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Analytical summary - Food safety and nutrition

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Namibia’s potential for agriculture is severely limited due to climatic and soil factors. The main food crops grown in Namibia are millet and maize. Other food crops include ground nuts, maize, wheat and sunflowers. During the past five years agricultural output has been seriously constrained by recurring drought, floods, locusts, insects and worm invasions.

The main agricultural output in Namibia is livestock (mainly beef cattle, sheep and goats) which is produced on commercial and communal farms. (FAO, 2008) The Ministry of Agriculture, Water and Forestry (MAWF) is implementing initiatives geared to improving food production, including the diversification of crop production to bring about improved nutritional status in the country. These initiatives include projects such as Green Scheme, National Horticulture Development Initiative, Dry-land Crop Production for grain producers and Strategic Food Reserve Facilities (silos). (MoHSS, 2011)

Detailed data on common food intake patterns in Namibia is sparse and information is mainly based on popular knowledge. It is believed that meals mostly consist of maize meal or mahangu (millet) which is prepared as porridge or thick paste. This is usually accompanied by fish or meat and few people consume legumes.

Vegetables such as green leaves, squash or tomatoes are sometimes added to the meat or fish but not every day. Fruits are apparently rarely consumed. Food patterns are believed to differ between urban and rural areas as well as different cultural groups. For example, some traditional diets are limited to meat and dairy products, and are an expression of deeply-rooted cultural values.

The consumption of diverse foods may be higher in urban areas where shops sell an extended range of fresh and industrial food products. The small local shops in rural areas mainly sell basic commodities and little or no fresh produce. The majority of people residing in informal settlements live in poor hygienic conditions and lack basic amenities such as potable water and sanitation facilities.

In addition, local foods which are usually grown or naturally available in rural areas are not available to households in towns and cities due to lack of space and water. Programmes must therefore emphasise the nutritional value of locally grown foods, with strategies for developing home gardens in urban areas as well as rural locations. (MoHSS, 2011)

12% of Namibia’s exports are food exports, mainly meat and fish. Industrial development is still at an early stage and food processing for both the domestic and the export market is the main activity. One third of all manufacturing is engaged in the fish and meat-processing, brewing and soft drinks, dairy and other food products.

Namibia is heavily reliant on food imports, especially of fruit and vegetables, mainly from South Africa. Between 50% and 80% of Namibia’s grain requirement is imported every year. 0.2% of cereal imports are in the form of food aid. 5.6% of Namibia’s imports are food imports. (FAO, 2008; FAO, July 2001)

Salt Iodisation Legislation was gazetted in 1994. The current Code for Marketing of Breast Milk Substitutes legislation requires updating. There is currently no regulation of commercial food fortification, which should be done in partnership with local food producers to help to alleviate the threat of micronutrient deficiencies. Food safety regulations also need to be developed. (MoHSS, 2011)

Food and nutrition activities are currently governed by the Food and Nutrition Policy for Namibia, 1995 and the National Declaration on Food and Nutrition, 1995 (National Food Security and Nutrition Council), which needs to be updated based on current national priorities. Food standards are in place for institutional feeding and institutions are evaluated every three years. This is an ongoing activity which is also applied to new applicants.

The Code of Marketing of Breast Milk Substitutes has been drafted and included in the Public Health Bill, but not yet enacted. Plans are in place for the design of guidelines for internal and external quality control of food safety and food fortification. (MoHSS, 2011)

Municipal health inspectors play an import role in implementing food safety regulations, and regulating the activities of kapana (street food) sellers’ organisations. (MoHSS, 2011) Training is planned for industries and importers, and health inspectors on the control of food safety and food fortification. The Ministry of Trade and Industry (MIT) regulates imports and exports, so should play a role in the regulation of safe food products as well as ensuring that food standards are adhered to through laboratory analysis at the Namibian Standard Institution (NSI).

MAWF has adopted a Farming Systems Research and Extension Approach (FSREA) which has enabled support services to reach farmers through a participatory farmer group approach. The focus of this approach has been placed on training of farmers and extension workers. Food safety advice is meant to be conducted at community level in line with the PHC approach.

However, health extension services have been very limited due to a dependence on volunteers. This should be remedied through the new Strategy for Health Extension Workers that builds on the Policy on Community-Based Health Care (CHBC). (MoHSS, 13/10/2011; Directorate of Primary Health Care Services, MoHSS, February 2010; MoHSS, 2009)

The National Food and Nutrition Policy for Namibia (1995) calls for the public to participate in solving their own food security and nutrition problems. (National Food Security and Nutrition Council, August 1995) However, mobilisation efforts have been limited due to lack of capacity. A number of public information materials on food safety exist, such as Feeding Young Children from Birth to 5 Years of Age.

A Resource Book for Mothers in Namibia (MoHSS, Unicef, 1994) and Food and Nutrition Guidelines for Namibia: Food Choices for a Healthy Life (National Food Security and Nutrition Council , 2000). However, dissemination and use have been relatively low and the lack of IEC materials in local languages reduces their effectiveness.

The National Agricultural Policy of 1995 provides ‘an enabling environment for increased food production by smallholder producers and households, as a means of improving employment opportunities, incomes, household food security and the nutritional status of all Namibians.’

The nutritional condition of children in Namibia is poor. Almost 30% of children are stunted. This is a marked increase from 2000, where the number of stunted children was just higher than 20%. Of children born during 2006/ 2007, 14% had a low birth weight. This indicates that a significant number of women suffer of insufficient calorie intake, or have pregnancy related complications that condition foetus development. (WHO, 2011)

Women and maternal and child health care givers are aware of the importance of nutrition to the health of pregnant women. This can be seen in terms of the high percentage of women taking iron supplements. However, the percentage of women taking antiparasite medicines is rather low. (MoHSS and Macro, August 2008; WHO, 2008). The 2011-2015 Strategic Plan for Nutrition includes strategic priorities to improve maternal nutrition and contribute to improved maternal health, as well as reductions in neo-natal and infant mortality rates.

The Ministry of Education (MoE) constantly controls the quality of food under the Namibia School Feeding Programme, and provides training to ensure the safety of food served. (MoHSS, 2011)

Malnutrition still persists as a contributing cause of morbidity and mortality and as a hindrance for children and young adolescent to grow and develop to their full biological potential. It also influences the ability of children and young adolescent to learn and acquire the skills they need for living their lives.

According to the latest NDHS 2006, 29% of under-five year olds are stunted, underweight stands at 17% and severely underweight at 4%. The problem of under-nutrition coexists with overweight and obesity in the same age group, 4% nationally with an urban/rural differential of 7%/3%. It is of added concern that chronic malnutrition (stunting) has increased from 23% (2000) to the 29% in 2006. (MoHSS, July 2010; MoHSS and Macro, August 2008)

Micronutrient deficiency is still prevalent in Namibia. Goitre continues to be a problem although public health action has considerably reduced the problem. Vitamin A deficiency is still prevalent according to serological surveys of children and zinc deficiency is considered to constitute a problem calling for action. HIV/AIDS can cause reduced food consumption, interfere with food digestion and absorption. In a survey among PLWHA (2008), 20.1% were found to be undernourished (BMI <18.5) and 2.5 percent were severely malnourished (BMI <16). Alcohol intake as a calorie substitute leads to malnutrition with micronutrient deficiency. (MoHSS, July 2010)

Routine nutritional surveys do focus on the under-five year age group leaving large gaps in knowledge regarding the nutritional status of the rest of the population.

Namibia is experiencing a transitional phase in which obesity doubles the burden of malnutrition, which is seen in many other African countries. This trend is observable first in adults before having an impact on children. The NDHS 2006-07 reported that 16% of mothers were overweight, with a BMI between 25 and 29, and 12% were obese with a BMI over 30 (giving a total overweight/obesity rate of 28%). In the meantime, slightly more than 4% of the children were overweight or obese. This situation was more present in urban settings (7% vs. 3% in rural areas) and in wealthier households.

The Strategic Plan for Nutrition 2010-2014 calls for accelerated interventions to target early detection and management of obesity, and the implementation of a life-course approach to preventing and treating chronic diet-related diseases with specific interventions at all stages of life (foetus, infancy and childhood, teenage years, adulthood and ageing). (MoHSS, 2011)

The findings from the 2003 World Health Survey, STEP 2 Survey in 2005, and Namibia Global School-Based Student Health Survey in 2004 indicate that 41% of study population were physically inactive, 31% lead sedentary life, 41% of school students did not do any physical exercise. (MoHSS, 2008)

The Non-communicable Diet-related Diseases Programme of the MoHSS focuses on delaying mortality due to non-communicable diseases and promoting healthy ageing of people through the implementation of the Global Strategy on Diet, Physical Activity and Healthy Lifestyles (WHO, 2004).

Although the programme was initiated in 1994, it has not yet been implemented due to lack of capacity at national level, although implementation is planned by 2014. (MoHSS, July 2010; MoHSS, 2011) The NDHS is the only reliable and national source of information of food intake patterns in Namibia. The survey that was conducted in 2006 shed some light on this issue, though more specific and reliable data are needed for accurate targeting of nutritional needs.

For example, the NDHS 2006-7 data suggested reasonable intake of vitamin A-rich foods among young children, but the food categories included some that are not rich in vitamin A. Substantial research and surveillance is required for all areas of nutrition to ensure more informed programming. A Multiple Indicators Cluster Survey (MICS) is urgently needed to gather information on the knowledge, attitudes and practices of vulnerable groups (children and women of reproductive age).

Also proposed for the near future is a PROFILES analysis, a nutrition policy and advocacy tool developed by the Academy for Educational Development (AED) which is used to demonstrate the medium- and long-term impact of nutrition action on human and economic development. By 2014 an assessment of implementation of new practices in trained health workers, and household food consumption survey are required.