Food security and nutrition--a household perspective.
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Biomedical subjects
Publications and source records attributed to Kraisid Tontisirin.
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The purpose of the present paper is to review the evidence in favour of food-based strategies to meet the challenges of micronutrient malnutrition in the developing world. Increasing dietary diversification is the most important factor in providing a wide range of micronutrients, and to achieve this objective in a development context requires an adequate supply, access and consumption of a variety of foods. Diets in developing countries generally lack many nutrients, including energy (inadequate amounts of food), so that strategies need to also emphasize an increase in total food intake, in addition to a greater variety. Agricultural and food policies tend to be oriented to primary agricultural productions, but they could also be formulated to promote and support home gardens and small livestock production for the explicit purpose of increasing the household consumption of micronutrient-rich foods. The adoption of 'desirable' dietary patterns for nutrition improvement, e.g. appropriately formulated to meet micronutrient needs, could be used in the formulation of agricultural policies and programmes. This process could be achieved through support for integrated farming systems oriented to assuring household food security, but also based on a variety of foods that will meet total dietary (including micronutrient) needs. Thus, availability of energy-rich staples, animal and/or fish as major sources of protein, and vitamin-, mineral- and phytonutrient-rich fruit and vegetables could constitute the types of production envisaged. The cultivation of edible indigenous plants as additional sources of micronutrients could also be added. The low bioavailability of some key micronutrients from foods, such as Fe, are substantially enhanced with the right food combinations and with appropriate food processing and preparation techniques. Simple appropriate technology for the preservation of micronutrient-rich foods would need further development and promotion for their year-round availability. Linking community development policies to national programmes for the alleviation of hunger and malnutrition, with an emphasis on increasing the variety of foods consumed, is probably the best strategy for improving micronutrient malnutrition sustainably.
The need for combined and integrated strategies to address iron deficiency is widely recognized, utilizing targeted supplementation, as well as food based strategies including both fortified and nonfortified foods. The challenge is not so much knowing "what" to do as is understanding "how" to implement effective and sustainable interventions. Because the causes of iron and other micronutrient deficiencies are complex, including inadequate food intake, unsanitary conditions and inadequate health services, the solutions may also be complex, requiring multisectoral and interdisciplinary approaches. Top-down strategies are unlikely to be effective and sustainable. Rather, the beneficiaries of the program at the community level must be able to understand malnutrition in simple terms, to envisage potential solutions and to become "demanders" of services. The experience in Thailand provides an example of a country-wide, community-based and participatory approach utilizing facilitators and motivators at the local level to implement and sustain interventions. The experience in Thailand indicates the potential for developing effective and sustainable interventions to address iron deficiency and other micronutrient problems as part of a broad, community-based effort.