Preventing blindness in Zambia / John Madeley

20 World Health • November-December 1992 Preventing blindness in Zambia John Madeley A n imaginative project is under way in Zambia to combat nutritional blindness by encouraging people to produce and eat more of the foods that contain vitamin A and carotene. Although still in a pilot stage, the initiative is likely to develop into a full-scale project in 1993. Shortage of vitamin A is a major cause of nutritional blindness in babies and young children. Every year about half a million young people go blind simply because their diets do not have enough of the vitamin. But blindness is only the first symptom; if the victims do not receive immediate treatment, around two-thirds of them will die of nutritional deficiency. There is no need for this suffering to continue. Foods to prevent vitamin- A deficiency can be grown on farms, in urban back yards or tiny garden plots, and even on window-ledges. Vitamin A is also present in fish, liver, milk and eggs; but many other foods contain carotene, which can be converted to vitamin A in the body. These include dark-green leafy vegetables - spinach and cabbage, for example; orange and yellow vegetables such as carrots and pumpkin; yellow (non-citrus) fruits and red palm oil. In recent times, the poverty of many of the world's subsistence farmers has led them to pay little or no attention to growing foodstuffs with vitamin A and carotene. The UN Food and Agriculture Organization (FAO) is cooperating with WHO, UNICEF, UNESCO and other UN agencies in a ten-year action programme to control and prevent vitamin-A deficiency. FAO's contribution to the programme is "to increase the production of vitamin A and carotene rich foods and ensure their increased consumption". Growing cabbages in southern Africa: a rich source of vitamin A In September 1991, FAO started a one-year technical cooperation programme in the Luapula valley of Zambia to tackle the problem of vitamin-A deficiency. The root crop cassava is the main staple food for the half-million poor people living in the valley. While cassava is drought- resistant and high in energy content, it is low in protein. Chronic eye defects A survey carried out in 1988 in one of the valley's three districts found that 64.7% of children suffered from chronic malnutrition; vitamin-A deficiency showed up "dramatically in eye defects", according to FAO. Local people have a name for night blindness - a common indicator of vitamin-A deficiency when a child has difficulty seeing in poor light; they call it "kafifi". The existence of a special name suggests local awareness of the problem. The programme engaged specialists in nutrition, horticulture and oil palm as consultants. After field visits, they pointed to the need to Making people aware of the link between diet and eyesight is a crucial first step to preventing youngsters from going needlessly blind. increase production of certain crops, especially vegetables and fruits that are rich in vitamin A, as well as groundnuts and palm oil. They also proposed an information programme to educate the public on the link between nutrition and eye disease. Before long, nutrition was incorporated into the training of primary-school teachers, agricultural assistants, crop husbandry officers and community development workers. Training materials emphasized that vitamin-A deficiency usually exists as part of a multiple deficiency problem, and that nutrition education has to aim at improving the intake of all nutrients. Smallholders were encouraged to grow different varieties of indigenous vegetables that are rich in carotene, while 16 demonstration plots at village and household level , and also in primary schools, showed them how. The programme is trying to ensure that 95% of families in Luapula valley have carotene-rich foods in sufficient quantities for at least six months of the year. It puts particular emphasis on improving the consumption of these foods by pregnant and lactating women and pre-school children. Women's organizations for horticultural development, schools and the mass media channels play their part in disseminating information World Heolth • November-December 1992 21 and demonstrating methods of getting the best results. Fruit tree nurseries are being established to produce high-quality fruit trees and oil palm seedlings to supply farmers, and there are plans for a seed bank for traditional vegetables. Agricultural extension staff in the valley are being trained to determine the extent of vitamin-A deficiency in their area, and to promote the production and consumption of carotene-rich foods. between diet and blindness. In this underdeveloped area of Zambia, a start has been made on reversing the factors that cause babies and young people to go needlessly blind. • One year after this pilot project started, much more food with vitamin A and carotene was being grown in Luapula valley and many more families were aware of the connection Mr John Madeley is Editor of the magazine International Agricultural Development. His address is 19 Woodford Close, Caversham, Reading RG4 7HN, Berkshire, UK. Educating mothers about nutrition . Ill-health retards development Better health is desirable as an end in itself. But it also brings substantial economic benefits - releasing resources that can then be used to achieve other development goals. Better health and nutrition raise workers' productivity, decrease the number of days they are ill, and prolong their potential working lives. Household survey data from nine countries suggest that the economic effects of illness may be substantial. An average adult worker in Peru can expect to be ill4.5 days a month and miss about one day of work as a result; in Ghana, the corresponding figures were 3.6 and 1.3 days. In the USA, workers aged between 1 8 and 44 years miss, on average, a quarter of a day's work o month, w hich equals 3 days a year! Diet, too, influences produc- tivity: in Sierra Leone, a 1 0% increase in the ca loric intake of farm workers who consumed 1 500 calories a day raised output by 5%. Similar results have been found among Kenyan road construction workers with a daily intake of 2000 calories. The potential income loss from illness in eight develop- ing countries ranges from 2. 1 %to6.5%ofyearlyearnings. Reducing illness obviously requires financial resources, but . .. ensures a healthy diet for children. these figures suggest that it might yield a large benefit even in narrow economic terms, quite apart from its human benefits. Potential loss of earnings is only a partial measure of output loss. The full cost would include the value of lost non-market work (such as child care and food prepara- tion), foregone earnings of other household members, costs of treatment, and so on. In short, the strictly economic case for taking effective steps to improve health is strong. Health and nutrition also have long-term effects on productivity and output because they influence a child's ability and motivation to learn. Among Nepalese children, height-for-age - a measure of nutritional history - was found to be the most important factor, aher family income, in explaining school enrolment and the grade attained. In the Philippines, weight-for-height was a significant predic- tor of performance in mathematics tests among urban schoolchildren. These effects, in turn , influence adult productivity. Studies in south India and the Philippines suggest that the long-term contribution of nutrition to wage- levels can be large and positive. Source. World Bank, World development report 1991 .