by
Professor Folake Samuel
Corridor discussions, seminar discussions, conference discussions and the like are a long-established feature of university life. I grew up to be a part of these kinds of interactions at the University of Ibadan, though I have observed that over the years, these have significantly reduced in number and even I daresay in quality. Who is to blame when lectures are just barely trying to stay afloat during a heavy crushing workload that has daily increased even among those of us “left behind” in the Nigerian higher education system?
I want to sincerely thank Dr Philip Olayoku for conceiving these ideas in his scholarly womb. And to his midwives : Dr Kudus, Dr Tella and others, I say thank you for together birthing this platform for us to have a rich academic conversation that showcases the scholarly identity of each of us here, thereby positioning us as thought leaders in our field. I am particularly excited at the insights that could be generated at the intersections of knowledge from our very different fields of research. Truly, as my biological father and first academic mentor loves to say: “Knowledge is one”.
In the next 15 minutes or so, I would like to highlight to this distinguished audience who I am in the nutrition research space and also, present an overview of my research career so far. What I will discuss will be limited to a small portion of the soup that God has helped me to cook these past couple of decades of my scholarship, but I will provide about enough to give a flavour of my intellectual activity and research. I realise that this is a wider audience than I have been used to. It is a mixed audience from a variety of disciplines. So, I will refrain as much as I can from technical jargons. So, in advance, I want to ask that you pardon my simplicity if it deviates from the scientific and academic norm that we are used to in university discussions.
Here today, I am more concerned about how to make my work accessible to the broader community. When I was first approached to join these two highly respected professors in a professional chat, my first reaction was panic. Those big words ‘Extalgia’ and ‘Wombiture’ … how do they link with my down-to-earth community nutrition? As a scientist, I have always respected the Humanities for their profoundness, creativity and complexity. However, I quickly reminded myself that this was also a good opportunity to learn; so I agreed to give it a go.
Permit me to introduce myself to you. I started with a bachelor’s degree in Food Science and Technology from OAU Ile-Ife. My project Supervisor at that time, the late Prof J.B Fashakin, kindled in me the love for nutrition, so I decided to apply for a Masters in Human Nutrition at UI. That marked the beginning of my relationship with Human Nutrition. Now, my broad area of research is community nutrition, which is a field of public health that focuses on improving the nutritional status of communities through a variety of strategies. It involves working with individuals, families, and communities to promote healthy eating habits, increase access to nutritious foods, and address the underlying social, economic, and environmental factors that contribute to malnutrition. In my work, I have probed issues around the nutritional well-being of people in various communities such as the urban, rural, workplace, marketplace, schools; and across the lifecycle from infancy to old age. My playing field has been Nigeria and South Africa.
Today, I want to structure my discussion around three buckets of my thoughts and research in community nutrition, with the exciting expectation that some ingredients can be gleaned from it to add to the discourse alongside insights from Professor Sola Olorunyomi and Professor Senayon Olaoluwa.
This is the outline of my discussion:
The First Bucket: “You are what your mother ate.” You have heard it said a lot of times that you are what you eat, but while this is true, this statement – you are what your mother ate is more profound. It alludes to the profound impact of maternal nutrition on the health of offspring.
The Second Bucket: “We need to look backwards to move forward.” In this bucket of thought, I want to unpack the concept of ‘nutrition transition’ and highlight its manifestation and consequences for Nigerians.
The Third Bucket: A brief celebration of my efforts in combining scientific research with insights from the Humanities and Social Sciences to gain a more comprehensive understanding of nutrition and food systems.
- “You are what your mother ate”.
Nutrition starts from the womb. Every part of your body was once a nutrient consumed in food. As such, an early start to healthy eating pays off. From your bones to the skin, every cell in our bodies is built from the nutrients we absorb from our food and our mothers while in the womb; and essentially from her breasts, once the child is born. The Maternal diet can “program” the child’s life, setting the stage for lifelong health; and development of the health and growth of the child. It is like building a strong foundation of a house – the materials and care you put into the foundation will affect how strong and stable the house will be. Leading from this is a very profound concept in nutrition namely the foetal origins of disease, which is theorised as ‘health problems that people have in adulthood can have their roots in their womb – time experiences!’
The Biafran war of 67-70 in Nigeria provides a tragic example of the long-term consequences of malnutrition during pregnancy. Key findings from a cohort study in Enugu showed that children born during the Biafran war had a significantly higher risk of developing chronic diseases such as hear disease, diabetes, obesity and HBP. 40 years after the war, and resulting from the acute food shortage and hunger which they experienced while their mothers carried them in the womb, these individuals were found to have increased risk of these diseases. What this implies is that priority must be given to the prevention of malnutrition during pregnancy and in infancy. Policies and interventions in community and public health nutrition include food fortification, nutrient supplementation, antenatal care, breastfeeding initiatives, community-based nutrition education programmes, and food security initiatives among others.
Some of my research work had duly focused on this priority.
For instance, some of my work have focused on the deficiencies and dietary intake gap of micronutrients particularly zinc, iron, folate, iodine, vitamin A and vitamin E in children, women of reproductive age, adolescents and the elderly. Results revealed poor micronutrient status and failure to meet the recommended dietary diversity and micronutrient intake in the communities in which these studies were carried out. To address these problems, we have used food science research to develop, test and promote nutritious foods, particularly for infants and young children. These foods consist of a combination of various food staples successfully prepared using simple methods and effective technologies that are well-suited for household and community-level utilization in Nigeria
I have worked with a host of collaborators to explore the nutritional vulnerability of children in urban and rural communities in Nigeria. The findings have confirmed the high burden of childhood undernutrition and revealed that the causes vary in different settings. One consistently observed cross-cutting cause is poor child feeding. Hence, I have studied breastfeeding and complementary feeding in different dimensions such as knowledge, attitudes, intention and practices of mothers, fathers, health workers and institutional caregivers. Other socially vulnerable, and left behind groups in the community, including out-of-school apprentice girls and schoolgirls with hearing disabilities were studied. Afterwards, we developed, implemented and evaluated interventions and found them to be effective in improving knowledge, attitudes and practice of child feeding.
The 3 year CASSAVITA II project is a case in point. This was a community-based randomized controlled trial conducted in Telemu Osun State that showed that children who consumed yellow biofortified cassava had a reduced risk of vitamin A deficiency; thus, showing that biofortified cassava is a sustainable and culturally appropriate solution for improving vitamin A status, especially in regions where access to vitamin A supplements is limited. In community nutrition, the understanding of the importance of maternal, infant and young child nutrition leads us to work on interventions for adolescent girls (pre-pregnancy and pre-breastfeeding preparedness), WRA, infants and children.
Now let us look at the second bucket of my thoughts: “Looking backwards to move forward”. Here, I want to expand on the transformation of the food system and the nutrition transition in Nigeria. My emphasis is that we need to urgently intervene and invest in our local food systems if we truly want to make significant progress in addressing malnutrition in all its forms in Nigeria. A quick clarification is needed here, to say that, while malnutrition is often associated with not having enough food, it can also mean having too much of the wrong kind of food, or a combination of both, hence we have malnutrition as both under and overnutrition.
Something is happening to the food systems worldwide, and it has not spared Nigeria. These changes have largely been driven by modernization, urbanization, economic development and market globalisation. It is a multifaceted challenge that we need to face headlong because it is associated with increasing undesirable health outcomes in the community and populations as a whole. Some of these dietary changes have led to the cultural erosion of traditional food habits and a narrowing of local patterns of dietary diversity. These are occurring side by side with increasing sedentariness thus leading to the development of undesirable health outcomes, particularly the development of nutrition-related non-communicable diseases among populations in which these changes are occurring.
In Nigeria, food eating patterns are changing and with this, the nutrition landscape is being modified. There is generally a shift away from traditional diets towards more Western diets, which is resulting in health implications, loss of knowledge about local/traditional foods, how to prepare them and also the agro-biodiversity that they bring to the food system. Due to the pressures of urban life, women and men do not have the time to cook traditional foods and young people are more interested in international fast food and snacks.
We have moved from simplicity in our traditional meals to complexity occasioned by advances in science and technology, with the resultant explosion in the variety of processed food products available in the market. While these have some benefits, especially in terms of convenience, food preservation, reduced postharvest losses and filling the production gap, there remain several unanswered questions with respect to the public health implications of these changes.
During the pre-independence days, the colonialists brought new diets as well as new food cultures. Over time, the transformation in Nigeria’s traditional food culture became obvious when it became easy to observe that the different cultural perspectives on food were gradually being eroded, while new ones or amalgams of the traditional and new were being formed. Globalisation has indeed played a significant role. There is a rapid diffusion of food culture from one region of the world to another, and people are quickly adopting new food patterns. Global foods have taken over our palates, that is, foods and beverages that have originated from specific cultures but are now consumed widely even at a global level. Examples include bread, cakes, biscuits, popcorn, chocolate, yoghurt, hotdogs, french fries, oatmeal, fried rice, noodles, samosa, ice cream, tea, salad, spaghetti, macaroni and pizza. Global foods originating from Africa include coffee, jollof rice and pepper soup. Globalisation is not a one-way process but a complex issue in which diversification and homogenisation of food culture are occurring simultaneously.
This, essentially is the concept of the nutrition transition. Nutrition transition has occurred in all regions of the world – with variations in the nature and pace of change; but essentially, with similar net effects on nutrient intake and nutritional status. It typically involves a move from a traditional diet toward a Western diet, with all the accompanying changes in physical activity and body composition. Modern societies seem to be converging on a pattern of a ‘Western’ diet high in saturated fat, sugar and refined foods and low in fibre.
Compared to other regions of Africa, the West African diet is still mostly traditional, but there’s a growing acceleration of the nutrition transition. This shift is linked to an increase in health problems like obesity, diabetes, and heart disease. A recent study found that these dietary changes are contributing to the high rate of stroke in Nigeria. Urbanisation is one major factor that is driving the way and pace by which diets in Nigeria are gradually being changed. There is a heavy reliance on imported food, especially polished rice, which has occupied a prime place in our daily meals all over the country, as well as fast street foods, while consumption of vegetables and fruit remains low. (More on this later)
Furthermore, there is a preponderance of motorised transport: traffic and long hours of commuting (including by car and public transport) and reduced exercise and physical activity due to office work, marketplace work, television watching, playing of computer games, lack of space for outdoor play for children, and work simplification in the home due to more labour-saving devices and technologies.
To put the issue of urbanisation and the nutrition transition in Nigeria in a proper perspective, it is necessary to highlight the magnitude and trends of urbanisation in Nigeria. In addition to accelerating population growth (the current population is estimated at over 200 million), the proportion of people living in urban areas has grown rapidly over the past decades. In 1991, one in three (33.3%) Nigerians was an urban dweller, compared to 40 years earlier when it was just one in ten (10%). At present, the proportion of urban to rural dwellers in the Nigerian population is about equal, with urban projected to be ahead of rural by 2025 (United Nations, 2018). The implication is that millions of Nigerians may soon join the nutrition transition ‘train’ and suffer from its ill effects, if actions are not taken urgently. How will our growing population be fed in 2050? How will our rapidly urban food systems be saved from the sophisticated, tempting, sometimes, forceful transformation of our nutrition space and resulting health?
To eradicate malnutrition in all its forms, it is imperative to intentionally bring a sustainable healthy diet perspective into the re-design of our food systems. This requires us to reverse our thinking: to look backwards to move forward – I am trying to emphasize the connection between our past and our future, and the importance of preserving traditional practices for the sake of our health and well-being. I want to bring us to a conversation between the old and the contemporary, all in preparation for a healthy future for all of us here and those who are to come – from the womb. Are we leaving our healthy traditional food culture behind? How can we make our traditional foods more available and accessible? What can we do to nudge us back to our (health-promoting) cultural nutrition heritages? In other words, there is a need to look backwards in order to move forward.
“We must not yield to cultural erosion; we must not take the foreign cultures inflicted on us hook, line, and sinker…. (however) we certainly must leave ourselves open to the ideas and developments from the globalized world, but our foundation of what we hold dear must be secure and strong enough to resist unsavoury and negative influences from outside” – Bolanle Awe (2010).
This brings me to the last two minutes of my presentation. This third thought will be brief, so that we can have some more time to chew on from the full discussions on wombiture and extalgia.
This aspect is an appreciation for the aspects of my research that have enjoyed methods, tools and perspectives from the Humanities and Social Sciences.
Methods such as cocreation, human centred designs, citizen science and real world interventions have greatly shaped my research in recent times. Around the time that COVID 19 struck, our research team aka FRUGGIES was busy implementing a community-based intervention study to promote the consumption of fruits and vegetables (F and V) among low income urban communities in Nigeria and Vietam. The aim was to create innovative food systems interventions that would support increased F and V consumption especially among economically-left behind people. We explored several interventions such as fruit coupons, promotional campaigns in schools, churches, mosques, radio etc, in partnenrship with market women at ojoo, moniya, abaeja and bagadaje.
Food choice comprises a complex interplay between culture, availability, price, quality, palatability, preference, convenience, perceived food safety, needs, and aspiration. Food choice or choosing to eat F and V is by no means a purely rational process, and it can be influenced by numerous environmental factors. Consumers depend on what is on offer, but their choice will ultimately be based on a mixture of rational and emotional drivers. This was why our study used a combination of surveys, interviews, and workshops to understand how marginalized communities can create new food retail innovations. We borrowed ideas from the humanities and social sciences, and then demonstrated that these communities could develop ideas for F and V consumption that are both practical for markets and homes. Both market vendors and low income consumers liked and embraced these new ideas.
Our findings also suggest that involving vulnerable people in public health initiatives can lead to innovative solutions that are contextually relevant, specific to their needs and can promote healthier eating habits. These results confirm the potential of bottom-up, co-creation, real-world interventions within informal settings to contribute towards fostering inclusive transformation of food systems.
Key takeaways: You are what your mother ate, let us look backwards to move forwards and community nutrition, though hosted in the College of Medicine, has benefited from methods and tools from the Humanities and Social Sciences.
Professor Folake Samuel is a Professor of Community Nutrition at the Department of Human Nutrition and Dietetics, University of Ibadan, Nigeria.