Mapfura database for Malnutrition

A digital application database of non-timber forest products as diet substitutes to convectional food sources to reduce the burden of malnutrition in Zimbabwe.

Malnutrition is a serious problem in Zimbabwe, affecting infants, children and women of a reproductive age. According to the July 2020 Zimbabwe Vulnerability Assessment Committee, prevalence of Global Acute Malnutrition in children between 6 months and 5 years was 7% which is above the 5% WHO threshold for public health emergencies. Stunting was 26.7% which remains high according to the World Health Organization classification. The minimum acceptable diet in young children has gone down to a record low at 2.1%, from 6.9% in 2019. Nationally, there was a decrease in households consuming diets with acceptable dietary diversity. Weekly disease surveillance for the month of December 2020 reported 195 kwashiorkor cases, 42 marasmus-kwashiorkor cases and 86 marasmus cases. Week 51 (14 - 20 December 2020) recorded the highest number of malnutrition cases (kwashiorkor, marasmus kwashiorkor and marasmus combined) on the weekly disease surveillance when compared to the same period in the past five years.

The Zimbabwe National Nutrition Strategy identified the following causal factors of malnutrition in children under 5 years:

1. There is inadequate knowledge and practices regarding appropriate and healthy diets for children, especially among mothers and caregivers of children in the first 1,000 days of their life;

2. Weak value chain for nutrient-dense foods (processed and unprocessed);

3. Weak coordination and inadequate resourcing of nutrition interventions in the country resulting in service coverage that is below scale, comprehensiveness and quality recommended for high impact interventions;

4. Inadequate knowledge and practices in relation to water, sanitation and hygiene and other pro-health seeking behaviors (such as immunization, family planning and malaria control), especially among mothers and caregivers of children under the age of five years; 

5. Absence of tailored nutrition services to meet needs of adolescents and adults outside the scope of regular maternal and child nutrition services; 

6. Weak capacity of systems for delivery of community-based nutrition services; 

7. Nutrition-blind social protection and other sectoral services; and 

8. Inadequate information to guide the design of relevant nutrition interventions, and assessment of progress made by on-going nutrition services within the Zimbabwean context.

Children who suffer from malnutrition are at a greater risk for recurrent infections and death. Stunting also prevents children from reaching their full mental potential with delayed mental development, poor school performance and reduced intellectual capacity. Nationally, this affects economic productivity. In Sub-Saharan Africa, child malnutrition is associated with approximately 60% under 5 mortality.

Mapfura, where we are deriving the name is a Shona word referring to the Marula plant which has a lot of benefits.Our solution is a database of non timber forest products (NTFP) which are locally and easily accessible to our underserved communities in terms of cost and preparation to try and provide substitutes to the now expensive nutritional food sources (also low in production of crops due to the drought effects of climate change) that are conventionally used by dieticians when prescribing a four star diet to malnourished patients. This database will include the NTFP, it’s nutritional value, where it is easily accessible geographically and what it can probably substitute, how to harness and prepare it. The database comes in the form of a mobile application which can be used by medical personnel and parents who have access to smartphones. This will come as an offline mobile application, with all the necessary information loaded onto the application and updated between every 3-6 months. We will use the Dart programming language which will allow us to have one codebase for both Android and IOS, which will allow for faster development, rapid updates and robust software. The USSD portal will then be used for those without smartphones and Internet access. They will dial in a code and receive necessary prompts and information from their network service provider, Econet or Netone. 

The solution serves families with children that are food-insecure, in areas most affected by malnutrition to meet their basic food and nutrition requirements. In 2022 Matabeleland North had the lowest household dietary diversity score followed by Mashonaland West and Mashonaland Central. Hwange and Hurungwe had the greatest proportion of households consuming poor diets, 92% and 72% respectively. There is a lack of availability of nutritious and diverse diets in these households which contributes to malnutrition. Access to the database of NTFPs (mopane worms, moringa powder, flying ants, honey, etc.) will allow families to easily source NTFPs thus improving the diets of children in the communities, leading to significant reductions in malnutrition rates. This would improve long term physical and mental health outcomes in their later lives. The database would assist caregivers in gaining knowledge on appropriate and healthy diets for their children as it contains nutritional values and the substitutions they would be making using NTFPs. 

Tendai Saungweme

• Medical Student graduating in 2023 who through rotations in pediatric medicine gets to witness many cases of malnutrition, interact with patience and parents to get an in-depth understanding of the causes and struggles. As part of the course works with a dietician in prescribing the four star diet in the growth catch up phase of malnutrition management witnessing the challenges that present in embracing it due to the low socio-economic status of patients.

• Went for elective (attachment) at Manicaland Provincial Hospital, a station which services all the districts in the province. Many malnutrition cases get referred there and he got the chance to also interact with the caregivers on the challenges they are facing in providing a diet that is adequate both in quality and quantity.

• Volunteered for a year with Biohub Trust, a non governmental organization that works in promoting Non timber forest products. He went for field trips to Nyanga and Mbire where workshops were done and also set up honey apiaries. 

• Through the international federation of medical students associations, worked on issues to do with social determinants of health (involving malnutrition as a result of low socio-economic status), SDGs 2& 3, courses on From idea to impact.

• Entered an essay competition on sustainable livelihoods and conservation in 2019.

Daniel Savanhu 

• Final year medical student who is keen on seeing greater use of technological solutions in Zimbabwe. 

• Early experiences include creating a Quiz Application for preclinical medical students to help in Anatomy, Physiology, Behavioral Sciences and Pathology. 

• Well-versed in Python, Android Programming and Java, and I have recently completed my Web Designing course with Freecodecamp.org, to equip me to achieve the tasks at hand. 

• After my pediatrics rotation, it is imperative that we come up with solutions to lower the burden of protein energy malnutrition in our underserved communities, in order to give these children a better chance at a healthy, more fulfilling life

• Interventions to our solution has two components .The first one is establishing the burden of malnutrition in Zimbabwe answer this question ,through our clinical rotations as medical students at central hospitals, provincial hospitals and rural attachments , we have come across every day with many cases of malnutrition, clerked the cases and followed them through the whole management took the opportunity to speak to the caregivers in trying to establish the cause and challenges that would present once the child would have been discharged. In most cases due to the low socioeconomic status of many people in the country ,many are not able to provide the child support with a diet that is adequate both in quality and quantity. We have also used secondary data from the ministry, World Food Program (WFP) country office and from an NGO called Fight against hunger which has shown a great need for an intervention to save our future children from stunting, wasting and severe effects of malnutrition.

• Secondly, we have started a consultative process with BIOHUB trust which has been doing work on Non timber forest products for sustainable livelihoods in remote areas of Zimbabwe. We have also engaged certain professors within the organization who have expressed the need for such a tool that we are developing to improve the diet of people as substitutes for the now scarce meat protein in underserved communities of Zimbabwe. This concept was sparked through a study that they did by introducing moringa powder into the porridge of a certain group of children in Binga district which greatly improved their nutrition.

This is a solution which is targeting the underserved communities who have difficulties in achieving a balanced diet for their children. We believe we'll be able to reduce the burden of malnutrition in this population with resources that are easily accessible to the communities living in poverty. This also empowers medical personnel and nutritionists with excellent alternative ways for diet supplementation as they will now have information on NTFP on their cellphones, which was not universally available to all health personnel. We believe using the data on NTFP will further drive research in this field, further benefiting the underserved population.

• Firstly, finish developing the application and beginning a consultative process with the ministry of health and other non governmental organization stakeholders (at least 3 working on promoting the usage of non-timber forest products) to discuss the outpolling of the tool to district hospitals first (beginning in highly burdened regions) followed by clinics then community health workers.

•  Do a pilot study in 5 districts randomly selected, to engage the target population and record their views, keenness to use the tool, areas of improvement and if there are any things that they feel we should add to make it user friendly and very beneficial.

• To have contacted Econet telecommunication service on developing a USSD code with a bot for the benefit of users who may not own a smartphone.

• Host at least 5 community workshops in marginalized areas e.g. one in Nyanga, Hwange, Mbire, Malipati and Muzarabani.

A mobile application which can be used by medical personnel and parents who have access to smartphones. This will come as an offline mobile application, with all the necessary information loaded onto the application and updated between every 3-6 months. We will use the Dart programming language which will allow us to have one codebase for both Android and IOS, which will allow for faster development, rapid updates and robust software. The USSD portal will then be used for those without smartphones and Internet access. They will dial in a code and receive necessary prompts and information from their network service provider, Econet or Netone

Expect to serve and directly impact 5000 people at minimum.

Technical barriers -Internet penetration in Zimbabwe remains at 34% meaning it may be difficult for people to be getting constant updates.We are going engage with the network service providers to make the application get updates on any phone with network and not necessarily data.

Financial barriers -Due to the highly inflated Zimbabwean dollar trading against the United States dollar goods and service provides tend to overprice which presents a challenge on procurement and may put a strain on the budget when we try to set up our first plants.

Legal barriers : Approval by the health board for NTFP as diet substitutes.However, the minister of health recently made a call for input into how we can tape into indigenous products for alleviation of health conditions which will not present much of a problem.Also,collection and access to NTFPs is generally regulated by By-laws under rural district councils together with Forestry Commission through its Communal Land Produce Act (Chapter 19:05). But since we are able to access a supporting letter and documentation from the University, we can have unrestricted access to these NTFPs. It also becomes  much easier if since we are able to identify areas /districts where these NTFPs are found. This way we can manage to make arrangements with our local Forestry Commission offices to help us access all the relevant people and materials. 

Market barriers - Due to the highly polarised economy in Zimbabwe and big difference between the rich and the poor, most people survive on retailing which poses a tendency for people to buy and overprice our produce on the market.This makes the poor fail to afford yet they remain one of the main targets of this intervention.To curb this we will resort to the electronic pseudo-commerce concept as stated in our business model

Biohub Trust is offering technical support in accessing geographically based information on non-timber forest products, facilitating a partnership with and organization Fight against Hunger and assisting in the implementation of our tool to marginalized districts.

Initially,through a grant , we are going go undergo the implementation of our mapfura database application for malnutrition to our targeted areas for people to familiarise ,use and also get to be educated on non timber forest product.In the process,we are then going to register our venture as a private limited company (Mapfura digihealth) for proper governance, planning and finance accountability are going to register our venture as a public limited company which will enable us to access loans and further grants to venture into production of NTFP starting with 5 key areas .We intent to set up production plants eg honey apiaries, mopane worms processors etc.We will then set up an online market which we list our products for sales on a delivery bases. In Zimbabwe there is high polarization between the haves and the have nots and due to the economy that now survives on buying and selling there is a high chance that our products get overpriced by the retailer and will not be affordable to one of our targeted group of customers in the rural areas . To curb this we will introduce a new innovative concept we call pseudo-electronic commerce as a solution.

We decided to call it ‘pseudo-electronic commerce’ because it’s not entirely electronic. It’s modified to suit the Zimbabwean economic terrain where internet penetration stands at only 33.4%. The idea of pseudo-electronic commerce is to get goods to people in small towns and villages at prices close to those charged in the cities, and here’s how it works. One sets up a booth in a small town. They create a billboard , showing high resolution images of the merchandise they sell, and assign a unique code to each product on sale. They create a digital version of the billboard in the form of a WhatsApp catalogue, which can be distributed on the widely used social media platform. Consumers place their orders by quoting the unique product code and paying in advance at the booth. The price charged is very close to that charged in the capital. In real time, the orders are relayed to an agent based in the capital. The agent purchases the ordered items and places them on the everyday commuters that transit between the capital and the small town for delivery. Buyers come back after 24 hours to pick their orders at the booth. With the current economic realities, who wouldn’t be willing to wait 24 hours and save $10 or more? This method has been proven to dramatically lower the cost of goods in rural areas. Taobao in China is an example of how impactful this modern retailing system is.

In addition employees on our plants will come from the underserved communities so as to improve their livelihoods.The targeted malnourished child will also benefit from the business corporate social responsibility.

Value proposition- Our underserved communities affected by malnutrition will benefit from the venture through employment opportunities from our established plants , education on how to harness and use NTFP as a way to fight malnutrition , funds from business’s corporate social responsibility responsibility.

Key customers : For the application, we are targeting all district hospital centers beginning with targeted ones, communities through outreaches and workshops as well as everyone in towns and cities who will also appreciate the value and health benefits of NTFP.Our product on the online market will be listed for all Zimbabweans to purchase with the plan to expand firstly to South Africa, Zambia, Malawi , Botswana and the United Kingdom and beyond.

Key activities: Application launch workshops, advertising, engaging in partnerships, production of NTFP in plants as well as sales.

Revenue streams :Grants ,loans from the bank, sales from products.

Key expenses: Transportation, capital for production, social responsibility to fight malnutrition using our product, company registration expenses.

Initially we would want to use a grant for the development and implementation of our database and well as advertising it over all national platforms.After registering as a private limited company, we become eligible to apply for small loans and grants for companies which we are to use to establish our production plants.We intent to list our products on an online market which we will extensively advertise to make sales locally and through export  that will generate us more income.We will also be partnering with other organizations ( both not for profit and profit making ) to apply for further grants to fund our venture.