capita intake of all food and nutrient varieties as compared to the non-projecthouseholds. Food intake was significantly higher in children and adult women. Energy intakewas significantly higher in children, adolescent girls and adult women while protein intake wassignificantly higher in adult women (see Table 27).

Table 27. Energy and protein intake of different target groups

Target groupProject households Non-project households

Energy (kcal) Protein (g) Energy (kcal) Protein (g)

Infants 461 14 451 16Children (2–9 years) 929 28 684 23Adolescent girls 1 005 50 1 666 44Adult women 1 989 56 1 654 42

11.16.1. Energy intake indicators

Among project households, the mean energy intake for adolescent girls was 1 850 kcal, muchbelow the RDA.96 The mean energy intake of adult women was 2 061 kcal, also below theRDA.97 The mean energy intake of non-project households was even lower, being 1 005 kcal foradolescent girls and 1 989 kcal for adult women.

The energy intake of adolescent girls appears to be grossly inadequate, meeting no more than50 percent of the RDA while that of the women meets about 75 percent of the RDA.

The energy-deficient diet of mothers is also reflected in the women’s susceptibility to chronicenergy deficiency and morbidity. Similar findings have been reported in other surveys inBangladesh. Household energy intake is often used as an indicator of poverty. Households withan energy intake of less than or equal to 2 122 kcal/person/day are considered “moderatepoor” and households with less than 1 805 kcal/person/day are considered as “extreme poor”(Bangladesh Bureau of Statistics, 1998).

95 Semolina/wheat cream96 RDA for energy for adolescent girls: 1 970 kcal for 10–12 years; 2 060 kcal for 13–15 years; 2 060 for 16–18 years;

ICMR, 1992. Reprinted 2004.97 RDA for moderate working adult woman: 2 225 kcal; ICMR, 1992; Reprinted 2004.

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Household energy intake is also used as an indicator of household food security (Bloem et al.,2003). However it does not indicate the quality of the household diet. Therefore, survey dataon consumption of various food varieties, vegetables and fruits as well as micronutrients areneeded to assess household dietary quality which, in turn, is an indicator of household foodsecurity.

11.16.2. Protein intake

Protein intake appears to meet the RDA among project households as compared to non-projecthouseholds. For infants and young children, the intervention promoted a mixture of traditionalfood types providing energy, protein and micronutrients. Rice is the main source of protein inthe diet of rural poor people in Bangladesh and is typically eaten with little vegetables, somefish and sometimes, lentils or eggs.

Although vegetables have vitamin A and iron, these micronutrients are not as well absorbedfrom plant as from animal food. With high-quality protein and vitamin A, eggs are a goodcomplementary food. To improve protein intake, it is necessary to increase the availability andconsumption of eggs.98

11.16.3. Micronutrient intake

The dietary assessment strengthened the premise that increased production and consumptionof diverse types of vegetables using homestead gardening, reduces micronutrient deficiency.This was also in keeping with the FAO recommendation to boost vegetable and fruitproduction and availability to support food-based programmes to improve nutrition.

A comparison of micronutrient intakes by adult women and adolescent girls in landless projectand non-project households is given in Table 28. All project-covered groups had higher intakesof all micronutrients. The difference in the intake of vitamin A was found to be statisticallysignificant (p <0.05), while in the case of vitamin C, the difference was not statisticallysignificant for adolescent girls (p >0.05) but significant for adult women (p <0.05). The differencein calcium intake was not statistically significant for adult women (p >0.05) but significant foradolescent girls (p <0.05), while the difference in iron intake was found to be statisticallysignificant (p <0.05).

Table 28. Intake of selected micronutrients by adult women and adolescent girls

MicronutrientProject households Non-project households

Adult women Adolescents Adult women Adolescents

Vitamin A 1 604 1 212 567 767(retinol equivalents µg)Vitamin C (mg) 107 129 48 104Iron (mg) 25 24 17 18Calcium (mg) 626 646 476 425

98 BBS. 2001. 1999 Statistical Yearbook of Bangladesh 20th edition. Dhaka, Bangladesh Bureau of Statistics.99 FAO/ILSI. 1997. Preventing Micronutrient Malnutrition: A Guide to Food Based Approaches – A Manual for Policy

Makers and Programme Planners. Washington, DC, International Life Sciences Institute Press.

99

Among women in project households, vitamin A intake of 1 604 µg was one and half times theRDA of 600 µg while women in non-project households had a daily intake of 567 µg, slightly

53

below the RDA. The intake of iron did not meet the RDA for both project and non-projectgroups. An adult woman doing moderate work needs 30 mg of iron daily and an adolescentgirl needs 28 mg of iron a day.

The micronutrient intake of infants and children in project households was higher than of thosein non-project households (see Table 29). There were significant differences in vitamin A andvitamin C intake among the two groups of children (p <0.05 for both). There was no significantdifference in calcium and iron intakes for both groups.

Table 29. Intake of selected micronutrients by infants and children

MicronutrientProject households Non-project households

Infants Children Infants Children

Vitamin A 234 609 100 290(retinol equivalent µg)Vitamin C (mg) 30 60 15 29Iron (mg) 5 13 2 8Calcium (mg) 223 358 483 303

Infants in both project and non-project households did not get the full RDA100 for vitamin A(350 µg retinol). Infants in non-project households got only about 28 percent of the RDA whilethose in project households had intakes closer to the RDA. Children between one to five yearsold had vitamin A intakes higher than the RDA in project households, and about 73 percent ofthe RDA intake in non-project households. As expected, both groups had low iron intake, withinfants and children in project households having higher intake than those in non-projectfamilies. Based on the absorbed-iron requirement of different physiological groups and withiron absorption of 3 percent from common mixed cereal diets, the recommended dietary intakefor iron is 12 mg for children between one to three years old and 18 mg for children betweenfour to six years old.101

11.16.4. Dietary improvement impact

The increased consumption of leafy and yellow-orange vegetables as well as fruits in projecthouseholds as a result of the intervention was reflected in vitamin A intake levels much abovethe RDA. A comprehensive approach to dietary improvement is needed to meet the dietary ironrequirement, particularly more iron-rich animal food.

Consumption of nutritious food combinations based on horticultural produce along with meat,fish, vegetables and vitamin C-rich fruits was promoted, together with traditional foodpreparation and processing methods. This can enhance the bioavailability of iron and othermicronutrients in the diet.

National nutritional surveillance data show that anaemia is still a public health problemamong preschool children and pregnant women in Bangladesh, and a moderate public healthproblem in children of school age, adolescents and women who are not pregnant. To meet the

100 For infants from 6 months to 1 year based on Indian RDA, ICMR.101 ICMR. 1998. Nutrient Requirements and Recommended Dietary Allowances for Indians. Expert Group Report.

New Delhi, Indian Council of Medical Research.102 Bloem. 2003. Health and Nutritional Surveillance for Development, New York, United States, Helen Keller

International.

102

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UN Millennium Development Goals (MDGs), Bangladesh must reduce the prevalence ofanaemia from 48 to 32 percent in preschool children, from 34 to 22 percent in children of schoolage, from 36 to 24 percent in adolescents, from 34 to 23 percent in non-pregnant women andfrom 51 to 34 percent in pregnant women by the year 2015.

The improved availability, preparation, preservation and consumption of food in projecthouseholds can be attributed to project inputs. However, this cannot be certain in the absenceof baseline data and due to the project’s short duration as well as the small number of controlsamples studied. The food consumption and dietary assessment study also shows that carefullycollected semi- and quantitative data, practical experience and technical expertise can forma sound basis for a nutrition programme.

Although project households had relatively higher food and nutrient intake, the findings abovehighlight the need for continued efforts to improve their nutritional status. There is a need toincrease household income and strengthen nutritional awareness and practices with householdsencouraged to use the maximum possible land to grow fruits and vegetables.

The food consumption and dietary assessment survey provides data to confirm the strengthsand contributions of food-based interventions to address micronutrient and malnutritionproblems. The second food consumption and dietary assessment will serve to validate thedietary improvement outcomes and findings of the first round.

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12. COMMUNITY-BASED ASSESSMENT AND IMPACT OFNUTRITION PROGRAMMES

A community-based participatory evaluation of the nutrition education programme to assessits impact on the farmers was conducted between December 2004 and February 2005.Participatory methods such as farmers’ seminars, focus group discussions and a SWOC/T(strength, weaknesses, opportunities and constraints or threats) analysis were used.

12.1. Farmers’ seminars

Eight farmers’ seminars were organized in as many selected HDTC areas involving farmerscovered by the project and stakeholders such as DAE district officials, extension staff, membersof the project management and experts. Discussions covered:

a) knowledge of food-based nutrition gained by the farmers

b) application of this knowledge at family level

c) implementation of lessons learned from the nutrition programme

d) farmers’ suggestions to improve the nutrition activities

The objective of the seminars was to determine the areas in which the project had benefited thefarmers, the lessons learned and the possible long-term impact on the farmers’ livelihood.

12.1.1. Development of the evaluation process and methodology

The primary method and process of the assessment was designed by the project’s national andinternational nutrition specialists together with the FAO Nutrition Backstopping Officer and theNational Project Coordinator. The primary methodology was field-tested in Pabna and Natoretowns by a team including the National Nutrition Education Specialist, the Participatory TrainingSpecialist and the UNDP Nutrition Intern. The findings were reviewed by the NPD, NPC,training, monitoring and nutrition specialists and necessary changes made to the methodology.

Focus group discussions (FGDs) were held at the village level with farmers as participants. TheSWOC/T analysis was organized at the HDTC level, involving farmers and other stakeholderslike DAE officers, extension staff, health officials and NGOs.

Guiding questions were used during the FGD to obtain information and the findings were putin a broad format during the SWOC/T analysis. Farmers and other stakeholders from15 HDTCs in project areas were chosen to ensure participation by a representative cross-sectionof actors. Health Department representatives and local NGOs also took part in the seminar.A total of 408 people participated in the seminar, including 366 farmers, 26 HDTC officers, otherstakeholders and 19 extension and field staff personnel (see Table 30).

Involvement of different project stakeholders was essential in view of their roles at variouslevels in supporting community participation and leadership. Each farmer group selected twomembers. About 50 farmers and selected stakeholders from the DAE, district health departmentand NGO took part.

The project team facilitating the seminar included the National Nutrition Education Specialist,Participatory Training Specialist, Socio-economic Monitoring and Evaluation Specialist and the

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UNDP Nutrition Intern. Logistical support at HDTC and village-level seminars was providedby HDTC staff.

12.1.2. Focus group discussions

Eight FGDs were organized in as many project villages involving 25 farmers from each village.The objectives of the discussion were to identify benefits of the nutrition intervention asexperienced by the farmers; determine its possible long-term impact on their food pattern andnutrition behaviour, elicit farmers’ suggestions and identify areas for improvement.

The discussions were facilitated by the National Nutrition Education Specialist with inputs andsupport from other specialists, the Nutrition Intern, HDTC officer in-charge and the HorticultureOverseer. In some cases, farmers were asked additional questions. They were also requested toexplain their views in detail. The discussions were held in a friendly atmosphere to encouragefull involvement of the farmers. Qualitative information was obtained and the seminars’findings and observations were summarized. After the discussion on each aspect, a farmerleader summarized the discussion and main points for consideration (see Table 31).

Table 30. Participation of district officials and farmers in the seminar

HDTC area Farmers DAE officialsExtension/Field

Totaland other staff

Pabna 45 3 2 50Natore 45 4 2 51Feni 45 2 3 50Rajbari 45 4 2 51Rangpur 48 2 3 53Chapai Nawabganj 45 3 2 50Rangamati 47 2 3 52Bandarban 46 3 2 51Total 366 26 19 408

Table 31. Outline of FGD findings

Issues

Nutrition knowledge and practicesAccess to vegetables and fruitsVegetable and fruit consumption practicesPreparing recipes learned through projectCommon food preparation knowledge and practicesPreparing and feeding of complementary food, learned through IHNDPRelated health, sanitation and hygiene practicesPossible impact to life and economy

12.1.3. Nutrition knowledge and practices

❖ The farmers were fully aware of the importance of nutrition and the human body’sneed for nutritious food. They could explain the nutritional importance of differentvegetables and fruits in terms by vitamin and mineral content and referred tonutrition and income benefits from the home garden.

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❖ They knew how to clean, cut and cook vegetables to conserve nutritive value suchas washing before cutting, cutting into big pieces, using just enough water forcooking, covering with a lid while cooking, using light heat and cooking leafy andyellow-orange vegetables in a little oil for vitamin A absorption.

❖ As part of the participatory nutrition activities, some farmers prepared nutritiousrecipes like mixed vegetables soup, mixed vegetables, kochu pata pitha (steamedcolocasia leaves snack). They explained preparation methods for sobuj bhath, sobuj ruti,vegetables, hotchpots (soft cooked mixture of rice and lentil), mushroom chop, carrothalwa, and complementary food for children.

12.1.4. Access to vegetables and fruits

❖ The farmers said that all of them had a home nutrition garden where they grewdifferent vegetables and fruits.

❖ They bought vegetables and fruits in the market during the off season or if theycould not produce in the home garden.

12.1.5. Vegetable and fruit consumption

❖ The farmers ate vegetables almost every day and fruits two days a week dependingon availability. The findings were similar to those of the Dietary Assessment Study103

in collaboration with the Institute of Nutrition and Food Science.

❖ A typical meal included four to five types of vegetables every other day. Redamaranth, Indian spinach, spinach, pumpkin, colocasia leaves, green papaya, potato,brinjal, cabbage, cauliflower, broccoli, bottle gourd and tomato (as salad) werecommonly eaten vegetables. This practice of having four to five vegetables every daywas in keeping with the nutrition message given to the farmers by the nutritioneducation programme.

12.1.6. Preparing recipes learned from project

❖ Mixed vegetable soup, sobuj ruti, sobuj bhath, drumstick leaves pakura, kochu pata pitha,mushroom curry and chop, as well as complementary food for children werecommonly prepared recipes.

❖ The farmers cooked mixed vegetables soup and sobuj ruti at least three timesa month. Recipes like sobuj bhath, pakura and pitha had been prepared only once.

❖ Recipe preparation depended on the availability and price of the vegetables.

❖ Most participants had tried and tasted only once or twice, the recipes learned duringthe project training at the HDTC or at village-based demonstration.

12.1.7. Food preparation knowledge and practices

❖ The farmers spoke of various food preparation and cooking tips, showing theirconfidence and application of the knowledge learned.

❖ The change in practice included washing vegetables before cutting, cutting into largepieces, stir frying leafy and yellow-orange vegetables, avoiding prolonged boiling,boiling and frying at right temperatures, avoiding smoking of oils and cooking ina covered pan.

103 INFS. 2004. Food Consumption and Dietary Assessment: Evaluations from FAO-UNDP-GoB IHNDP. Dhaka, Instituteof Nutrition and Food Science, Dhaka University, Bangladesh.

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12.1.8. Preparation and feeding of complementary food

❖ Most group members, who were mothers with infants or young children, preparedcomplementary food and said that their children demanded it.

❖ They could also describe the steps in preparing the complementary food.

❖ The mothers prepared and stored the complementary food and used it regularly.

12.1.9. Health, sanitation and hygiene practices

❖ Other practices included washing hands with water and soap before cooking andeating, taking care104 of children, especially small ones, clipping children’s nails intime, using slippers in the toilet, and washing hands with soap or ash after visitingthe toilet.

❖ The farmers also explained the care for pregnant women and lactating mothers, thefood given to them and the right attitude shown by elder family members.

❖ They emphasised the importance of regular visits to health centres, particularly bypregnant women and young children. They knew of the vital importance of antenatalcare during pregnancy and the need for health and related care for sick familymembers.

12.1.10. Possible impact on life and economy

❖ The farmers understood very well that their changed practice would result innutritional benefits and good health for the family.

❖ They believed that regular use of the knowledge given to them by the project wouldmake their children healthy and free from disease. They were taking children lessoften to the doctor and themselves needed medical care less frequently than before.

❖ They felt that participation in the nutrition activities had and would continue toimprove the household economy. Following the nutrition knowledge and practiceslearned from the project had helped them reduce health care costs.

12.2. SWOC/T analysis

A SWOC/T analysis of the project’s nutrition activities began with participants being briefedabout the objectives, methods, time required and responsibilities. Four groups were formed andsupported by HDTC officers and extension staff. The farmers identified and reviewed key areasof nutrition learning, highlighting strengths, weaknesses and threats or constraints, andopportunities for improvement. Each group presented the outcome of its discussion to theothers. In some instances, the groups debated among themselves, especially when elderlywomen were present.

12.2.1. Findings

Strengths

❖ Farmers felt empowered with the information and skills obtained from the nutritionprogramme.

104 This was explained in terms of concern for their children, time spent with them and taking care of their affectionneeds.

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❖ They found the nutritional training and demonstrations highly useful in daily food,nutrition and hygiene management at home.

❖ Awareness of the nutritional value of vegetables and promotion of the fruit varietiesby the project had improved their dietary choices.

❖ Preparation of new and nutritious recipes from locally available vegetables and fruitshad diversified monotonous household diets.

❖ They knew about the daily consumption requirement of vegetable and fruits for goodnutrition and could prepare nutritious recipes from a variety of vegetables and otherfood.

❖ Mothers and other child carers had benefited from the training for horticulture-basedcomplementary food preparation for infants and small children together with thepictorial flip charts given to households.

❖ The knowledge given by the project, including nutritional value of vegetables andfruits, diet for children, adolescent girls and pregnant women, preparation ofnutritious recipes and complementary food, and the importance of health care forchildren, adolescents and pregnant women, was of great importance to them.

❖ The sharing of nutritional knowledge in village group meetings105 was an excellentopportunity to review, renew and expand learning and experiences.

Weaknesses

❖ Written instructions were not given after the training and demonstration sessions,making it difficult to put these in practice.

❖ Inadequate information on care for pregnant women and diet for children over twoyears of age.

❖ Farmers not covered by all training and demonstration sessions; requested moretraining, specifically in nutrition and care of pregnant women and children betweentwo to five years old.

Constraints

❖ Not enough land for home nutrition garden as most farmers had less then 0.5 acre.106

❖ Seasonal availability of vegetables needed for recipes.

❖ Lack of participation by males; conservative social and family attitudes.

❖ Superstitious beliefs, especially on the fotoa (fatwa) given by village religious leaderthat mushroom is a haram (unholy) food.

❖ Financial problems including lack of funds for new initiatives and recipes.

Opportunities/suggestions for improvement

❖ Provide more nutrition training and demonstrations to group members.

❖ Give more recipes and recipe options with vegetables and fruits for adolescents andadults.

❖ Teach more food preservation techniques.

❖ Facilitate supply of improved seasonal vegetable seeds.

❖ Ensure more practical and hands-on support in all training and demonstration.

❖ Organize community-level cooking and recipe competitions.105 Farmers’ group meetings were held regularly in the village as part of farmer group activities.106 2.37 acre = 1 ha

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12.3. Observation and lessons learned

The seminars indicated that the project offered collaborative learning opportunities and resultedin unanimous participation by the farmers who discussed almost everything they had learnedin the project nutrition activities. Younger farmers took the lead in almost all areas of discussionand a lively debate took place among the groups during the presentation of their work outputsto the plenary session.

12.3.1. Inter-sectoral stakeholder participation

The DAE officers, health officials and NGO representatives actively facilitated the farmers’working groups and took part in the discussion during the plenary session where theyexplained their role in the nutrition activities. The active collaboration of NGOs and healthpartners was considered essential for strengthening and smooth implementation of nutritionactivities. All stakeholders expressed readiness for involvement in project nutrition activities asand when needed.

12.3.2. Changes in practice and behaviour

The farmers revealed that an outcome of the intervention was that the attitude of older women familyheads towards younger or newly-wed women had started changing. The older woman farmer, whois often the family head, had become generous towards the young or new daughter-in-law withregard to food distribution and health care. In Pabna, an elder group member said she wasmore responsive and dutiful to her daughter-in-law during the latter’s pregnancy and lactationas a result of the knowledge gained from the project.

12.3.3. Empowerment

Women farmers from far away places participated confidently in the seminar, discussingcooking ingredients and methods. They showed solidarity in planning food-based activities andpromoting horticultural food consumption for household nutritional improvement.

The farmers identified the strengths, weaknesses, opportunities and constraints of the projectnutrition interventions from their perspective, proving their ability to debate various aspectsamong themselves. They presented their findings confidently in the plenary session in thepresence of government officials.

12.3.4. Idea generation

The farmers identified issues and areas for future training and demonstration such as food forthe elderly, food distribution among family members, relation between food and gender, andnew recipes for teenagers. They pinpointed factors affecting the application of the nutritionknowledge in their lives. These mainly related to traditional pregnancy dietary beliefs such aseating less for fear of having a big baby and difficulties during birth, as well as lesser maleparticipation.

12.3.5. Traditional attitudes

Farmers had typical traditional attitudes towards learning, such as requesting longer projectduration, more training and demonstrations, and more material inputs. At the same time, thismanifested the often-seen dependency of resource-poor communities.

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12.3.6. Community adoption and replication

During the farmers’ group discussions, older females acted as resource persons and motivatorsto spread nutrition information and messages among the community. This also strengthened thelink between the Sub Assistant Agriculture Officer and the community and was in keeping withthe project’s community-based approach needed for longer-term sustainability and impact.

12.3.7. Overall outcome and impact

The findings of the community-based assessment appeared to be consistent with those of thefood consumption and dietary survey. The change in practice found during the seminar andthe farmers’ commitment to apply the knowledge, were positive aspects of the intervention.

The application of the knowledge and skills learned from the project was picking up and itscontinuation depends on opportunity and accessibility of resources. However, it takes long tobring about changes in behaviour in terms of nutrition and food management at the householdlevel.

While the quantitative dietary survey provided appropriate estimates of the impact andefficiency of the nutrition intervention, the community-based assessment had implications forprogramme design and monitoring. Community-based assessments of other project componentscan help link nutrition-related project outputs with specific horticultural inputs under othertechnical components of the project.

Further documentation of case studies is needed, highlighting the activities of both successfuland unsuccessful farmers in project areas and these should be made available to thestakeholders.

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13. ESTABLISHING AND FOSTERING LINKAGES

The success of the Integrated Horticulture and Nutrition Development Project was a result ofpartnership at national, district and community levels, including public sector academic andresearch institutes, national nutrition training institutions, national stakeholders, health sectorrepresentatives, schools, international non-government organizations and others.

The project also established functional linkages with FAO’s Special Programme for FoodSecurity (SPFS). The nutrition programme and strategy were developed as part of fosteringlinkages between FAO projects.

Preliminary meetings with agencies working in the field of nutrition were organized by theProject Management and Nutrition Technical Team in 2002 and 2003 to explore the scope forcollaboration. Recommendations were made by the Mid-term Evaluation Team in April 2003and Technical Nutrition Backstopping Missions in August and December 2003.

As several nutrition institutions in Bangladesh were implementing activities in consonance withthe IHNDP, it was recognized that project objectives and goals would have to be achieved incoordination and collaboration with different partners working for horticulture and nutritiondevelopment. The project activities were linked to national line institutions dealing withhorticulture and nutrition. Collaboration was also necessary to avoid overlap in activities andensure uniformity in the messages given by all nutrition-related institutions and projects.

The collaboration centred on training and capacity building, developing NIEC (nutritioninformation and education communication) materials, formation of an advisory committee,nutrition assessment and building sustainable mechanisms. Ten meetings were held withstakeholders during the project duration. A list of national organizations and agenciespromoting the nutrition programme is given in Table 32.

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Table 32. National Institutions collaborating with IHNDP, FAO

Institution Area of collaboration Type of institution

Bangladesh HRDB TOT, in-service training and school Nutrition training and extensionteachers’ nutrition training; advice on (MOA)field implementation of nutritionactivities; NAC member; participationin FAO/IHNDP meetings, seminars,workshops

INFS Nutrition impact assessment (food Academic training and researchconsumption and dietary assessment); in nutrition and food scienceNAC member; participation inFAO/IHNDP meetings, seminars,workshops

NNP NAC member; participation in National nutrition programme,FAO/IHNDP meetings, seminars, MOHworkshops

Rural schools in School Nutrition Programme (nutrition Education of school children15 HDTC areas education and school gardening)SPFS, FAO Sharing NIEC materials, developing/ Food security in resource-poor

implementing common nutrition field districts/communitiesstrategy

ICDDR, B NAC member; participation in Academic training and researchFAO/IHNDP meetings, seminars, in nutrition, health developmentworkshops and diarrhoeal diseases research

HKI Participation in FAO/IHNDP meetings, Nutrition surveillance, homeseminars, workshops gardening programme

BNNC NAC member; participation in NIEC resource centre, researchFAO/IHNDP meetings, seminars, and national nutrition policyworkshops; review of NIEC materials advice

College of Participation in FAO/IHNDP meetings, Academic training in homeHome Economics seminars, workshops; planning recipes economics

for hill tracts/tribal people

NAC: National Advisory Committee

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14. POLICY IMPLICATIONS

The Integrated Horticulture and Nutrition Development Project illustrated the links betweendifferent horticulture components that prevent micronutrient malnutrition and promote foodsecurity, health and livelihoods. It demonstrated the effectiveness of household production inaddressing undernutrition and micronutrient deficiencies in Bangladesh.

A nutrition strategy based on household production is more sustainable than externalintervention in the form of supply of drugs and centralised fortification facilities outside thecontrol and supervision of the beneficiaries. Strengthening it with institutional support shouldbe a key government concern.

The project’s results can be the basis for future food-based initiatives in Bangladesh. However,considerable institutional strengthening and human resource development are needed to extendit to other areas. Further collaboration between the Ministry of Education and the Ministry ofAgriculture and Fisheries is needed to upscale the school nutrition programme and ensuretechnical support to teaching staff.

A formal policy for food-based nutrition through integrated homestead systems production isneeded in Bangladesh with coordination among the Ministries of Health, Education andAgriculture.

A school-based nutrition programme will benefit students and the wider community, resultingin social and economic development through improved productivity and quality of life. Thisrequires harnessing of horticulture and nutrition resources at national, community and schoollevel besides advocacy of school health and nutrition.

14.1. Nutrition-oriented horticulture diversification

Horticultural production and diversification can benefit resource-poor rural farmers throughtargeted interventions to increase productivity and efficient marketing of food products andquality seeds. Also needed are effective extension services, credit availability for women farmersand more use of farm inputs like fertilizers and improved seeds.

The project demonstrated that a combination of technology and investment in people, especiallynutrition and health education for men and women farmers can yield high rates of return.Incorporation of nutritional considerations in production policies and programmes can avoidsome negative aspects of the new technologies.

Food diversification must increase the production of nutritious food rich in fat, protein andmicronutrients such as beans, leafy, yellow and orange vegetables, root crops like yellow sweetpotato, and fruits.

It is important to identify food purchasing and consumption trends in developing countries inview of the disparity in the quality and depth of information on production, distribution andconsumption of fruits and vegetables.

Policy makers and planners must be aware how specific target groups perceive, obtain andconsume fruits and vegetables. What may be appropriate for one consumer section may not berelevant for another. Identifying social groups at risk of under-consumption of fruits andvegetables and understanding the reasons for the risk, is essential for designing sound nutritioninterventions.

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14.2. Implications for nutrition and health

Micronutrient-deficient diets are responsible for some of the world’s most widespread anddebilitating nutritional disorders, including birth defects, mental and physical retardation,weakened immune systems, blindness and even death. Inadequate consumption of fruits andvegetables, a major reason for such micronutrient deficiencies,107 is estimated to cause about31 percent of ischaemic heart diseases and 11 percent of strokes worldwide.108 Overall, it isestimated that that up to 2.7 million lives can be saved each year with increased fruit andvegetable consumption.

The FAO/WHO expert consultation on diet, nutrition and the prevention of chronic diseasesrecommended a daily intake of 400 g of fruits and vegetables (excluding potatoes and otherstarchy tubers) to prevent heart disease, cancer, diabetes and obesity. This can also preventseveral diseases caused by micronutrient deficiency in developing countries.

A high-level international review of research findings on the link between fruit and vegetableconsumption and cancer risk, coordinated by the WHO and the International Agency forResearch on Cancer (IARC), concluded that eating fruits and vegetables may lower the riskof some cancers, particularly of the gastro-intestinal tract. According to IARC estimates, 5 to12 percent of all cancers and 20 to 30 percent of cancers of the upper gastro-intestinal tract canbe prevented with adequate consumption of fruits and vegetables.109

The project can be a catalyst linking horticultural innovation with household nutritionalimprovement, working in partnership with other stakeholders such as the government, NGOsand beneficiaries.

14.3. School nutrition

School-based nutrition programmes have an important role in promoting healthy eating habits.As diet also influences the learning potential, national education programmes must aim toensure that children get adequate nutrition and health care to attend school with healthy mindsand bodies.110

Schools also offer the most effective way of reaching out to large sections of society, includingyoung people, school teachers and personnel, families and community members. Schoolsprovide a setting to introduce the community to nutrition information and technologies, leadingto community advocacy of nutrition improvement policies and services.111 Girls, in particular,benefit from good nutrition which is beneficial during later pregnancy, lactation andnourishment of children.

The school nutrition programme should emphasize harnessing of horticultural and nutritionresources at country, community and school level while assisting government advocacy ofschool health and nutrition. Advocacy is needed to influence government policy and ensurelong-term sustainability of the initiative.

107 FAO/WHO. 2003. Diet, nutrition and the prevention of chronic diseases. Report of the Joint WHO/FAO ExpertConsultation. Geneva, World Health Organization.108 WHO. 2002. World Health Report 2002. Reducing risks, promoting healthy life. Geneva, World Health Organization.109 IARC. 2003. Handbook on fruit and vegetable consumption and cancer prevention. Washington, DC, International

Agency for Research on Cancer.110 NEGP. 1993. The national educational goals report: building a nation of learners. Washington, DC, National Education

Goals Panel, US Department of Agriculture, Food and Nutrition Service, Nutrition and Technical Services Division.111 WHO. 1996. Status of School Health. Geneva, World Health Organization.

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Discussion with various agriculture and nutrition stakeholders has shown the need to widenthe school nutrition initiative and the MOE and MOA can initiate efforts to make practicalnutrition education and school gardening activities a part of the regular school curriculum.

FAO’s technical projects on school gardening are linked to the global flagship partnershipprogramme “Education for Rural People” (ERP) launched at the 2002 World Summit onSustainable Development. These are expected to be part of the FAO/WHO joint initiative “Fruitand Vegetables for Health” to enhance fruit and vegetable consumption.

The school nutrition programme of the Integrated Horticulture and Nutrition DevelopmentProject should be part of the initiative by FAO and the UNESCO (United Nations Educational,Scientific and Cultural Organization) Institute of Education Planning which led to the 2004publication of the school gardening book “Revisiting garden-based learning in basic education”.

The school nutrition programme, combined with the school garden programme can beintegrated with wider curriculum development by the Ministry of Education and needs to betaken up as a priority by policy makers.

An extension of the project horizon would be useful in linking educational with nutritionprogrammes. It would increase donor interest in health and nutrition of school age children andadolescents, which are closely linked with women’s health and nutrition. Such a strategy wouldbenefit the Government of Bangladesh in its planning of nutrition development projects thatcould be based on the findings of the IHNDP. A focus area for the IHNDP exit strategy shouldbe influencing government policy through advocacy and the long-term sustainability of theschool nutrition initiative.

14.4. Institutionalizing the community nutrition education programme

The project has successfully raised awareness of the importance of nutrition education in all ofHDTCs and a wide variety of vegetables is now being consumed as soups and pickles.112 A shiftof practice in the use of vegetables, cooking and child feeding has also been manifest on variousoccasions.

While emphasis has been on horticultural production and access to vegetables has increased,the frequency of consumption of vegetables has also increased through learning and practiceof new horticulture-based recipes in the project. Field observations and the findings of thecommunity-based assessment underscore the need for regular follow-up so that the nutritionknowledge is put into practice.

There is a felt need to institutionalize the community-based nutrition education programme.Resource-poor farmers should be empowered with ownership of nutrition programmescombined with income generation activities. This, in turn will ensure sustainability of nutritioneducation at the rural level leading to qualitative changes in the life of farmers.

14.5. Food safety implications

An important implication of the IHNDP’s nutrition component is the importance of food safetyand hygiene. Food safety should be a component of DAE’s future horticulture-relatedprogrammes. The technologies promoted through the food preparation and processing activitiesfor nutrition improvement should be further replicated.

112 Mid-term Mission Report, 2003, IHND Project, Dhaka.

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There is a need for more data on the nutritional composition of cooked recipes. Food safetyaspects related to fruits and vegetables, focusing on pesticide residues, related chemicalcontaminants like heavy metals (arsenic) and mycotoxins, and microbiological contaminants(bacteria and parasites) should be considered. This can have implications for the safety ofhorticultural produce in locations with high reported arsenic soil levels.

14.6. Strengthening links with food and nutrition policy

The lessons, nutritional (dietary) impact assessment and practical research outcomes of IHNDPcan be used to strengthen food policy initiatives of relevant departments and sectors of theMinistry of Agriculture, Bangladesh. The project outcomes can be used by DAE to foster andsupport interaction among government entities as well as between them and relevantcommunity organizations working to promote food and nutrition policies within the frameworkof national policies on agriculture, poverty reduction, health and population.

Food-based nutrition models for dietary diversification and horticultural production using theIHNDP experience to widen the food basket should be upscaled. Specifically, this can be fordevelopment of nutrition or micronutrient-based food policies, implementation of food safetyand nutrition enhancement progammes. Issues related to access to food, its preparation andconsumption within households in Bangladesh should be identified as these form an importantbasis for improved food policy decisions and change at the national level.

14.7. Mainstreaming food-based nutrition approaches or programmes

The community-based nutrition activities must be mainstreamed with other DAE developmentactivities. An approach to food and nutrition security based on a homestead gardening systemshould also be considered beyond project areas, particularly for landless farmers. Horticulturalcropping potential can be combined with rearing small animals, poultry and fish breeding fordietary improvement of marginal rural households.

The technical partners of the National Nutrition Programme (NNP) have requested IHNDP andFAO collaboration for initiating food-based nutrition programmes. This was discussed duringthe NNP workshop under the Health, Nutrition and Population Sector Programme (HNPSP).Specifically, requests have been made to integrate the food-based nutrition model and approachwith the HNPSP.

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15. LESSONS LEARNED

The Integrated Horticulture and Nutrition Development Project reached out to the communitydirectly, enabling beneficiaries to improve their lives with locally available resources andsupport from local-level government functionaries. The farmers trained by the project canprepare nutritious food, have more food available for their families and use improved foodpreservation and consumption techniques. Food preparation demonstrations and the schoolnutrition programme have become routine DAE activities.

The project also has lessons relevant to other developing countries in the region whereinadequate nutrition is an important indicator of poverty. Food and nutrition interventions linkagricultural production to good health and agriculture-based strategies can be the key topoverty reduction and nutritional improvement among rural communities in developingcountries. Major FAO initiatives, namely the International Conference on Nutrition (ICN), theWorld Food Summit (WFS), WFS: five years later and the International Alliance Against Hunger(IAAH) focused attention on global hunger, drawing commitments from governments toaddress problems of food insecurity and nutrition, including developing National Plan of Actionfor Nutrition (NPANs). Good nutrition and health are cornerstones of the UN MillenniumDevelopment Goals (MDGs).

FAO is addressing food insecurity and malnutrition in a holistic way, promoting integratedfood-based strategies to enable nations, communities and households achieve the right to food.This report is an example of best practices for incorporating nutritional considerations inhorticulture programmes and policies.

A food-based strategy combined with extensive nutrition education offers a long-termsustainable approach to controlling and eliminating micronutrient malnutrition. Food anddietary diversification are central to food-based strategies. Dietary diversification is the mostimportant factor in providing a wide range of nutrients and this requires adequate access to andconsumption of a variety of foods.

Food and dietary diversification includes all interventions aimed at improving the supply,access to, consumption and bio-efficacy of micronutrient-rich food. In particular, dietarydiversification requires assessment of dietary consumption, expansion and diversification offood production, improvement of food processing, preservation, storage and marketing as wellas food preparation. This must be supported by a nutrition education programme.

Diets in Asian developing countries are deficient in a wide range of micronutrients and it isnecessary to enhance total energy and micronutrient intake besides ensuring the bioavailabilityof the ingested micronutrients. Linking horticultural development policies and national nutritionprogrammes with a focus on increasing food variety may be the best strategy for sustainablereduction of micronutrient malnutrition. Horticultural cropping potential can be combined withrearing small animals, poultry and fish breeding for dietary improvement of marginal ruralhouseholds.

The project experience in Bangladesh shows that agricultural and food policies, traditionallyoriented towards primary agricultural production, should also promote home-based food andsmall livestock production with the explicit aim of increasing household consumption ofmicronutrient-rich food.

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113 Gopalan, C. 2000. Status of food based approaches to prevent and control micronutrient malnutrition. New Delhi,Nutrition Foundation of India.

Agricultural policies and programmes can promote nutritional improvement through“desirable” dietary patterns, for example, formulated to meet micronutrient needs. This can bethrough integrated farming systems oriented to promoting household food security, but can alsobe based on a food variety that meets all dietary and micronutrient needs. These could beenergy-rich staples, protein-rich fish and/or animal food, and vegetables and fruits rich invitamins, minerals and phytonutrients. The cultivation of edible indigenous plants as additionalsources of micronutrients could also be encouraged.

The low bioavailability of some key micronutrients in food, such as iron, can be significantlyenhanced with the right food combinations as well as by appropriate food processing andpreparation techniques. To ensure year-round availability of micronutrient-rich food, simplepreservation technologies need to be further developed and promoted.

As Gopalan113 states, “a comprehensive food-based approach towards achieving householdnutrition security (including micronutrient adequacy) is, in effect, a ‘People’s Movement’.” Thecornerstones of this Movement are self-help, self-reliance, effective mobilization and optimalutilization of locally available food resources.

Instead of “dependence, doles and drugs”, the basic philosophy of the food-based approach isthat the poorest community, adequately motivated, organized, mobilized, educated andprovided with basic logistic and technical support, can meet its basic nutritional requirements.A food-based nutrition improvement programme can bring about a qualitative improvement notonly in the nutritional and health status of a community, but also in its overall productivity andcreativity.

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