WEBVTT

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[sil.]

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When there is a common interest
and if it is the health,

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and if everybody is united to do
something, then it is not difficult.

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People believed that the reason
for night blindness is -

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if you kick the chicken\'s cage. There\'s a
difference between expecting communities

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to pay for those services as opposed to actually
getting involved with government systems.

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[music]

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[music]

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On Lake Mweru, in Zambia\'s Northern Luapula province,
fishermen are bringing in the day\'s catch.

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[music]

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But for local people, a plentiful diet
of fish has had unexpected consequences.

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A survey showed

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that 57% of blind people in Zambia
come from Luapula province.

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The cause lack of vitamin A - a
lethal public health problem

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which also has a significant effect
on child deaths as well as increasing

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the risks to women dying in childbirth.

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On the shores of Lake Mweru,

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Dr. Kunda runs a child health clinic
serving the fishermen\'s families.

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People here regard fish as their
only nutritious type of food,

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so they deprive the children
of other foodstuffs,

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giving priority to fish.

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Dietary supplements are so
low, most of the mothers

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go for field work in the morning,
they come back very late,

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so feeding is compromised.
We usually detect

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that when there is diarrhea
and when a patient comes

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with eye problems that\'s
when we see that surely

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there is a vitamin A deficiency.

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The impact of vitamin A deficiency,
it has brought in high

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mortality and morbidity.

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We need to encourage these mothers to be
giving their children vitamin A supplements.

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As you can see, if you look at the conjunctive
of the child, it\'s very, very red.

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You see? So measles also affects the eye.

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So it\'s very easy for these children, especially
if they are malnourished, to get blind.

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[music]

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In Zambia\'s capital, Lusaka,
Freddie Mubanga is responsible

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for increasing vitamin A intake - both in Luapula
Province, and throughout the whole country.

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We started investigating

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the micronutrient deficiencies in
1995 where we undertook a survey

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in one of the provinces,
Luapula, which had recorded

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high levels of blindness. It
was found that about 16.2%

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of children 6 to 72 months had
subclinical vitamin A deficiency.

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That, of course, gave way to start thinking

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of some strategies to see how we can
reduce the levels of deficiencies.

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[music]

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Since the 1995 survey, Zambia has implemented vitamin
supplements for children at child health clinics -

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both throughout the country,
and in the capital Lusaka.

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George has got a very big catchment
area and we see a lot of children.

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It\'s a really highly-populated place.
Yes. And it\'s a very busy clinic.

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We have a lot of underweights,

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malnourished children.

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We give vitamin A to the under fives.

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[sil.]

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So I think for my baby to be healthy, I
need to be coming here to get medicine

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for her to be protected
from various diseases.

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[sil.]

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Breastfeeding is the best.
And it\'s cheap, very cheap!

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You can buy vegetables, you eat,

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when the baby feeds she gets all the nutrients.
It\'s very cheap - in fact. I like it.

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[sil.]

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Yes, they can get it through breastfeeding, yes. In case they don\'t
get enough through the foods, then we supplement at the clinic

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by giving them vitamin A capsules.

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[sil.]

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Following the national survey on vitamin
A deficiency in 1997, we realized

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that the problem is so immense. So
we had to look at other options.

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In addition to supplementation, we thought
of moving into sugar fortification.

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We looked around what
food vehicles we can use,

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and sugar seemed to be the one
that was produced centrally

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and it was found in almost
every part of the country.

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To add vitamin A to sugar, the
government needed the co-operation

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of Zambia Sugar - a private corporation
and the country\'s sole producer.

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It was a program that was introduced
by the government to the industry -

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so it was very new to us. We knew literally
nothing. People working with the government,

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they had contacts in Guatemala
who were really the…

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the founders of VA fortification of sugar.
So the best way

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to undertake that project was to
go to the source, to the experts.

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And me being the production manager, I had to
go there, because eventually I had to come

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and implement that project.

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Zambia Sugar agreed to help out
with the national health problem

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that the whole country faced -

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as a sign of goodwill. So it\'s
actually doing it for free.

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The company bears the cost.

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[sil.]

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It\'s very expensive. Every year we spend

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almost a million dollars
to buy the VA - vitamin A.

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[sil.]

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USAID has also been a major supporter - and
initiator - of the sugar fortification program.

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[sil.]

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Since we implemented the fortification
program at Zambia Sugar in 1998,

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we\'ve had several delegations
coming from other countries -

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Uganda, South Africa, Malawi and

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Kenya last year. They\'ve been here
to enquire and to familiarize

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themselves with the VA fortification,

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with a view of them also
going the same way.

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[music]

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It may cost a million dollars a year

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to fortify all of Zambia\'s sugar with
vitamin A, but the cost per bag of sugar

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is just a few cents. And even
that pales into insignificance

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when you add in the number of lives saved and the huge
health benefits of vitamin A fortification for all Zambians.

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[music]

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Last year actually the Zambian
Government passed regulations

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to say all the sugar that has to be…

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that has to be consumed in households
has to be fortified with vitamin A.

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Since we started enforcing that,
the border areas - in Zimbabwe,

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and in Namibia, Botswana and so forth -

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their sugar is still coming in. You know,
so it becomes a bit difficult to enforce,

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or to control, the influx of this. But all the
sugar that enters through the border points,

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it has to conform to the regulations.

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[sil.]

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This is brown sugar coming from Zimbabwe.

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Now we\'ve got one truck
carrying sugar, brown sugar,

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30 metric tons, yes, from Zimbabwe.

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[music]

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When the truck comes which is carrying sugar
from Zimbabwe or South Africa, we take samples.

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When we get the primary samples,
we submit them to Lusaka

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for further analysis at the
food and drugs laboratory.

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We have the food and drugs regulations,

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where the levels of vitamin A in sugar are
stated. So we make sure that from the analysis,

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we check whether the levels
do conform to the standard.

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[sil.]

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We receive the samples
from all over the country.

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We also get samples from Zambia Sugar company
itself. Part of their quality control program

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is actually to bring the
samples here for analysis.

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We discovered that some samples of sugar

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was indicating there was no vitamin A. But when they were
analyzed at the factory, they were finding some vitamin A.

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But after storage, the levels
of vitamin A were going down,

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until at one point we were finding
actually a zero. From that time on,

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there\'s been regular sampling to make
sure that problem does not occur again.

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We have to keep on, you know, checking
on the quality of food, because

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we can\'t relax and say, \"Well, since we\'ve been testing so
far, maybe now we should stop.\" No, it\'s an ongoing process.

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Although fortification of sugar
has been a success in Zambia,

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it reaches only 52% of the
population in comparison

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to Zambia\'s staple food maize, or
mshima, which is consumed by over 90%.

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We felt that probably we need to diversify

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the food base for fortification.

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And one sort of food that we thought of was
maize, because it\'s highly consumed in Zambia.

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[music]

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In Lusaka\'s Chawama Township,

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government scientists are testing adding of vitamin
A supplements to maize at the local Hammer Mill.

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[sil.]

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Unlike sugar which is produced
at one single source,

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40% of maize produced in Zambia
is ground in local mills

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used by people in poor
urban and rural areas.

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[sil.]

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Simple methods had to be
found to ensure local people

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would mix vitamin A into
their own maize meal.

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[sil.]

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[music]

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While Zambia has expanded fortification
of foodstuffs with vitamin A,

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evaluating its impact can be difficult.

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It\'s ideal to do the impact study now
because the baseline was done in 1997,

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and now it\'s almost like six
years - we could actually find

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what has been happening. However, we
have malnutrition levels very high.

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We have HIV problems we\'re going through. It will
be very difficult to actually to tease out which…

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which component has… has
vitamin A supplementation

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has actually affected our population.

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It\'s very difficult,
because the… the amounts

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that are put in sugar are very minimal,

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so you need to… At the same time as you are looking at fortification,
you have also to look at dietary levels, which might take longer.

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It\'s one of the most
important things to follow.

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Let\'s change our people\'s diets so that we don\'t
even bother of fortifying, supplementing.

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From the diet they could eat, you
could have a lot of vitamin A.

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[sil.]

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Back in Luapula province, nutritionists

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are working on improving people\'s diet and preventing
future cases of blindness, illness and death.

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Even us as nutritionists, we are
promoting that you can take fruit,

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you can take vegetables, for vitamin A. But
as long as there\'s no presence of oil,

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so it can\'t be absorbed by the body.

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These palm oil trees are imported
by the project from Costa Rica.

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We brought them because naturally there are along the Luapula
Valley. We have got the traditional ones. So those ones,

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they are not bearing much fruit and even the fruit which
are received, they are not giving us much oil as expected.

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So these improved seeds, they
are helping to give us more

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and more oil from one bunch. When
they grow, after at least one year -

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when they come like this
ones – so we put them now…

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we start now giving out to the communities. Now the
communities - there are some who are accessing them

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at very low cost, just to promote
this and to give them the ownership.

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So far I think we\'ve distributed 57,000.

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And we\'ve imported so far could be 65,000

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or so since we started in 1997.

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It takes four years for
the palms to bear fruit.

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In local villages women have
been learning to make palm oil.

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Mrs. Eskembene

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of Sensima village was sent to Ghana
to study palm oil production.

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[non-English narration]

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We used to process palm oil before,
but for no particular reason.

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Sometimes people would use it, others not.

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But after we knew the benefits of it,
we decided to increase production.

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[non-English narration]

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Zambians were quick to realize that
vitamin A deficiency was contributing

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to an intolerably high rate
of morbidity and mortality,

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especially for children, and they were also quick
to understand the importance of supplementation,

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fortification and diversification programs.
Zambia is a country that is confronting

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a food crisis this year.
This is forcing government

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to reconsider the way they look at food in the way they
handle food. A part of this, and we hope that UNICEF

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will play a very active role. We will be making certain that mothers
and people who are in charge of providing food for the household,

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first are equipped to establish
and maintain household gardens

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and that we provide the
education that\'s necessary for,

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so that they know how to prepare the foods.

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[sil.]

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Back at Dr. Kunda\'s clinic, mothers are now taking cooking
classes to learn how to prepare vitamin-rich foods.

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We\'ve started a program
where we encourage mothers

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to be using the local valuable foods -

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like green vegetables, yellow
fruits like paw-paw, oranges.

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And here we are lucky because
we have these palm trees.

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Now research has discovered that these
things are very rich in vitamin A.

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So we are encouraging mothers to
be using the oil from palm trees.

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[non-English narration]

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For the people of Luapula
Province, adding vitamin A

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to their fish diet now promises
a healthier, brighter future.

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[non-English narration]

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[sil.]