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“Adequate nutrition combined with appropriate hygiene positively influence child growth”

“Adequate nutrition combined with appropriate hygiene positively influence child growth”

Arie Hendrik Havelaar (PhD)

Arie Hendrik Havelaar (PhD) is a professor of Microbial Risk Assessment and Epidemiology of Foodborne Diseases at the University of Florida’s Institute of Sustainable Food Systems. In an interview with Samuel Getachew of The Reporter, Havelaar reflects on the new collaborations of USAID’s Feed the Future program and Bill and Melinda Gates Foundation funded CAGED project, on the challenges on the issues of nutrition in Ethiopia, on the efforts to improve stunting and the local poultry industry during his time spent in Haramaya University this past summer, where he led local and American researchers at the nation’s leading agricultural university. Excerpts:

The Reporter: I am aware the University of Florida is collaborating with a number of local partners on research within Ethiopia. Share with me the highlights? 

Arie Hendrik Havelaar (PhD): The USAID funded Feed the Future Innovation Lab for Livestock Systems (LSIL) is involved in seven projects in Ethiopia. Six of these are subawards, with PIs at institutions other than UF. Four FOCUS grants (short term projects; up to 1½ year) are being finalized and results will be publicly available in due time. Two REACH grants (long term projects; up to 4 years) are in their second year of execution. One project, the EQUIP project funded by an additional grant from the Bill and Melinda Gates Foundation, is led by UF and is currently in its first year. All projects are annually presented to stakeholders in Ethiopia at the Innovation Platform (IP) meeting. The last IP was organized in January 2018.

Tell me about the Campylobacter Genomics Environmental Enteric Dysfunction (Its history and work in some other nations, including Ethiopia)?

THE CAGED project, a sub-project of the EQUIP project described above, is only planned in Ethiopia. Several lines of evidence inspired the project design. The overall vison of LSIL is to sustainably intensify smallholder livestock systems in order to improve the nutrition, health, livelihoods, and incomes of the poor. A particular emphasis is placed on promoting consumption of animal source foods (ASF) by pregnant women and young children. One option to achieve this is by intensifying smallholder egg production. Eggs are highly nutritious, and a recent trial in Ecuador has shown that feeding infants one egg per day for six months reduced stunting by about half. The intensification of egg production is also in line with the Ethiopian Livestock Master Plan.

However, other lines of evidence indicate that there are also risks to child health associated with poultry ownership. Keeping chickens in the home overnight is a risk factor for stunting, according to IFPRI research. Chickens are natural hosts for Campylobacter bacteria, and colonization of children’s guts with these bacteria has been shown to be associated with chronic inflammation (environmental enteric dysfunction – EED) and stunting, according to the multi-country MAL-ED project.

We therefore suggested that increasing egg production should be accompanied by increasing hygiene in poultry production and management, in particular proper management of chicken excreta.

What is the vision of CAGED?

Research has shown that young children who eat chicken eggs grow better and gain life-long benefits. Our research in Ethiopia tests the benefits of improved poultry production by smallholders aiming to produce more eggs for their children. We also examine the advantages of protecting their children from chicken droppings by using coops, which should further improve health and growth of the children

Our hypotheses are against a background of increased chicken production by smallholder farmers,(a)symptomatic colonization with Campylobacter bacteria of children between 6 and18 months of age will be reduced by limiting their exposure to chicken excretathrough animal husbandry interventions and hygiene training and reduced colonization by Campylobacter bacteria willreduce the prevalence of environmental enteric dysfunctionin children, and, in combination with improvedaccess to eggswithin the household and basic nutrition and WASH training,will increase linear growth among children between6 and 18 months of age

You have been involved in various projects in the developing world. Are the challenges all the same or are the challenges most of these countries face different than the other. What makes the challenges of Ethiopia different than the others?

This is a difficult question. We now work in eight countries, all selected because of high levels of stunting. But we recognize that these countries are very different and designed a process within the LSIL Management Entity that was participatory and relied on in-country stakeholders to identify priority areas of concern and potential for improving nutrition of children through the livestock sector.

Through this process, which operated from October 2015 through November of 2016, we also learned that these countries share common challenges and priorities. Feed availability and quality arose as a major constraint for livestock production everywhere, as did animal disease. Animal management is suboptimal, leading to poor performance and resource utilization. All farming communities that we work with are genuinely interested in new developments and motivated to adopt new approaches or technologies once they feel confident it may help them address their problems.

You were most recently in the Eastern part of Ethiopia, in Harar for a week. Tell me about that?

A team of researchers from the US (University of Florida, Ohio State University, and Washington University) visited Haramaya University for two weeks this past August. During that time we discussed results of ethnographic research that has already been completed and prepared for upcoming data collection. This included training in research ethics, interview skills, electronic data collection, methods for child health assessment, microbiological laboratory methods, and quality assurance. The work was very intensive, with high commitment from all participants, and was a mutual learning experience. For the US researchers, it was an opportunity to learn about the local situation, to observe life in rural Ethiopia, and to understand the hardships of smallholder farmer families and how advances in scientific knowledge could help to improve child health and nutrition.

Our ethnographic team has characterized the region as experiencing high population growth, increasing land and water scarcity, and vulnerable toclimate change. It is a deeply paternalistic society with high poverty levels, undergoing rapid economic and technological changes. A key change over the past 10-15 years has been the development of a khat economy, providing families with cash income (albeit it subject to seasonal price changes), and the ability tobuy food and other commodities in markets. Nevertheless, malnutrition levels are still high and animal source food consumption is low.

Most people still live on a diet of starchy staple foods with little or no supplementation of nutrient dense foods.

I am aware there is now an effort to help improve the quality of the poultry needs of the country as a way to help the nutrition needs of children. Tell me about that?

As already mentioned, eggs are a rich source of essential nutrients, and promoting and increasing egg consumption of young children will improve their nutrition. There are, however, many barriers to achieving this goal. The CAGED project explicitly addresses the manure hygiene aspect. In order for the trial to be successful, we will also develop training modules for our participants to support the intervention.

These will address other key constraints to egg consumption and overall child nutrition, which are also important when thinking about scaling up the interventions. People consider eggs a luxury food, and typically sell the eggs to supply family income so that other goods can be bought. Including more eggs in the diet is also not sufficient for adequate nutrition; other products (fruits, vegetables) need to be included as well. Improving hygiene should not be restricted to only chicken droppings, but should also include excreta from humans and other animals, particularly goats that are omnipresent near and in homes in the region where we are working.

Training of participants will include education and behavior change components that address these aspects of animal husbandry and human nutrition. Constraints on chicken production include feed availability (a general constraint for all livestock production), animal disease epidemics, and time poverty, specifically of women. In the trial, we will address these constraints by providing families with feed, by vaccinating chickens, and by providing health care for chickens. Any increase or exacerbation in time poverty as a consequence of the project will be addressed by the research team with compensation or other mechanisms to offset this impact.

Importantly, the work we are doing as part of this study are not designed to be sustainable; the goal of the trial is to provide a proof of principle that adequate nutrition combined with appropriate hygiene positively influence child growth. If successful, the trial should be followed by development project, aiming to develop sustainable solutions to major constraints and scale up to national or even international level.