Linking Agriculture, Health and Education in an Innovative Approach to Food and Nutrition Security in St. Kitts-Nevis and the CARICOM

I Granderson, K Gray-Donald, and L.E. Phillip1

End-of-project Knowledge-Sharing Workshops – June 10 and 16, 2014

La Guerite Conference Centre, Department of Agriculture, St. Kitts and Nevis

Outline

• Background – why are we here? • Project activities – what did we do? • Project results – what are our key findings? • Recommendations and actions for consideration • Interactive Discussion • Conclusions

Why are we here?

• To present key outcomes and findings for “stakeholder discussion” and policy considerations;

• To present the project’s evidence-based multidisciplinary, multi-sectoral, partnership building approach to problem solving to address food and nutrition security

– Driven by local and regional actors, addressing national and regional

challenge of overweight and obesity, a major risk factor in NCDs -a major economic burden for CARICOM

– The farm to fork model links farmers to consumers (children) in school

feeding programmes to encourage healthy eating and market and community development

We set specific goals (worked within “Jagdeo Initiative” and the Caribbean Commission on Health & Development)

• Improve nutrition & health outcomes of CARICOM populations through

increased availability and intake of vegetables & fruits, decrease caloric intake, and increase micronutrient intake;

• Develop food production systems based on agricultural diversification, water

conservation & efficient use of land; • Understand constraints to, and accelerate the rate of technology adoption by

small farmers; • Adapt international standards of food safety and quality for a healthy, market-

oriented food supply chain; • Expand and build human and institutional capacity to solve problems of food

and nutrition insecurity in CARICOM; • Build and test a Farm to Fork Model for CARICOM food and nutrition security;

Farm to Fork

Increased farm Production

School Meals Centre

Schools

Children

Consumer Household Food Security

57%

43% Food secure

Food Insecure

N=297 48%

52% Food secure

Food Insecure

N=188

Trinidad

St Kitts

11 % are very food insecure

Food security %

Underweight for height

%

Overweight or obese

%

Insecure 46 5 28

Secure 54 4 38

Children from food insecure households are not more likely to be too thin

0

5

10

15

20

25

30

35

40

45

<-2 -2 to -1 -1 to 0 0 to 1 1 to 2 >2

Perc

ent

Height and BMI for Age

Height for AgeBMI for Age

8

WHO Z Score

Health and Nutrition Status of Children

Baseline Surveys: Farm-To-Fork Model

School feeding and food procurement

St Kitts-Nevis • 7 schools

• 3 control • 4 intervention

• Intervention = improving the school meals

School feeding

Before Rice and beans, turkey wings,

Noodles/ground meat Hot dogs Chicken soup with pumpkin

and dumplings Cheese sandwich Sugar drink

Added String beans, carrots Tomatoes, cucumbers Sweet potato, pumpkin Melon, green banana

11

2013 2014

Product Jan Feb Mar Apr May Jun Sept Oct Nov Dec Jan Feb Mar

Tomato 26 19%

surplus 83%

surplus 0 0 17 57 43 53 36 82 78 80

Pumpkin 19 0 23 45 62 88 25 72 97 22 67 88 94

Cucumber 63 33%

surplus 25 0 30 73 14%

surplus 0 38 67 33 0 0 String Beans 43 33 41 8 33 20 15 0 53 70 17 18 43

Carrots 8 25 5%

surplus 33 14%

surplus 92 0 0 0 86 77 82 8%

Surplus

Sweet Potato 73 0 33 0 19 35 19 58 59 0 22 28 10

White Potato 0 29 31 60 14 0 0 16 0 0 43 87 1%

Surplus

Cabbage 0 0 0 0 92 0 0 23 93 0 86 97 92

Watermelon 0 0 21 14 79 26 25 0 9 0 8 0 13

Cantaloupe 0 0 0 0 0 0 26 0 0 0 0 0 0

Banana 0 0 0 0 0 0 7 0 25 0 4 7 1

Other fruits 0 0 0 0 0 0 0 13 53 25 8 3 0

Onion 28 42%

Surplus 85

Mutton 0 0 24 0 0 0 0 0 0 0 0 0 0

Extent of produce supplied by Local Farmers in St. Kitts relative to School Meal Centre Needs – January 2013 to March 2014 school year

Extent of supplied (%)

0-25 26-50 51-70 76-100 Surplus

0

20

40

60

80

100

120

Jan-Jun 2013 Sept-Dec 2013 Jan-Mar 2014

7 17

6

37 55

96

28 30 26

51 34

100

% o

f Pro

duce

supp

lied

Proportion (%) of produce supplied to St. Kitts School Meals Centre (SMC) by farmers in relation to SMC needs- January 2013 until

March 2014 school year

Fruits Vegetables Pulses Roots

Food procurement for school feeding

Calculated school offerings per child

0

5

10

15

20

25

30

35

40

45

50

Protein Carbohydrates Fiber Total sugars Total sugars withjuice

Fat

Gra

ms

Average Macronutrient Distribution

Control

Intervention 1

Intervention 2

Control April 2013 October 2013

Portions of F &V. 0.13 0.51 1.07

Meal acceptance of new foods %

N/A 46-85 ---

Meal cost: food alone EC

0.96 1.57 2.06

Meals examined during April and October 2013

Containing costs to Scale-up

• Linear programming by Hazel Patterson-Andrews • Competitive buying to ensure best price • Eliminate most costly meals

Intervention 24 hour dietary recall

“End of project” intake of fruit and vegetables by children (8 to 12 year old) in St Kitts, based on number of children eating the school lunch meals on recall day

0

0.1

0.2

0.3

0.4

0.5

0.6

Fruit and vegetable intake

Serv

ings

frui

ts a

nd v

eget

able

s

Control

Improved menu

Final diet for one day in control and menu change groups

CONTROL MENU

Energy 1755 1659

Protein g 61.9 63.2

Fat g 28.11 27.34

Fiber 9.60 10.21

Calcium mg 476 484

Iron mg 11.98 12.91

Change in overweight status over the project.

• Overweight and obesity increased from 20.1

to 26.6 in under 2 years • No differences between treatment groups

Recommendations • Ensure that children receive a healthy lunch each day with at

least 1 full serving of fruit or vegetables every day. • Portion control • At least one meatless meal per week • The use of locally produced food is a priority and a link of

farmers to school kitchen is needed: Food procurement officer.

• Controlling sugar intake need attention as children are gaining excess weight as they grow

• Food safety at the SMC and at schools needs to be monitored • Food service and nutrition expertise needed for adapting

menus

Dialogue on School Wellness

• Beverages currently include 96+ lbs sugar • Snacks sold daily in schools / fundraising

– Healthy snacks? – Timing?

• Physical activity in school? • Nutrition education?

– Teacher training

THANK YOU

CARICOM Project website: www.mcgill.ca/globalfoodsecurity/research-initiatives/caricom-project