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©FAO 2011. Combating Micronutrient Deficiencies: Food-based Approaches
(eds B. Thompson and L. Amoroso) 163
Abstract
Home gardening, focusing on provitamin A-rich vegetables, is a long-term strategy that can contribute to
combating vitamin A and other nutritional deficiencies which are of public health significance in develop-
ing countries. The provitamin A carotenoid content of foods and their potential contribution towards
meeting the vitamin A requirements of the target population are predominant considerations in the selec-
tion of crops to be planted. This chapter describes a home garden approach that integrates gardening
activities with nutrition education, using community-based growth monitoring as entry point. Studies
using this approach in South Africa showed a favourable effect on maternal knowledge of vitamin A nutri-
tion, dietary intake of provitamin A-rich vegetables, caregiver-reported child morbidity and children’s
vitamin A status. Provitamin A-rich vegetables and fruits contributed significantly towards achieving the
recommended dietary intake of vitamin A and various other micronutrients. Seasonal availability of pro-
vitamin A-rich vegetables and fruits needs to be taken into consideration to ensure year-round availability
of provitamin A-rich foods.
The approach is flexible and entry points other than community-based growth monitoring can be
used to promote production and consumption of provitamin A-rich vegetables and fruits.
Demonstration gardens to serve as training centres, community-based nurseries for orange-fleshed
sweet potato cuttings and a seed distribution system are important components of the home garden
projects. Various constraints experienced with vegetable gardens and possible solutions are high-
lighted. Participation in gardening projects is self-selective. Non-participating households within the
project areas are, however, exposed to the promotion activities, resulting in a spill-over effect to non-
participating households.
Keywords: food-based approach, home gardens, vitamin A, provitamin A carotenoids, vegetables and
fruits, South Africa
9 A Home Gardening Approach
Developed in South Africa to Address
Vitamin A Deficiency
M. Faber1 and S. Laurie2
1Nutritional Intervention Research Unit, Medical Research Council, Cape Town,
South Africa; 2Agricultural Research Council – Roodeplaat Vegetable and Ornamental
Plant Institute, Pretoria, South Africa
Introduction
Vitamin A deficiency is prevalent in most
developing countries. Globally 33.3% or 190
million children younger than 5 years are
deficient in vitamin A, with South-east Asia
and Africa having the highest prevalence of
vitamin A deficiency at 49.9% and 44.4%,
respectively (1).
Vitamin A is essential for maintaining
immune function, eye health, vision,
growth and survival in humans (2). Vitamin
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164 M. Faber and S. Laurie
A deficiency is the leading cause of pre-
ventable blindness in the world. Children
who are vitamin A-deficient have lower
resistance against common childhood
infections such as respiratory and diar-
rhoeal diseases, measles and malaria (2).
Globally, vitamin A deficiency resulted in
6% of deaths (0.6 million) among children
under 5 years old in 2004 (3). Improving
the vitamin A status of children between 6
months and 5 years reduces the all-cause
mortality by 23% in areas with high vitamin
A deficiency (4).
Nutritionally vulnerable communities
often consume monotonous low-energy,
low-protein diets that are predominantly
based on starchy staples and often include
little or no animal products, limited dietary
fat and few vegetables and fruits. As a result
their diets are low in a number of micronu-
trients, including vitamin A. Dietary modi-
fication strategies that aim to increase the
vitamin A intake include various approaches
to increase: (i) the production, availability
and access to vitamin A-rich foods; (ii) the
consumption of vitamin A-rich foods; and/
or (iii) the bioavailability of vitamin A in
the diet (5).
Dietary sources of vitamin A consist of
either preformed vitamin A (retinol) from
foods of animal origin or provitamin A caro-
tenoids (predominantly b-carotene) from
foods of plant origin that are converted to
retinol by the body. Preformed retinol from
foods of animal origin is the most bioavaila-
ble dietary source of vitamin A, but these
foods are often not within the financial reach
of the poor. Foods of plant origin are more
affordable and can be cultivated at household
level. Local production of provitamin A-rich
vegetables and fruits, including the under-
utilized indigenous wild-growing leafy veg-
etables, can provide households with direct
access to foods rich in provitamin A caroten-
oids. Therefore, home gardening is a funda-
mental strategy to address vitamin A
deficiency in resource-poor communities by
increasing the availability of, access to and
ultimately consumption of foods that are rich
sources of vitamin A. Integration of small-
animal husbandry (such as fish, poultry,
small livestock, milking cows or goats) with
home gardening increases dietary variety
and availability of foods rich in preformed
retinol (6).
Home gardening can be part of a sustain-
able long-term strategy that complements
household food security, nutrition education,
supplementation and food fortification inter-
ventions. It is recognized that the various
interventions to address vitamin A deficiency
should be used in combination because they
each serve a particular target group and none
of them has 100% coverage (6). It is further
recognized that home gardening projects that
aim to produce particularly provitamin A-rich
foods for household consumption will not
eliminate vitamin A deficiency, but can help
to reduce the risk of vitamin A deficiency by
increased consumption of home-grown pro-
vitamin A-rich vegetables (6).
Berti et al. (7) argued that home garden-
ing is inherently an effective intervention
which most people, given access to land and
other agricultural inputs, can adopt. However,
to ensure that gardening activities translate
into improved dietary quality, home garden-
ing projects need to include a strong nutrition
education and behaviour change component
(5). Dietary modification through successful
promotion of behaviours that provide ade-
quate dietary intake, together with ensuring
availability of supply, is likely to be both sus-
tainable and affordable (8).
Furthermore, it is believed that home
gardens are preventive, cost-effective, sus-
tainable, culturally acceptable and have the
potential for income generation (9,10).
Gardening projects empower households to
take ultimate responsibility for the quality of
their diet by growing their own nutrient-rich
foods and making informed consumption
choices. It has further been argued that the
benefits of gardening projects are tangible
and rewarding for the community (11). Home
gardening projects can reach a majority of
rural and many urban/peri-urban house-
holds and all their members, not just a par-
ticular age group, as is the case, for example,
in high-dose vitamin A supplementation pro-
grammes. Generally, communities that have
no or limited access to supplementation and
food fortification programmes benefit the
most from home gardens.
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Home Gardening Approach 165
Home Garden Projects to Address
Vitamin A Deficiency in South Africa
The national prevalence of vitamin A defi-
ciency among 1- to 9-year-old South African
children was 64% in 2005 (12). Compared
with a national survey conducted in 1994 (13),
the vitamin A status of South African children
appears to have deteriorated despite the
national vitamin A supplementation pro-
gramme which targets 6- to 59-month-old
children and postpartum mothers within 6–8
weeks of delivery. National vitamin A supple-
mentation coverage rates were found to be
72.8% for children aged 6–11 months and
13.9% for children aged 12–59 months (14).
Children in South Africa generally con-
sume a diet that is low in animal foods, veg-
etables and fruits, resulting in approximately
half of the children consuming less than 50%
of the required amount of vitamin A (15). The
consumption of vegetables and fruits is gen-
erally low in the rest of the South African
population as well. Analysis of household
availability of different foods showed that 196
g of vegetables and fruits were available per
person per day at the household level (16).
This amount is about half of the World Health
Organization recommended daily intake of
more than 400 g of vegetables and fruits per
person to protect against cardiovascular dis-
ease and certain cancers (17). Rural and urban
South African women in KwaZulu-Natal and
Western Cape Provinces considered afforda-
bility, and to a lesser extent availability, as
major constraints for the consumption of veg-
etables and fruits (18).
Home gardens can provide households
with direct access to provitamin A-rich vege-
tables that are not readily available or within
their financial reach. In theory, a well-planned
home garden of size approximately 15 m × 10
m can supply a sufficient amount of provita-
min A-rich vegetables to fulfil the vitamin A
requirements among other micronutrients of
a household of six throughout the year (19).
This chapter gives an overview of home
garden projects that were done in South
Africa by the Medical Research Council
(MRC) and Agricultural Research Council
(ARC). The aim of these projects was to
address vitamin A deficiency through
increased production and consumption of
vegetables and fruits all year round, particu-
larly those rich in provitamin A carotenoids.
Integral to these projects is the emphasis on
nutrition and agriculture linkages.
The first project was initiated in 1998 and
formed the foundation for the second project.
The study population for the first project was
composed of residents of Ndunakazi, a rural
village in the Valley of a Thousand Hills in
KwaZulu-Natal Province. Almost 50% of the
children in the area were previously shown to
be vitamin A-deficient (20). The population
density of this village was low and approxi-
mately 200–300 households with, on average,
eight persons per household were scattered
over a mountainous area of approximately 11
km long and 1 km wide. The gardening activ-
ities were integrated with community-based
growth monitoring and linked to nutrition
education. The project had high input from
the research team and was closely monitored.
Project evaluation showed a positive impact
on maternal knowledge regarding vitamin A
nutrition, dietary vitamin A intake and the
vitamin A status of children aged 2–5 years
(21). The research team gradually withdrew
while putting mechanisms in place to enable
continuation of the gardening activities.
Aspects that were given consideration
included seasonal availability of vegetables
and fruits (determined during 2003–2005)
(22) and a sustainable seed system.
Unpublished results from a survey done in
2007 suggested that the gardening activities
were sustained after withdrawal of the
research team. The latter survey showed that
a substantial number of households obtained
provitamin A-rich vegetables and fruits from
either a home garden or a community/group
garden; and that the vitamin A intake was
higher than at baseline.
In the second project from 2002 to 2005, a
similar approach was used but with less input
from the research team, and with the focus on
community mobilization and technology
transfer. The study population resided in
seven rural villages, approximately 200–700
households per village, in Lusikisiki, situated
in the Pondoland Coastal Plateau in the
Eastern Cape Province.
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166 M. Faber and S. Laurie
Crops cultivated in the home gardens
The aim of the aforementioned two projects
was to improve the vitamin A intake of nutri-
tionally at-risk populations. The b-carotene
content of the crop and its potential contribu-
tion towards the vitamin A requirements of
the target population were predominant con-
siderations in the selection of crops to be
planted. Crops inherently rich in provitamin
A carotenoids (particularly b-carotene)
include dark-green leafy vegetables (e.g. spin-
ach and wild-growing leaves), carrot, orange-
fleshed sweet potato, butternut squash,
pumpkin, mango and papaya.
Although the bio-efficacy of provitamin
A carotenoids in plant foods is less than pre-
viously thought (23), it has been shown that
plant provitamin A carotenoids from green/
yellow vegetables can sustain vitamin A sta-
tus, as demonstrated in Chinese children (24).
Consumption of cooked green leafy vegeta-
bles (25–27), sweet potato (26,28,29) and car-
rots (27) was shown to improve vitamin A
status, providing evidence supporting the use
of provitamin A-rich plant foods in food-
based strategies to address vitamin A
deficiency.
Orange-fleshed sweet potato varieties
offer one of the highest sources of naturally
occurring b-carotene, but are currently not
widely grown in Africa (30). A randomized
controlled trial done in South Africa showed
that orange-fleshed sweet potato was accepted
well by primary-school children and
improved their vitamin A status when given
as part of the school meal (29). Between 70%
and 92% of the b-carotene in orange-fleshed
sweet potato is retained during cooking (31).
Of the orange-fleshed varieties available,
some were found naturally, while others have
been developed through conventional breed-
ing (32). Sweet potato varieties have also been
developed through improved biotechnology
(33,34). Sweet potato is adaptable to a broad
range of agro-ecological conditions and is
suitable for low-input agriculture. It is, in
many ways, an ideal crop for gardening
projects, as it grows on low-nitrogen soils, is
more drought-tolerant than conventional
vegetable crops, crowds out weeds and suf-
fers from relatively few pests (35).
The colour of the sweet potato is directly
related to the b-carotene content, and colour
intensity (cream, yellow, yellow-orange,
dark orange) may therefore be used as an
indicator of provitamin A value (36).
Vegetable garden projects in South Africa
use varieties with an orange to dark-orange
colour and are supported by a breeding pro-
gramme for orange-fleshed sweet potato at
the ARC – Roodeplaat Vegetable and
Ornamental Plant Institute. Orange-fleshed
varieties had been used as early as the 1980s
in the ARC programme but were mainly
aimed at the frozen-food industry, and were
characterized by low dry-matter content,
poor storability, and tended to have long
curved shapes (37). In 1996, the renewal of
orange-fleshed sweet potato breeding began
by examining breeding lines used in the
1980s, selecting some with higher dry-matter
content and acceptable shape; and, in addi-
tion, orange-fleshed cultivars originating
from the USA were obtained from the germ-
plasm collection of the International Potato
Center. Vegetable garden projects in South
Africa originally used some of the US varie-
ties (particularly Resisto, W-119 and Excel).
After several years of crossing, evaluation
and selection, three orange-fleshed varieties
(Khano, Serolane and Impilo) were released
from the ARC programme between 2006 and
2008 (38,39). The breeding programme is
developing sweet potato cultivars with high
b-carotene content, good yield, good taste,
drought tolerance and tolerance to major
diseases, and is linked with the HarvestPlus
Sweet Potato Biofortification Program
(40,41).
Orange-fleshed sweet potato is a new
crop in South Africa. Nevertheless, in a
paired preference test, 85% of respondents
preferred the taste of orange-fleshed sweet
potato to the usual white-fleshed sweet
potato, and 53% had a definite liking for the
colour (42).
The use of orange-fleshed sweet potato
to combat vitamin A deficiency is an interna-
tional trend. Orange-fleshed sweet potato is
used to combat vitamin A deficiency in sub-
Saharan African countries, e.g. Western
Kenya, Mozambique and Uganda (43–45), as
well as South and West Asia (46).
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Home Gardening Approach 167
Ndunakazi project
The Ndunakazi home garden project was ini-
tiated in 1998, with the aim of improving the
vitamin A status of children through produc-
tion and consumption of provitamin A-rich
vegetables and fruits.
Community-based growth monitoring
activities were used as a platform for the pro-
motion and implementation of the home gar-
den project. The community-based growth
monitoring project was established in 1995
because of the lack of health facilities within
the area (47). The growth monitoring project
had an estimated coverage of 90% and an
average monthly attendance ratio of 71% for
children aged 5 years and younger (48). The
community-based growth monitoring activi-
ties, therefore, provided a suitable platform
for the promotion and implementation of the
home garden project as a large number of
mothers had access to the nutrition education
and agricultural training activities that were
given during the growth monitoring sessions.
Growth monitoring sessions were hosted
at households which were identified taking
into consideration the geographical location,
accessibility, number of pre-school children in
the vicinity of the household, availability of
space and willingness of the mother within
the household to participate. The households
made their homes available on a voluntary
basis, once a month, to serve as meeting
points. Activities during the monthly sessions
included: (i) growth monitoring of children
aged 5 years and younger; (ii) basic nutrition
education (including aspects of breastfeed-
ing, complementary feeding, hygiene and
sanitation); and (iii) counselling of mothers or
referral to the clinic when growth faltering
occurred in children. The growth monitoring
activities were carried out by nutrition moni-
tors (local people, but not specifically from
within the village, trained for the project),
who were employed by the MRC.
A home garden project was integrated
with the growth monitoring activities during
the last quarter of 1998. Demonstration gardens,
which served as training centres for gardening
activities, were established at each growth
monitoring site. During the monthly growth
monitoring sessions, household production
and daily consumption of provitamin A-rich
vegetables and fruits were promoted through:
(i) education on vitamin A nutrition (simple,
inexpensive education material that was
attractive and acceptable to both the mothers
and the nutrition monitors was used to guide
the nutrition monitors through the lessons);
(ii) cooking of locally produced provitamin
A-rich vegetables; and (iii) demonstrations of
the planting process in a demonstration gar-
den. Many of the mothers were not familiar
with the provitamin A-rich vegetables, so
cooked vegetables on growth monitoring
days were used to: (i) introduce the mothers
and children to these vegetables; (ii) teach the
mothers various ways of preparation; and
(iii) give the mothers the opportunity to
observe their children eat and enjoy it. The
latter served as motivation for the mothers to
plant these vegetables at household level and
to prepare them at home.
The nutrition education component of
the garden project focused on, among other
things, optimal food preparation methods to
maximize the bioavailability of provitamin A
carotenoids. Based on evidence that between
3 g (28) and 5 g (49) of fat per meal is required
to enhance carotenoid absorption, the moth-
ers were encouraged to add the minimum
amount of fat to the meal containing provita-
min A-rich foods.
Destroying the food matrix in which the
carotenoids are incorporated may help to
improve the bioavailability of carotenoids.
During food preparation, mechanical process-
ing of vegetables through, for example, cut-
ting, chopping or grinding disrupts the
sub-cellular membranes in which the caroten-
oids are bound (50). The mothers were there-
fore encouraged to grate carrots, for example.
To retain the nutrients (particularly heat-
labile and water-soluble micronutrients) dur-
ing cooking, the mothers were encouraged to
use little water and not to overcook the vege-
tables. The mothers were further encouraged
to eat yellow fruits (e.g. mangoes, papayas
and yellow peaches) when fully mature.
On the day of growth monitoring, gar-
dening activities were promoted and demon-
strated by a nutrition monitor to all mothers
attending the growth monitoring session.
Crops that were planted in the demonstration
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168 M. Faber and S. Laurie
gardens were orange-fleshed sweet potato,
carrot, spinach (Swiss chard) and butternut
squash. KwaZulu-Natal has a tropical climate
and a papaya tree was therefore planted in
each demonstration garden. Pumpkin and
imifino (a collection of various dark-green
leaves that is eaten as a vegetable; the leaves
either grow wild or come from vegetables
such as pumpkins, beetroots and sweet pota-
toes) were already produced locally, but the
quantity grown and eaten was low (51).
Consumption of pumpkin and imifino was
promoted, but these vegetables were not
planted in the demonstration gardens.
Mothers were encouraged to plant provi-
tamin A-rich vegetables and papaya trees at
the household level in addition to any exist-
ing crops. A crop rotation system was recom-
mended for soil improvement and pest
control. Staggered planting, which is small,
regular plantings at intervals during the
planting season, was promoted to lengthen
the period of availability of individual provi-
tamin A-rich vegetables.
Impact of the home garden project on
maternal nutritional knowledge, vitamin A
intake and vitamin A status
The effect of the garden project on maternal
knowledge, dietary intake and vitamin A sta-
tus of 2- to 5-year-old children was evaluated
through two cross-sectional surveys – one at
baseline (February–March 1999) and a follow-
up survey 20 months later (November 2000). A
neighbouring village that had similar commu-
nity-based growth monitoring activities but no
home garden project served as control village.
A significant improvement in maternal
knowledge on vitamin A nutrition was
observed. Within 20 months, most of the
mothers in Ndunakazi could: (i) name at least
three food sources of vitamin A (Ndunakazi
71% versus control village 18%); (ii) relate the
colours yellow/orange and dark green with
vitamin A-rich vegetables (Ndunakazi 82%
versus control village 15%); and (iii) name at
least one symptom related to vitamin A defi-
ciency (Ndunakazi 74% versus control village
27%) (21).
Before implementation of the garden
project, the children consumed a cereal-based
diet, with staple foods being a stiff porridge
made with maize meal, bread and rice.
Legumes, mostly beans, formed an integral
part of the diet. The intake of vitamin A-rich
foods was low, resulting in a median vitamin
A intake of 35% of the required amount (52).
The home gardening project added variety to
the diet and did not replace a major compo-
nent of fruits and vegetables previously con-
sumed (mostly cabbage, banana and orange).
The intake of yellow/orange-fleshed and
dark-green leafy vegetables increased, and as
a result, the intake of vitamin A increased, with
at least 85% of the vitamin A intake being from
provitamin A-rich fruits and vegetables (53).
The prevalence of vitamin A deficiency
(serum retinol <20 mg/dl) decreased from
58% at baseline to 34% in Ndunakazi village.
Ndunakazi children from households with
project gardens had a significantly higher
mean serum retinol concentration than (i) the
Ndunakazi children without a project garden
at household level and (ii) children from the
control village (21). During the two weeks
prior to the follow-up survey, children in
Ndunakazi suffered less from diarrhoea than
children in the control village (10% versus
22%) (54).
A qualitative assessment using focus
group discussions showed that the commu-
nity gained a sense of empowerment through
a better understanding of what makes their
children healthy (through the nutrition educa-
tion), how to check this (through the growth
monitoring) and skills to produce food to
achieve this (through the training in gardening
activities). The community was positive
towards the home gardens, realizing the health
benefits and relating the project with poverty
alleviation (55). The mothers’ understanding
of the underlying factors of poor growth and
health of their children, which was obtained
through monthly growth monitoring and
nutrition education, contributed towards the
success of the home garden project.
Seasonal dietary intake of provitamin
A-rich vegetables
The dietary surveys that were done in
February and March 1999 and November
2000 showed seasonal variations in the
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Home Gardening Approach 169
consumption of yellow and dark-green leafy
vegetables (56). Climatic conditions and sea-
sonal patterns affect the cultivation of provi-
tamin A-rich vegetables and this can
potentially impact dietary vitamin A intake.
Additional data were, therefore, collected on
the seasonal availability of these vegetables
and the impact thereof on dietary vitamin A
intake (22). The proportion of 2- to 5-year-old
children who consumed provitamin A-rich
vegetables and fruits at least once weekly was
determined from February to December in
2003, and during February, May, August and
November in 2004 and 2005. Although the
absolute values differed, results of these sur-
veys showed that butternut squash, pumpkin
and orange-fleshed sweet potato were con-
sumed mostly during the first quarter/half of
the year, while spinach and carrot were con-
sumed mostly during the second half of the
year. The proportion of children who con-
sumed orange-fleshed sweet potato was low,
suggesting that a more intensive promotion
campaign was needed to sustain local pro-
duction and frequent consumption of this
newly introduced crop.
Foods reported during a quantified die-
tary survey in 2005 showed that consumption
of spinach and imifino complemented each
other, with imifino being consumed mostly
during the first and last quarter of the year
and spinach (mostly Swiss chard) during the
third quarter (57). This highlights the impor-
tance of promoting the consumption of both
conventional (spinach) and traditional (imi-
fino) leafy vegetables to ensure year-round
consumption of dark-green leafy vegetables.
Quantified dietary intake for 2- to 5-year-
old children during February, May, August
and November of 2005 showed that the prev-
alence of inadequate dietary vitamin A intake
was approximately 20% or less, with the low-
est prevalence (6%) reported for the November
survey. The provitamin A-rich vegetables and
fruits contributed between 49% and 74% of
total vitamin A intake (22). This suggests that
provitamin A-rich vegetables and fruits can
sustain an adequate vitamin A intake through-
out the year for the majority of the popula-
tion. Promoting and cultivating a variety of
provitamin A-rich vegetables and fruits will
extend the period of and ensure year-round
availability, provide variety and spread the
risk for crop failure. The period of availability
of certain vegetables can be lengthened by
manipulating agricultural practices. Du Plooy
et al. (58) showed, for example, that the avail-
ability of orange-fleshed sweet potato can be
extended to at least nine months of the year in
areas with moderate winter climate by using
various planting and harvesting dates, plant
spacing and soil storage.
Availability of provitamin A-rich
vegetables and fruits
The 2003 survey showed that unavailability
was the main reason for not consuming spe-
cific vegetables during the off-season. This
survey showed that the majority of house-
holds did not have access to butternut squash
for the period April to December, pumpkin
and orange-fleshed sweet potato during the
second half of the year, and carrots and spin-
ach during the first half of the year (22).
To ascertain to what extent the house-
holds had access to provitamin A-rich vegeta-
bles and fruits through the local shops, the
availability of vegetables and fruits in the five
most accessible shops in the village and sur-
rounding areas was recorded during 2004.
Potato, cabbage, onions and tomato were
available most of the time in all five shops.
The provitamin A-rich vegetables pumpkin,
butternut squash and carrot were not availa-
ble in the shops. In terms of fruits, apples and
bananas were available for most of the time,
while the availability of oranges fluctuated.
For provitamin A-rich fruits, mangoes were
never available, some yellow peaches were
available during February to April, and some
papayas were available during December
(22). In areas where provitamin A-rich vege-
tables and fruits are not available in local
shops, the community will not have easy
access to these foods unless they produce
them locally.
Contribution of provitamin A-rich vegetables
and fruits towards dietary intake of nutrients
other than vitamin A
Two surveys in the project area showed that
home gardens focusing on provitamin A-rich
Thompson_Ch09.indd 169Thompson_Ch09.indd 169 8/24/2010 5:03:52 PM8/24/2010 5:03:52 PM
170 M. Faber and S. Laurie
vegetables and fruits can improve the overall
nutritional quality of the diet, and address
multiple nutrient deficiencies simultaneously.
In the first survey, which was done in
February–March 2000 (one year after imple-
mentation of the project), dietary intake was
determined for 2- to 5-year-old children from
households with and without a project gar-
den. Children from households with a project
garden had significantly higher dietary
intakes for riboflavin, vitamin B6 and vitamin
C, and a tendency towards a higher calcium
intake; provitamin A-rich vegetables and
fruits contributed more than 50% of total
intake for calcium and iron, and between 25%
and 50% of total intake for magnesium, ribo-
flavin and vitamin C (53).
Similar findings were observed through
a repeated cross-sectional dietary survey that
was done for 2- to 5-year-old children in
February, May, August and November of
2005, which showed that provitamin A-rich
vegetables and fruits contributed towards
total dietary intake of especially calcium and
iron, and to a lesser extent of magnesium,
riboflavin and vitamin C (22). This is a signifi-
cant additional benefit of the home gardening
project, more so as these nutrients were all
shown to be deficient in the diets of 1- to
9-year-old South African children as deter-
mined in the National Food Consumption
Survey of 1999 (15).
Community-based nursery for orange-fleshed
sweet potato and distribution of seeds
To ensure that the households have access
to orange-fleshed sweet potato planting
material, a community-based sweet potato
nursery in a netted structure, 10 m × 5 m, was
established at one of the households in 2003.
The nursery contains approximately 200
plants in planting bags from which cuttings
are obtained. The plants are replaced with
virus-tested stock plants every two to three
years to keep supply cuttings of good quality.
The number of cuttings that were distributed
from the nursery was 1377 in 2004, 2430 in
2005, 3220 in 2006, 7970 in 2007, 3955 in 2008
and 5750 cuttings in 2009. Considering that
there are approximately 200–300 households
in this village, these numbers are quite
significant. The nursery supplies cuttings not
only to households in the village, but also to
households and schools in nearby villages.
A distribution system for seeds for but-
ternut squash, carrot and spinach is linked to
the community-based orange-fleshed sweet
potato nursery. Seeds are bought in bulk,
repacked and distributed at a price signifi-
cantly lower than in the shops in the village
or nearby towns, where small packages are
sold at expensive prices.
Sustainability of the project
The research team gradually withdrew after
the impact evaluation that was done in
November 2000 (21). The growth monitoring
project, which served as a platform to pro-
mote the gardening activities, was terminated
through a gradual withdrawal process in
2006. Since the implementation of the com-
munity-based growth monitoring project in
1995, the roads and transport system
improved considerably. As a result, the com-
munity now had relatively easy access to the
nearest clinic, and households were encour-
aged to take their children to the clinic for
regular growth monitoring, as this would
also give them regular access to health pro-
grammes such as the vitamin A supplementa-
tion programme.
From March to May 2007, a question-
naire was completed for 100 randomly
selected households that were recruited
through grade 4 to grade 7 scholars of the
local school (unpublished data). The caregiv-
ers of the scholars were interviewed using a
structured questionnaire to determine sources
of vegetables and fruits, household food con-
sumption, knowledge of nutritional benefits
of provitamin A-rich vegetables and fruits,
and gardening practices at household level.
Dietary intake was quantified for the scholars
and caregivers using a 2-day repeated 24-hour
dietary recall. The SAS software package ver-
sion 9.1 (SAS Institute Inc., Cary, North
Carolina) was used to convert food intake to
macro- and micronutrients, using the SAFoods
food composition database.
The average age of the caregivers
who were interviewed was 38 ± 10 years
(mean ± standard deviation), and 48% had
Thompson_Ch09.indd 170Thompson_Ch09.indd 170 8/24/2010 5:03:52 PM8/24/2010 5:03:52 PM
Home Gardening Approach 171
some secondary school education (grades
8 to 12).
Eighty per cent of the households col-
lected imifino from the wild. Approximately
one-third of the households obtained provita-
min A-rich vegetables from a community or
group garden. This could be a reflection of
two group gardens planting mostly provita-
min A-rich vegetables that were established
in the area (one in 2004 and the other in 2005).
More than 40% of the households planted
provitamin A-rich vegetables in their own
gardens. Figure 9.1 shows the percentage of
households who obtained provitamin A-rich
vegetables from either a home or a commu-
nity/group garden. Although the main func-
tion of the vegetable gardens was to produce
food for home consumption, 40% of those
households with vegetable gardens (20% of
the total study population) sold some of their
produce.
Crops faced a variety of physical, eco-
nomic and structural challenges. Animals
destroying the crops were seen as the major
physical threat, and this problem can be
attributed to the lack of fencing affecting
nearly two-thirds of households growing
vegetables. Other major problems experi-
enced by more than half of the households
growing vegetables were plant diseases,
insects, lack of money to buy supplies and
shortage of water for irrigation. Lack of seeds
and access to orange-fleshed sweet potato
cuttings was a problem for less than 10% of
the households growing vegetables.
The respondents were knowledgeable on
the nutritional benefits of provitamin A-rich
vegetables and fruits. Ninety-six per cent of
the respondents thought that yellow/orange
vegetables are good for their children. Main
reasons given for this were because it is
healthy (42%), contains vitamin A (13%) and
promotes child growth (10%). A variety of
other reasons were listed (each by <10% of
the caregivers). When asked to name one
symptom related to not eating yellow/orange
vegetables, four symptoms were each named
by at least 10% of the respondents: eye prob-
lems (26%), diarrhoea (22%), sores (15%) and
poor child growth (13%).
Ninety-one per cent of the respondents
were familiar with the term vitamin A: 62%
knew that vitamin A is a nutrient in food; 78%
associated the colours yellow and orange
with provitamin A-rich vegetables; 68%
named three foods that are rich sources of
vitamin A; and 89% could name one symp-
tom related to vitamin A deficiency.
The quantified dietary data showed that
the median (interquartile range; 25th–75th
percentile) vitamin A intake for the caregiv-
ers was 662 (444–886) retinol equivalents
0
10
20
30
40
50
60
Carrot Butternut squash Pumpkin Orange-fleshed
sweet potato
Spinach
Percentage of households (%)
Fig. 9.1. Percentage of households in Ndunakazi obtaining provitamin A-rich vegetables from either a
community/group garden ( ) or a home garden ( ) in 2007.
Thompson_Ch09.indd 171Thompson_Ch09.indd 171 8/24/2010 5:03:52 PM8/24/2010 5:03:52 PM
172 M. Faber and S. Laurie
(RE) and for the scholars 561 (406–797) RE.
This is substantially higher than the vitamin
A intake reported for children and caregivers
in the area before implementation of the
home garden project; a median vitamin A
intake of 150 (56–579) RE for 2- to 5-year-old
children and 177 (97–644) RE for caregivers
was reported (52).
In summary, the results of the 2007 sur-
vey showed that the caregivers were knowl-
edgeable on the nutritional benefits of
provitamin A-rich vegetables and fruits; a
substantial number of households obtained
provitamin A-rich vegetables and fruits from
either a home or community/group garden;
and vitamin A intake was higher than at base-
line. These results suggest that that the gar-
dening activities in the area were sustained
after withdrawal of the research team.
Lusikisiki project
The Ndunakazi project had high input from
the research team and was closely monitored.
The question, though, was whether this
approach could be implemented on a wider
scale and with less input from the research
team. The Lusikisiki project was implemented
in 2002, with the aim of promoting local pro-
duction and frequent consumption of provi-
tamin A-rich vegetables and fruits. The focus
of the project was on technology transfer,
mobilization of the local community and
involvement of the local governmental
Departments of Health and Agriculture. This
enabled reduced input from the research
team. Agricultural extension officers served
as agricultural advisors for the project and
acted as links between the researchers and
community members involved in the project.
Two community members per village
were identified and trained as project health
volunteers. Implementation was based on the
‘training of trainers’ principle and, during the
second year of the project, each group of vol-
unteers trained two more groups in each vil-
lage. The project health volunteers were
responsible for cultivating and promoting
provitamin A-rich vegetables with the sup-
port of the agricultural extension officers,
providing nutrition education, and for growth
monitoring for 1- to 5-year-old children with
the support of the Department of Health.
The project built on existing structures
and activities, namely: (i) decision making
and problem solving were linked with exist-
ing monthly farmer forum meetings; (ii)
growth monitoring was added mostly to
crèche activities; and (iii) the demonstration
plots were established mostly in existing gar-
dens. Since the existing gardens were already
fenced, there were no additional costs to fence
the demonstration gardens.
At four of the seven sites, growth moni-
toring was added to crèche activities. Crèches
are convenient sites, as access to children
attending the crèche is readily available.
However, using a crèche as the site for growth
monitoring has its limitations. The caregivers
of the children were often not present during
the growth monitoring sessions, making it
difficult for the project health volunteer to
give feedback to the caregiver on the child’s
growth (which is an integral part of growth
monitoring). Also, caregivers who did not
attend the growth monitoring sessions held
at a crèche could not benefit from the nutri-
tion education and promotion given during
the growth monitoring sessions.
The monthly growth monitoring sessions
and annual/biannual farmers’ days were used
to: (i) create awareness on the importance of
vitamin A and health; and (ii) promote project
activities in the area (e.g. distributing pam-
phlets on vitamin A-rich vegetables, making
cooked and processed products of orange-
fleshed sweet potato available for tasting).
In each of the seven villages, orange-
fleshed sweet potato field nurseries were
established in order to ensure a continuous
supply of cuttings. Selection criteria for sites
for demonstration plots and community-
based field nurseries included fencing, water
available for irrigation and willingness to
engage in the process. Training in gardening
activities was done at both the demonstration
plots and the field nurseries.
Homesteads at the demonstration gar-
dens and nursery sites were used to demon-
strate the preparation and processing of
orange-fleshed sweet potato, with emphasis
on sweet potato bread, soup, chutney, juice,
sweet potato leaves as green vegetables and a
Thompson_Ch09.indd 172Thompson_Ch09.indd 172 8/24/2010 5:03:52 PM8/24/2010 5:03:52 PM
Home Gardening Approach 173
sweet potato curry dish. This introduced a
variety of preparation methods, which could
potentially lead to a more frequent use of the
orange-fleshed sweet potato. Using a variety
of products also could create a greater demand
for the orange-fleshed sweet potato, which
could potentially enhance the sustainability
of local production. Bottled products such as
chutney are a way to lengthen the period of
availability of orange-fleshed sweet potato
for consumption. When using orange-fleshed
sweet potato in baking bread, part of the
wheat flour is substituted with boiled orange-
fleshed sweet potato. It is, however, impor-
tant that the dark-orange varieties are used to
ensure that the baked bread provides ade-
quate amounts of vitamin A (59). Processed
products using orange-fleshed sweet potato
should also be economically viable (59). With
the high prevalence of overweight and obes-
ity in South Africa (56% of adult females are
either overweight or obese) (60), it is impor-
tant that prepared dishes and processed prod-
ucts are low in fat, sugar and salt.
In 2005, three years after initiation of the
project, participating and non-participating
households were compared in terms of child
morbidity, nutritional knowledge, dietary
intake and gardening practices. Table 9.1
shows that the project activities had a favour-
able effect on the caregivers’ knowledge of
vitamin A nutrition, morbidity of 1- to 5-year-
old children as reported by the caregivers, con-
sumption of provitamin A-rich vegetables and
growing of provitamin A-rich vegetables (61).
These observations suggest that the project
contributed significantly towards nutritional
outcomes. However, a significant limitation of
the project was the lack of quantitative base-
line data. Thus, the study cannot provide con-
clusive evidence that the observed differences
between participating and non-participating
households were because of the project per se.
Community-based growth monitoring as
platform to promote provitamin A-rich
vegetables and fruits
In the two projects described above commu-
nity-based growth monitoring activities,
Table 9.1. Summary of results comparing project households with control households in the Lusikisiki
food-based project three years after implementation. (Adapted from Laurie and Faber (61).)
Caregiver’s knowledge
of vitamin A nutrition
Morbidity for 1- to
5-year-old children
Vegetable consumption
for 1- to 5-year-old
children
Obtained provitamin
A-rich vegetables from
own garden
Thought yellow
vegetables/fruits are
good for children: 73%
versus 45%
Vomiting: 6% versus
13%
Butternut squash: 32%
versus 22%
Butternut squash: 38%
versus 24%
Familiar with the term
‘vitamin A’: 89%
versus 63%
Experienced fever: 30%
versus 42%
Carrot: 31% versus
31%
Pumpkin: 70% versus
61%
Knew that vitamin A is a
nutrient in food: 83%
versus 53%
Sores on the skin: 6%
versus 19%
Pumpkin: 67% versus
67%
Carrot: 28% versus
18%
Named three foods rich
in vitamin A: 56%
versus 27%
Continuous runny nose:
20% versus 33%
Orange-fleshed sweet
potato: 24% versus
15%
Orange-fleshed sweet
potato: 24% versus
10%
Diarrhoea: 2%
versus 7%
Poor appetite: 7%
versus 14%
Spinach: 73% versus
63%
Spinach: 41% versus
28%
Results are given for the project versus control households.
Thompson_Ch09.indd 173Thompson_Ch09.indd 173 8/24/2010 5:03:52 PM8/24/2010 5:03:52 PM
174 M. Faber and S. Laurie
which extended and complemented the
growth monitoring activities of the
Department of Health, provided the platform
to promote the production and consumption
of provitamin A-rich vegetables and fruits.
For sustainability, methods of integrating gar-
dening activities with existing community-
based growth monitoring activities,
particularly those activities falling under the
Department of Health, should be investi-
gated. For instance, in the Eastern Cape
Province, the local Department of Health
implemented community-based growth
monitoring in 2005 and, by 2008, there were
148 growth monitoring sites in the province.
Growth monitoring is done by community
health workers who are attached to a clinic,
and each growth monitoring site has a vege-
table garden at the clinic (62).
In the Lusikisiki project, where the
growth monitoring was done by project
health volunteers who were not remunerated,
various concerns regarding the sustainability
of the growth monitoring activities were
highlighted. These concerns included a lack
of a continuous and adequate supply of pro-
vitamin A-rich vegetables to cook for the chil-
dren attending the growth monitoring
sessions; a lack of financial resources needed
to maintain food preparation activities dur-
ing the growth monitoring sessions (e.g.
cooking oil, sugar, paraffin, firewood); broken
scales and flat batteries and lack of resources
to fix/replace them; and poor interpretation
of the growth curve by the project health vol-
unteers (61). Funding from local government
departments or external agencies is needed to
sustain the activities at the community-based
growth monitoring sites and for the provision
of sustainable stipends for the project health
volunteers. Besides the need for adequate
funds to sustain community-based growth
monitoring, the growth monitoring process
(weighing procedure, plotting the weight and
appropriate counselling) and using appropri-
ate weighing scales were identified by the
Department of Health in the Eastern Cape
Province as areas within community-based
growth monitoring that need to be strength-
ened (62).
The Ndunakazi and Lusikisiki projects
showed that community-based growth
monitoring is a suitable platform for promot-
ing the production and consumption of pro-
vitamin A-rich vegetables and fruits, but there
are constraints as described above. To
strengthen the food-based approach described
in this chapter, it is important that first the
constraints of community-based growth
monitoring be addressed, and second that the
feasibility of other platforms to promote pro-
vitamin A-rich vegetables and fruits be
investigated.
As part of their technology transfer and
capacity development activities, the ARC
explored various other entry points to be used
as a platform to promote the production and
consumption of provitamin A-rich vegetables
and fruits. They collaborated with other role
players and used existing infrastructure to
implement the food-based approach. Entry
points that were explored included school
gardens, clinic gardens, crèche gardens, com-
munity gardens and institutional programmes
such as sustainable land-use programmes or
agricultural assistance programmes (63).
School gardens were used as the entry
point in one of the provinces as part of
‘Sustainable Food Production in Schools’,
which is a sub-programme of the National
School Feeding Programme of the Department
of Education. Teachers from 200 schools
received training in the food-based approach
and demonstration plots were established in
existing school gardens. The community was
introduced to the cultivation of provitamin
A-rich vegetables, particularly the orange-
fleshed sweet potato, during large-scale open
days. In some cases, the orange-fleshed sweet
potato was introduced in clinic gardens that
were used as a platform for training as well as
the distribution of cuttings of orange-fleshed
sweet potato to people visiting the clinics.
The ‘Mdantsane for Vitamin A Program’
is an example of a local project that integrated
the promotion of provitamin A-rich vegeta-
bles, particularly the orange-fleshed sweet
potato, with the vitamin A supplementation
programme. Evaluation of the integrated
project showed an increase in the number of
children who received vitamin A supplemen-
tation, as well as an increase in the cultivation
and consumption orange-fleshed sweet
potato (64).
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Home Gardening Approach 175
Spill-over effect
Participation in gardening projects is volun-
tary and self-selecting, and not all house-
holds will opt to grow their own vegetables.
Non-gardening households can, however,
potentially benefit from community-based
gardening projects because of the increased
awareness that is created by the visibility of
the demonstration and home gardens, as
well as the nutrition education and promo-
tion that is done during, for example, growth
monitoring sessions or farmers’ days.
An evaluation one year after implemen-
tation of the Ndunakazi project showed an
increased vitamin A intake for both partici-
pating and non-participating households
(53). Although some mothers opted not to
have a project garden, many of them realized
the nutritional benefits of these vegetables
and negotiated with other community mem-
bers to obtain some of these vegetables. The
non-participating households also showed an
increased consumption of imifino and pump-
kin, two vegetables that were promoted but
not planted in the project gardens because
they were already grown locally. The increased
vitamin A intake in non-participating house-
holds was, however, not sufficient to improve
the vitamin A status of the children (21).
A spill-over effect was also observed in
the Lusikisiki project. Approximately half of
the non-participating caregivers received
nutritional information from the project
health volunteers, who were local people
from within the villages. Nutritional informa-
tion was provided not only during the
monthly growth monitoring sessions, but
also at local events such as annual farmers’
days (61).
Problems experienced with the vegetable
gardens and possible ways to solve them
Problems experienced with vegetable gar-
dens and possible ways to handle them are
shown in Figs 9.2 and 9.3. Figure 9.2 contains
data for food-based projects done at
Ndunakazi (as determined during the 2007
survey), Lusikisiki (61) and Giyani (unpub-
lished data). Giyani is situated in a dry sub-
tropical region in Mopani District in Limpopo
Province, and data were collected in five rural
villages from 153 households growing vege-
tables in either a home or communal garden.
Shortage of water was a problem for at
least 50% of the vegetable gardens in all three
of the projects. Water is a critical element of
productivity as South Africa is classified as a
water-stressed country (65). Households
often do not have easy access to water for irri-
gation. In Lusikisiki, for example, nearly two-
thirds of the households with vegetable
gardens depended on water from the river for
irrigation (61). The time and labour needed to
collect irrigation water from the river places
an additional burden on the gardening activi-
ties. Gardening projects should, therefore,
include aspects of water-saving and water-
harvesting techniques (66,67).
A lack of fencing, resulting in animals
destroying the vegetables, was also a major
problem (although to a lesser extent in
Giyani). Proper fencing is expensive and most
households in resource-poor rural communi-
ties do not have the financial means to fence
their vegetable gardens. The formation of
small garden groups (approximately ten per-
sons per group) could potentially help to alle-
viate the problem with fencing. In Ndunakazi,
for example, two groups were formed on
their own initiative and they were assisted by
the research organization to obtain sponsor-
ship for fencing of the two gardens. Natural
fencing is another strategy that can be used to
prevent animals destroying the vegetables. It
has been recommended that food-based
approaches to address vitamin A deficiency
include not only local production of provita-
min A-rich plant foods, but also local produc-
tion of animal foods that are rich in vitamin A
such as poultry, small livestock, milking cows
or goats (6). The practicality in terms of the
animals destroying the vegetable gardens
should be taken into consideration when
implementing food-based projects.
Including aspects of integrated pest man-
agement can address some of the problems
experienced with plant diseases and insects.
Compost-making and buying agricultural
supplies in bulk and then redistributing
within the community can help to overcome
Thompson_Ch09.indd 175Thompson_Ch09.indd 175 8/24/2010 5:03:52 PM8/24/2010 5:03:52 PM
176 M. Faber and S. Laurie
Possible constraints
Water for
irrigation Fencing Agricultural
supplies
Plant pests &
diseases
Seeds and
cuttings
Water
harvesting
Group gardens
and sponsors
Natural fencing
Soil fertility
Buy in bulk
Integrated
pest
management
Community-
based nursery
Buy seed in bulk
Make own seeds
Compost-
making
Possible solutions
Fig. 9.3. Possible solutions for handling constraints in home garden projects.
0 1020304050607080
Lack of knowledge
Percentage (%)
Lack of irrigation equipment
Lack of sweet potato cuttings
Lack of garden tools
Lack of pesticides
Lack of fertilizer
Lack of seeds
Constraint
Plant diseases
Lack of funds for supplies
Insects
Lack of fencing
Shortage of water
Fig. 9.2. Constraints experienced in home garden projects at Ndunakazi ( ), Lusikisiki ( ) and Giyani ( )
in South Africa.
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Home Gardening Approach 177
the lack of funds to buy agricultural supplies.
It is further important to address soil fertility
to ensure that households growing their own
vegetables obtain reasonable yields. A situa-
tion assessment in Lusikisiki showed low soil
fertility (61), which often is a constraint in
rural crop production (68).
In 2007, lack of seeds and access to
orange-fleshed sweet potato cuttings were
not seen as a major problem (<10% of the
households with a home garden) in
Ndunakazi, which probably could be ascribed
to the community-based nursery and seed
distribution system that was put into place in
2003. Easy access to a regular supply of qual-
ity seed, seedlings and e.g. virus-free, orange-
fleshed sweet potato cuttings at an affordable
price is critical for the success and long-term
sustainability of gardening activities. A study
in South Africa showed that most of the capi-
tal cost of home gardening is spent on buying
seeds (69). Strategies to ensure an affordable
supply of seeds include using crops that can
be vegetatively propagated (e.g. sweet
potato), buying seeds in bulk which are then
repacked and sold at the community level,
and own seed production (e.g. butternut
squash and papaya).
Conclusions
Integral to the approach described in this
chapter is the integration of nutrition and agri-
culture. Nutritionists from the MRC and agri-
culturists from the ARC have been working
together since 1998 to develop a food-based
approach contributing towards the elimina-
tion of vitamin A deficiency. This is in line
with the view that food-based interventions
should have a well-designed agricultural
component as well as a well-designed nutri-
tional component, and that these two compo-
nents should be mutually reinforcing (70).
The critical components of the approach
are illustrated in Fig. 9.4. The approach is
flexible and allows for different entry points
to be used as platforms for the education
and promotion activities. The food-based
approach as described by Faber et al. (19)
acknowledges the underlying causes of
childhood malnutrition (71) and topics other
than vitamin A nutrition are covered in the
nutrition education component, such as
breastfeeding, immunization, vitamin A sup-
plementation, hygiene and sanitation (19).
Increasing the access to micronutrient-
rich foods through, for example, home pro-
duction is one of the ways in which agriculture
can contribute to improved nutrition (72). The
main aim of the gardening activities in the
projects described in this chapter was to pro-
duce adequate amounts of provitamin A-rich
foods for household consumption. Income
generation was a secondary aim, and only in
cases where there was a surplus of vegetables.
Potential criticism towards an approach
focusing on provitamin A-rich crops is that
people need a range of nutrients, not only
vitamin A. Production of provitamin A crops
was shown to improve the intake not only of
vitamin A, but also of some other micronutri-
ents (53). The provitamin A-rich vegetables
and fruits were shown to contribute signifi-
cantly towards dietary intake of nutrients such
as calcium, iron, magnesium, riboflavin and
vitamin C (22), nutrients which were all found
to be deficient in the diet of South African chil-
dren (15). Because production of provitamin
A-rich crops was promoted in addition to
existing crops already being planted, the vari-
ety of vegetables consumed increased. In
Ndunakazi, for example, vegetables con-
sumed prior to the project were mainly toma-
toes, cabbage, pumpkin and imifino. The
gardening project added butternut squash,
carrot, spinach and orange-fleshed sweet
potato. Increasing the intake of vegetables and
fruits in general will not only impact micronu-
trient status, but could also reduce many non-
communicable diseases (73). An additional
benefit of specifically provitamin A-rich foods
is that food carotenoids are credited with other
beneficial effects on health, independent of
their vitamin A activity, such as the reduction
of the risk of degenerative diseases like certain
types of cancer, cardiovascular disease, cata-
ract and macular degeneration (74).
Integrating the food-based approach
with existing health, agricultural and devel-
opment programmes will enhance sustaina-
bility and cost-effectiveness and will provide
scope for national implementation.
Thompson_Ch09.indd 177Thompson_Ch09.indd 177 8/24/2010 5:03:53 PM8/24/2010 5:03:53 PM
178 M. Faber and S. Laurie
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Additional topics
Breastfeeding
Growth monitoring
Vitamin A supplementation
Hygiene and sanitation
Immunization
Agriculture
Demonstration
garden
Training centre
for gardening
activities
Home
gardens
Production of
provitamin A-rich
crops for
household
consumption
Community-
based nursery
Distribution of
cuttings
Nutrition
Increased access to
and availability of
provitamin A-rich foods
Increased awareness
and knowledge on
vitamin A nutrition
Increased intake of provitamin A-rich foods
Improved vitamin A status
Entry point for
food-based
approach
Community-based
growth monitoring
School
Crèche
Clinic
Community garden
Health programme
Nutrition
education and
promotion
Vitamin A and
health
Food preparation
Taste cooked and
processed
vegetables
Food-based approach
Fig. 9.4. Overview of the food-based approach to address vitamin A deficiency developed in South
Africa.
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Home Gardening Approach 179
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