A lot has been tried by many different actors throughout several decades, to alleviate and eventually eradicate Vitamin A Deficiency (VAD) in Tanzania. Efforts there started in 1987 when, to begin with, children in medical care suffering from VAD related diseases were given supplements of this micronutrient (Masanja et al. 2006). Since then, nothing has been left untried. Vitamin A Supplementation (VAS) was integrated into routine checkups for post partum mothers’ as well as for children at the age of 9 months together with measles vaccination. In 2001 UNICEF introduced bi-annual VAS for children from 6 to 59 months nationwide, alongside a campaign to create public awareness for the widespread problem. 
These bi-annual supplementations are still going on today (Masanja et al. 2006). And last but not least, there have been efforts since 1990 to engineer and introduce the so-called “Golden Rice” (GR). It aims to solve this form of malnutrition once and for all by enhancing the staple food rice with elevated amounts of beta-carotene (which then is converted into Vitamin A by the body) through biotechnology (Nash 2000). Due to several reasons, including technical challenges, legal barriers and public resistance, GR has not (yet?) found its way into the fields of farmers in the affected regions (Philpott 2016). Critics have also rightly pointed out that by merely boosting the content of beta-carotene in rice, VAD probably won’t be solved. Vitamin A is a fat-soluble nutrient and therefore can only be properly absorbed by the body in combination with a source of fat (TNNS 2014). But prevalent diets in countries affected by VAD are often also lacking in other nutrients, including fat, a factor that can decrease absorption (Nestle 2001).
Despite all these efforts and different strategies, VAD remains a problem in Tanzania. A notable one, as one third of Tanzanian children age 6 to 59 months and one third of Tanzanian women age 15 to 49 years are still suffering from VAD in 2014 (UNICEF). VAD is not only the “leading cause of preventable blindness of children in the global south” (Mullins 2011), but it is also responsible for an “increased risk of disease and death from severe infections like diarrhoeal disease and measles” (WHO). This persistent rate of VAD reveals the at least partial ineffectiveness of the previously taken measures: While VAS is likely to not reach certain groups of people and therefore can be compared to a wide-meshed net, GR is still facing legal and technical problems and is therefore not likely to pass a
s a viable solution any time soon. It is therefore important, given the lack of a currently available and comprehensive solution, to tackle the matter differently, namely by the roots: Vitamin A is contained in many root and other vegetables, which are available in Tanzania. Especially the ones orange and dark green in color contain high amounts of Vitamin A: Sweet potatoes, carrots, pumpkin, mangos, green cabbage and spinach are only a few of Vitamin A rich foods (NIH). These foods, eaten regularly and combined with any source of fat – for example a few drops of oil or a slice of avocado – can ensure Vitamin A intake of the body and prevent children from going blind while reducing overall child mortality (WHO). Due to the fact that animal products, despite them being excellent providers of bio-available Vitamin A (NIH), are not affordable on a regular basis for most people affected by VAD, they can’t be a part of a large-scale solution.
There have been efforts to increase knowledge about VAD among the general public and health care workers in Tanzania (see for example Kidala et al. 2000). This has to be accompanied though by providing mitigation instruments in order for the affected to take 
the reins themselves. By calling upon the people’s own initiative, the growing of fruits and vegetables in one’s own garden can represent an important source of Vitamin A. Advantages of homegrown alternatives that can complement supplementation campaigns are manifold: This kind of supply has a greater reach than traditional VAS which only aims at children and women of a very specific age. It can also enhance and diversify the general consumption of fruit and vegetables which is essential for a well-balanced diet. And it ensures the regular provision of vegetables at a relatively low cost. SAT herein assumes the role of a trainer that provides the small-scale farmers with knowledge and assistance in the organic cultivation of foods rich in Vitamin A and helps them to overcome possible challenges.
The approach’s strength lies in its holistic focus and 
in its immediate and sustainable effects. It not only tackles VAD at its roots, literally, but also improves food security and a well-balanced diet of small-scale farmers and may even generate an additional source of income. Instead of isolating the problem, an unbalanced diet due to various reasons, and fighting its symptoms, VAD, one can also start at the root of the problem. This is what SAT chose to do by enabling small-scale farmers to help themselves – approaching several challenges at one go.
This article is part of a recurring series on nutrition in connection with sustainability and SATs activities, written by Karin Augsburger, a volunteer at SAT.
References:
Kidala Diana et al., Five-year follow-up of a food-based vitamin A intervention in Tanzania, in: Public Health Nutrition 3 (2000), 425-431.
Mullins Jolene and Laura Ehrlich, Assessment of the National Vitamin A Supplementation and De-worming Program in Tanzania. Strategies for VAS and De-worming Distribution in Tanzania. Five Year Plan, in: http://www.a2zproject.org/pdf/TanzaniaVASDAssessmentStrategicPlan.pdf, 08.04.2016.
Nash J. Madeleine, This Rice Could Save a Million Children a Year, in: TIME. http://content.time.com/time/magazine/article/0,9171,997586-3,00.html, 06.04.2016.
National Institutes of Health (NIH), Vitamin A. Fact Sheet for Health Professionals, in: https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/, 08.04.2016.
Nestle Marion, Genetically engineered “golden” rice unlikely to overcome vitamin A deficiency, in: Journal of THE AMERICAN DIETETIC ASSOCIATION, 101³ (2001), 289-290.
Philpott Tom, WTF Happened to Golden Rice?, http://www.motherjones.com/tom-philpott/2016/02/golden-rice-still-showing-promise-still-not-field-ready, 04.04.2016.
Tanzania Food and Nutrition Centre (TFNC), Tanzania National Nutrition Survey 2014. Final Report, 2014.
UNICEF, http://www.unicef.org/tanzania/nutrition.html, 04.04.2016.
WHO, http://www.who.int/nutrition/topics/vad/en/, 06.04.2016.