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Neeta Singh, PhD, RD, MBA University of the Incarnate Word San Antonio, Texas, USA

Neeta Singh, PhD, RD, MBA University of the Incarnate Word San Antonio, Texas, USA. A sustainable approach to nutrition intervention: Addressing the role of proximal determinants of undernutrition , Bukoba rural, Republic of Tanzania. Bukoba Rural, Kagera Region, Republic of Tanzania.

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Neeta Singh, PhD, RD, MBA University of the Incarnate Word San Antonio, Texas, USA

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  1. Neeta Singh, PhD, RD, MBA University of the Incarnate Word San Antonio, Texas, USA A sustainable approach to nutrition intervention: Addressing the role of proximal determinants of undernutrition, Bukoba rural, Republic of Tanzania

  2. Bukoba Rural, Kagera Region, Republic of Tanzania Started with two nonprofit organizations (NGO) a more holisticapproach towardsmalnutrition

  3. Bukoba Rural, Kagera Region Republic of Tanzania

  4. Women’s Global Connection (WGC) • Women’s Global Connections – (WGC), a Non-Governmental Organization, consisting of a group of academicians, scientist, researchers from various fields, graduate students, and volunteers, physically located at the University of the Incarnate Word, San Antonio, TX. • The Reach-out-Africa (ROA) initiative was started by WGC in 2006 • ROA-WGC has made several trips to Tanzania, Zambia, Uganda and South Africa, delivering capacity-building workshops, as well as incubating research projects. http://www.womensglobalconnection.org/

  5. BUWEA - (CBO) • Bukoba Women Empowerment Association – BUWEA (it’s a registered NGO). • The group has evolved into an association whose mission is to improve the economic status and well-being of women and their families in the Bukoba region.

  6. BUWEA - (CBO) • The BUWEA wants to expand • women’s basic knowledge of business, • technological skills, • health, and nutritional status, thereby making an economic impact as well as improving the overall wellbeing of its members.

  7. BUWEA Cont. • The group is now helping women in twenty-seven cooperatives in the surrounding villages (total 600 members and their families, approx3,000 beneficiaries ). • The group has acquired fifty acres of land and wants to do commercial farming business as a means to improve the nutritional/heath status and hence create economic sustainability.

  8. Background – Nutritional Status • The first Tanzania Mainland Nutrition Survey on children under five and mothers of child-bearing age (Tanzania Food and Nutrition Center (TFNC), 2006) reports a high severity of malnutrition, and its statistics place the Bukoba rural district as one of eleven districts classified as having a high severity of malnutrition, according to the criteria established by the World Health Organization (WHO). Bukoba Rural, Kagera Region, Republic of Tanzania - WHO, UN: Stunting (34.7)– high, Wasting (28)– poor, and Underweight (20.4)– high

  9. Begin with a research topic of importance to the community with an aim of combining knowledge and action for social change to improve community health. METHODS Community Based Participatory Research

  10. Methods/Approach – • Initially (June 2007), focus group of 42 women representing 220 members of the BUWEA was conducted to share the TFNC survey findings to assess local diet and nutritional knowledge of commonly consumed foods.

  11. Methods – • The identified direct determinants of undernutrition were lack of 1) availability; 2) accessibility; and 3) utilization of food • Identified proximal determinants were women’s lack of • 1) sustainable purchasing power; • 2) decision making power; • 3) business acumen; and • 4) horticultural and technical assistance. • These latter implied the lack of women’s person and social empowerment in their family and community context.

  12. Methods • A need based, bottom-up approach was utilized to pilot soybean cultivation project. • Four day post-harvest workshop was offered covering various related topics as well as for strategic planning and expansion of the project.

  13. Purpose • The purpose of this project is to contribute towards reduction of rural malnutrition with specific emphasis on creating agricultural and economics sustainability among the women and children of Kagera region of the Republic of Tanzania • The study aims to incorporate grassroots women in a ground-up approach, as a means to implement and sustain change.

  14. Why Soybean? • Soybean has been know to be a nutritionally superior food, as it contains a very high percentage of “bio-available” protein and has several uses in meal preparation, such as soy meal, infant formula, for disease condition and can be easily adapted in local food preparations. • The soybean is a moderate consumer of nutrients, compared to other crops. • Comparatively, soybean is expensive in African market. • Soybean has been successfully grown for consumption and sales by some neighboring countries in the continent of Africa such as South Africa, Zambia, Mozambique, Botswana and Kenya, to name a few.

  15. Staples – Cassava/mihogo Source: www.fao.org

  16. Staples – Plantains Some micronutrients such as – I cup of sliced plantain contains - vitamin c (45.38% DV) vitamin a (33.35% DV) vitamin b6 (22% DV) potassium (21.10% DV) source: USDA National Nutrient Database for Standard Reference

  17. Workshop (Day 1) – Benefits of Soybean • Interactive teaching about benefits of soybean in the diet. • Poster on the topics of role of protein, health, soybean cultivation and marketing were presented. • Interactive games.

  18. Teaching Aids used for the workshop

  19. Teaching Aids - Poster

  20. Teaching Aids - Poster

  21. Teaching Aids - Poster

  22. Workshop (Day 2 & 3) – Cooking Demos • Cooking demonstration were conducted on adding soybean in the local recipes such as chapatti, porridge/ugali, soy milk, roasting soybean & curries. • Visited several villages/each visit (yearly)

  23. Workshop (day 4) – Strategic Planning • Increasing crop to 30 acres – 2008 -14 • Horticulture training (local experts) • Small business training • Bookkeeping • Marketing • Marketing activities • Seeking local markets – schools, hospitals etc. • Packaging • Nutritional information • Testing soymilk

  24. Translating Information

  25. Proximal Determinants Piece • The soy cultivation was not “stand-alone” project • Required Horticulture component – training, • Extensions/Education component – IT, business skills, marketing… • Finance, accounting/book keeping • Leadership to carry project • Synchronizing all components to achieved desired outcomes…

  26. Other /Proximal Indicators • Involvement in major family decision making • Participation in public action • Physical Mobility/Social Interaction • Political and legal awareness • Ability to make small and large purchases.

  27. The Reality Piece Global economy does not excuse competition – makes it hard for rural/indigent population.

  28. Results/Outcomes • Initially, BUWEA members were provided financial resources and technical expertise (horticultural and nutrition extension officers) to grow soybean on 10 acres. • This money has allowed the members to collaboratively prepare the existing land, buy seeds and start cultivating. • The plowing, seeding, fertilizer application (twice), weeding (twice), harvesting was a collaborative effort – worked as training process/tools

  29. Results Cont. • The initial harvest outcome was 4,440 lbs of soybeans • After harvesting the first crop, the group attended a 4 days workshops/demonstrations (twice a year, 2007 -2011) on several related topics such as the benefits and the uses of soy in local diets, commercial farming and covering various business aspects. • The workshop also helped the BUWEA seek the local market for the harvested crops as well as planning the next crop, while increasing the knowledge, confidence, and continuity of the project.

  30. Tangible Output/Outcomes

  31. BUWEA Case/Story Conclusions • The soybean cultivation pilot project presents a need based, CBPR approach, and targets direct and proximal determinants of the problem of malnutrition in the rural areas, with potential for replication and continuity. • Approaching the problem of undernutrition, policy makers and funders should address both of these determinants to create sustainable solutions, as in the case of Bukoba Rural, Republic of Tanzania.

  32. Bukoba Rural, Kagera Region, Republic of Tanzania The Challenges

  33. Indicators • Clinical assessments - edema • Biochemical assessments • Anthropometrics • Growth data (height, weight, mid-upper arm circumference); • Functional data (hand grip strength); and • General health indices (presence of diarrhea, symptoms of respiratory illness and health care access). 

  34. Challenges • Measuring the actual social impact on rural women of capacity building activities delivered over a five-year period (2004-2008). • The difficulty in assessing impact hinders the potential for further funding for program continuity and expansion.

  35. Challenges • Emphasis has been placed on building women’s business and leadership skills with the intention to improve their health and economic status and impact their role in family and community. • On-going evaluation since 2004 has evidenced changes in women’s attitudes, behaviors and family and community involvement.

  36. Challenges • It is still complex to mention true impact. For example, a woman will indicate in an outcome evaluation, “This project enables me to pay school fees for my daughter and buy beans for our table.” • “Was able to participate in city meeting.” • “Was able to attend Muwanza group meeting, they have been doing quite well.” • “I can tell my husband that my daughter will attend school.”

  37. Challenges • “I bought seeds for my own plot’” • “I tried soy three times wk. and I feel better, not to tired.” • “We should offer HIV screening in BUWEA meeting, so we know about our health.” • To convert this important information into existing economic indicators, thus satisfying stakeholders, is problematical.

  38. Bukoba Rural, Kagera Region, Republic of Tanzania The updates - 2016

  39. Timeline…. • 2004-2005: Acquired 50 acres of land • 2006: shared Tanzania Mainland Survey • 2007: Series of workshops on plant based protein • 2008: Workshops – cooking, making soymilk • 2009: Microenterprise – soy flour • 2010: Feeding programs • 2011: Milling machine – income generating business • 2012: Soy plan in operation /increase soy production • 2013 - 2015: New bakery & value added products • 2016: Childcare center as income generating venture & value added soy products to increase income & sustainability..

  40. Updates 2016 • There have been several crop failures • BUWEA received several grants from Flora Family Foundation, Microfinance Partners of Africa, US Embassy, Tanzania & several private foundations to continue their efforts in expansion of the project. • WGC & BUWEA has started a clinical trail on pre-school feeding program. • BUWEA is sharing their expertise to replicate the project in Kakamega, Kenya.

  41. Updates 2016 • June 2016 there will be faculty/partners from Business and Food Industry will visit the area to expedite marketing part of project • The money from sales of soy goes to micro lending projects, educational workshops, BUWEA learning center to address/work towards proximal determinant of malnutrition and food security issues in the area. • Helping BUWEA to come up with other soy value-added products for marketing and sustainability.

  42. THANK YOU

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