Malnutrition is a global issue. Access to nutrient-rich food of all classes is an important component of combating malnutrition – and promoting healthy eating is important for healthy outcomes for all ages, but especially for pregnant women, children, and adolescents. In this section, we look at nutrient loading in maize, and promoting nutritious foods.

At least 13 maize varieties are cultivated by farmers in Karatu District, Tanzania, including mixtures, hybrid, traditional, and open-pollinated varieties, which presents an interesting question for scaling up: how does one successfully penetrate such a farming society with an improved and validated variety? While there are nutritional differences between varieties, the choice of variety is also likely to be influenced by yield and other characteristics such as drought tolerance and resistance to pests and diseases.

Farmers still lack knowledge about the nutritional content of vegetables and their health benefits

Promotion of pearl millet and pigeon pea as nutritional food for schoolchildren in central Tanzania led to increased consumption of these foods. Messaging on the nutritional value of vegetables, also in central Tanzania, is following a path of awareness-raising and training on nutrition. The project is promoting innovative vegetable recipes through messaging in Karatu District. Farmers still lack knowledge about the nutritional content of vegetables and their health benefits. More than 80% of the households would like to increase vegetable consumption, and 60% plan to increase family vegetable consumption. Against this background, nutrition training was conducted in eight villages involving 332 farmers (52% women), 10 NGO employees, 8 government extension staff, and 16 restaurant/food-kiosk staff, covering knowledge and skills on food groups and better diets to reduce undernutrition, particularly in children under 5 years of age and women of reproductive age. Two new recipes were developed during the nutrition training. Major activities included the provision of information on the importance of eating diverse foods, recipe preparations, ways to add value to farm produce based on the relationship between plant health and human health, and advice on changing diet-related habits to improve nutritional status.

In central Malawi, protein and micronutrient deficiencies are widespread. In maize– bean intercropping using nutrient-dense (iron and zinc) common bean varieties with contrasting growth habits (bush and climbing) at three sites, the mean grain yield of common bean was 298–600 kg/ha. The local climbing variety gave the highest yield in intercrop at two sites, and all intercrops had land equivalence ratios greater than 1 (i.e., more maize and bean produced in intercrop than if they were grown as monocrops on half the land).

In Ghana, tools developed for formative research include barrier analysis to identify the behavioral determinants (enablers and barriers) of five key infant and young child feeding and maternal nutrition behaviors (exclusive breastfeeding, dietary diversity, complementary feeding/food density, joint household decision-making among couples, consumption of fruits and vegetables). The formative research was conducted in partnership and strong collaboration with the Ghana Health Service at the district and subdistrict levels. Results indicate that the role of secondary targets (husbands, friends, in-laws) on the primary target audience (e.g., mothers) significantly affects nutritional problems being addressed – affecting, for example, perceived social norms concerning spending money on the purchase of ingredients such as vegetables, fish, and meat for the household. Husbands are primarily influenced by friends and wives by in-laws. These groups of influential individuals need to be factored into the design of nutrition programs.

For people who already fed fruit and vegetables to their children (‘doers’) and those who did not (‘non-doers’), the only determinant of fruit and vegetable consumption was perceived self-efficacy. Doers were almost three times more likely than non-doers to mention “the availability and/or own production of fruits and vegetables” as a factor that makes it easier to consume fruit and vegetables at least three times a week. Home gardens will therefore contribute to improving the availability of vitamin-rich fruits and vegetables. Meanwhile, non-doers were almost three times more likely than doers to mention “child likes the fruits or has appetite” as a factor that makes it easier for a child to consume fruits and vegetables at least three times a week, implying that they depend on their children liking fruit and vegetables to offer these to them. This is a barrier, indicating that non-doers will not proactively give their children fruits and vegetables. Thus, nutrition education is needed to influence mothers to consciously offer fruits and vegetables to their children.

Perception of positive and negative consequences was not a determinant of consumption of fruits and vegetables; respondents did not often mention the advantages and disadvantages of consuming fruits and vegetables – this finding also calls for nutrition education in this area.

Nutrition education is needed to influence mothers to consciously offer fruits and vegetables to their children

In communities in semi-arid central Tanzania, focus groups indicated that pearl millet grain is largely perceived as food for caregivers (generally female, young, and school-going children), but over 60% of caregivers were unaware of the nutritional health benefits of pearl millet for children (though aware of the benefits of iron and zinc, both present in pearl millet). Pearl millet’s iron and calcium could also be of benefit against adolescent nutritional vulnerabilities. While 65% of caregivers were not worried about availability, 30% indicated the time required for processing is a challenge. Medical doctors are trusted and influential in disseminating nutrition and health messages (over 90% of caregivers) – this indicates a key route for nutritional education for caregivers and others.