Biofortification with Zinc and Iron for Eliminating Deficiency in Pakistan (BiZIFED2)

Lead Research Organisation: University of Central Lancashire
Department Name: Sch of Sport and Health Sciences

Abstract

Zinc and iron deficiencies are a global public health problem, with the greatest burden occurring in low and middle-income countries. In Pakistan, over 40% of women are zinc deficient and over 20% have iron deficiency anaemia. These micronutrient deficiencies have negative consequences for maternal and child health, and it is imperative that sustainable and cost-effective solutions are found.

The project will investigate the potential of biofortification to reduce zinc and iron deficiencies in Pakistan. Biofortification is a process by which the nutritional quality of food crops is improved through conventional plant breeding techniques and addition of nutrient-rich fertilisers. HarvestPlus has developed a variety of wheat with significantly greater zinc and iron concentrations, compared to standard varieties. Wheat is the staple crop in Pakistan and most families consume chapatis (made from wheat flour) with every meal. Therefore, we believe that biofortified flour may benefit communities who cannot afford to consume a diverse range of foods.

The project has three main components, to be delivered over two years. The first component is a randomised controlled trial effectiveness study, to assess the impact of consuming biofortified flour on zinc and iron status. The participants will be 500 adolescent girls (aged 10-16 years) and 500 children (aged 1-5 years) living in a low-resource community in North West Pakistan. In phase 1 (months 1-6), the participants and their families will consume their usual locally purchased flour. The cost of the flour will be reimbursed as an incentive to participate in the study. In phase 2 (months 7-12), they will consume either biofortified flour (intervention group) or standard flour (control group), both of which will be grown locally. The participants will be randomly allocated to the intervention or control group and they will not know which flour they are consuming (nor will the research team). A range of biochemical measures will be taken to assess the impact of consuming biofortified flour on zinc and iron status. We will also record the incidence of diarrhoea and upper respiratory tract infections (in children), which are known to be associated with zinc deficiency.

The second component focuses on understanding wheat growing conditions in Pakistan, and supporting farmers to improve the yield and grain quality of biofortified wheat. Variations in soil fertility and grain quality will be mapped across Punjab Province, where 80% of Pakistan's wheat is grown. Computer modelling techniques will be used to predict which soil properties (e.g. soil organic matter, fertility) and management options would lead to optimal zinc concentrations in the wheat grain. Cost-benefit analyses will be conducted for different scenarios, such as standard vs. biofortified wheat, addition of zinc fertilisers, improved soil organic inputs etc.

The third component focuses on promoting the sustainable production and consumption of biofortified wheat in Pakistan. Mixed methods will be used to explore the views and perspectives of farmers (wheat producers) and community members (wheat flour consumers) to understand what factors influence their decisions to adopt biofortified wheat or not. Participants will be recruited from marginalised communities, who often have the poorest diets and may not access other types of nutrition interventions such as centralised flour fortification. The wheat market system in Pakistan will be mapped through consultations with a range of stakeholders. This information will be used to develop and pilot interventions to promote the sustainable production and consumption of biofortified wheat.

As well as intensive communication activities with farmers and consumer, findings will be disseminated to researchers, policy makers, donors, world-wide, through a comprehensive Pathways-to-Impact activities.

Technical Summary

The overall aim of BiZiFED2 is to investigate the potential of biofortification as a strategy to reduce zinc and iron deficiencies in Pakistan. Three main objectives, corresponding to three Work Packages (WPs) are summarised below:

Obj. 1. To determine the potential for biofortified wheat to improve zinc and iron status among adolescent girls and children, living in a low resource community in Khyber Pakhtunkhwa Province (KPK) Province, Pakistan.

Obj. 2. To quantify spatial variation in grain and soil zinc status across Punjab Province, Pakistan, to enable ex-ante evaluations of farmer crop and soil management options to improve grain quality.

Obj. 3. To improve understanding of the socio-cultural factors and market systems that affect the sustainable uptake of biofortified wheat in Pakistan.

WP1: A trial effectiveness study (double-blind, randomised controlled trial) will be conducted to assess the impact of consuming biofortified flour on zinc and iron status among 500 adolescent girls (aged 10-16 years) and 500 children (aged 1-5 years) in a low-resource community in NW Pakistan.

WP2: Spatial variation in wheat grain and soil zinc status will be mapped using data across Punjab Province, where 80% of Pakistan's wheat is grown. Geospatial modelling will be used to predict which soil properties and farm management practices would lead to optimal zinc concentrations in the wheat grain, and determine cost-benefit (and uncertainties) at provincial, district and farm scales.

WP3: Mixed methods will be used to explore the views and perspectives of farmers (wheat producers) and community members (flour consumers) to understand what factors influence their decisions around adoption of biofortified wheat. The wheat market system in Pakistan will be mapped through consultations with a range of stakeholders to develop and pilot interventions to promote the sustainable production and consumption of biofortified wheat.

Planned Impact

Our goal is to reduce the prevalence of zinc and iron deficiencies in Pakistan by delivering evidence on: (1) the effectiveness of a new variety of biofortified wheat to increase individual zinc and iron status; (2) optimal strategies for crop and soil management to optimise wheat grain quality; (3) sustainable production and consumption of biofortified wheat in Pakistan.

The interdisciplinary nature of this research means that the results will be relevant to a very broad community, with whom we will interact. The team already has a diverse involvement in a range of professional and informal networks, also with policy/donor groups, and with academic networks at national and international level. The team is therefore credible to engage with effective knowledge exchange across a wide range of scales and across subject disciplines.

Communities in Pakistan where zinc and iron deficiencies are prevalent will benefit from this research. The project will provide data that will contribute to the evidence base for the potential impact of biofortification of a staple crop to alleviate zinc and iron deficiencies among the poorest communities. An integral part of this research is dialogue with community members, leaders and farmers regarding their views about biofortification. The outcomes of this study will be disseminated to communities via culturally appropriate mechanisms, such as committees of village elders (Jirga).

Industrial partners will benefit from this project through the opportunity to promote a range of crop and soil management options, during engagement with farmers involved in soil and crop sampling activities and dissemination of seed. Such activities can help to inform product development and marketing.

As zinc and iron deficiencies are common in low and middle-income countries, particularly in Sub-Saharan Africa and South Asia, the findings of the research will be applicable more widely to other countries on the Development Assistance Committee (DAC) List of ODA Recipients. Team members with on-going activities in these areas will ensure these linkages are followed for greatest impact.

Policy makers and non-profit organisations engaged in finding sustainable solutions to micronutrient deficiencies will benefit from the data and knowledge generated during this research, in particular, they will be informed by ex ante evaluations of farmer management options in terms of adoption of new crop varieties and soil management options.

Researchers within the team delivering this project will benefit from this research through training and capacity strengthening. Knowledge exchange between researchers from the Pakistan and UK teams will be encouraged and facilitated.

Publications

10 25 50
 
Description BIZIFED2 is the first large-scale investigation into the potential of biofortified wheat to reduce zinc and iron deficiencies among adolescent girls and children in Pakistan. Therefore, this research has direct relevance to Sustainable Development Goal 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture. The findings will be applicable more widely to other countries on the Development Assistance Committee (DAC) list countries where zinc deficiency is common, particularly in Sub-Saharan Africa and South Asia. Team members with on-going activities in these areas will ensure these linkages are followed for greatest impact. Gender is a central consideration in this project because zinc and iron deficiencies have negative long-term consequences for health, particularly among women of reproductive age (WRA), adolescent girls and children. In Pakistan, the National Nutrition Survey in 2018 indicated that 22.1% of WRA and 18.6% of children under 5 were zinc deficient; likewise, 18.2% of WRA and 28.6% of children under 5 had Iron Deficiency Anaemia (Government of Pakistan and UNICEF 2019). The prevalence of zinc and iron deficiencies is likely to be even higher in low-resource, rural communities where diets are dominated by plant source foods (with lower concentrations and bioavailability of these micronutrients). The primary study participants in our randomised controlled trial are adolescent girls (aged 10-16 years) because this is a critical time in the life-course to influence maternal and neonatal outcomes, and the health of future generations. Furthermore, we are exploring the views and perspectives of male and female community members through our mixed methods research on factors affecting the sustainable uptake of biofortified wheat. Benefits for research participants include free four provided to 500 households for 12 months during the RCT (economic benefit). The wider community including non-participants will benefit from improvement of local health facilities, increased awareness of nutritional deficiencies and employment of local staff (including specific roles for women in our research team). Considerable efforts have been made to clearly communicate the purpose of the RCT, so that all community members understand that we do not yet know if there are any health benefits associated with consuming biofortified flour. If the study findings show improvements in nutritional status and/or health outcomes, this evidence will inform future decision making in relation to scaling up biofortified wheat in Pakistan.
First Year Of Impact 2019
Sector Agriculture, Food and Drink,Healthcare
Impact Types Cultural,Societal,Economic

 
Description BIZIFED2 collaborators and partners 
Organisation British Geological Survey
Country United Kingdom 
Sector Academic/University 
PI Contribution UCLan's contributions include research management, knowledge and expertise, data management, data analysis, capacity building.
Collaborator Contribution The project partners listed above have contributed in many ways to the ongoing success of this project, including knowledge and expertise, development and distribution of seed, development of zinc fertilizers, management of field experiments, stakeholder engagement, community engagement, participant recruitment and retention, data collection, laboratory facilities, data entry, capacity building. For example, Fauji Fertilizer Company has recently trained 50 Field Assistants, who will engage with and collect data from over 2,800 farmers in Punjab Province. This partnership is essential to the success of Work Package 2.
Impact Multidisciplinary collaborations across the academic fields of human nutrition, plant nutrition, soil science, agriculture, geology and social sciences. Private sector and charity sector implementation partners in Pakistan.
Start Year 2019
 
Description BIZIFED2 collaborators and partners 
Organisation Fauji Fertilizer Company
Country Pakistan 
Sector Private 
PI Contribution UCLan's contributions include research management, knowledge and expertise, data management, data analysis, capacity building.
Collaborator Contribution The project partners listed above have contributed in many ways to the ongoing success of this project, including knowledge and expertise, development and distribution of seed, development of zinc fertilizers, management of field experiments, stakeholder engagement, community engagement, participant recruitment and retention, data collection, laboratory facilities, data entry, capacity building. For example, Fauji Fertilizer Company has recently trained 50 Field Assistants, who will engage with and collect data from over 2,800 farmers in Punjab Province. This partnership is essential to the success of Work Package 2.
Impact Multidisciplinary collaborations across the academic fields of human nutrition, plant nutrition, soil science, agriculture, geology and social sciences. Private sector and charity sector implementation partners in Pakistan.
Start Year 2019
 
Description BIZIFED2 collaborators and partners 
Organisation Khyber Medical University
Country Pakistan 
Sector Hospitals 
PI Contribution UCLan's contributions include research management, knowledge and expertise, data management, data analysis, capacity building.
Collaborator Contribution The project partners listed above have contributed in many ways to the ongoing success of this project, including knowledge and expertise, development and distribution of seed, development of zinc fertilizers, management of field experiments, stakeholder engagement, community engagement, participant recruitment and retention, data collection, laboratory facilities, data entry, capacity building. For example, Fauji Fertilizer Company has recently trained 50 Field Assistants, who will engage with and collect data from over 2,800 farmers in Punjab Province. This partnership is essential to the success of Work Package 2.
Impact Multidisciplinary collaborations across the academic fields of human nutrition, plant nutrition, soil science, agriculture, geology and social sciences. Private sector and charity sector implementation partners in Pakistan.
Start Year 2019
 
Description BIZIFED2 collaborators and partners 
Organisation King's College London
Country United Kingdom 
Sector Academic/University 
PI Contribution UCLan's contributions include research management, knowledge and expertise, data management, data analysis, capacity building.
Collaborator Contribution The project partners listed above have contributed in many ways to the ongoing success of this project, including knowledge and expertise, development and distribution of seed, development of zinc fertilizers, management of field experiments, stakeholder engagement, community engagement, participant recruitment and retention, data collection, laboratory facilities, data entry, capacity building. For example, Fauji Fertilizer Company has recently trained 50 Field Assistants, who will engage with and collect data from over 2,800 farmers in Punjab Province. This partnership is essential to the success of Work Package 2.
Impact Multidisciplinary collaborations across the academic fields of human nutrition, plant nutrition, soil science, agriculture, geology and social sciences. Private sector and charity sector implementation partners in Pakistan.
Start Year 2019
 
Description BIZIFED2 collaborators and partners 
Organisation London School of Hygiene and Tropical Medicine (LSHTM)
Country United Kingdom 
Sector Academic/University 
PI Contribution UCLan's contributions include research management, knowledge and expertise, data management, data analysis, capacity building.
Collaborator Contribution The project partners listed above have contributed in many ways to the ongoing success of this project, including knowledge and expertise, development and distribution of seed, development of zinc fertilizers, management of field experiments, stakeholder engagement, community engagement, participant recruitment and retention, data collection, laboratory facilities, data entry, capacity building. For example, Fauji Fertilizer Company has recently trained 50 Field Assistants, who will engage with and collect data from over 2,800 farmers in Punjab Province. This partnership is essential to the success of Work Package 2.
Impact Multidisciplinary collaborations across the academic fields of human nutrition, plant nutrition, soil science, agriculture, geology and social sciences. Private sector and charity sector implementation partners in Pakistan.
Start Year 2019
 
Description BIZIFED2 collaborators and partners 
Organisation The Abaseen Foundation U.K.
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution UCLan's contributions include research management, knowledge and expertise, data management, data analysis, capacity building.
Collaborator Contribution The project partners listed above have contributed in many ways to the ongoing success of this project, including knowledge and expertise, development and distribution of seed, development of zinc fertilizers, management of field experiments, stakeholder engagement, community engagement, participant recruitment and retention, data collection, laboratory facilities, data entry, capacity building. For example, Fauji Fertilizer Company has recently trained 50 Field Assistants, who will engage with and collect data from over 2,800 farmers in Punjab Province. This partnership is essential to the success of Work Package 2.
Impact Multidisciplinary collaborations across the academic fields of human nutrition, plant nutrition, soil science, agriculture, geology and social sciences. Private sector and charity sector implementation partners in Pakistan.
Start Year 2019
 
Description BIZIFED2 collaborators and partners 
Organisation University of Nottingham
Country United Kingdom 
Sector Academic/University 
PI Contribution UCLan's contributions include research management, knowledge and expertise, data management, data analysis, capacity building.
Collaborator Contribution The project partners listed above have contributed in many ways to the ongoing success of this project, including knowledge and expertise, development and distribution of seed, development of zinc fertilizers, management of field experiments, stakeholder engagement, community engagement, participant recruitment and retention, data collection, laboratory facilities, data entry, capacity building. For example, Fauji Fertilizer Company has recently trained 50 Field Assistants, who will engage with and collect data from over 2,800 farmers in Punjab Province. This partnership is essential to the success of Work Package 2.
Impact Multidisciplinary collaborations across the academic fields of human nutrition, plant nutrition, soil science, agriculture, geology and social sciences. Private sector and charity sector implementation partners in Pakistan.
Start Year 2019
 
Description BIZIFED2 update from Pakistan - October 2019 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Wider dissemination and awareness of our research project.
Year(s) Of Engagement Activity 2019
URL https://www.uclan.ac.uk/research/explore/assets/images/bizifed2-blog-for-c4globe-website.pdf
 
Description BIZIFED: Biofortified Zinc and Iron Flour to Eliminate Deficiency. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Talk delivered on May 04, 2020 at Pakistan Zinc and Iodine Day organized by NIAB Faisalabad Pakistan at University of Sargodha.
Year(s) Of Engagement Activity 2020
 
Description Guest blog for IZiNCG: BIZIFED2 - Biofortification with Zinc and Iron for Eliminating Deficiency in Pakistan 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Wider dissemination and awareness of our research project.
Year(s) Of Engagement Activity 2019
URL https://www.izincg.org/new-blog-1/2019/5/22/bizifed2-biofortification-with-zinc-and-iron-for-elimina...
 
Description Presentation at the International Society for Trace Element Research in Humans (ISTERH) Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Prof Nicola Lowe was invited to give a presentation at the ISTERH meeting in a session on novel biomarkers, entitled "Novel approaches to Biomarkers of Zinc Status:  the BiZiFED study" The presentation sparked a lot of interest in future collaboration in with experts in the field of zinc biomarkers.
Year(s) Of Engagement Activity 2019
URL https://www.isterh2019.com/
 
Description Presentation at the Pakistan National Dietetics and Nutrition Society, first international conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Prof Nicola Lowe was invited by the Pakistan National Dietetics and Nutrition Society to give a presentation at their first international conference, to share my experience in successful grant writing, and to use the BIZIFED project as a successful case study. The presentation was entitled "What makes a successful international research grant proposal? Key principles from the UKRI Global Challenges Research Fund  ". There was a great deal of interest in this topic, and questions about the UKRI/GCRF fund. Prof Lowe was invited to do a similar presentation at the Agha Khan University in Karachi, which is the leading research University in Pakistan.
Year(s) Of Engagement Activity 2019
URL http://rdn.pnds.org/2019/05/21/first-pnds-international-conference-on-non-communicable-diseases-in-c...
 
Description Research Seminar at the University of Reading 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Undergraduate students
Results and Impact Prof Nicola LoweI was invited by Prof Simon Andrews at the University of Reading to give a seminar to undergraduate and postgraduate students entitled "Biofortification of wheat as a strategy to improve zinc status in Pakistan:  the BiZiFED study" Approximately 25 students attended. Interest in this "real world" research with impact was expressed and appreciated by the students.
Year(s) Of Engagement Activity 2019
 
Description Workshop on the Global Code of Conduct for Research in Resource Poor Settings 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Third sector organisations
Results and Impact This workshop was for the BIZIFED2 research team during our project meeting in Islamabad in October 2019. It started with an introduction to the concept of ethics dumping and the development of the Global Code of Conduct. We then divided into four groups to consider the four values of fairness, respect, care and honesty. Each group discussed the articles within the code and identified those they felt were especially relevant to BIZIFED2. We identified what we are already doing well, areas where we could improve and ways we could focus on developing equitable partnerships.
Year(s) Of Engagement Activity 2019
URL https://www.uclan.ac.uk/research/explore/assets/images/bizifed2-blog-for-c4globe-website.pdf