Culture, environment and food to prevent vitamin A deficiency

Abstract

National nutrition programmes are frequently designed to the exclusion of existing local dietary culture. Sometimes, they simply do not take account of the widely varying diet culture in different parts of the country. A rapid assessment method for obtaining such information at the local level is a useful tool for managers at district and sub-district level, who need to fine-tune the tenets of national programmes to their local context. This book describes the methods and results from pre-testing of a focused ethnographic study (FES) instrument, a simple tool for obtaining the answers to the basic issues pertinent to consumption of locally available vitamin A-rich foods. It establishes an important premise up front: that you cannot prescribe change without knowledge and understanding of the current situation. The FES method is applied to vitamin A nutrition to elicit the list of vitamin A foods that can be promoted, and for formulating the appropriate messages about them. This is described in simple language that is easy to read and understand, and which makes it a ready-to-use tool for programme managers. Successful application of the FES method in the diverse cultures covered in the five studies is a good indication of its flexibility. In the studies described, the FES was applied to small, culturally well-defined population groups. Whilst this was done in the pre-test, it is important to understand that it is not required to conduct the FES for all the cultural and ecological sub-groups in a country before a programme of action can be articulated. Several ingredients for its successful application are noted. Most important are the non-issues, such as that a health and nutrition or social science background is not a prerequisite. The following are important: initial training of the team using the FES manual, local composition of the team, local adaptation of the instrument and its application in different seasons if the seasonal variation in food ecology is marked. All of these prerequisites are available at least at the district level of the health system in most countries. The study in China provides a clear example of the merits of the FES instrument over traditional population survey instruments. In one example, the in-depth interviews provided insight into the politico-economic reasons why carrot production/consumption is no longer practised by the people of Doumen. This is information that would be vital to any initiative to promote carrots as part of a vitamin A programme, but which could not have been captured in a population survey of what people eat. Pile sorting particularly is good for determining the position of foods in terms of their attributes (positive or negative) which is important knowledge for any programmes that seek to promote these foods. It is interesting to note the remarkable cross-cultural consistency in food beliefs, and of the vitamin A deficiency name meanings, e.g. chicken eyes for xerophthalmia, and the basis of treatment. The indication here for programme managers is that if dietary inter-ventions have been possible in other settings, there is always the potential for them in their own settings. The crucial issue becomes the knowledge basis for developing the intervention. This book is recommended reading for national programme managers; but more importantly for local managers who must necessarily contribute to the development of national plans, and who in any case carry the responsibility for translating these plans into programmes on the ground.