In Bangladesh, the Chakaria Food System Rickets Project meets a large and heartrending need—preventing and treating diet-related rickets. Children are extremely vulnerable to this disease. Their bones soften and become malformed.

“You wouldn’t call it a maize project or a wheat project,” says CIMMYT agronomist Craig Meisner. “It looks at rickets from a ‘food system’ or ‘nutrient delivery’ perspective. In other words, what’s happening in Chakaria’s food and nutrition system to cause this disease?”

Shahidul Haque, of the CSO Social Assistance and Rehabilitation of Physically Vulnerable (SARPV), says that CIMMYT has helped focus the capabilities of many agencies to work on the food system–nutrition link as it relates to rickets, including CSOs such as the Bangladesh Rural Advancement Committee (BRAC), national agencies such as BARI and BRRI, and institutions such as Cornell University.

Before meeting Meisner, Haque focused on combating rickets through a school he established, where children receive treatment, an education, and learn about diets to prevent rickets (see photo below). The organization also lobbies government officials and has modest public awareness activities. It was through Meisner, however, that Haque saw the connection between agriculture and rickets prevention. He was also brought into the Cornell University–USAID-supported Chakaria Food Systems Project, which further extended his networking and outreach efforts.

“I’ve worked with CSOs that address nutrition-related diseases and deficiencies,” says Haque, “but they never talked about the whole food production system at the family level. Dr. Meisner and Dr. Razzaque from CIMMYT and their Cornell colleagues talk about family nutrition and family food production, and they also tie the issue into generating income and food security. Now I think that rather than reverting just to treatments, we need to look at food production and cropping systems and nutrient availability, if we are to address the affliction of rickets.”

Linking agriculture
and health

Chakaria, which is located in southeastern Bangladesh, has an abnormally high incidence of rickets. Compared to many other people in South Asia, the people in Chakaria are doing relatively well in terms of access to food, but in the past 20 years the incidence of rickets has gone from very low to high. About 50,000 children show some form of the disease.

“Usually rickets is associated with a lack of vitamin D,” Meisner explains. “The body manufactures vitamin D in the presence of sunlight, but there’s no shortage of sun here. Based on results of a USAID-funded clinical trial, we surmise that calcium deficiencies are a root cause of the disease, but questions remain. Rickets is not as prevalent in poorer areas of Bangladesh where more rice and a less varied diet are consumed. So why here, why now, and what can we do about it?”

Even when calcium is found in the diet, there are questions about its bioavailability, how the presence or absence of other micronutrients affects its absorption, and agronomic factors that affect calcium levels in the crops themselves. Perhaps the biggest challenge is to produce more calcium-rich vegetables and crops in a farming system heavily disposed to rice, and then get people to consume them.

Catalyzing change
in local food and nutrition systems

Aside from acting as a catalyst in the project, CIMMYT is pursuing the food and cropping system side of the disease equation and helping with public awareness.

“We bring CIMMYT’s knowledge in cropping systems research to the table together with the knowledge of the Bangladeshi institutes,” says Meisner. “Some dark green vegetables, pulses, and maize are high in available calcium, but not all are adapted to Chakaria’s acidic soils, and many diseases and pests make it risky for farmers to grow them.”

CIMMYT has contributed improved maize varieties to Chakaria, where maize itself is a relatively new crop. CIMMYT also provides expertise to produce seed of a virus-resistant okra developed by BARI so that more farmers can grow it. Aside from its health benefits—okra is rich in calcium—it fetches a high price, so growers like it. Improved cowpea varieties are available through ICRISAT, and project partners are facilitating their adoption along with improved mung beans. Both crops are rich in calcium.

Meisner and Razzaque are excited about increasing the production of calcium-rich foods in local farming systems through other technologies that CIMMYT works with, such as zero tillage and bed planting. Zero tillage would allow farmers to plant mung beans and other pulses more quickly after rice, which means higher yields and less risk of crop loss. Bed planting works well with okra and could encourage more lentil production. CIMMYT provides technical backstopping at a demonstration farm owned by SARPV, where techniques for producing calcium-rich vegetables are evaluated and demonstrated to local residents.

Reaching thousands

Through theatrical productions and a video, the project has reached tens of thousands of Bangladeshis with messages about treating rickets, eating a diverse diet to prevent rickets, and growing the food to support diverse diets. CIMMYT is also developing materials and a cadre of trainers to use the Whole Family Training approach (see "Smallholders Profit from Lucrative New Crop in Bangladesh") to promote farming systems that produce calcium-rich vegetables
and pulses.

“Being involved in these types of networks extends the impact of agriculture in many ways,” says Meisner. For Meisner, those payoffs are important, but they are not his immediate priority. “When you see a mother and father with their bowlegged, rachitic child, and they look into your eyes thinking you are ‘Doctor’ Meisner who is going to help them, it gets to you. I can’t do anything as a medical doctor—my doctorate’s in agriculture—but we can do something about the delivery of nutrition and food.”

	For more information:
	c.meisner@cgiar.org

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February, 2004