Nutrition
and Disability
LOUISE LABUSCHAGNE
DIRECTOR
REAL IMPACT FOR SUSTAINABLE GROWTH
LABUSCHAGNE@REALIMPACT.OR.KE
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Thika, Kenya
Is Good Nutrition a ‘Right’?
New Kenya Constitution:
Recognises the right quality and
quantity of food as a basic right
for children.
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Thika, Kenya
Real Impact NGO
2-hectare Nutrition Farm
link planting programme to nutritionally balanced
repeating menu for 160 staff of Real IPM
Half acre small scale farmer model farm
sufficient nutrition and cash crop
family of two children
Land for Nutrition Farm for PWD – employees, trainers and trainees
Research
Design of planting programmes
low-input growing systems
cost benefit analysis
Capacity building
extension workers (health, agriculture, education)
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Thika, Kenya
Transform Nutrition
Consortium
University of Nairobi
Save the Children
International Food Policy
Research Institute (IFPRI)
CGIAR
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Thika, Kenya
Nutrition in Kenya
30% (10 million) chronically food insecure.
7% of children under five are wasted and
16% are underweight.
stunting rate 35% (2.1 million children)
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Thika, Kenya
Nutrition in Kenya
61,000 Kenyan children die every year:
• underweight,
• deficient in vitamin A
• or not exclusively breastfed.
400,000 suffer mental retardation
• insufficient iodine.
46% children (18 to 23 months) are stunted
11% of children < six months are stunted.
• Insufficient calcium and protein
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Thika, Kenya
Women’s Rights
Size and age of mothers at conception has significant
impact on nutrition of child
Longer intervals between conception, reduces the
likelihood of undernourished children
Status of women in the culture affect child nutrition
(lack of control over family planning)
1,000 Kenyan children die every year:
• underweight,
• deficient in vitamin A
• or not exclusively breastfed.
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Thika, Kenya
Where does the Problem begin?
Average five children per woman
Million pregnancies in Kenya unplanned.
one in every four women aged 15-19 already has a child.
“We
recommend two children per family,”
Nelson Keyonzo
Director Urban Reproductive Health Initiative
World Population Day, 2012
“Kenyans
will continue to wallow in
poverty if the population continues to
grow at the current rate”
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Thika, Kenya
Focus
1,000 days after conception are the most important.
Intervening within this period will have life-long and lifechanging impacts on:
•
•
•
•
educational attainment,
labour capacity,
reproductive health
and adult earnings.
If we wait until a child is two years old, the effects of
under-nutrition are already irreversible
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Thika, Kenya
Components of Nutrition
Land, water, fertiliser, seeds
Storage (inputs and outputs)
Existing knowledge agronomy,
nutrition (agro-nutrition)
Family planning
Create demand
Improve Access
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Thika, Kenya
What’s the difference?
Kitchen Garden
Output measured in KILOS per meter square
Nutrition Garden
Output measured in MINERALS and VITAMINS per meter square
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Thika, Kenya
What’s the problem?
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Thika, Kenya
Not enough vegetables
The World Health Organization
recommend 400g of vegetables and
fruits intake per person per day
Kenyans today are consuming
about 114kg per day
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Thika, Kenya
Addiction
Too much carbohydrate
excessive consumption ugali
Too much sugar
mostly from sugary tea
Health problems
12% Kenyan people obese
10% diabetes type 2
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Thika, Kenya
Addiction
Too much alcohol
WHO maximum intake:
21 units per week (men)
3 – 4 units/day
17 units per week (women
2-3 units/day
1 unit = half pint normal strength beer
= 25ml spirits (one shot)
= one small glass wine
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Thika, Kenya
Alcohol Abuse
Excess alcohol consumption can
reduce absorption of minerals and
vitamins – severe health risks
Individuals who consume more
than 30 percent of their calories as
alcohol have the greatest risk
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Thika, Kenya
Alcohol Abuse
• thiamine (vitamin B1) deficiency
• Wernicke-Korsakoff syndrome (WKS)
alcoholic brain disease
confusion,
paralysis of eye nerves
difficulty with movement.
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Thika, Kenya
Alcohol Abuse
Alcoholics may be deficient in vitamin A.
alcoholic liver disease > liver cirrhosis
need a liver transplant to survive.
Combination of vitamin A supplements and
alcohol can be toxic (must give up alcohol).
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Thika, Kenya
Maize Lethal Necrosis Disease
Widespread virus infection of maize
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Thika, Kenya
Food and Nutrition Security
Diversify crops and grow more
vegetables
Learn to cook and eat more quantity
and types of vegetables
Eat smaller quantities of ugali and
sugar
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Thika, Kenya
Recommended Daily Intake
• Daily intake level of a nutrient to meet
health requirements of individuals.
• International standards
• Based on 2,000 kcal for a ‘normal’
healthy adult
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Thika, Kenya
Recommended Daily Intake
Exact amount of all minerals & vitamins in
100g/ 100mls of every type of food
Nutritionists design menus with correct
amount minerals and vitamins - healthy body.
% RDI (of each mineral and vitamin)
per 100 grams (of each food type)
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Thika, Kenya
US – Focus on Healthy Eating
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Thika, Kenya
Healthy oils – vegetable
(corn, soya, sunflower) - liquid
NOT Healthy oils – animal
(animal fat ) - solid
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Thika, Kenya
© The Real IPM Company
Thika, Kenya
Health Warning
reduce amount of ugali consumed and
only eat unprocessed, more healthy ugali
(not processed white ugali)
Only 100 g of maize flour provides 26%
RDI carbohydrate and 29% RDI of fibre
Since both carbohydrate and fibre are
common in other foods, it is wise to limit the
quantity of ugali flour to 100 g once per day
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Thika, Kenya
100 g ugali has 29% RDI fibre
Effect of too much in diet
Stomach Cramps
Diarrhoea
(increases the speed in which food moves
through gut)
Fibre Sometimes, unable to absorb minerals and
vitamins.
Constipation and intestine blockage
too much fibre without enough water
Intestinal Gas
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Thika, Kenya
% RDI carbohydrate per 100 g
source
% RDI
chapatti
25
ugali
20
bread
cassava
rice
yams
potatoes
sweet pot.
arrowroot
17
13
9
9
7
6
4
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Thika, Kenya
% RDI sugar per 100 g
source
soda
fruit juice
% RDI
120
75
honey
410
table sugar
500
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Thika, Kenya
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Thika, Kenya
Sugar is addictive
Carbohydrate is addictive
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Thika, Kenya
Kenya’s main mineral/vitamin deficiencies
IRON
VITAMIN A
Government supplement
programme
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Thika, Kenya
Main minerals in Nutrition Kitchen
sources
iron
Moringa,
other flours (pumpkin & seed flour,
chickpea, buckwheat, millet, sorghum,,
wholemeal maize amaranth),
arrowroot
wheat bran, wholemeal wheat flour,
soyabean, sorghum, peas, beans, lentils,
spinach, amaranth, pumpkin leaves,
saget.
WHO Kenya classified ‘ severe deficiency’ in national diet
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Thika, Kenya
2
Main minerals in Nutrition Kitchen
Deficiency symptoms
deficiency
Contributes to maternal
deaths in childbirth
In Kenya - 424 per 100,000 live births
increased risk of ill health in children,
iron
iron
reduced work productivity in adults
poor food digestion and absorption
depression, stress, post natal depression
WHO Kenya classified ‘ severe deficiency’ in national diet
impaired physical and cognitive development
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Thika, Kenya
2
Iron supplement warning
Guidance should be sought from Public Health
Management Teams about local policy on iron
supplements (tablets) for persons with HIV/AIDS
Iron supplements may be detrimental to
HIV/AIDS sufferers
Iron from natural vegetables and meat is
NOT a problem with HIV/AIDS sufferers
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Thika, Kenya
RDI of Iron in common foods
% RDI
iron
% RDI
Vit C
pumpkin
seeds
83
3
liver
34
1
29
3
21
2
19
2
16
2
Source
soybeans
sunflower
seeds
lentils
ked kidney
beans
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Thika, Kenya
% RDI leafy greens per 100 g
Leafy green
% RDI
iron
% RDI
A
Vit
% RDI Vit
C
spinach
20
210
16
spider plant
(saget)
18
72
70
amaranth
(terere)
13
55
69
coriander
(dahnia)
10
135
45
kales
(sukuma)
5
272
68
nightshade
(managu)
5
0
41
broccoli
4
31
108
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Thika, Kenya
Main vitamins in Nutrition Kitchen
Food sources
Moringa,
sweet potato flour,
Vit A matoke,
soft yellow margarine, butter,
green vegetables, whole podded legumes
(sugarsnap, mangetout), kunde,, pumpkin leaves,
saget, courgette, leeks
pumpkin, butternut, sweet potato, carrots, guava,
passionfruit, mango, papaya, loquat,
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Thika, Kenya
Main vitamins in Nutrition Kitchen
symptoms of deficiency
What are deficiency symptoms?
Night blindness, blindness
Poor mucous membranes prone to bacterial infection
respiratory, reproductive and alimentary tracts.
Vit A
Vit
A
Skeletal System irregular development of the skeleton, distortion and
injury of the brain and the spinal cord. Growth of bone and teeth are
markedly impaired.
Toad skin. The sweat glands of the skin become blocked with horny
plugs of keratin so that their secretion diminishes.
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Thika, Kenya
% RDI of vitamin A in 100 g/ml
Source
% RDI
Vit A
% RDI
iron
% RDI Vit
C
Carrots
341
2
6
Butternut
67
4
6
Liver
522
34
1
Sweet
potato
315
4
21
Pumpkin
100
3
8
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Thika, Kenya
% RDI leafy greens per 100 g
Leafy
green
% RDI
Vit A
% RDI
iron
% RDI
Vit C
210
20
16
spider
plant
72
18
70
amaranth
55
13
69
coriander
135
10
45
kales
272
5
68
0
5
41
31
4
108
spinach
nightshade
broccoli
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Thika, Kenya
Main minerals in Nutrition Kitchen
sources
selenium
zinc
Moringa,
other flours (soyabean, chickpea, millet, sorghum,
wholemeal maize, amaranth, wholemeal wheat ),
wheat bran, brown rice,
mushrooms, garlic,
macadamia, peanuts, cashew,
omena, rabbit, eggs, pork, beef, fish, goat, chicken.
pumpkin seeds,
other flours as above,
chickpea, macadamia, peanuts, cashew, mushrooms.
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Thika, Kenya
2
Main minerals in Nutrition Kitchen
deficiency
What
aresystem
symptoms of deficiency?
Poor
immune
General lack of energy and mental fatigue
Heart palpitations, emotional disturbance,
selenium
moisture on the skin, sensitivity to light
Selenium Miscarriage and changes in menstruation.
weakening of the heart in children
Difficulty sleeping or concentrating, hyperactivity,
zinc
fatigued or easily irritated
zinc
PMS , post-natal depression and reduced fertility,
loss of sex drive
Diarrhoea and inflammatory bowel disease.
delayed wound healing and mild anaemia.
acne and eczema
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Thika, Kenya
2
Common Sources of Selenium
Source
Selenium %RDI
from 100g
omena
161
carrot flour
109
wholegrain wheat flour
101
dehydrated amaranth
101
Sunflower seeds
96
fish(tilapia)
78
watermelon seeds
68
dehydrated mushroom
66
pork
64
rabbit
55
eggs
44
cashew
28
macadamia
17
peanuts
11
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Thika, Kenya
Common Sources of Zinc
Source
Zinc
Pumpkin seeds
50
beef
40
Cashew nuts
39
Sunflower seeds
35
Amaranth grains
31
Oats
26
peanuts
22
Pork
19
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Thika, Kenya
Eat the WHOLE pod + pea = MORE Nutrition
All types of peas can be harvested young
and eaten WHOLE (lablab and cowpea)
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Thika, Kenya
Common Sources of Vitamin C
Source
% RDI Vit C
in 100 g
guava
381
oranges
89
cabbage
62
tomatoes
38
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Thika, Kenya
Main vitamins in Nutrition Kitchen
Food sources
Vit
E
Vit
B6
Vit
B12
Soyabean flour,
liquid vegetable oils, butter,
spinach, avocado, peanuts, coriander,
other flours (soyabean, chickpea, millet, sorghum, wholemeal
maize, amaranth, wholemeal wheat, brown rice),
wheat bran, brown rice, arrowroot Irish potato, matoke
garlic, rosemary, chilli,
soya bean, red & green peppers, spinach, avocado,, sweet
banana, rhubarb, macadamia, peanuts, cashew,
omena, rabbit, beef, eggs, pork
Not in vegetables,
small amounts in goat and cow milk,
a lot in omena and rabbit, also useful amounts in fish and other
meat.
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Thika, Kenya
Deficiency
Vit
E
Muscle weakness, visual problems (especially at night), immune
system changes, and poor sense of balance.
May progress to blindness, heart disease, nerve damage, and
impaired thinking
Vit
B6
Insomnia, irritability, weakness, paranoia, depression, anxiety,
lack of sex drive, water retention, rapid weight gain or loss,
problems with processing sugars, problems walking, cracked skin
at the corners of the mouth
Vit
B12
weakness, tiredness or light-headedness, rapid heartbeat and
breathing
sore tongue, easy bruising or bleeding, including bleeding gums,
stomach upset and weight loss, diarrhoea or constipation
If the deficiency is not corrected, it can damage the nerve cellstingling or numbness in fingers and toes, difficulty walking,
mood changes or depression, memory loss, disorientation, and
dementia
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Thika, Kenya
Main vitamins in Nutrition Kitchen
Food sources
Moringa.
other flours (as above)
protein Soya bean, sorghum, (maize low in protein)
legumes and lentils, kunde,
arrowroot, nuts, omena, meat and fish.
Moringa,
soyabean flour,
calcium spinach, amaranth, nightshade, spider plant,
garlic, herbs ( rosemary, parsley, garlic, basil,
mint)
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Thika, Kenya
Main minerals in Nutrition Kitchen
What are
Deficiency
symptoms
symptoms
of deficiency?
Severe weight loss
Muscle wastage
protein
protein Muscle and joint pain
Craving for carbohydrate
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Thika, Kenya
2
Main minerals in Nutrition Kitchen
What are
Deficiency
symptoms
symptoms
of deficiency?
Stunted growth
osteoporosis, bones porous and fragile
muscle cramps,
calcium
calcium numbness /tingling in the arms and legs.
insomnia, impaired growth,
excessive irritability or nerves,
brittle nails,
eczema
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Thika, Kenya
2
Common Sources of Protein & Calcium
Meat & animal products
Beans
milk
Nuts & seeds
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Thika, Kenya
% RDI Calcium leafy greens per 100
Leafy green
%RDI
Calcium
Amaranth
21
Nightshade
15
Spider plant
15
Spinach
14
Kales
7
Coriander
7
Broccoli
4
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Thika, Kenya
Main vitamins in Nutrition Kitchen
Food sources
folate
Arrowroot, beetroot, guava, avocado
Other flours (soyabean, pumpkins & seed,
chickpea, millet, buckwheat, cassava)
wheat bran, soyabean,
legumes and lentils
spinach, Romaine lettuce, broccoli,
amaranth,
kunde, okra, peanuts, pumpkin seeds,
herbs, eggs
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Thika, Kenya
Pregnant women require
more folate to meet the
needs of developing baby.
Folate deficiency could lead
to a baby with spina bifida
or hyrdocephalus
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Thika, Kenya
Spina bifida
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Thika, Kenya
Hydrocephalus
spinal fluid builds up inside the head, causing pressure to increase
and the skull to expand to a larger than normal size. It can also
cause convulsions, tunnel vision, mental disability or death
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Thika, Kenya
Good Fats and Bad Fats
• ‘Bad Fats’: Increase cholesterol risk obesity, heart
diseases : saturated fats and trans-fats
• ‘Good Fats’: Protect heart, overall health: Omega-
3-fats, monounsaturated fats and polyunsaturated
fats
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Thika, Kenya
GOOD FATS
Good fats- Liquid at room temperature
Monounsaturated fat
Polyunsaturated fat
Canola oil
Soy bean oil
Peanut oil
Sunflower oil
Sunflower oil
Safflower
Sesame oil
Sunflower, sesame
and pumpkin seeds
Avocadoes
Fatty fish
Nuts (peanuts,
macadamia nuts,
hazelnuts, cashews)
Soy milk
Peanut butter
Tofu
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Thika, Kenya
BAD FATS
BAD FATS- Solid at room temperature
Saturated Fats
Transfats
High-fat cuts of meat
(beef, lamb, pork)
Commercially-baked pastries,
cookies, doughnuts, muffins,
cakes, pizza, mandazi
Chicken with the skin
Packaged snack foods (crackers,
popcorn, chips)
Whole-fat dairy products
(milk and cream)
Stick margarine –blue band
Butter
Vegetable shortening-Kasuku,
Kimbo, Tily etc.
Cheese
Fried foods (French fries, fried
chicken)
Ice-cream
Palm and coconut oil
Lard
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Thika, Kenya
‘How do we ensure we have enough
nutritional food to eat?’
• Planting programme:
Using a carefully calculated planting programme in a
Nutrition Garden.
• Diversification into vegetables:
grow a wider range of vegetables to ensure ‘something
to eat’ if pests attack and also increase range of vitamins
• Food Preservation & Value addition:
Preserving and value adding the food produced during
plenty season for use when in shortage.
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Thika, Kenya
Moringa - superfood
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Thika, Kenya
‘Why do we need to change our
cooking methods?’
• Overcooking food destroys nutrients
• Discarding of nutritious broth
• finely chopping vegetables increases nutrients
leakage
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Thika, Kenya
How good are school meals?
average RDI %
per meal per day
72 93
0
52
0
0
14
36
3
46
40
39
63
cumulative weekly % RDI from menu (7-days) one main meal per day
(2000 calories/day)
Vit B12
Vit C
Vit E
Iron
Calcium
Selenium
Zinc
fat
processed
35
ugali
wholemeal
70
ugali
maize
6
kernels
red beans 6
vegetable
4
oil
7
70
98 133 0
91
0
0
7
35
0
14
84
42 126
200
7
196 364 406 0 252
0
0
28 182 14 308 168 112 252
40
3
23
30 79
0
17
0
0
0
16
1
0
18
10
23
40
3
20
10 36
0
7
0
2
0
19
4
2
8
1
7
10
7
0
0
0
0
0
0
61
0
0
0
0
0
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Thika, Kenya
calories
Vit B6
100
weekly units per servings
order person /person
(kg) (g or ml) per wk
Vit A
Carb
344
ingredient
44
Fibre
50
Protein
Institute
beneficiaries
avg. grams
food per
meal
108 31
NUTRITION LEAGUE TABLE
% RDI obtained from 100 gm cooked serving
ugali (processed)
ugali
(wholemeal)
red bean
maize kernels
githeri (50:50
maize + red
beans)
moringa powder
(10 g)
fine beans
carrots
sweet potato
spinach
cabbage
amaranth
kales (sukuma)
pumpkin
matoke banana
(plantain)
sweet banana
Calcium Selenium
total N
score
Protein
Carb
Fibre
Vit A
Vit B6
Vit C
Iron
10
14
19
0
13
0
5
0
2
63
14
17
19
26
8
25
29
30
66
0
0
0
18
6
14
0
2
0
13
16
13
1
3
1
22
2
0
123
84
138
36
33
96
0
20
2
29
4
2
111
17
14
2
3
6
3
4
4
1
3.8
8
3
6
1
2
1
2
2
1.8
38
12
10
10
8
0
8
4
125
0
341
315
210
2
55
272
100
5
8
8
12
6
9
7
2
8.6
2
6
21
16
62
69
68
8
28.25
6
2
4
20
1
13
5
3
50
6
3
3
14
5
21
7
1
90
2
1
0
2
1
1
1
0
324.45
81
378
370
291
90
173
374
121
2
2
10
8
9
10
18
1
12
18
18
15
3
1
0
1
2
1
74
57
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Thika, Kenya
Nutrition Garden crops
Crops in bags – sukuma and amaranth
Crops in beds with two drip lines: cabbage, sweet potato
and fine beans
Crops in beds with three drip lines: carrots spinach
Crops on fences: pumpkin
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Thika, Kenya
© The Real IPM Company
Thika, Kenya
Moringa oleifera
Fast growing, deep tap root, drought resistant
Leaves, bean pods and roots can be eaten
Can be eaten fresh or dried or as powdered leaves
Small quantities needed in diet – concentrated nutrition
High in protein, iron and calcium
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Thika, Kenya
Miracle tree
Grow as short coppice hedge – just for the leaves
Double row – always one tall line as windbreak
Grow more than needed – dry and make powder
Only one tablespoon of powder per person per day
Five meters of coppice hedge per person
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Thika, Kenya
What next for Real Impact?
Design, Evaluate and Demonstrate
cost effective, sustainable production and use of :
Protein:
insect derived nutritional supplements
moringa leaf (fresh and nutritional supplements)
animal based – rabbits, fish, eggs
Calcium: goats milk
Vit B (various) animal sources
Design, build and evaluate a half acre family shamba for 4
members
Design and build adapted nutrition garden for persons with
disability
Design and test Food Bridges for Semi Arid areas
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Thika, Kenya
What next for you?
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Thika, Kenya