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Zambia: Seeing is Believing
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Zambia: Seeing is Believing
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Many people in Zambia don't consume enough vitamin A, which leads to blindness, infant mortality, and a host of other health problems. However, the Zambian government has initiated programs to ensure its people receive the nutrition they so desperately need.

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Segment 1

VOICEOVER
On Lake Mweru, in Zambia's northern Luapula Province, fishermen are bringing in the day's catch. But, for local people, a plentiful diet of fish has had unexpected consequences. A survey showed that 57 percent of blind people in Zambia come from Luapula Province. The cause: lack of vitamin A, a lethal public health problem, which also has a significant effect on child deaths, as well as increasing the risk of women dying in childbirth.
TITLE
Seeing is Believing
VOICEOVER
On the shores of Lake Mweru, Dr. Kunda runs a child health clinic serving the fishermen's families.
DR. SIMON KUNDA [Kabuta Rural Health Centre]
People here regard fish as the only nutritious type of food, so they deprive the children of other foodstuffs, giving priority to fish. Dietary supplements are so low. Most of the mothers go for fieldwork in the morning. They come back very late, so feeding is compromised. We usually detect that when there is diarrhea, and when a patient comes with eye problems, that's when we see that surely there is a vitamin A deficiency. The impact of vitamin A deficiency, it has brought in high mortality and morbidity. We need to encourage these mothers to be giving their children vitamin A supplements. As you can see, if you look at the conjunctive of the child, it's very, very red. So, measles also affects the eye, so it's very easy for these children, especially if they are malnourished, to get blind.
VOICEOVER
In Zambia's capital, Lusaka, Freddy Mubanga is responsible for increasing vitamin A intake, both in Luapula Province and throughout the whole country.
SIGN
The National Food and Nutrition Commission
FREDDY MUBANGA [Acting Executive Director, National Food and Nutrition Commission]
We started investigating the micronutrient deficiencies in 1985, when we undertook a survey in one of the provinces, Luapula, which had recorded high levels of blindness. It was found that about 16.2 percent of children 6 to 72 months had subclinical vitamin A deficiency. That, of course, gave way to start thinking of some strategies to see how we can reduce the levels of deficiencies.
VOICEOVER
Since the 1995 survey, Zambia has implemented vitamin supplements for children at child health clinics, both throughout the country and in the capital, Lusaka.
SIGN
George Clinic: Family planning services available here.
NURSE
George has got a very big catchment area, and we see a lot of children. It's a really highly populated place, and it's a very busy clinic. We have a lot of underweight, malnourished children. We give vitamin A to the under fives.
WOMAN [Mother]
I think for my baby to be healthy, I need to be coming here to get medicine for her to be protected from various diseases. Breastfeeding's the best, and it's cheap, very cheap. You can buy vegetables. You eat. When the baby feeds, she gets all the nutrients. It's very cheap, in fact. I like it.
NURSE
Five or six months?
WOMAN 2 [Mother]
Five.
NURSE
Yes, they can get it through breastfeeding, yes. In case they don't get enough through the foods, then we supplement at the clinic by giving you vitamin A capsules.
FREDDY MUBANGA
Following the national survey on Vitamin A deficiency in 1997, we realized that the problem is so immense, so we have to look at other options. In addition to supplementation, we thought of moving into sugar fortification. We looked around [at] what food vehicles we can use, and sugar seemed to be the one that was produced centrally, and it was found in almost every part of the country.
VOICEOVER
To add vitamin A to sugar, the government needed the cooperation of Zambia Sugar, a private corporation and the country's sole producer.
JAMES MUKUKWA [Production Manager, Zambia Sugar]
It was a program that was introduced by the government to the industry, so it was very new to us. We knew literally nothing. People working with the government, they had contacts in Guatemala who were really the founders of VA fortification of sugar. So the best way to undertake that project was to go to the source, to the experts, and me being the production manager, I had to go there because eventually I had to come and implement that project. Zambia Sugar agreed to help out with the national health problem that the whole country faced as a sign of goodwill, so it's actually doing it for free. The company bears the cost. It's very expensive: every year, we spend almost USD$1 million to buy the VA, the vitamin A.
VOICEOVER
USAID has also been a major supporter, and initiator, of the sugar fortification program.
JAMES MUKUKWA
Since we implemented the fortification program at Zambia Sugar in 1998, we've had several delegations coming from other countries: Uganda, South Africa, Malawi, and Kenya last year. They've been here to inquire and familiarize themselves with the VA fortification, with a view of them also going the same way.
VOICEOVER
It may cost USD$1 million a year to fortify all of Zambia's sugar with vitamin A, but the cost per bag of sugar is just a few cents. And even that pales into insignificance when you add in the number of lives saved and the huge health benefits of vitamin A fortification for all Zambians.
FREDDY MUBANGA
Last year actually the Zambian government passed regulations to say all the sugar that has to be consumed in households has to be fortified with vitamin A. Since we started enforcing that, the border areas -- Zimbabwe, Namibia, Botswana and so forth -- their sugar is still coming in. So it becomes a bit difficult to enforce, or to control, the influx of this. But all the sugar that enters through the border points, it has to conform to the regulations.
SIGN
Customs and Immigration: Entrance
CHILUBA MWAPE [Plant Health Inspector, Chirundu Border Post]
This is brown sugar coming from Zimbabwe. Now we've got one truck carrying sugar, brown sugar, 30 metric tons. Yes, from Zimbabwe. When the truck comes which is carrying sugar from Zimbabwe or South Africa, we take samples. When we get these primary samples, we submit them to Lusaka for further analysis at the food and drugs laboratory.
SIGN
Ministry of Health Food and Drugs Control Laboratory, Lusaka
MRS. SONGOL [Food And Drug Control Laboratory]
We have the food and drugs regulations, where the levels of vitamin A in sugar are stated. So we make sure that, from the analysis, we check whether the levels do conform to the standard. We receive the samples form all over the country. We also get samples from Zambia Sugar company itself. Part of their quality control program is actually to bring the samples here for analysis. We discovered that some samples of sugar were actually indicating that there was no vitamin A, but when they were analyzed at the factory, they were finding some vitamin A. But after storage the levels of vitamin A were going down, until at one point we were finding actually zero. From that time on, there's been regular sampling to make sure that that problem does not occur again. We have to keep on checking on the quality of food, because 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.

Segment 2

VOICEOVER
Although fortification of sugar has been a success in Zambia, it reaches only 52 percent of the population in comparison to Zambia's staple food, maize, or mshima, which is consumed by over 90 percent.
FREDDY MUBANGA
We felt that probably we need to diversify the food base for fortification, and one sort of food that we thought of was maize, because it's highly consumed in Zambia.
VOICEOVER
In Lusaka's Chawama township, government scientists are testing the adding of vitamin A supplements to maize at the local Hammer Mill. Unlike sugar, which is produced at one single source, 40 percent of maize produced in Zambia is ground in local mills used by people in poor urban and rural areas. Simple methods had to be found to ensure local people would mix vitamin A into their own maize meal. While Zambia has expanded fortification of foodstuffs with vitamin A, evaluating its impact can be difficult.
WARD SIAMUSANTU [National Food and Nutrition Commission]
It's ideal to do the impact study now because the baseline was there in 1997, and now it's almost like six years. We could actually find what has been happening. However, we have malnutrition levels very high. We have HIV problems we're going through. It will be very difficult actually to tease out which component has vitamin A supplementation has actually affected in our population. It's very difficult because the amounts that are put in sugar are very minimal, 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. It's one of the most important things to follow. Let's change our people's diets so that we don't even bother fortifying, supplementing. From the diet they could eat, you could have a lot of vitamin A.
VOICEOVER
Back in Luapula Province, nutritionists are working on improving people's diet and preventing future cases of blindness, illness, and death.
DON KAYEMBE [Provincial Nutritionist, Luapula Province]
Even us as nutritionists, we are promoting that you can take fruit, you can take vegetables, for vitamin A, but as long as there's no presence of oil, so it can't be absorbed by the body. These palm oil trees are imported by the producer from Costa Rica. We brought them because naturally they are along the Luapula Valley, we have got the traditional ones, so those ones are not bearing much fruit, and even the fruit which are received are not giving us as much oil as expected. So these improved seeds, they are helping to give us more and more cocoa oil from one bunch. When they grow, after at least one year, when they become like these ones, we start now giving out to the communities. Now, the communities, there are some who are accessing them at very low cost, just to promote this and to give them ownership. So far I think we've distributed 57,000, and what we've imported so far could be 65,000 or so since we started in 1997.
VOICEOVER
It takes four years for the palms to bear fruit. In local villages women have been learning how to make palm oil. Mrs. Eskembene of Sensima Village was sent to Ghana to study palm oil production.
MRS. ESKEMBENE
We used to process palm oil before, but for no particular reason. Sometimes people would use it, others not. But, after we knew the benefits of it, we decided to increase production.
DR. STELLA GOINGS [UNICEF Representative, Zambia]
Zambians were quick to realize that vitamin A deficiency was contributing to an intolerably high rate of morbidity and mortality, especially for children, and they were also quick to understand the importance of supplementation, fortification, and diversification programs. Zambia is a country that is confronting a food crisis this year. This is forcing [the] government to reconsider the way they look at food and the way they handle food. A part of this -- we hope that UNICEF will play a very active role -- will be making certain that mothers and people who are in charge of preparing food for the household are equipped to establish and maintain household gardens, and that we provide the education that's necessary for ... so they know how to prepare the foods.
VOICEOVER
Back at Dr. Kunda's clinic, mothers are now taking cooking classes to learn how to prepare vitamin-rich foods.
DR. SIMON KUNDA
We've started a program where we encourage mothers to be using the local variable foods, like green vegetables, yellow fruits like pawpaw, oranges, and here, we are lucky because we have these palm trees. Now, research has discovered that these things are very rich in vitamin A, so we encourage mothers to be using the oil from palm trees.
VOICEOVER
For the people of Luapula Province, adding vitamin A to their fish diet now promises a healthier, brighter future.
TITLE
[end credits]

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