Translating GeoNutrition (TGN): Reducing mineral micronutrient deficiencies (MMNDs) in Zimbabwe

Mineral micronutrient deficiencies (MMNDs) remain a global challenge affecting the growth, development, health, and livelihoods of more than 2 billion people. MMNDs are especially prevalent in Low Income Countries of sub Saharan Africa (SSA) and South Asia. Women and children are at particular risk of MMNDs due to unequal access to nutrient-rich foods within the home. Constraints to reducing MMNDs, especially in SSA, include: (1) baseline data on the distribution of MMNDs, especially within a country; (2) national research capacity to get the information needed to provide a sound evidence base, and potential solutions, for policy makers, private sector investors, and other interested parties (citizens, donors, public health professionals).

We have built up substantial knowledge on how to approach this challenge based on ongoing research, and lessons learned, from an existing portfolio of Global Challenge Research Fund (GCRF, and other ODA and institutional) funding, which seeks to, (1) reduce the impact of MMNDs by understanding local nutrition from the soil through to the person via complex food systems pathways (a 'GeoNutrition' approach), and (2) strengthen research capacity in SSA.

The work will be undertaken with partners in Zimbabwe, where >50% of the population are affected by MMNDs. The Government of Zimbabwe (GoZ) plans to embed a full MMND survey in a wider health survey in 2020/21. There is therefore a window of opportunity for impact by: (1) informing the design of this GoZ survey, specifically by translating GCRF-funded 'GeoNutrition' research findings from Malawi, and (2) promoting new policy and commercialisation pathways through research capacity strengthening. This project has the highest-level support from the GoZ, including from the Ministry of Health and Child Care, and the Ministry of Higher Education. The project has been co-designed with the University of Zimbabwe (UZ).

Translating GeoNutrition Aims:
1. To co-design a national surveillance programme to establish baseline MMNDs in Zimbabwe
2. To improve institutional and individual research capacity in Zimbabwe, including to test policy interventions for alleviating MMNDs and to promote private sector engagement

Aim 1 will be delivered through activities in two (parallel) Work Packages (WPs), linking the Nutrition (WP1) and Agriculture (WP2) sectors. These can be scaled up as required.

WP1: Biomarker Survey Pilot, to support mapping of MMNDs, and to inform the design of the full MMND surveillance programme. The activity sequence includes: (i) design, (ii) area selection, (iii) data sharing, (iv) ethical approvals, (v) training and sensitisation, (vi) logistics/risk assessments, (vii) sample collection and processing (blood, urine), (viii) storage/shipping, (ix) lab. analyses, (x) data management, (xi) data analyses, (xii) communication.

WP2: Agricultural Survey, to link agriculture and nutritional policies, by mapping parts of the Food Systems which affect MMNDs, and to identify new market opportunities. Activities include those described above, with sample collection focusing on soils and crops.

Aim 2 will be delivered via WP3, which will be designed to include interim and final evaluations, within a Theory of Change. Of particular focus will be improving skills in data management, statistics, ethics, lab. analyses, finance systems, Higher Education curriculum development, and training-of-trainer (ToT) systems. An important component of research capacity strengthening is how research cultures and systems are developed; what works, for whom, when, and why, including how gender and social inclusion strategies are operationalised. Beyond the award, we shall use institute investment to co-develop a joint PhD programme between UoN and UZ, based on new UoN/Malawi models, which shall help to incentivise private sector engagement in the food, nutrition, and agri-services sectors.

The primary intended beneficiaries of impact from this work are populations living with the multiple burdens arising from chronic mineral micronutrient deficiencies (MMNDs) in sub-Saharan Africa (SSA). Our translation award focuses on Zimbabwe, where >50% of the population are estimated to be affected by MMNDs based on proxy date (e.g. anaemia, stunting). A successful translation of research via this award would include the delivery of an economic, effective and efficient ('3Es') micronutrient surveillance programme design for the Government of Zimbabwe (GoZ). This would enable - for the first time - the GoZ to make reliable estimate of baseline MMNDs which is essential for effective policy making, including the prioritisation of potential interventions, and private sector investment. By building on specific research activities in Malawi, and by including Malawi partners in this translation project, we are looking at wider regional potential benefits in the short-to-medium term.

We contend that a major constraint to the alleviation of MMNDs in SSA is a lack of research capacity in national institutions (Higher Education and Government Research Organisations). By embedding a research capacity strengthening component to this translation activity, and guided by a Theory of Change and robust evaluation framework, we shall directly benefit research institutions in Zimbabwe to sustain impact. This component of the project includes consideration of multiple levels of agency, including students, research support staff, academics, and technical specialists, working together with institute-level leaders.

This project has the highest-level support from the GoZ, including Permanent Secretary and Ministerial letters of support, from the Ministry of Health and Child Care, and the Ministry of Higher Education, respectively.

By strengthening UK-Zimbabwe relationships, at both institute and individual levels, there is the potential to secure wider benefits in terms of global prosperity and stability. One specific example of how we plan to contribute to this wider agenda is through extending a joint PhD programme, based on fee-sharing and common aspirations, as developed previously between UoN and LUANAR in Malawi. There are currently fewer than 50 researchers per million population (according to Frascati Definitions, including PhD students) based in most countries in SSA, including Malawi and Zimbabwe, compared to >4000 in the UK. Yet there a pressing need to develop evidence in SSA to support progress towards the Sustainable Development Goals by 2030 as we embrace a period of rapid population growth (Africa's Demographic Dividend) and environmental change over the coming decades.