Homestead Food Production: A Strategy to Combat Malnutrition & Poverty

Homestead Food
Production –
A Strategy to Combat
Malnutrition & Poverty
HELEN KELLER INTERNATIONAL
ASIA-PACIFIC

Homestead Food Production –
A Strategy to Combat
Malnutrition & Poverty
HELEN KELLER INTERNATIONAL
ASIA-PACIFIC

Editors (listed alphabetically)
Martin W. Bloem
Saskia de Pee
Federico Graciano
Lynnda Kiess
Regina Moench-Pfanner
Aminuzzaman Talukder
Cover Photograph
HKI/Cambodia
© Helen Keller Worldwide 2001
Reproduction of part or all of this document, excluding those pages which contain reproductions of articles from scientific
journals, is encouraged, provided due acknowledgement is given to the publisher and the publication.
With regard to the scientific articles that have been reproduced in this document, these can only be reproduced when specific
permission for copyright has been obtained from the original publisher.
The following articles have been reproduced in this document with the permission of their respective publishers.
Reproduced from the Food and Nutrition Bulletin. © United Nations University
• Bloem MW, de Pee S, Darnton-Hill I. Food Nutr Bull 1998; 19:137-148.
• Talukder A, Kiess L, Huq N, de Pee S, Darnton-Hill I, Bloem MW. Food Nutr Bull 2000; 21:165-172.
• de Pee S, Bloem MW, Kiess L. Food Nutr Bull 2000; 21:232-238.
• Kiess L, Moench-Pfanner R, Bloem MW. Food Nutr Bull 2001; 22, no. 2. In press.
Reproduced with permission by the European Journal of Clinical Nutrition. © Stockton Press
• Bloem MW, Huq N, Gorstein J, Burger S, Kahn T, Islam N, Baker S, Davidson F. Eur J Clin Nutr 1996; 50:S62-S67.
• de Pee S, West CE. Eur J Clin Nutr 1996; 50 (suppl 3):S38-S53.
• de Pee S, Bloem MW, Tjiong R, Martini E, Satoto, Gorstein J, Shrimpton R, Muhilal. Eur J Clin Nutr 1999; 53:288-297.
Reproduced with permission by the International Journal for Vitamin and Nutrition Research. © Hogrefe & Huber
Publishers, Toronto, Seattle, Bern, Göttingen
• de Pee S, Bloem MW, Satoto, Yip R, Sukaton A, Tjiong R, Shrimpton R, Muhilal, Kodyat B. Int J Vit Nutr Res 1998; 68:389-
398.
Reproduced with permission by the American Journal of Clinical Nutrition. © Am J Clin Nutr. American Society for Clinical
Nutrition
• de Pee S, Bloem MW, Gorstein J, Sari M, Satoto, Yip R, Shrimpton R, Muhilal. Am J Clin Nutr, 1998; 68:1068-1074.
• de Pee S, West CE, Permaesih D, Martuti S, Muhilal, Hautvast JGAJ. Am J Clin Nutr 1998; 68:1058-1067.
Reproduced with permission by The Lancet. © The Lancet
• de Pee S, West CE, Muhilal, Karyadi D, Hautvast JGAJ. Lancet 1995; 346:75-81.
• Reddy V, Underwood BA, de Pee S, West CE, Muhilal, Karyadi D, Hautvast JGAJ. Lancet 1995; 346:1634-1636.
When referencing this publication, please use the following suggested reference:
Helen Keller International/Asia-Pacific. Homestead Food Production – A Strategy to Combat Malnutrition and Poverty. Helen
Keller International, Jakarta, Indonesia, 2001.

Table of contents
Foreword .......................................................................................................................................... ii
Summary .......................................................................................................................................... 1
List of references ............................................................................................................................ 7
Appendices to the Summary
APPENDIX 1. FOOD-BASED STRATEGIES: CAN THEY PLAY A ROLE IN POVERTY ALLEVIATION? ..................................... 11
APPENDIX 2. INCREASING THE PRODUCTION AND CONSUMPTION OF VITAMIN A-RICH FRUITS AND VEGETABLES:
LESSONS LEARNED IN TAKING THE BANGLADESH HOMESTEAD GARDENING PROGRAMME TO A NATIONAL
SCALE .................................................................................................................................. 20
APPENDIX 3. PRODUCTION OF FRUITS AND VEGETABLES AT THE HOMESTEAD IS AN IMPORTANT SOURCE OF
VITAMIN A AMONG WOMEN IN BANGLADESH ................................................................................ 28
APPENDIX 4. IMPACT OF A SOCIAL MARKETING CAMPAIGN PROMOTING DARK-GREEN LEAFY VEGETABLES AND EGGS
IN CENTRAL JAVA, INDONESIA .................................................................................................... 34
APPENDIX 5. REAPPRAISAL OF THE ROLE OF VEGETABLES FOR VITAMIN A STATUS OF MOTHERS IN CENTRAL JAVA,
INDONESIA ........................................................................................................................... 44
APPENDIX 6. DIETARY CAROTENOIDS AND THEIR ROLE IN COMBATING VITAMIN A DEFICIENCY: A REVIEW OF
THE LITERATURE ....................................................................................................................... 51
APPENDIX 7A. LACK OF IMPROVEMENT IN VITAMIN A STATUS WITH INCREASED CONSUMPTION OF DARK-GREEN
LEAFY VEGETABLES ................................................................................................................... 67
APPENDIX 7B. VITAMIN A STATUS AND DARK GREEN LEAFY VEGETABLES ...........................................................74
APPENDIX 8. ORANGE FRUIT IS MORE EFFECTIVE THAN ARE DARK-GREEN, LEAFY VEGETABLES IN INCREASING
SERUM CONCENTRATIONS OF RETINOL AND β-CAROTENE IN SCHOOLCHILDREN IN INDONESIA ......................78
APPENDIX 9. WHO HAS A HIGH VITAMIN A INTAKE FROM PLANT FOODS, BUT A LOW SERUM RETINOL
CONCENTRATION? DATA FROM WOMEN IN INDONESIA ..................................................................... 88
APPENDIX 10. NEW ISSUES IN DEVELOPING EFFECTIVE APPROACHES FOR THE PREVENTION AND CONTROL OF
VITAMIN A DEFICIENCY ............................................................................................................. 98
APPENDIX 11. EVALUATING FOOD-BASED PROGRAMMES FOR THEIR REDUCTION OF VITAMIN A DEFICIENCY AND
ITS CONSEQUENCES ................................................................................................................ 110
APPENDIX 12. DOES THE PRODUCTION OF DARK-GREEN LEAFY VEGETABLES AND FRUITS PLAY A ROLE IN THE
ETIOLOGY OF MATERNAL NIGHTBLINDNESS, DIARRHEA AND MALNUTRITION IN BANGLADESH? (ABSTRACT) .... 117
APPENDIX 13. BANGLADESH – XEROPHTHALMIA FREE: THE RESULT OF AN EFFECTIVE VITAMIN A CAPSULE
PROGRAM AND HOMESTEAD GARDENING IN REDUCING VITAMIN A DEFICIENCY (ABSTRACT) ................... 118
APPENDIX 14. THE STRENGTH OF LINKING SURVEILLANCE AND PROGRAM: HISTORICAL PERSPECTIVE OF
HKI’S EXPERIENCE IN HOMESTEAD FOOD PRODUCTION IN BANGLADESH, 1982-2001 ............................ 119
Acknowledgments ..................................................................................................................... 122
List of HKI publications on Homestead Food Production ..................................................... 124
List of Key Conferences & Workshops on Homestead Food Production ...................... 128
i

Home Gardening is a key program activity for Helen Keller International
(HKI) in the Asia-Pacific region. In 1988, HKI conducted a pilot Home
Gardening project among 1,000 households in Bangladesh. Based on
the results and experience gained from this pilot project, we then started the
NGO Gardening and Nutrition Education Surveillance Project (NGNESP) in the
early 1990s. Today, it has achieved nationwide coverage and reaches
approximately 800,000 households throughout the country – indeed it is the
largest program of its kind in the world.
When it started, the NGNESP was implemented mainly to combat vitamin A
deficiency disorders. Based on new knowledge gained from the vast amount
of research conducted over the last decade on the etiology of such disorders,
HKI has recognized that Home Gardening needs to be broadened to
Homestead Food Production – including animal husbandry and poultry raising
– to be more effective and address other micronutrient deficiencies as well.
However, advocating Homestead Food Production programs remains
challenging because the important question of how they affect individuals at
the household level is difficult to answer. Even renowned organizations in
agricultural development, such as the Food and Agriculture Organization of
the United Nations (FAO) and the International Fund for Agricultural
Development (IFAD), have difficulties in showing a clear impact of such
activities. Therefore, in the 12 years of implementing the NGNESP, HKI has
dedicated a great deal of effort to assessing the impact of food-based
approaches, which we would like to share through this publication.
This publication highlights the extensive work of HKI and of individuals
working with HKI in the area of food-based approaches and the efforts to
identify their different impacts. First, we review current knowledge on food-based
approaches and their impact on nutritional status, health and
development, with an emphasis on Homestead Food Production and social
marketing of vitamin A-rich foods. These issues are discussed in the context of
HKI’s food-based programs in the Asia-Pacific Region. Then, we include our key
articles that have brought food-based approaches such as Homestead Food
Production into the mainstream of scientific and programmatic discussion.
These articles highlight the extensive work conducted by HKI in Bangladesh,
the important findings about the bioavailability of vitamin A from fruits and
vegetables and social marketing in Indonesia, and experiences in evaluating
food-based programs – which illustrates the breadth of our work in food-based
approaches.
It is important to understand that while Homestead Food Production will not
eliminate micronutrient deficiencies, the data generated over the years show
that it can help reduce the risk of such deficiencies in a household by
increasing the consumption of home-grown micronutrient-rich vegetables
and fruits, increasing household income from the sale of garden produce that
is used to purchase micronutrient-rich animal products, and improving
household caring practices through the empowerment of women.
ii
Foreword

iii
Foreword
Food-based approaches have much to offer. They build on existing knowledge
and technologies and provide poor people the means to increase their self-sufficiency.
Homestead Food Production deserves to be seen in its original
context; that is, it is an activity that has been practiced for millennia, since the
first humans learned to cultivate their own crops and domesticate animals for
food production, and it is part of daily life in rural and peri-urban areas. It is
therefore a highly sustainable and adaptable approach to breaking the cycle
of malnutrition and poverty in which the world’s poorest are needlessly
mired. In fact, Homestead Food Production especially has a role to play when
economic development is not yet at its best. The advantage of having such a
program will also be that the beneficiaries can take better advantage of other
health delivery systems and other interventions can link to the system. Thus,
the benefits are multiple, even if the quantification of specific benefits is a
real challenge.
Programmatically, our experience with the NGNESP has shown that it was
possible to scale up a very small pilot study into a nationwide program and
reach a high level of sustainability. Sustainability is the ultimate goal of
successful program implementation, and the program’s strategy of working
through local NGOs and the promotion of indigenous crops have proven to be
a successful formula.
The achievements of HKI’s Homestead Food Production program which has,
directly or indirectly, led to many of the papers included in this publication,
are the product of the hard work and tireless effort of the many local and
international partners with whom we have always collaborated and with
whom we continue to collaborate. We have attempted the immense task of
acknowledging all of these partners in the Acknowledgements section of this
publication (p122). Several organizations and individuals, however, were key to
the program’s development and its continued existence. In particular, credit
must be given to Dr. Frances Davidson (United States Agency for International
Development), the Netherlands Organization for International Development
Cooperation (NOVIB), Dr. Elly Leemhuis de Regt (Goverment of the
Netherlands), and Dr. Robin Marsh (Asian Vegetable Research and
Development Center). Additionally, we thank FAO (particularly in the region
through Dr. Nandi Biplab) and IFAD for their strong advocacy of our program. I
am also especially grateful to Dr. Barbara Underwood (International Union of
Nutritional Sciences) and Dr. Nevin Scrimshaw (United Nations University) for
their tireless advocacy to bring Homestead Food Production onto the
international platform.
Martin W. Bloem
Regional Director
HKI Asia-Pacific

1
Summary
Homestead food production is a
worldwide practice that has existed for
many centuries.1 The main purpose of
this indigenous practice is to grow food for the
family and provide additional income.2,3 A few
decades ago, projects were started that aimed
at improving, and sometimes also initiating,
homestead gardening for the purpose of
combating vitamin A deficiency disorders
(VADD). Those projects focused particularly on
growing and consuming dark green leafy
vegetables and yellow/orange fruits. In areas
where the availability of vitamin A-rich
vegetables and fruits did not appear to be a
constraint for increasing their consumption,
social marketing campaigns were conducted in
order to stimulate their consumption.
In recent years, the concept of homestead
gardening has increasingly been broadened to
also include the production of animal foods, for
example through poultry keeping, small animal
husbandry and/or fish ponds, and it is therefore
called homestead food production. The main
aims of homestead food production are still the
production of nutritious, micronutrient-rich,
foods for household consumption and the
generation of additional income, but its role in
women’s empowerment, community
mobilization, and poverty reduction are
increasingly being recognized.4
Helen Keller International’s (HKI) food-based
programs
HKI’s homestead food production programs, the
first of which was started in the early 1990s in
Bangladesh, aim to increase the production and
consumption of vegetables and fruits all year
round, particularly those rich in vitamin A. HKI’s
homestead food production programs are
unique in the sense that they are implemented
on a large scale (approximately 800,000
households in Bangladesh at the start of 2001)
and at a very low cost (for example, US$5 per
household during the first year of the HKI
homestead food production project in
Cambodia). This is possible because the
program, known as the NGO Gardening and
Nutrition Education Surveillance Project
(NGNESP), is largely implemented by local non-governmental
organizations (NGOs) that have
integrated the support for homestead food
production into their services to the community,
and because homestead food production is a
long existing practice in Asia. Talukder et al have
described how the HKI homestead food
production program in Bangladesh was started,
how it was scaled up, and how it is continuously
monitored in order to ensure good
performance.5
However, we also highlight that
implementation has been successful because
the NGNESP is anchored in the community, both
through the links with the local NGOs and the
development of village nurseries. Based on the
experience in Bangladesh, HKI/Asia-Pacific has
now also started to promote homestead food
production programs adapted to the local
context in Nepal and Cambodia. Further details
on the practicalities of homestead food
production are presented in HKI’s home
gardening handbook for South Asia6 and the
Food and Agriculture Organization of the United
Nations/International Life Sciences Institute
guide to food-based approaches.7
HKI has long experience in designing and
implementing social marketing campaigns in
Indonesia, where fruits and vegetables are
relatively easily available throughout most of
the year. Initially, these campaigns focused on
promoting high-dose vitamin A capsules and
then later also on the consumption of vitamin
A-rich foods, including both green leafy
vegetables as well as eggs.
Evaluating impact of food-based programs
The aim of food-based programs is to increase
the consumption and, where necessary, the
production of fruits and vegetables as well as
improve the nutritional status of the household
members. All of these aspects should be
assessed when evaluating a program. Assessing
whether a program has increased production
and/or consumption of fruits and vegetables is
relatively straightforward, but assessing an
impact on nutritional status is more
complicated. In the following section, we will

2
Summary
discuss the evidence for an impact of
homestead food production on production and/
or consumption of fruits and vegetables and
then discuss the evidence for an impact on
nutritional status.
Impact of HKI’s food-based programs on
production and consumption
Regular monitoring of HKI’s homestead food
production programs (see Appendix 2, p20, and
Round Reports from Bangladesh, Cambodia and
Nepal, listed on p124) has shown that the
proportion of households that practice
homestead gardening increases markedly in
areas where the program is introduced and that
less than 5% of households discontinue
homestead food production after having joined
the program.
Homestead gardening practices also improve
considerably over time. Improvements have
been observed in the following areas: 1) An
increase in the proportion of households that
grow plants in one or more fixed plots rather
than, or in addition to, growing them in a
scattered manner of a few plants around the
house; 2) an increase in the number of varieties
of fruits and vegetables grown; and 3) an
increase in the number of months of the year
during which vegetables and fruits are grown.
These changes in gardening practices markedly
increase the amount and variety of fruits and
vegetables produced. Households participating
in the HKI Homestead Food Production program
in Bangladesh currently produce an estimated
45,000 metric tons of vegetables and fruits
(valued at US$7 million) on an annual basis, and
the program provides employment to over
55,000 women in rural areas.
Homestead food production, as promoted by
HKI’s program in rural Bangladesh, is associated
with a higher vitamin A intake.5,8 More
specifically, a higher vitamin A intake was
associated with the type of garden, a larger
total quantity of fruits and vegetables produced
and/or a larger number of varieties of fruits and
vegetables grown. Several other groups have
also reported an increased production and
consumption of vitamin A-rich foods after the
start of homestead food production
activities.3,9-14
One study suggests that gardening does not
increase the demand for vegetables.15 However,
this study examined the impact of a commercial
gardening program on vegetable consumption.
These findings most likely reflect the different
objectives of the program as well as the
different economic status and motivations of
participating households.
Nutrition surveillance data collected before and
during a social marketing campaign promoting
the consumption of dark-green leafy vegetables
and eggs in Central Java, Indonesia, showed that
the consumption of both types of food
increased after the start of the campaign.16 Also,
an in-depth analysis of cross-sectional data
collected by one round of the nutrition
surveillance system in Central Java showed that
the consumption of vitamin A from plant foods
was higher in households with a homestead
garden, whereas the consumption of vitamin A
from animal foods was higher in households
with a higher socioeconomic status.17
Potential direct and indirect ways for food-based
programs to decrease miconutrient
malnutrition
Food-based approaches can affect vitamin A
status in various ways. The increased
consumption of the vitamin A-rich foods,
achieved either through promotion or
production, can increase vitamin A status (direct
impact); the production of foods in the
homestead can increase income and enable the
purchase of other foods rich in vitamin A, such
as eggs, milk or liver (indirect impact); the
consumption of vitamin A-rich foods could
reduce morbidity and hence reduce the need for
vitamin A (indirect impact); and increased
empowerment of women could enable them to
take better care of themselves and their
children, and hence increase intake of vitamin
A-rich foods and/or reduce morbidity (indirect
impact).

3
Summary
Bioavailability of provitamin A and revised
conversion factors
Until recently it was assumed that 6 μg of
dietary β-carotene was equivalent to 1 μg retinol
equivalents (RE).18 A recent review of the original
literature19 and new research findings have
challenged this assumption20-24. It now appears
that the bioavailability of β-carotene and other
provitamin A carotenoids from vegetables, but
also from fruits, is much lower than assumed
and varies widely.19,25 β-carotene bioavailability
depends on food preparation26, especially fat
content27,28 and homogenization29-31, and host
characteristics, particularly parasitic
infestation32,33 and gastric acidity34.
The significance of these recent findings about
the lower bioavailability of dietary carotenoids
has been acknowledged by two leading
organizations in the field of nutrition in
developed as well as developing countries. The
U.S. Institute of Medicine (IOM) in 2000
recommended a conversion factor of 12:1 for
calculating the ‘retinol activity equivalents’
derived from dietary b-carotene.35 And the
International Vitamin A Consultative Group has
recognized that the bioavailability of dietary
carotenoids varies widely and that the
conventional conversion factor of 6:1 seems too
optimistic.36 Based on the IOM recommendation
and the results of studies in Indonesia21,37 and
Vietnam22, a conversion factor of 21:1 is
recommended for dietary β-carotene, and 42:1
for other dietary provitamin A carotenoids38,39.
Evaluating biological impact of food-based
approaches
Based on these revised conversion factors, the
expectation of an impact of food-based
programs on VADD, particularly those based on
an increased consumption of dark-green leafy
vegetables, has become more modest. The
strength of food-based approaches, however, is
that they reach everyone throughout the life
cycle, not just one particular group such as
preschool children.40 In addition, they can be
adopted by households and communities in a
self-sustainable way, and can have a positive
impact on nutritional status, including VADD, in
ways that go beyond improving vitamin A
status through increased consumption of
vitamin A-rich fruits and vegetables.41 The
consumption of fruits and vegetables has also
been shown to play a role in preventing
degenerative diseases42 and mortality43.
The real challenge of food-based approaches is
in evaluating their impact on health and
nutritional status.41,44 The majority of the
evaluations of food-based programs use the
plausibility approach. This approach often uses
experimental and quasi-experimental
evaluation designs and cross-sectional
surveillance data. It assesses dose-responsive
relationships, changes in multiple indicators,
and changes over time. This approach is the
most appropriate way to assess the impact of
food-based programs on nutritional and health
status for several reasons.45 First, study designs
that involve the random allocation of subjects
or households to treatment groups cannot be
used. In addition, the identification of an
appropriate control group is difficult. Finally, the
impact of food-based programs may be modest
and can be confounded by many factors,
therefore larger-scale evaluations permit
analyses that control for these confounding
factors.
Sound decision-making for policies and
programs will benefit from recognizing the
different merits of controlled trials, intervention
studies and evaluations of food-based
programs, and most importantly their
complementarity. In intervention studies, host-related
factors that affect the impact of
consumption of particular foods are usually
controlled by involving only a particular target
group and by intervening in order to have a
relatively homogenous group of subjects, for
example by deworming. Therefore, conclusions
are limited to the particular group that was
selected for the intervention and under the
particular prevailing circumstances. In program
evaluations, host-related factors are generally
not controlled and when information is
collected about them, they can be studied
better and results of such evaluations can

4
Summary
therefore differ from results of intervention
studies41 (for further elaboration, see Appendix
11, p110). When conducting a program, host-related
factors can be taken into account by
targeting specific target groups as well as by
implementing particular interventions for
optimizing carotene bioavailability, such as
deworming.
Thus, while intervention studies can elucidate
the relationship between consumption of
particular foods and vitamin A status, their
limitation is that the number of confounding
factors that can be taken into account is limited.
Therefore, the design of food-based programs
can be based on intervention studies, but their
impact has to be evaluated separately because
of the many factors that play a role. Also,
program evaluations can more easily reveal the
impact of a particular intervention relative to
that of another intervention, for example of
food-based programs relative to that of vitamin
A capsule distribution. Furthermore, while the
impact of vitamin A capsules on health mainly
varies with the host’s need for vitamin A, the
impact of food-based approaches can vary more
widely, because it depends on the particular
approach as well as on the environment under
which the program is implemented.
HKI’s experience in evaluating impact of
food-based programs
HKI has evaluated the impact of food-based
approaches in the Asia-Pacific region in several
ways and found strong evidence that these
approaches have a role in reducing VADD. A
cross-sectional analysis of factors related to
vitamin A status of women in Central Java
showed that the intake of vitamin A from plant
foods, ownership of a homestead garden, intake
of vitamin A from animal foods, and
socioeconomic status were all related to vitamin
A status.17,33 Using the plausibility approach, the
impact of a social marketing campaign in
Central Java that promoted consumption of
dark-green leafy vegetables and eggs was
evaluated by analyzing nutrition surveillance
data collected before and during the campaign.
Vitamin A intake, measured by several methods,
increased as a result of the campaign. This
increase in vitamin A intake was associated
with an improvement in vitamin A status. The
evaluation, which was carefully planned so that
respondents were not aware of the link
between the data collected and the campaign,
concluded that the social marketing campaign
improved vitamin A status.16
The impact of homestead food production in
Bangladesh has been assessed several times
since its inception. Firstly, in the early 1980s, it
was found that children living in households
with a homestead garden were less likely to be
nightblind than children living in households
without a homestead garden.46 Secondly,
baseline data collected at the start of the
homestead food production program in the
early 1990s showed that vitamin A intake was
higher among households with a homestead
garden8, and that a higher vitamin A intake of
women, which was nearly all from plant foods,
was associated with less nightblindness and
less diarrhea47.
Thirdly, analysis of the data collected by
Bangladesh’s national vitamin A survey
conducted in 1997-1998 among mothers and
underfives in more than 24,000 rural
households showed that among children aged
12-59 months who had not received a vitamin A
capsule in the six months prior to the survey,
the risk of nightblindness was lower when their
house had a homestead garden.48 Futhermore,
the effect of vitamin A capsules on the risk of
night blindness among children was less in
households with a home garden than those
without one. This suggests that home gardens
provide additional protection against child
night blindness. The analyses controlled for
other factors, including morbidity and
socioeconomic status. Furthermore, the survey
showed that the risk of night blindness among
women and children was significantly lower in
households that had both home gardens and
poultry, compared to households with either a
garden or poultry or neither of these. Again,
these analyses were controlled for
socioeconomic status and morbidity. These
findings provide important evidence of the

5
Summary
more beneficial impact of homestead food
production. Thus, for children in rural
Bangladesh, both receiving a vitamin A capsule
as well as homestead gardening contributed to
reducing their risk of VADD. For other target
groups, that are not eligible for receiving a
vitamin A capsule, such as women, homestead
food production is likely to be even more
important for reducing the risk of VADD.
It is important to note that all the evaluations
conducted in Bangladesh assessed the impact
of homestead food production in general, and
not specifically HKI’s program. However, HKI’s
program successfully improves the production
of the homestead gardens and increases the
consumption of vitamin A-rich foods (see
Appendix 2, p20, and Round Reports from
Bangladesh and Cambodia, listed on p124), and
therefore ensures that more and more
households in the country experience the
nutrition and health benefits of homestead
food production. Other groups have also
reported a reduction of VADD and/or related
disorders, such as acute respiratory infections
and reduced growth, after implementing
homestead food production programs.10,11,13,14,49
While homestead food production has
traditionally been practiced in rural areas, the
HKI programs in the Asia-Pacific also extend to
peri-urban and urban areas. The experience
from the NGNESP in urban and peri-urban areas
has shown that consumption of fruits and
vegetables increased through establishing a
homestead garden. Data from Indonesia
collected before the onset of the economic crisis
showed that vegetable and fruit consumption
in urban areas was much lower than in rural
areas, while consumption of fortified foods was
much higher in urban areas.50 However, in less
affluent urban populations, in countries where
only very few fortified foods are available, and/
or in economically less favorable times, the
consumption of fortified foods will be lower and
dependence on other sources of micronutrient-rich
foods, such as homestead food production,
will be higher.
Additional impacts of homestead food
production programs
When homestead food production programs
and social marketing campaigns for the
consumption of vitamin A-rich foods were first
started, their main aim was to help combat
VADD. Therefore, evaluations conducted by
investigators in the nutrition field to assess the
effectiveness of homestead food production
programs have mainly focused on households’
consumption of vitamin A-rich foods and, to a
lesser extent, on nutritional status and health.51
However, there are many more reasons why
households and organizations conduct
homestead food production. In combination
with the recent findings that dark-green leafy
vegetables and fruits contribute less to
improving vitamin A status than previously
assumed, the focus of homestead food
production programs has gradually shifted.
First of all, the concept of homestead gardening
has been broadened to also include the
production of animal foods by having small
animal husbandry, poultry and/or fish ponds.
Animal foods have a higher content of
micronutrients such as vitamin A, iron and zinc,
and the bioavailability of these nutrients is
generally much higher than the bioavailability
from plant foods. Consumption of animal foods
will therefore be an important contribution to
combating micronutrient deficiencies. HKI is
now planning to include the production of
animal foods at the homestead and/or
community level in its homestead food
production programs in Bangladesh, Cambodia
and Nepal.
Because the production of foods at the
homestead is mainly the responsibility of
women, they receive training and non-formal
education as a result of the program, and
become part of a social network through which
they share experiences. This results in an
increase of skills, confidence and self-esteem,
and an increased role in household decision-making
among women.5 Also, it is very often the
women who are responsible for the additional
income earned from selling garden produce3

6
Summary
and it has been found that, when this is the
case, the money is largely spent on other good
quality foods, education and health care (see
Appendix 2, p20, and Round Reports from
Bangladesh and Cambodia, listed on p124). This,
in combination with the woman’s increased
self-esteem and decision-making capacity,
contributes to improved health and nutrition of
household members.
In addition to the role of homestead food
production in women’s empowerment, its role
in income generation and poverty alleviation is
also increasingly being recognized.4 These
outcomes may even become goals in
themselves. Homestead food production is
relatively independent of the macroeconomic
environment and it largely benefits poor
households and women in particular. Experience
has shown that the work in the homestead is
shared among household members and is
therefore not a large burden on the women. In
fact, many households are already growing
some fruits or vegetables and are eager to
increase their productivity when they have
access to seeds, seedlings or saplings and can
get technical support from the NGOs that
participate in HKI’s homestead food production
programs. The eagerness of the households to
participate is also illustrated by the fact that
less than 3% of the households drop out of the
program each year (data from Bangladesh and
Cambodia).
Finally, the infrastructure that is created and/or
strengthened by homestead food production
programs can also be used to deliver other
health or nutrition interventions, such as
deworming or multi-micronutrient
supplements for particularly vulnerable groups.
Conclusion
The above discussion presents clear evidence
that homestead food production and social
marketing campaigns for increased
consumption of vitamin A-rich foods contribute
to combating VADD. It is recognized that the
amount of vitamin A obtained from the
consumption of vitamin A-rich fruits and
vegetables is on average 3-4 times lower than
previously assumed and that there is therefore
a need to complement it with consumption of
animal foods as well as, for particular target
groups, micronutrient supplements. Meanwhile,
the scope of homestead food production is
much wider than increasing vitamin A intake
through consumption of self-produced
vegetables and fruits. First of all, the production
of animal foods is increasingly being
incorporated into homestead food production
activities. Secondly, an increased consumption
of micronutrient-rich foods, an increase of
income, and empowerment of women, all
contribute to a better nutritional status,
including vitamin A status, and health through
improved diets and care-seeking. Thirdly, the
role of homestead food production programs in
income generation and poverty alleviation is
increasingly being recognized.
HKI’s work in this field demonstrates the
importance of linking programs and research. In
particular, the development and expansion of
the NGNESP in Bangladesh characterizes the
HKI/Asia-Pacific Regional Office’s (HKI/APRO)
approach of linking surveys and surveillance
with programs and advocacy. It provides an
example of a successful application of what the
United Nations Children’s Fund has termed the
‘Triple-A Approach.’ Between 1982 and 2001,
HKI/APRO has used findings from surveys and
surveillance, and recent scientific knowledge to
design and develop programs. Experience
gained from these programs are then taken
back into routine surveys and surveillance to
measure and explore the broader implications
of the relationships between food, agriculture,
health and nutrition (see Appendix 14, p119).
We strongly hope that this publication will
further help to advocate for homestead food
production programs and that these programs
will receive the appropriate attention from
governments and donors in the effort to combat
malnutrition and poverty.

7
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Muhilal, Hautvast JGAJ. Orange fruit is
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23. Tang G, Gu X-f, Hu S-m, Xu Q-m, Qin J,
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RM, Yin S-a. Green and yellow vegetables
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24. Persson V, Ahmed F, Gebre-Medhin M,
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25. Castenmiller JJM, West CE. Bioavailability
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26. Rodriguez-Amaya DB. Carotenoids and
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28. Roodenburg AJC, Leenen R, van het Hof KH,
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E in humans. Am J Clin Nutr 2000; 71:1187-
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30. Castenmiller JJ, West CE, Linssen JP, van het
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32. Jalal F, Nesheim MC, Agus Z, et al. Serum
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(Appendix 9, p88)
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Russell, RM. Gastric acidity influences the
blood response to a b-carotene dose in
humans. Am J Clin Nutr 1996; 64:622-626.
35. Institute of Medicine, Food and Nutrition
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Scientific Evaluation of Dietary Reference
Intakes. Dietary reference intakes for
vitamin A, vitamin K, arsenic, boron,
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molybdenum, nickel, silicon, vanadium, and
zinc. National Academy Press, Washington,
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Permaesih D, Wang Y, Xu X, van Breemen
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United Nations/Administrative Committee
on Coordination – Subcommittee on
Nutrition, Geneva, Switzerland, 1994.

11
Appendix 1
Food-based strategies: Can they play a role in
Abstract
poverty alleviation?*
Kiess, Lynnda; Moench-Pfanner, Regina; Bloem, Martin W.
The authors are affiliated with Helen Keller International Asia-Pacific Regional Office in Indonesia
Over the past two decades the definition of
poverty has been broadened to include social,
economic, environmental and human
development dimensions. In line with this shift
of thinking, all countries committed at the G-8
Summit in Okinawa to achieve the International
Development Goals to alleviate poverty by 2015.
Development organizations, such as the
international development banks, have
committed to provide support to countries to
reach the seven goals, including two goals that
specify significant reductions of child and
maternal mortality.
There is significant evidence that malnutrition,
particularly micronutrient malnutrition,
contributes to child mortality and growing
evidence that malnutrition plays a similar role
in maternal mortality. Inadequate dietary intake
is an immediate cause of malnutrition and thus
it seems logical that food and agriculture
activities could contribute to improvements in
nutrition and micronutrient status. Global
availability of cereals is adequate, but the rate
of undernourishment (inadequate caloric
intake) is still high and child undernutrition still
persists in many countries, suggesting that
distribution of food is poor. Global availability of
non cereal foods, such as animal and
horticulture foods, is well below global
requirements. Consequently, micronutrient
deficiencies, which result mainly from
inadequate intake of micronutrient-rich foods,
particularly animal foods, are prevalent in most
developing countries. Food-based strategies,
such as home gardening, small animal
husbandry, poultry, and social marketing, lead to
better food production, food consumption and
overall food security. Examining the relative
contribution of the determinants of food
security - availability, accessibility and
consumption/choice - in a given setting
provides insight into how the nutrition benefits
from food-based strategies, as well as from
macro food policies, might be maximized. When
implemented in this context, food-based
strategies can help countries achieve several of
the IDGs.
Evolution of the definition of poverty and
the international development agenda
Over the past two decades there has been a
shift in thinking regarding the goals of
international development. This change was
stimulated in part by Sen, Dreze, Schultz and
others, who introduced the concept that poverty
goes beyond the traditional definition of lack of
income to encompass economic, social and
governance dimensions.1,2,3 Sen further argues
that poverty alleviation also requires better
opportunities and freedoms for the poor.4 This
thinking was the basis for the development of
the human development index (combining life
expectancy, adult literacy and income to reflect
health, education and resources, respectively),
promoted by UNDP to rank a country’s level of
development. Although historically the
programs and policies of the international
development banks have emphasized economic
growth, Sen and others influenced the strategic
thinking and policies of these organizations at
the international level as well as the process
and content of their programs at country level.
Motivated by the broader definition of poverty
and re-focus in development, leaders of all
* This article will also be published in the Food and Nutrition Bulletin, Volume 22, number 2, December 2001.

12
Appendix 1
countries agreed on International Development
Goals (IDGs) to alleviate poverty by 2015 at the
G-8 Summit in Okinawa. These goals combine
economic growth, human development,
environmental management and increased
participation of women.5,6 Measurement of
poverty is beyond the scope of this paper, but it
is an essential component of global as well as
country-specific poverty alleviation strategies.7,8
Mortality reduction and nutrition
Two of the seven IDGs concern mortality –
reduction in the mortality rates for infants and
children less than five (5) years of age by two-thirds
and reduction by three-fourths the
maternal mortality ratio. A model showing the
link between mortality, nutrition and food is
presented in Figure 1. The majority of mortality
in children is attributed to preventable diseases,
such as acute respiratory infections, diarrhea,
measles or malaria.9,10 The main causes of
maternal death are hemorrhage, eclampsia, and
post-partum sepsis.11 In this model, malnutrition,
a main underlying cause of disease, is
characterized by two arms - micronutrient
malnutrition and energy or protein-energy
malnutrition. The contribution of energy
malnutrition, even moderate and mild
malnutrition, to child mortality has been
established,12 although this contribution may
not be equivalent for all diseases.13 There is also
evidence that micronutrient deficiencies are
associated increased risk of child and maternal
mortality. Improvements in vitamin A status
result in a reduction of child mortality by at
least 23% and, although more research is
needed, results from a study in Nepal showed
that vitamin A supplementation during
pregnancy among deficient populations may
reduce maternal mortality.14,15 Other nutrients,
such as iron, zinc, are essential for many
Figure 1.
Conceptual model of the links
between poverty, nutrition
and food-based strategies

13
Appendix 1
biological functions and for host immunity,
thus deficiencies in these nutrients are likely to
influence child and maternal mortality.16,17,18
Although the two forms of malnutrition often
co-exist and are inter-related in etiology, the
quality of the diet (adequacy in terms of
vitamins and minerals) is better reflected in
micronutrient status, whereas changes in diet
quantity are more likely to be reflected in
anthropometry, particularly maternal BMI.16,19,20
Avenues to improve nutrition and
micronutrient status
This new perspective, that improvement in
nutrition and micronutrient status can help
countries reach the IDG mortality goals, should
be translated into policies and programs at the
international, national, and community levels.21
The multi-dimensional aspects of malnutrition,
starting from its etiology, suggest that
different sectoral approaches can be employed
to improve micronutrient status. For instance,
micronutrient status can be improved through
supplements (iron tablets, vitamin A capsules).
Incorporation of supplementation into health
programs appears to be straight forward, but
aside from the high-dose vitamin A capsule
supplementation programs, which are
administered bi-annually through campaigns,
there has been limited success in effectively
implementing programs for iron
supplementation.22 More is now being done to
make these programs effective, but even so,
supplementation alone cannot solve
micronutrient deficiencies in many developing
countries in the immediate future.
Food fortification can also increase
micronutrient intake and has been successful
in the developed world and particularly in
several countries in Latin America.23,24 However,
despite the available technology, there are still
several hurdles in the way of successful food
fortification initiatives in many developing
countries, including the challenge to
manufacture fortified products that are within
the economic reach of poor households. The
role of social marketing programs is also
important; their advantages and limitations
are presented as part of food-based strategies
below.
Inadequate dietary intake is an immediate
cause of malnutrition and thus it seems logical
that food and agriculture activities could also
contribute to improvements in micronutrient
status. The global availability of cereals has
improved since the green revolution and is
currently sufficient to meet global
requirements. The rates of undernourishment,
defined as inadequate caloric intake (calculated
as only calories from cereals in some cases) have
declined over the past 10 years, however, more
than 790 million households still do not have
enough to eat.25 The prevalence of child
undernutrition, measured most commonly as
the percentage of children with weight-for-age
below a reference standard, has also declined
somewhat over the past decade.26 However, the
persisting high rates of both undernourishment
and undernutrition suggest that the
distribution of cereals and calories is
inadequate.27,28 Availability of most non cereal
foods, including horticulture and animal foods,
still falls short of global requirements and is
certainly inadequate in many developing
countries today.28,29 With urbanization, economic
development and rapidly changing dietary
preferences, meeting non cereal food
requirements in the future will be even more
daunting.29 Consequently, rates of micronutrient
malnutrition, resulting from inadequate intake
of micronutrient rich foods, particularly animal
foods, are also extremely high in many
countries.
At the country level, food includes both
domestic production and economic (food)
policies to support production and import.
Successful economic growth will require the
development of the rural economy; which will
occur through a series of changes in most
countries, including diversification of the
agriculture production (to new products and
beyond cereals) and development of the non-agriculture
sector.30 Because of the large gap
between food availability, distribution and
requirements and the serious negative
consequences of malnutrition, all mechanisms

14
Appendix 1
for increasing food availability and food quality
should be promoted. For countries that are
transitioning from agrarian to a more
diversified rural economy, food-based strategies,
such as gardening, small animal husbandry
programs, and poultry can contribute to food
production and improve food availability and
accessibility at the household and country level.
Increased production of non-cereals in the
farming system should also be promoted
through food policies that support crop
diversification and marketing. Inclusion of poor
segments of the population into these schemes
is essential if the goal is poverty alleviation.
Food-based strategies and food security
At the national, sub-national and household
levels, food-based strategies should be
examined in the context of food security.
Traditionally, food security is categorized into
three determinants: food availability, food
access and food utilization.31 Food availability
refers to agriculture production, including cash
crops, livestock and food crops. Domestic
production may be enhanced by food imports.
Food access refers to household purchasing
power and the ability to secure foods from the
market or other sources. Food utilization
incorporates diverse aspects including
sufficiency in required intake, food habits and
preferences, intra-household distribution of
food, food safety, and caring practices. We prefer
to label food utilization as ‘choice’ because
when accessibility and availability are ensured,
utilization primarily represents household and
individual ‘choices’ – for food, health care, and
other opportunities.
While this three-tiered classification of food
security is widely accepted, the relative
contribution of these three determinants of
food security varies across and within country
settings, in response to crises or disasters, and
over time. A good understanding of the balance
between availability, accessibility and choice in
a particular setting can be used to identify the
most appropriate policies and programs to
address food security. A comparison of several
country situations will help to demonstrate the
importance of this approach. Again, food
security is defined as sufficient availability,
access and ‘choice’ of cereals, legumes, animal
and horticulture foods.
Figure 2a represents schematically the
determinants of food insecurity among poor
households in a country such as Bangladesh. In
rural Bangladesh, adequate food availability is
still a large problem. Although Bangladesh is
nearly self-sufficient in cereal production, the
availability of other foods, such as animal foods,
dairy and fruits and vegetables is still well
below the requirements.32,33 In addition, more
than 35% of the Bangladeshi population falls
below the poverty line, thus food accessibility is
also a major constraint to achieving food
security.34 In this situation, food choice is a much
less important determinant of food security.
Examination of food security in Bangladesh in
this manner would suggest that social
marketing or behavior change programs, should
be coupled with programs to improve food
availability and access, to improve food security.
In fact, evidence from the HKI home gardening
and nutrition education program in Bangladesh
showed that production, coupled with
information on complementary feeding and
opportunities for women was associated with
increased consumption/intake.35,36
In addition to variance across countries, crises
and other events can change the determinants
of food security. In Figure 2b we show a graphic
comparison of the determinants of food
security in Indonesia before and after the Asian
economic crisis. Again, these figures are
generalized, but suggest that prior to the crisis,
availability and access were less important
determinants of food security than in
Bangladesh. In this setting, choice was a more
important determinant. This scenario is
supported by results from a social marketing
program in Central Java that promoted
increased consumption of eggs and vegetables.
An evaluation of this program showed that egg
consumption increased and micronutrient
status improved after the campaign.37 The
economic crisis in Indonesia in mid-1997
increased food and other commodity prices and

15
Appendix 1
Figure 2.Determinants of food security in Bangladesh, in Indonesia (prior to and after
the start of the economic crisis), and in developed countries
a) Bangladesh b) Indonesia c) Developed countries
reduced employment opportunities, thus
lowering the real income and purchasing power
of households. An examination of household
egg consumption after the crisis revealed that
weekly consumption declined.19,38 When prices
stabilized somewhat after the crisis and
household purchasing power improved again,
household expenditure of animal foods
increased and childhood anemia rates
decreased. This scenario suggests that during
this crisis period, social marketing alone would
probably have been ineffective in increasing the
consumption of eggs or other high quality foods
such as animal foods or fortified foods. This
example in Indonesia shows how an
understanding of the relative contribution of
the determinants of food security can influence
the type of programs that may be most
effective.
Figure 2c portrays the relative determinants of
food security in developed countries. In this
scenario, the main determinant is choice, which
coincides with the major role of the food
industry, food packaging and consumer food
marketing that exists in many of the developed
countries.
Food-based strategies and micronutrient
status
There is growing evidence that food-based
strategies, including home gardening have an
impact on vitamin A deficiency and other
micronutrient deficiencies. In Bangladesh, a
comparison of two surveys suggested that a
decline in the prevalence of night blindness
occurred both among vitamin A capsule (VAC)
recipients and non-recipients over the 15-year
period. A decline of night blindness among the
group who did not receive the VAC suggests
that underlying causes, including vitamin A
intake, had improved. These studies both
showed that the current risk of night blindness
was lower among children in households with
homestead gardens.39,40 Controlling for
socioeconomic status, the prevalence of night
blindness was 3.6% among mothers in
households without gardens compared to 3.1%
and 2.7% among households with either garden
or poultry, compared to 1.9% among women in
households with both poultry and gardening (c2
test for trend, p<0.01). Home gardening was
associated with a higher intake of vegetables
and lower risk of vitamin A deficiency among
women in Central Java, Indonesia.41 A study in
Ethiopia showed that home gardening, linked

16
Appendix 1
with a dairy goat project, increased the intake of
vitamin A rich foods. Women/children in
households who participated in home
gardening had lower prevalence of night
blindness than the control group.42 Also, as
described above, a social marketing campaign in
Central Java led to an increase in egg and
vegetable consumption and improvements in
vitamin A status. These findings suggest that
there is a role for food based strategies in
improving micronutrient status.
Food policy and micronutrient deficiency
The links between nutrition and macro food
policy and economic development have been
introduced previously.43,44 However, although
improved economic development is associated
with a reduction of mortality, morbidity and
malnutrition, there is limited data that allows a
thorough examination of the impact of macro
food policies, such as food prices, on nutritional
status.
Recent analyses from the Nutrition Surveillance
Project in Bangladesh showed that the decline
in rice prices was strongly correlated with a
decline in child nutritional status. Rice
consumption did not change during this time
period, but the decline in rice price was
associated with an increase in household
expenditure on non cereal foods. The increase in
expenditure on non cereal foods was also
strongly correlated with the decline in child
malnutrition (underweight), suggesting that an
increased intake of micronutrient-rich foods
contributed to this decline.45
The economic crisis in Asia has provided a
unique opportunity to examine nutrition and
food policy. Analysis of data from Indonesia
suggests that the Asian economic crisis
increased the prevalence of iron and other
micronutrient deficiencies and maternal
wasting.19,20,38 Data from the NSS supports the
hypotheses that the events of the crisis would
have a larger impact on household access to
more expensive food items (e.g., animal foods
and fortified foods), thus reducing consumption
of micronutrient-rich foods. The decrease in
intake of quality foods led to an increase in the
prevalence of micronutrient deficiencies and
ultimately to a ‘lost generation’ and increased
mortality. Since 1999, the economic situation in
Indonesia has improved slightly and the NSS
shows an increase in the share of household
food expenditure on animal foods and an
improvement in the prevalence of anemia
among children 12-23 months of age in urban
poor areas in Jakarta declined. Food policy
responses to these types of crises can influence
access to micronutrient-rich foods and therefore
can positively or negatively affect nutritional
status.
Conclusions
The broader definition of poverty and the
accompanying shift in development goals
makes the role of nutrition in poverty reduction
and international development more evident.
The links between nutrition and mortality,
observed more than a century ago, are being
substantiated with new research. At the same
time, the source of nutrients and energy – food
– is also being examined with greater intent for
the World Food Summit. Global food availability,
including the availability of animal foods, and
food security are major components of poverty
alleviation. The role of agriculture and the
importance of the development of the rural
economy, (despite or perhaps more importantly
because of urbanization trends) make this
discussion of food-based strategies in the
context of food production, food security and
poverty alleviation equally noteworthy.
Although not within the scope of this paper, the
benefits of food-based strategies towards
alleviating poverty go beyond their impact on
micronutrient status and maternal and child
mortality. Food-based strategies can improve
household income, increase women’s
involvement in decision-making, and enhance
the skills of women and other household
members, benefits that are part of the other
seven IDGs. Furthermore, there is significant
evidence that micronutrient malnutrition has
functional consequences, such as slowed
cognitive development and physical growth in
children and lower work productivity.46 Thus
prevention and control of micronutrient
deficiencies also contributes to future

17
Appendix 1
development by expanding the capabilities of
the poor and enabling them to use education
and technologies more effectively. Finally, we
cannot ignore the debate about measurement
of poverty. The inclusion of indicators of dietary
quality, such as the starchy-staple ratio, or
micronutrient status, such as childhood anemia,
may be useful for the monitoring progress
towards reaching the broader goal of poverty
alleviation.
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effect of malnutrition on mortality. Am J
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Pradhan E, Shrestha SR, et. al. Double blind
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Edmonston B, McCabe G, Ross AC, Harvey B.
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impact of economic crises on health and
nutrition. Nutr Rev 2001; Accepted.
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Tjoing R, Kosen S., Muhilal, Satoto.
Indonesia’s crisis causes considerable
weight-loss among mothers and
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S, Nalubola PR. Iron and folate fortification
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24. Phillips M, Sanghvi T, Suarez R, McKigney J,
Fiedler J. The costs and effectiveness of
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1668.
25. FAO. The state of food insecurity in the
world, 1999. Rome: Food and Agriculture
Organization, 1999.
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malnutrition declining? An analysis of
change in levels of malnutrition since 1980.
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28. FAO. World Food Situation Report. Rome:
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29. Delgado C, Rosegrant C, Steinfeld H, Ehui S,
Courbois C. Livestock to 2020: The next
food revolution. Food, Agriculture and the
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30. Timmer P. Getting agriculture moving: Do
markets provide the right signals? Food
Policy 1995;20(5):455-472.
31. FAO. Rome Declaration on World Food
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32. FAO. The State of Food and Agriculture 1997.
FAO Series No. 30, Rome: FAO, 1997.
33. Ramphal and Gill HS. Demand and Supply
of vegetables and pulses in South Asia. In
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at Islamabad, Pakistan, 24-29 September
1990, Shanmugasundaram S 1990 eds.
AVDRC Publication No 90-331. AVDRC,
Taiwan.
34. World Bank. Knowledge for development.
World Development Report. New York:
Oxford University Press, Inc., 1999.
35. Talukder A, Kiess L, Huq N, de Pee S,
Darnton-Hill I, Bloem MW. Increasing
production and consumption of vitamin A-rich
fruits and vegetables - Lessons learned
in taking the Bangladesh homestead
gardening program to national scale. Food
Nutr Bull 2000;21(2):165-172.
36. Marsh R. Building on traditional gardening
to improve household food security. Food,
Nutrition and Agriculture 1998;22:4.
37. de Pee, S., Bloem, M.W., Satoto,. Impact of
social marketing campaign promoting
dark-green leafy vegetables and eggs in
Central Java, Indonesia. Int. J. Vit. Nutr. Res
1998;68, 389-398.
38. Bloem MW and Darnton-Hill I.
Micronutrient Deficiencies: First Link in a
Chain of Nutritional and Health Events in
Economic Crises. In Bendich A, Deckelbaum
RJ, eds. Primary and Secondary Preventative
Nutrition. Totowa NJ: Humana Press, Inc.,
2000:357-373.
39. Kiess L, Bloem MW, de Pee S, Hye A, Khan TA,
Huq N, Talukder Z (1999). Bangladesh –
Xeropthalmia Free: Combined effect of
vitamin A capsule distribution and home
gardening. Washington D.C., APHA Abstract
1999;361.
40. Cohen N, Jalil MA, Rahman H, Matin MA,
Sprague J. Islam J, Davidson J, Leemhuis de
Regt E, Mitra M (1985). Landholding, wealth
and risk of blinding malnutrition in rural
Bangladeshi households. Social Science and
Medicine 1985;21(11):1269-1272.
41. De Pee, S., Bloem M.W., Gorstein, J., Sari, M.,
Satoto, Yip, R., Shrimpton, R., Muhilal.
Reappraisal of the role of vegetables for
vitamin A status of mothers in Central-Java,
Indonesia. Am. J. Clin. Nutr 1998;68, 1068-
1074.

19
Appendix 1
42. Ayalew WZ, Gebriel W, Kassa H. Reducing
vitamin A deficiency in Ethiopia: Linkages
with a women-focused dairy goat farming
project, OMNI research report series No. 4,
Washington, D.C.: International Center for
Research on Women, 1999.
43. Martorell R. The role of nutrition in
economic development. Nutr Rev
1996;54(4):S66-71.
44. Sahn D. and Scrimshaw N. Nutrition
Interventions and the process of economic
development. Food Nutr Bull 1982;5(1):2-15.
45. Torlesse H, Kiess L, Bloem MW. The
influence of macroeconomic policy on child
nutritional status: Evidence from the
Nutrition Surveillance Project in
Bangladesh, Food Policy, submitted.
46. The World Bank. Enriching Lives:
Overcoming vitamin and mineral
malnutrition in developing countries.
Washington D.C.: The World Bank, 1994.

20
Appendix 2
Reprinted from:
Food and Nutrition Bulletin 2000; 21:165-172
© United Nations University Press, Tokyo, Japan

28
Appendix 3
Reprinted from:
European Journal of Clinical Nutrition 1996; 50:S62-S67
© Stockton Press, Basingstoke, Hampshire, UK

34
Appendix 4
Reprinted from:
International Journal for Vitamin and Nutrition Research 1998; 68:389-398
© Hogrefe & Huber Publishers, Toronto, Seattle, Bern, Göttingen

44
Appendix 5
Reprinted from:
American Journal of Clinical Nutrition 1998; 68:1068-1074
© The American Society for Clinical Nutrition, Bethesda, MD, USA

51
Appendix 6
Reprinted from:
European Journal of Clinical Nutrition 1996; 50 (suppl. 3):S38-S53

67
Appendix 7a
Reprinted from:
The Lancet 1995; 346:75-81
© The Lance Publishing Group, London, UK

74
Appendix 7b
Reprinted from:
The Lancet 1995; 346:1634-1636
© The Lancet Publishing Group, London, UK

78
Appendix 8
Reprinted from:
American Journal of Clinical Nutrition 1998; 68:1058-1067
© The American Society for Clinical Nutrition, Bethesda, MD, USA

88
Appendix 9
Reprinted from:
European Journal of Clinical Nutrition 1999; 53:288-297

98
Appendix 10
Reprinted from:

110
Appendix 11
Reprinted from:

117
Appendix 12
Abstract from
XVII IVACG Meeting Report. The Nutrition Foundation 1996,
Washington DC

118
Appendix 13
Abstract from:
American Public Health Association 126th Annual Meeting Report,
Novermber 15-18, Washington DC.

119
Appendix 14
The Strength of Linking Surveillance and Programs:
Historical perspective of HKI’s experience in homestead
food production in Bangladesh, 1982-2001
The value of linking research, programs and
policies, and monitoring and evaluation
has been recognized by program
managers and scientists for decades. However,
there are still few experiences where research
and programs have been linked in an iterative
manner or where the cycle of Assessment,
Analysis and Action has been used to support
program decision-making in the field. The NGO
Gardening and Nutrition Education Surveillance
Project (NGNESP) in Bangladesh provides an
excellent application of what UNICEF refers to
as this ‘Triple-A approach’. The NGNESP
experience characterizes Helen Keller
International’s (HKI) well-established approach
to the prevention of micronutrient deficiency
and to poverty alleviation in the Asia-Pacific
Region.
In 1982, HKI conducted a national survey to
estimate the prevalence and determinants of
nutritional blindness.1 The survey showed that
the presence of a home garden was associated
with a lower risk of night blindness among
preschool children.1 Around this time, evidence
of the child mortality impact of vitamin A
deficiency disorders (even mild VADD) was
becoming established.2 Based on these survey
findings, HKI initiated a pilot program in one
subdistrict in 1989 to study gardening practices
in rural Bangladesh and to explore the
feasibility of improving the production and
consumption of vitamin A-rich foods.
In 1992-93 HKI conducted an evaluation of the
pilot program.3,4 The evaluation showed that
vegetable and fruit production and
consumption increased among the program
beneficiaries. Based on these findings, HKI
developed a large-scale program to reduce
vitamin A deficiency among poor households. In
order to define program elements and an
implementation framework, HKI also mapped
the ongoing home gardening programs and the
social and political environment within
Bangladesh at that time [assessment]. The
program design of NGNESP incorporated local
non-governmental organizations (NGOs) and
their role in community-based development,
traditional gardening practices, and the role of
women in decision-making. By working with the
local NGOs, home gardening was made part of a
‘menu’ of community-based programs that
included nonformal education, health, and
microcredit. This integrated community
approach provides households and individuals
with freedoms, opportunities, and choices.
The NGNESP includes a monitoring and
evaluation (M & E) system that provides
information to monitor the program objectives,
to manage program implementation and to
fine-tune the program. The data from the M & E
system are used to report on the performance
of nurseries; on home garden practices, garden
size and production; and on household and
individual consumption, as well as on the
performance of the program in different sites
and among different partner NGOs. After each
round of monitoring, findings are shared
through program reports and bulletins. HKI has
successfully used these findings to advocate the
benefits of the program and, consequently, the
NGNESP has been expanded to new areas with
new local NGO partners over the past 8 years.
This dissemination of the NGNESP experience
has also stimulated the Department of
Agriculture Extension and the Government of
Bangladesh to replicate the program inside their
agriculture and health programs.
In 1997, building on the experience with
NGNESP, questions about home gardening
practices, poultry and fisheries were
incorporated into the Nutrition Surveillance
Project (NSP) and the National Vitamin A Survey.
These questions were added in order to assess
the impact of homestead food production on a

120
Appendix 14
Figure 1. Timeline of the ‘Triple-A’ cycle (Assessment, Analysis, Action) approach of
HKI/APRO’s Homestead Food Production program
Assessment & Analysis Action
1982
1989
1992
1993
1995-6
1997
1998-9
Association between Home
Gardening and VADD
Baseline evaluation
Home Gardening increases
production and consumption
Mapping report
M & E of NGNESP
Home Gardening
indicators added to the
NSP
Association of gardening and
poultry to maternal and child
VADD
Formulation of
International Development
Goals
2001
Pilot
program on
Home Gardening
NGNESP
working with
NGOs
NGNESP
incorporated
into other national
programs
NGNESP
expanded to
Cambodia and
Nepal
Broaden
HFP to poverty
alleviation
Nutritional Blindness
survey
Key:
Assessment
Analysis
Action

121
Appendix 14
national level, to monitor trends and patterns of
production and consumption of plant and
animal foods, and provide a comparison group
for the NGNESP. Analysis of the vitamin A survey
confirmed that home gardening lowered the
risk of VADD among preschool children. In
addition, the survey results suggested that the
risk of night blindness was lowest among
women and children in households with
combined home gardening and poultry raising.
These findings have been presented at
international meetings to support the role of
food and homestead food production. At the
same time, HKI has used this experience and
the momentum to start home gardening
programs in Nepal and Cambodia.
Information from the M & E of the NGNESP and
the surveys/surveillance systems has also been
used for broader purposes. At the 1997
International Union of Nutritional Sciences
meeting in Montreal, Canada, the experiences
from HKI and other organizations formed the
basis for the new conceptual model describing
the direct and indirect mechanisms for the
impacts of home gardening on nutritional
status.5,6 The data from NGNESP and the home
food production indicators in the NSP are used
to improve the national estimates of vegetable
and fruit production. The experience has also
stimulated ‘thinking’ on how to use surveillance
and surveys to monitor national programs, and
has provided insight to our understanding of
determinants of food security – food availability,
access and demand, particularly of high quality
foods, such as animal foods, fruits and
vegetables. This experience has been
instrumental in helping to define and develop
the food and nutrition links of the Food
Insecurity Vulnerability Information Mapping
Systems (FIVIMS). In addition, the experience in
surveillance in Indonesia during the Asian
economic crisis has stimulated ‘thinking’ about
indicators. The initial findings that demonstrate
how child anemia and maternal BMI reflect food
accessibility may be useful for future
monitoring of homestead food production, in
the context of vitamin A, micronutrients and
poverty alleviation.7
The experiences of the NGNESP have broadly
contributed to and have been influenced by new
thinking about poverty and development goals
and priorities, the negative, long-lasting
consequences of malnutrition and the co-existence
of micronutrient deficiencies. This
new thinking has simultaneously influenced
how the NGNESP is promoted, how the benefits
are monitored, and how households are most
effectively reached regarding choices to improve
their lives. The initial motivation for VADD
programs – that improving VA status would
reduce the risk of child mortality – is also part of
the same motivation for promoting homestead
food production to help achieve the
International Development Goals, particularly
the goals to reduce maternal and child
mortality. The new perspective on poverty,
however, recognizes how homestead food
production can contribute to other goals, such
as lowering poverty and increasing women’s
opportunities.
References
1. Cohen N, Jalil MA, Rahman H, Matin MA, Sprague J,
Islam J, Davidson J, Leemhuis-de Regt E, Mitra M.
Landholding, wealth and risk of blinding malnutrition in
rural Bangladeshi households. Soc Sci Med 1985; 21:1269-
1272.
2. Sommer A, Hussaini G, Tarwotjo I, Susanto D. Increased
mortality in children with mild vitamin A deficiency. The
Lancet 1983; 2:585-588.
3. Marsh R. Building on traditional gardening to improve
household food security. Food Nutr Agric 1998; 22:4-9.
4. Bloem MW, Huq N, Gorstein J, Burger S, Kahn T, Islam N,
Baker S, Davidson F. Production of fruits and vegetables
at the homestead is an important source of vitamin A
among women in rural Bangladesh. Eur J Clin Nutr 1996;
50:S62-S67.
5. Bloem MW, de Pee S, Darnton-Hill I. New issues in
developing effective approaches for the prevention and
control of vitamin A deficiency. Food Nutr Bull 1998;
19:137-148.
6. De Pee S, Bloem MW, Kiess L. Evaluating food-based
programmes for their reduction of vitamin A deficiency
and its consequences. Food Nutr Bull 2000; 21: 232-238.
7. Kiess L, Moench-Pfanner R, Bloem MW. New conceptual
thinking about surveillance: Using micronutrient status
to assess the impact of economic crises on health and
nutrition. Nutr Rev 2001; In press.

122
Acknowledgements
Helen Keller International would like to acknowledge the multitude of collaborating
governmental and non-governmental organizations and other in-country agencies that
have been key in the sustainable implementation of the Homestead Food Production
program in their respective countries.
Bangladesh
• ANANDA
• BANCTHE SHEKHA
• Bangla German Sampreeti (BGS)
• Bangladesh Cha Sramik Union (BCSU)
• Bangladesh Rural Advancement Committee
(BRAC)
• Bangladesh Rural Advancement Through
Voluntary Enterprise (BRAVE)
• Bangladesh Rural Improvement Foundation
(BRIF)
• Church of Bangladesh Social Development
Program (SODAP)
• Community Development Association (CDA)
• CONCERN Bangladesh
• Dak Diye Jai (DDJ)
• Daridra Nirashan Procehsta (DNP)
• DIPSHIKHA
• Dushtha Shasthya Kendra (DSK)
• Friends In Village Development Bangladesh
(FIVDB)
• Gandhi Ashram Trust (GAT)
• Gono Kallayan Sangstha (GKS)
• Gonoshahajjo Sangstha (GSS)
• Grameen Jonokallayan Sangsad (GJKS)
• Grameen samaj Kendra (GSK)
• IMPACT Foundation-Bangladesh
• Integrated Development Foundation (IDF)
• Integrated Social Development Enterprise (ISDE)
• Jagrato Juba Sangha (JJS)
• Jatiyo Kallyan Sangstha (JAKAS)
• Mass Organization for Technical, Health,
Education & Rehabilitation of the Disadvantage
(MOTHER)
• Ministry of Agriculture, Department of
Agriculture Extension (DAE)
• NIJPATH
• Noakhali Rural Development Society (NRDS)
• Palli Mongal Karmosuchi (PMK)
• Palli Punargathan Club (PPC)
• PRODIPAN
• Progoti Samaj Kallyan Sangstha (PSS)
• Program for Community Development (PCD)
• Proshika Manobik Unnayan Kendra (PROSHIKA)
• Rangpur Development Samajik Sangstha (RDSS)
• Rural Development Academy (RDA)
• Rural Dinajpur Rural Services (RDRS)
• Rural Organization for Voluntary Activities
(ROVA)
• Sabalamby Unnayan Samity (SUS)
• SANGKALPA
• SETU
• Shirashuni Humanitarian Enhance Territorial
Unity (SHETU)
• Social Development Community (SDC)
• Society for Health Extension Development
(SHED)
• SRIZONY
• The Coastal Association for Social
Transformation Trust (COAST Trust)
• UDDIPAN
• UTTARAN
• Voluntary Association for Rural Development
(VARD)
• Welfare Association for Village Environment
(WAVE)
• Young Power in Social Action (YPSA)
Cambodia
• Adventist Development and Relief agency
(ADRA)
• Chamran Cheat Khmer (CCK)
• Khmer Women’s Cooperation for Development
(KWCD)
• Partners for Development (PFD)
• Southeast Asian Outreach (SAO)
• Village Support Group (VSG)
• Women Services Organization (WOSO)
Nepal
• Center for Environmental and agriculture Policy
Research, Extension and Development
(CEAPRED)
• Environment, Culture, Agriculture, Research and
Development Society (ECARDS)
• Gramin Sudhar Manch (GSM)
• Multiplication Research Sustainability Center
(MRSC)
• Nari Bikash Sangh (NBS)
• Nepal Red Cross Society (NRCS)
• Rama Roshan Vikas Samaj (ROSHAN)
• Rural Women’s Development and Unity Center
(RUWDUC)

122
Acknowledgements
HKI would like to acknowledge the authors of the scientific articles that appear in the
Appendices. This list represents the individuals who have contributed to the development
and advocacy of the Homestead Food Production program.
HKI Asia-Pacific
• Martin W. Bloem
• Saskia de Pee
• Nasreen Huq
• Nael Islam*
• Tabibul Kahn*
• Lynnda Kiess
• Elviyanti Martini
• Regina Moench-Pfanner
• Mayang Sari
• Roger Shrimpton
• Aminuzzaman Talukder
• Roy Tjiong
HKI Africa & Headquarters
• Shawn Baker
• Susan Burger*
• Ian Darnton-Hill*
*Formerly with HKI/Headquarters
Authors not affiliated with HKI
• Frances Davidson
• Jonathan Gorstein
• Joseph G. A. J. Hautvast
• Darwin Karyadi
• Benny Kodyat
• Sri Martuti
• Muhilal
• Dewi Permaesih
• Vinodini Reddy
• Satoto
• Asmira Sukaton
• Ray Yip
• Barbara A. Underwood
• Clive E. West
* Formerly with HKI/Bangladesh

124
HKI Publications
on Homestead
Food Production
Since the start of the Home Gardening program in Bangladesh, HKI has generated a
multitude of publications on the subject of Homestead Food Production in the Asia-Pacific
region. The following is a comprehensive list of these publications.
Bangladesh
• Helen Keller International, Bangladesh (1991).
Vitamin A Home Gardening and Promotion of
Consumption for Prevention of Nutritional
Blindness. Evaluation Report-Pilot Project
(October 1991). Dhaka, Helen Keller International.
Blindness. Baseline Report (December 1991).
Dhaka, Helen Keller International.
Blindness. Monitoring Report, Round 1 (October-
November, 1991). Dhaka, Helen Keller
International.
Blindness. Monitoring Report, Round 2 (December
1991-January 1992). Dhaka, Helen Keller
International.
Blindness. Monitoring Report, Round 3 (February-
April 1992). Dhaka, Helen Keller International.
Blindness. Monitoring Report, Round 4 (May-July
1992). Dhaka, Helen Keller International.
• NGO Gardening and Nutrition Education
Surveillance Project (1992). Home Gardening
Activities in Bangladesh – A Mapping Report
(April 1992). Dhaka, Helen Keller International.
Home Gardening in Bangladesh. Pilot Project
Evaluation Report. Dhaka, Helen Keller
International and the Asian Vegetable Research
and Development Center.
Surveillance Project (1993). Home Gardening in
South Asia – The Complete Handbook (English
Version). Dhaka, Helen Keller International.
Surveillance Project (1993). Monitoring of
Activities in Central Nurseries, Gram Nurseries
and Household Gardens. Report of Round 1
(November-December 1993). Dhaka, Helen Keller
International.
(March-April 1994). Dhaka, Helen Keller
International.
Mobilization of Voluntary Agencies for Vitamin A
Awareness, Promotion and Supplementation.
Annual Report (July 1994). Dhaka, Helen Keller
International.
and Household Gardens. Report of Round 3 (July-
August 1994). Dhaka, Helen Keller International.
(November-December 1994). Dhaka, Helen Keller
International.
Gardens for BangladeshTM: A Ten Year Initiative to
Sustainably Improve the Health, Nutrition and
Food Security of the Poorest in Rural Bangladesh.

124
HKI Publications
on Homestead
Food Production
(February-April 1995). Dhaka, Helen Keller
International.
• Marsh, R.R., Talukder, A., Baker, S.K. and Bloem,
M.W. (1995). Improving Food Security through
Home Gardening: A case Study from Bangladesh
(June 1995). Dhaka, Helen Keller International.
• NGO Gardening & Nutrition Education
Surveillance Project (1995). Summary Report on
the Results of Vegetable Seed Production in
Central and Gram Nurseries between December
1993 and November 1994. Dhaka, Helen Keller
International.
(September-November 1995). Dhaka, Helen Keller
International.
(December 1995 – February 1996). Dhaka, Helen
Keller International.
Surveillance Project (1996). Promotion of Home
Gardening Through Training: A DAE-NGO
Collaboration. Monitoring of Activities in Block
Nurseries and Household Gardens. Report of
Round 2 (March-May 1996). Dhaka, Helen Keller
International.
Round 3 (June-August 1996). Dhaka, Helen Keller
International.
Round 4 – Final Report (December 1996). Dhaka,
Helen Keller International.
Round 1 (December 1995-February 1996). Dhaka,
Surveillance Project (1996). Home Gardening in
South Asia – The Complete Handbook- Bangla
Version (1996). Dhaka, Helen Keller International.
and Household Gardens. Report of Round 8 (April-
June 1996). Dhaka, Helen Keller International.
and Household Gardens. Report of Round 9 (July-
September 1996). Dhaka, Helen Keller
International.
Collaboration. Regional Workshop on Homestead
Production Through Partnership (September
1996). Dhaka, Helen Keller International and
Department of Agriculture Extension.
Collaboration. Proceedings of the Regional
Workshop on Homestead Production Through
Partnership (September 1996). Dhaka, Helen
Keller International, Department of Agriculture
Extension (DAE) and Agricultural Support
Services Project (ASSP).
• Baker, S. and Talukder, A. (1996). A large-Scale
Model for Delivering Homestead Horticultural
Technologies in Bangladesh. Micronutrients and
Agriculture No. 2, pp22-24. Washington, DC,
International Food Policy Research Institute.
Surveillance Project (1997). Home Gardening
Activities in Bangladesh – Mapping Report and
Inventory (1997). Dhaka, Helen Keller
International.

126
HKI Publications
on Homestead
Food Production
Surveillance Project (1997). Guidelines for
Vegetable Seed Production-Winter (March 1997).
Surveillance Project (1997). Guidelines for
Vegetable Seed Production-Summer (March 1997).
Surveillance Project (1998). Special Guidelines for
Post-flood Homestead Gardening (October 1998).
Surveillance Project (1998). Household Food
Security Through Nutrition Gardening Project.
Base Line Report (November 1998). Dhaka, Helen
Surveillance Project (1999). Household Food
Security Through Nutrition Gardening Project.
Midterm Evaluation Report (December 1999).
and Household Gardens. A summary report of
surveys 10-13 (October 1996-October 1998).
Cambodia
• Helen Keller International, Cambodia (2000).
Multi-benefit Food and Health Model Program
Round Report – Round 1 (July-September 1999):
Monitoring of activities in village model gardens
and household gardens. Phnom Penh, Helen
Round Report – Round 2 (November 1999-
February 2000): Monitoring of activities in village
model gardens and household gardens. Phnom
Penh, Helen Keller International.
Round Report – Round 3 (March-June 2000):
Monitoring of activities in village model gardens.
Phnom Penh, Helen Keller International.
Round Report – Round 4 (July-October 2000):
Monitoring the activities of household gardens.
Phnom Penh, Helen Keller International.
Nepal
• Helen Keller International, Nepal (2001). Home
Gardening in Hilly and Tarai areas in Nepal:
Impact on Food Production and Consumption.
Nepal Nutrition Bulletin, Vol. 1, Iss. 1, May 2001,
Katmandu: Helen Keller International.

126
HKI Publications
on Homestead
Food Production
Publications related to the social marketing of vitamin A-rich foods:
Indonesia
• Helen Keller International, Indonesia (1996).
Localvita – Improvement of maternal and child
survival through promotion of vitamin A-rich
foods in South Kalimantan and South Sulawesi.
Jakarta, Helen Keller International.
• Helen Keller International, Indonesia (1997). The
Central Java Project: Maternal Postpartum
Vitamin A Supplementation, Increased Intake of
Vitamin A-rich Foods and Early Childhood
Survival in Central Java. Jakarta, Helen Keller
International.
Localvita Baseline Survey Results: South
Kalimantan – Launch of SUVITAL (the social
marketing campaign for the promotion of
vitamin A-rich foods) in Banjarmasin. Jakarta,
Localvita Baseline Survey Results: South Sulawesi
– Launch of SUVITAL (the social marketing
campaign for the promotion of vitamin A-rich
foods) in Ujung Pandang. Jakarta, Helen Keller
International.
Localvita – Project Update (April ’97-April ’98).
Jakarta, Helen Keller International.

128
Key Conferences
& Workshops
As one of the leading implementing agencies of homestead food production programs, HKI
has often participated in conferences and workshops on the subject at the request of their
organizers. Through these fora, HKI has shared key findings from its programs as well as
helped to shape the future of food-based strategies to combat malnutrition and poverty.
Below are some of the key conferences and meetings in which HKI has participated.
1991
• Prevention of Vitamin A Deficiency and its
Morbid Consequences through Community-
Based Interventions. XIV International Vitamin A
Consultative Group (IVACG) Meeting, Guayaquil,
Ecuador, June 1991.
Sessions:
– Management Issues
– Availability and Consumption Issues
– Information, Education and Communication
Issues
(Oral presentations and video session; for
further information, abstracts can be found in
the XIV IVACG Meeting Report, on pages 58, 64
and 72)
1993
• Towards Comprehensive Programs to Reduce
Vitamin A Deficiency. XV IVACG Meeting, Arusha,
Tanzania, March 1993.
Sessions:
– Dietary Behavior Poster Session
(Summarized as short oral presentations in
the plenary session; for further information,
an abstract can be found in the XV IVACG
Meeting Report, on page 132.)
1994
• Two Decades of Progress: Linking Knowledge to
Action. XVI IVACG Meeting, Chiang Rai, Thailand,
October 1994.
Sessions:
– Food-Based Interventions
(Concurrent workshop; for further
information, an abstract can be found in the
XVI IVACG Meeting Report, on page 71.)
– Home Gardens
(Concurrent workshop and poster session; for
the XVI IVACG Meeting Report, on pages 76
and 92.)
1995
• Bioavailability and bioconversion of carotenoids:
Can foods rich in provitamin A carotenoids
provide adequate vitamin A for human needs?
Workshop organized by The Micronutrient
Initiative (MI) & Opportunities for Micronutrient
Interventions (OMNI), April 1995.
• Food-Based Approaches to Preventing
Micronutrient Malnutrition: Setting an
International Research Agenda. Salt Lake City,
USA, November 1995.
1996
• Virtual Elimination of Vitamin A Deficiency:
Obstacles and Solutions for the Year 2000. XVII
IVACG Meeting, Guatemala City, Guatemala,
March 1996.
Sessions:
– Dietary Interventions
(Concurrent session and poster session; for
the XVII IVACG Meeting Report, on pages 82
and 98.)
1997
• Food Gardening for Nutrition Improvement:
Potential contribution of home gardening to
improve micronutrient status of vulnerable
groups. International Union of Nutritional
Sciences (IUNS) Committee II/8, Wageningen,
Netherlands, May 1997.
• Bioavailability ’97. Wageningen, Netherlands,
May 1997.
• 16th International Congress of Nutrition.
Montreal, Canada, July 1997.

128
Key Conferences
& Workshops
• Sustainable Control of Vitamin A Deficiency:
Defining Progress Through Assessment,
Surveillance, Evaluation. XVIII IVACG Meeting,
Cairo, Egypt, September 1997.
Sessions:
– Surveillance, Monitoring and Evaluation
– Food-Based Interventions
(Concurrent sessions; for further information,
abstracts can be found in the XVIII IVACG
Meeting Report, on pages 88, 100 and 106.)
1999
• Vitamin A and Other Micronutrients: Biologic
Interactions and Integrated Interventions. XIX
IVACG Meeting, Durban, South Africa, March
1999.
Sessions:
– Dietary Approaches to Sustainable
Micronutrient Improvement
– Methods and Outcomes of Vitamin A
Program Evaluation
(Concurrent sessions; for further information,
abstracts can be found in the XIX IVACG
Meeting Report, on pages 86, 101 and 102.)
• Dietary Approaches to Vitamin A Deficiency.
International Union of Nutritional Sciences
(IUNS)/United Nations University (UNU), Seoul,
Korea, August 1999.
2000
• Update Conference of the International Vitamin
A Consultative Group (IVACG). Annecy, France,
Oct 2000.
• Long-Term Food-Based Approach Towards
Eliminating Vitamin A Deficiency in Africa.
National Research Programme for Nutritional
Intervention, Medical Research Council, Cape
Town, South Africa, November 2000.
2001
• Years of Progress in Controlling Vitamin A
Deficiency: Looking to the Future. XX IVACG
Meeting, Hanoi, Viet Nam, February 2001.
Sessions:
– Selected presentations on interventions
(For further information, abstracts can be
found in the XX IVACG Meeting Report, on
pages 46 and 70.)

Contact information:
Helen Keller International
Asia-Pacific Regional Office
Jl. Bungur Dalam 23A-B
Kemang, Jakarta 12730
Indonesia
Fax: +62-21 719 8148
Email: info@hkiasiapacific.org

Helen Keller International
A division of
Helen Keller Worldwide
www.hkworld.org
www.hkiasiapacific.org

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