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

锌和铁缺乏症是一个全球性的公共卫生问题，最大的负担发生在低收入和中等收入国家。在巴基斯坦，40%以上的妇女缺锌，20%以上的妇女患有缺铁性贫血。这些微量营养素缺乏症对妇幼健康产生不利影响，必须找到可持续和具有成本效益的解决办法，该项目将调查生物强化在减少巴基斯坦锌和铁缺乏症方面的潜力。生物强化是通过传统的植物育种技术和添加营养丰富的肥料来改善粮食作物营养质量的过程。HarvestPlus已经开发出一种小麦，与标准品种相比，其锌和铁浓度显着增加。小麦是巴基斯坦的主要农作物，大多数家庭每餐都吃chapatis（由小麦粉制成）。因此，我们认为，生物强化面粉可能会使那些无法消费各种食品的社区受益。该项目有三个主要组成部分，将在两年内交付。第一部分是一项随机对照试验有效性研究，以评估食用生物强化面粉对锌和铁状态的影响。参与者将是生活在巴基斯坦西北部低资源社区的500名少女（10-16岁）和500名儿童（1-5岁）。在第一阶段（1-6个月），参与者及其家人将食用他们通常在当地购买的面粉。面粉的费用将作为参与研究的奖励予以报销。在第二阶段（7-12个月），他们将食用生物强化面粉（干预组）或标准面粉（对照组），这两种面粉都将在当地种植。参与者将被随机分配到干预组或对照组，他们不知道自己吃的是哪种面粉（研究小组也不知道）。将采取一系列生化措施来评估食用生物强化面粉对锌和铁状况的影响。我们还将记录腹泻和上呼吸道感染（儿童）的发病率，已知这些疾病与缺锌有关。第二个组成部分侧重于了解巴基斯坦的小麦种植条件，并支持农民提高生物强化小麦的产量和谷物质量。巴基斯坦80%的小麦种植地--旁遮普省将绘制土壤肥力和谷物质量的变化图。计算机建模技术将用于预测哪些土壤特性（例如土壤有机质、肥力）和管理方案将导致小麦籽粒中的最佳锌浓度。将对不同的情景进行成本效益分析，如标准小麦与生物强化小麦、添加锌肥、改善土壤有机投入等。第三个组成部分侧重于促进巴基斯坦生物强化小麦的可持续生产和消费。混合方法将用于探讨农民（小麦生产者）和社区成员（面粉消费者）的观点和观点，以了解哪些因素影响他们决定采用生物强化小麦或不。参与者将从边缘化社区招募，这些社区通常饮食最差，可能无法获得其他类型的营养干预措施，如集中强化面粉。巴基斯坦的小麦市场体系将通过与一系列利益攸关方的磋商进行规划。这些信息将用于制定和试点干预措施，以促进生物强化小麦的可持续生产和消费，以及与农民和消费者的密集沟通活动，调查结果将通过全面的影响途径活动传播给世界各地的研究人员，决策者，捐助者。

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.