Annual Report 2018

The CGIAR Research Program on Agriculture for Nutrition and Health (A4NH) is dedicated to the realization of Sustainable Development Goals 2 and 3, laid out by the United Nations. In 2018, A4NH began its second phase of work, with five research flagships, seven managing partners, and activities in more than 30 countries all working toward realizing this vision.

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Flagship 1: Food Systems for Healthier Diets

The Food Systems for Healthier Diets (FSHD) flagship takes a national perspective, focusing on an in-depth look at dietary gaps in food systems of four countries: Bangladesh, Ethiopia, Nigeria, and Viet Nam. In various contexts, researchers “zoom out” to global food systems or “zoom in” to urban food systems to better understand national food system dynamics. In alignment with national policies and using decision-makers’ narratives, FSHD works with stakeholders to develop food system innovations that contribute to consumption of and demand for healthier diets. A systemic approach highlights the relationships among different food system components and how a change in one component influences other outcomes, and recognizes that food systems involve multiple actors managing multiple value chains in an interactive way. The flagship brings in private partners, especially small and medium enterprises, and seeks to strengthen the food systems thinking capacity of public, private, and civic partners and to involve early-career researchers who will be the future leaders guiding food system transformations. This flagship is led by Wageningen University & Research (WUR), with support from Bioversity International, the International Center for Tropical Agriculture (CIAT), the International Food Policy Research Institute (IFPRI), the International Institute for Tropical Agriculture (IITA), and the Global Alliance for Improved Nutrition (GAIN).

Mind the Gap: Comparing Food Intake and Dietary Quality
To understand dietary patterns and identify where gaps in healthy diets exist, A4NH researchers have undertaken analyses in the flagship’s four focus countries using nationally representative household expenditure surveys. This allows for comparisons of food intake and dietary quality across regions, locations, and socioeconomic groups. Reports including data analyses for Ethiopia and Nigeria were released in 2018, while data processing was completed for Viet Nam and Bangladesh. Researchers created food-composition data tables and conducted diagnostic workshops with stakeholders in Nigeria and Bangladesh. Foresight analysis revealed how the Nigerian food system is expected to transform in coming decades and identified leverage points for ensuring the transformation contributes to balanced diets. Moving forward, research will relate the dietary situation to the food environment, considering access to markets, information, and roads and other infrastructure that may affect consumption. Findings will be shared with policymakers to help target areas for intervention.
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Vegetable Consumption for Healthier Diets in Nigeria
Knowledge on drivers, motives, and barriers affecting consumer food choices is crucial for the development of interventions, policies, and food innovations to improve diets. In urban Nigeria, consumers who primarily valued mood, familiarity, and health characteristics of food reported a higher vegetable intake. Deeper insights into consumer motives were collected through focus group discussions and interviews in four cities that are geographically spread over Nigeria. Increasing knowledge and belief in one’s own ability to prepare vegetables could help to increase vegetable consumption, especially in combination with interventions and policy design that account for the role of prices and differences between socioeconomic classes. These insights have led to an intervention to deliver fresh and washed vegetables called Veg-On-Wheels. The research also contributed to an improved questionnaire for assessing food choice motives in the local setting of urban Nigeria.
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Health and Sustainability: Assessing Food Systems
A4NH researchers contributed significantly to the food systems and healthy diets literature in 2018. A paper published in World Development, titled “When Food Systems Meet Sustainability: Current Narratives and Implications for Action,” describes different views and interpretations of food system crises that depend on the field of expertise of the person involved, and research and priorities needed to “fix” the problem. The authors detail how sustainability is defined in different narratives and note the unavoidability of trade-offs between various dimensions of sustainability. They lay out a framework for transitioning to sustainable food systems, a topic of intense attention globally. While this paper looks at food systems broadly in the context of sustainability, other publications dove deeply into policies around food systems and healthy diets in Bangladesh and Viet Nam, providing insights for policymakers in those countries and an opportunity for other countries to draw their own lessons from those experiences.Download Full Highlight (PDF 490KB)

Flagship 2: Biofortification

More than two billion people in the world do not get enough essential vitamins and minerals in their daily diets. Those suffering from this less visible form of undernutrition are vulnerable to blindness, impaired physical and cognitive development, disease, and even death. In 2018, HarvestPlus, which leads A4NH work on enhancement of the micronutrient content in staple crops, collaborated with many partners to develop and disseminate more biofortified crops. In addition, new research strengthened the evidence that these biofortified crops measurably improve micronutrient status and health. Policy and advocacy efforts to sustain biofortification’s impact also advanced.

Biofortification’s Growing Global Reach
In collaboration with partners, HarvestPlus has developed and disseminated 211 varieties of 11 staple food crops, benefiting more than 38 million farm family members to date. In 2018, iron-biofortified pearl millet was released in Niger—the first release of this variety in Africa. Well-suited for dryland cultivation, pearl millet is the major dietary energy source for millions of people in Africa’s Sahel region. This variety helps combat iron-deficiency anemia and supports healthy cognitive and physical development in children. Zinc-biofortified maize was released in three more countries in Latin America—Colombia, Guatemala, and Nicaragua—following introduction in Honduras in 2017. These varieties will help address widespread stunting by improving childhood growth and immune system development. In Guatemala, nearly half of children under five are stunted and 30 percent of the population is estimated to consume inadequate amounts of zinc.
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Building the Evidence Base
Two key studies establishing the efficacy of iron and zinc biofortification to improve health and nutrition were published in 2018. First, a study published in the Journal of Nutrition shows biofortified high-iron pearl millet can significantly improve nutrition and cognitive performance, stemming the negative effects of iron deficiency. This is the second landmark study to demonstrate such functional improvements, which can profoundly impact women’s and teens’ success at school and work. Nearly half of all Indian women and children under five are anemic; iron deficiency is a major cause. Second, a study published in Nutrition Journal details how vulnerable young children in India who ate foods prepared with zinc enriched wheat spent significantly fewer days sick with pneumonia and vomiting. Zinc deficiency is common in India, leaving nearly 40 percent of children under age five physically stunted and vulnerable to common infections.
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Engaging Policymakers
Supportive policies are essential for sustaining and scaling up biofortification’s impact, and 2018 saw progress at national and regional levels. By the end of the year, 21 countries had included biofortification in their national agricultural and/or nutrition strategies. India prioritized nutrition in breeding by setting official minimum standard levels of iron and zinc for the release of pearl millet cultivars. The Indian government also declared millets “nutri-cereals,” important for improving food and nutrition security, and recommended their inclusion in the country’s extensive public food distribution system. HarvestPlus Founder and CEO Howarth Bouis was inducted into African Leaders for Nutrition, a high-level forum initiated by the African Union and African Development Bank (AfDB) to strengthen commitments to ending malnutrition. The AfDB also committed to prioritizing nutrition-smart investments like biofortification to help Africans reach their cognitive potential.Download Full Highlight (PDF 303KB)

Flagship 3: Food Safety

Food safety has rapidly moved up on the development agenda, propelled by a confluence of circumstances: A growing body of research demonstrates the significant burden of foodborne disease. Growing numbers of middle-class consumers are demanding access to safe food. Increasingly complex food systems have put greater distance between consumers and farms, with a need to ensure food’s safety along the value chain—through harvest, transport, storage, and sale. These circumstances all intersect in low- and middle-income countries, which are growing and changing fast. With so many factors in play and different circumstances facing each country, food safety research, evidence, and policy support are more critical than ever. A4NH researchers are working across contexts and situations to provide this evidence and support to those who need it, from farmers to consumers and from market agents to policymakers. This flagship is led by ILRI with support from IITA and IFPRI.

Contributing Research to Dialogues and Decision-Making
Food safety is a topic of great interest to policymakers and consumers alike the world over, but more evidence is needed to better understand where risks exist and to identify appropriate actions and policy interventions. Working to fill this need, A4NH researchers produced more than 100 peer-reviewed publications, chapters, policy briefs, and presentations at scientific and policy meetings in 2018. Among those were contributions to the high-impact Lancet Countdown report on health and climate change, which is the highest-ranked CGIAR publication of all time on Altmetrics. Researchers also contributed 12 articles on leveraging value chains for food safety and nutrition security to a special edition of Global Food Security. Other new research includes a paper on the first-ever randomized control trial on aflatoxin and stunting, published in BMJ.

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Aflatoxin Mitigation Work Moves Forward in Africa
A4NH researchers have an established history of knowledge and innovation for aflatoxin mitigation, and their work is drawn upon by policymakers across Africa. In 2018, under the East African Community (EAC) Aflatoxin Prevention and Control Project (APPEAR), a series of nine policy briefs were developed that provide an implementation strategy and action plan for aflatoxin control and prevention through the health, agriculture, livestock, trade, industry, and environmental sectors. Outlining key strategic policy recommendations and actions to prevent and control aflatoxin contamination along food and feed value chains in East Africa, the policy briefs were released during a two-day regional forum in Kenya in August. Also during 2018, six Aflasafe products were approved by regulatory authorities responsible for biopesticide registrations for use in Ghana, Zambia, and Tanzania—two products per country.

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Research Informs Design of $13 Million Investment in Improving Food Safety
Food safety is a relatively new focus for international agricultural research, and A4NH work is helping to bring attention and resources to this critical development issue. In 2018, the Bill & Melinda Gates Foundation and the UK Department for International Development used cumulative evidence from ILRI, which leads A4NH work in this area, on the food safety burden and management in informal markets to shape their first joint investment in food safety. In response to their call, six grants totaling $13 million were awarded. Evidence-based interventions will be tested at a large scale, potentially reducing foodborne disease risks for millions of consumers in Burkina Faso, Ethiopia, Kenya, Mozambique, Nigeria, Tanzania, and one state in India.
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Flagship 4: Supporting Policies, Programs, and Enabling Action through Research (SPEAR)

A4NH’s fourth flagship works with a range of partners, governments, civil society, and regional and global organizations to develop multisectoral solutions to the challenges of malnutrition in all its forms (including undernutrition, overweight, and obesity). Bringing agriculture, nutrition, and health stakeholders together, SPEAR helps stimulate an enabling environment for partnerships and joint programs and policymaking, paying particular attention to issues of gender and equity. Researchers work directly with governments to help them support and implement national policies and programs and to shine a light on the value of knowledge and evidence for improving these initiatives. This flagship is led by IFPRI with support from Bioversity International and the Institute of Development Studies (IDS).

Childcare Centers as Platforms for Agriculture and Nutrition
A new study led by researchers at IFPRI looked at whether agriculture and nutrition interventions delivered through community-based childcare centers in Malawi impacted the nutrient intake, dietary diversity, and nutritional status of participating children and their younger siblings. Results showed that not only did nutrient intake and dietary diversity increase among children participating in the program but also stunting declined in their younger siblings. The program’s impacts were due to increased household production and consumption of nutritious food, as well as improved caregiver knowledge about optimal feeding practices.
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Strengthening Capacity of Nutrition Leadership
For an impressive seventh year, the Transforming Nutrition course, led by IFPRI and IDS, trained global leaders, practitioners, and other professionals, bringing the total number of people reached through the course to nearly 200. Leaders who have taken the course have gone on to apply knowledge gained to their professional work in delivering programs and supporting policy processes for improving nutrition. A survey of course participants showed overwhelming agreement that participation in the Transform Nutrition short course has been useful for their work, and that they have shared lessons from the course with colleagues. Twenty-five percent of survey respondents stated they were aware of changes in policy and 54 percent stated they were aware of changes in practice influenced by the course.

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Culmination of Leveraging Agriculture for Nutrition in South Asia (LANSA)
In 2018, the Leveraging Agriculture for Nutrition in South Asia (LANSA) project wrapped up, following six years of work. To summarize the project’s research and findings, a special issue of Food Policy presented LANSA’s core themes and cross-cutting issues. Five overarching lessons for researchers and policymakers were highlighted, including the need to understand the (enabling) policy and institutional environment and adopt a systems approach; recognize trade-offs and potential unintended consequences; move from words to action; agree on metrics for defining success; and understand and adapt to context.
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Flagship 5: Improving Human Health

Agriculture transforms both landscapes and livelihoods, changing both the conditions that allow human diseases to emerge and spread and the capacity of communities to protect themselves. Agricultural and health systems share problems but rarely work together, leaving missed opportunities not only for collaboration and learning, but also for improving the lives of people throughout low- and middle-income countries. A4NH’s fifth flagship, Improving Human Health, is working to change this by bringing agricultural and human health researchers together to identify evidence of positive and negative effects of agricultural development on disease, and to develop interventions to reduce disease risks and improve human health. This flagship is co-led by the London School of Hygiene and Tropical Medicine (LSHTM) and ILRI, with support from IITA.

Re-examining the Link between African Rice Production and Malaria
As malaria comes under greater control, irrigated rice schemes may become malaria hot spots, a particular risk in parts of Africa where irrigation for rice-growing is expanding. Improving Human Health researchers have re-evaluated the link between African rice production and malaria. Historically, when malaria prevalence was high overall, this link was weak, but more recent studies suggest that malaria risk in rice-growing villages is now higher than in non-rice villages. A rice intervention to reduce vector production by regularly raising and lowering water levels in irrigated rice is being developed with Africa Rice for 2019 trials.
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Supporting Government Decisions and Planning on Rift Valley Fever Interventions
Rift Valley fever (RVF) is a viral disease of cattle, sheep, goats, and camels that occurs after periods of abnormally high rainfall and flooding. It can spread to livestock producers and other livestock value chain actors, like slaughterhouse workers, via contact with infected animals or animal products. Understanding where and when outbreaks may occur is critical for targeting interventions. A 2018 A4NH publication has shown the environmental limits of RVF and guided refinement of RVF decision-support tools, including risk, for governments to use for planning interventions. Maps have been used in Kenya to develop contingency plans and to target surveillance/ response activities, and new work has begun in Uganda, with good prospects for further research.
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Improving Hospital Diagnostics for Human Brucellosis
Human brucellosis is a bacterial infection that spreads from animals to people, often through dairy products. A4NH research published in 2017 showed that the poor performance of standard hospital-based diagnostics for human brucellosis led to inappropriate drug use. This work contributed directly to the development of a new policy in Kenya in 2018, with key researchers participating in the national policy review committee. While the national brucellosis policies in Kenya and Tanzania are under review, there has been growing demand from county-level hospitals for the improved diagnostics stemming from this work.
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Focus: Gender and Equity

To identify the most vulnerable groups and understand how best to reach them, agriculture, nutrition, and health researchers must consider factors such as gender, age, wealth, location, ethnicity, religion, and more. Implementing interventions without accounting for these factors can lead to unintended negative consequences for those most in need. The Gender, Equity, and Empowerment (GEE) Unit helps A4NH researchers better address how gender and equity influence the relationships between agriculture, nutrition, and health.

A Dynamic Portfolio of Gender Research Projects
A4NH has a thriving portfolio of projects helping us understand the role gender and equity play in the connections between agriculture, nutrition, and health. Many of these projects yielded interesting new insights in 2018, particularly about women’s empowerment in nutrition-sensitive agriculture programs. Other projects continued to collect data and develop tools and trainings, ranging from integrating gender into work on food safety in the pork value chain in Viet Nam to measuring women’s empowerment among milk traders in peri-urban Nairobi.
A4NH also curates the Gender- Nutrition Idea Exchange (GNIE), a forum for sharing research about gender in agriculture, nutrition, and health. In 2018, blogs touched on gender in Africa’s informal food markets, how households make diet and nutrition decisions, and why equity matters for food and nutrition research. GNIE promotes discussion about gender research within and outside of A4NH, with over 19,000 views in 2018.

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Setting Priorities for Equity Research in A4NH
A 2017 external review found A4NH research investigates several areas of equity, including gender, income, poverty, life stage, youth, and geography, but only focuses systematically on gender. Using the recommendations from this review and input from our management and advisory teams, A4NH is working to strengthen key areas of equity research. In 2018, A4NH commissioned a set of studies on equity in agriculture, nutrition, and health. These include a structured review of existing research to identify gaps and opportunities for equity research; a framing paper about youth and food systems transformation to guide A4NH work in this area; and an effort to develop frameworks for identifying how equity fits into pathways between food systems innovations and healthier diets. These studies will be completed in 2019. To inform a new equity strategy, A4NH held a series of consultations around the world with stakeholders and partners to better understand what equity research is already happening; how partners integrate equity into their work; and what resources, knowledge, and tools are needed.
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Measuring Women’s Empowerment in Agricultural Development Projects
The Gender, Agriculture, and Assets Project, Phase 2 (GAAP2), is developing quantitative and qualitative tools to measure women’s empowerment and inclusion in agricultural development projects, with 13 pilot projects underway. In 2018, GAAP2 launched the project-level Women’s Empowerment in Agriculture Index, or pro-WEAI, which helps assess women’s empowerment in an agricultural development project setting, diagnose areas of disempowerment, design strategies to assess deficiencies, and monitor and evaluate project outcomes. Since the original WEAI launched in 2012, more than 85 organizations in over 50 countries have fielded and adapted versions of the index. GAAP2 seeks to create a community of practice to engage research partners, policymakers, donors, and other stakeholders. In 2018, GAAP2 held two pro-WEAI launch events and several capacity development workshops and seminars, launched an updated website for the WEAI Resource Center, and began developing a distance learning course about how to use and interpret pro-WEAI.
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