Vitamin Distribution to Remote Rural Communities in Gambia

Foundation for Rural Education, since 2016, has been intervening in remote rural communities that are normally left out of official government distribution of vitamin A for children under the age of five which should be taken biannually including intake of multivitamin for women who are breastfeeding and those in pregnancy. What we have realized over the years is that, due to the quantity of vitamin drugs we receive as Field Partners of Vitamin Angels (a US based charity) in The Gambia, coupled with the fact that we lack transport van of our own, logistics is always a problem to reach our beneficiary communities all over the country.

A recent report by the Food and Agricultural Organization on The Gambia describes the crippling effects of lack of enough vitamins in the country especially in rural communities which has resulted into the prevailing high rate of malnutrition. Annually, The Gambia loses over US dollar 10 million in Gross Domestic Product (GDP) to vitamin and mineral deficiencies Scaling up core micro-nutrient interventions would cost just over US dollar 1

million per year. The Gambia has relatively lower rates of stunting than countries in its region and income group. However, within the country, there is likely to be variation across geographies and socio-demographic groups.
The first and only Demographic Health Survey (DHS) in the Republic of The Gambia  was conducted in 2013, and found that under-5-mortality had decreased in the 15 previous years from 89 to 54 deaths/1000 live births Reductions in other child mortality indicators have also been observed, and were reported to have met or even exceeded Millennium Development Goal (MDG) Target #4.  The prevalence of stunting and wasting remained mostly unchanged in the same time period: in 2015, a SMART survey estimated that 23% of children 0-59 months of age
were stunted and 10% were wasted; the 2013 DHS found prevalence of 25% and 12%, respectively, while the 2012 SMART survey reported respective prevalence of 21% and 10%; in 2000, the Multiple Indicator Cluster Survey (MICS) found prevalence of 19% and 8%. Among children, the problem of overweight seems as of now to be limited, considering that its
prevalence is less than 3%. On the other hand, about a quarter (23%) of adult women are overweight  according to the 2013 DHS. The 2015 SMART survey found similar results, with 24.1% of women classified as overweight or obese
In The Gambia, nationally-representative data on micro-nutrient status and diet-related non-communicable diseases (NCDs) are limited and/or outdated. The last national micro-nutrient survey on iron and vitamin A status was conducted in 1999; it estimated the deficiency prevalence in preschool-age children and pregnant and lactating women. The prevalence of iron deficiency for all groups ranged from to 20-26% (see [3]; note that these prevalence estimates were adjusted for some measure of acute phase response). In children and pregnant women, the majority of anemia was associated with iron deficiency, while in lactating women, about half of anemia cases were also iron deficiency.

The use of adequate technology is part of our intention in engaging in MIT Solve challenge. Since the organization's membership consists of teachers, medical practitioners and nurses, we are thinking of adopting the use of 'expert system' technology.Vitamins are organic foods that are indispensable for the growth and health of the body

In case of health problems, especially lack of vitamins, people are more
trusting doctor and nutritionist to find out whether the treatment is
still low-level disorder or chronic. With the use of technology
applications such as expert systems, the needs of society in diagnosing
early vitamin deficiency can be realized. An expert system is one branch
of artificial intelligence to learn how to “adopt” an expert way of
thinking and reasoning in solving a problem, and contains a decision and
draw conclusions from a number of facts. Application of expert system
diagnosis of vitamin deficiency in humans is in the form of
desktop-based application. This application uses forward chaining method
and technique of depth first search engines. Forward Chaining method is
a a method that is driven by the data where the tracking starts from
the observation of the input information and then try to describe the
conclusions. Application of expert system is able to facilitate
community in diagnosing early vitamin deficiencies that can save time,
costs, and makes it easy for the user.

Since acute shortage of vitamin in these rural population can only be determined by the use if medical experts advise, coupled with access to the beneficiaries which the government has been avoiding due to their remote locations, and this population, based on our analysis are over 200,000 people, the organization requires a van to serve as a mobile clinic which will periodically visit these communities which are over one hundred and fifty villages in the five regions of the country in order to benefit this population.

It seems that the health service nowadays is lack of doctor and  nutritionist to take care of any nutrition problem including vitamin deficiency. This can be solved through using the technological application to solve the problem nutrition problem especially vitamin. Expert system is a smart computer program that use knowledge and inferential procedure to solve difficult problem that needs expert to solve it . An expert is a person who has capability in particular domain, has knowledge or special skill which doesn’t have and know by anybody else.

The target population are those communities located in remote parts of North Bank Region, Central River Region, Upper River Region, Lower River Region and West Coast Region whose combined population are more than 200,000. These are a subsistence farming population without access to Western education and do not understand the importance of balanced diet ad cannot even afford it. In view of this, we have their population malnourished as a result of poverty. They have no health facilities and currently, they can only be served by mobile facilities.

Considering the fact that they do not have health service providers posted to their communities as a result of the fact that no health worker will willingly accept to serve in these communities, it is very important for civil society organizations to take up the challenge as the dwellers in these communities are also part of the Gambian population.

We believe that, if the government can set up teams of health experts to visit these communities regularly, and not leave it to civil society organizations to visit, educate and distribute vitamin drugs to these communities, citing the fact that The Gambia is a poor country as expressed by the UNDP poverty index, the poor vulnerable population will be taken care of. The fact that we have been able to trace each beneficiaries home in these communities over the five regions despite our little resource base and distribute vitamins bi-annually since 2016, means we have been able to take care of the needs of this population and with adequate support, we will be able to improve the living standards of the beneficiaries.  

After conducting a feasibility studies of these locations in 2016, we realized that it was necessary for us to have offices in all the regional capitals across the country. Another thing we did was to visit community

Our solution currently serve over 200,000 people.

We are planning to solve the problem f accessibility to our beneficiaries by using this platform to gain publicity around the world and receive the required support to secure more vitamins and distribute them to beneficiaries. 

Another thing we are trying to achieve is to be able to secure at least two vans that will make us have a quick access to our beneficiary communities so that we can meet our overall target of our intervention in good time.

Our solution to vitamin deficiency in The Gambia have shown that even remote rural communities can be accessed with life-saving drugs since it is their rights as citizens to have a good healthcare like their urban counterparts. We made use of horse and donkey carts to penetrate these rural communities with our Vitamin A, Albendazole and Multi-vitamin tablets on a bi-annual basis.

This can become broader if we have access to vans such as jeeps or land rovers that can penetrate rough roads which will help us to conveniently access these communities. If this is possible, we will be able to have access to much larger quantities of vitamins which will be beneficial to these communities. Eventually, we will be able to provide cheap healthcare for the communities and the inhabitants will become healthier.

Our impact goal for next year is to is to increasingly penetrate more communities and presently, we are serving around 135 communities and we plan to add another 25 to this number in a year's time.

In another five years, we plan to have cover 230 communities with our vitamin solution and then, we will be left with around 25 communities to cover. We plan to have an impact on all these communities and enable Gambia to have healthy citizen and improve on the nation's GDP since as they say, 'health is wealth'.

In health, The Gambia has one of the best health care systems in the sub-region. For instance, our immunization coverage is praised as one of the best and evidence exists to show that over 90 percent of pregnant women are seen and checked by a trained health worker at least 3 times during pregnancy. HIV 2 is on the decline from 1.1 – 0.9 and HIV/AIDS 1 has increased from 0.6 –1.2 and Doctor to population ratio has improved significantly with the introduction of nearly 150 Cuban Doctors.
However, a review of key development indicators reveals a mixed picture. Population size has increased from 1.1 million in 1993 to 1.4 million in 2003, but population growth rate has declined from 4.2% to 2.8% in 2003. On the economic front, real GDP per capita has increased from USD309 in 1993 to USD350 in 2003. The single most influential factor behind the high
level of overall poverty is low productivity and income. On poverty, the poverty head count ratio (% of population) was 69 percent in 1998, overall poverty (% population) with 60 percent in 1998 while food poor (% population) was 37 percent in 1998. In the light of the foregoing,poverty in The Gambia has persisted despite concerted Government efforts to fight it. The persistence of and inequalities in poverty is linked to low productivity in Agriculture, high unemployment or – underemployment, weak redistribute policies, especially in public social services, and weak support mechanisms for the poorest households. However, it is critical to take due cognizance of the fact that at the heart of the empowerment process is the need for an effective and well funded and coordinated Information Education and
Communication programme. An initiative that will ultimately grow from IEC to behavior change communication. Because in the final analysis, it is when there is this progression from Awareness creation to Attitude and behaviour change that we will see the impact of these efforts on the lives of the people.

Vitamin A deficiency disorders (VADD) are a major public health problem in many parts of the world and one of the leading underlying causes of childhood mortality. Therefore, VADD control programs can contribute to reaching the international development goal of reducing childhood mortality by two thirds by the year 2015. Although economic development leads to greater food consumption of animal products (the most bio-available source of vitamin A), other strategies, such as high dose vitamin A capsule supplementation, fortification and food production programs have been developed to tackle the VADD problem independent of economic development efforts. In this article, we discuss the essential role of process indicators in monitoring and fine-tuning VADD control and prevention programs toward ensuring that such programs will be more effective and cost-effective.

The vitamin A supplementation program for preschool children is a global
program, organized primarily by UNICEF. Most of the vitamin A capsules
used are produced centrally and then distributed to developing countries. At the country level, the capsules are distributed to provincial and sub-provincial health offices and distributed to households through organized campaigns and during health care visits. Donor agencies commonly provide financial support for vitamin A supplementation programs. A number of different organizations provide technical support at all levels of the program. Decentralization of health care systems, which has become common in the past decade, is transferring responsibility for both financial and program
implementation to sub-national levels—including direct procurement of
vitamin A capsules, training and other program components—which may
influence one's approach to monitoring and evaluation.Vitamins play a crucial role in health, but modern lifestyles may lead to sub-optimal intakes even in affluent countries. The aim of the present study is to review vitamin intakes  and to compare them with respective national recommendations. Data on adults from the most recently published national dietary intake surveys  
were used as a basis for the analysis.

The proportions of the populations with intakes below recommendations were categorized as < 5, 5–25, >25–50, >50–75 and >75 % for each vitamin. The data generated are presented in a ‘traffic light display’, using colors from green to red to indicate degrees of sufficiency. The trends found were compared with the results from the European Nutrition and Health Report 2009, even though in that report, only information on mean intakes in the different countries was available. We showed that, although inter-country differences exist, intakes of several vitamins are below recommendations in a significant part of the population in all these countries. The most critical vitamin appears to be vitamin D and the least critical niacin. The variation between the countries is most probably due to differences in recommendations, levels of fortification and local dietary habits. We show that a gap exists between vitamin intakes and requirements for a significant proportion of the population,even though diverse foods are available.

Foundation for Rural Education, Wildlife and Environment is 'on course' to meet one target for maternal, infant and young child nutrition (MIYCN). Some progress has been made towards achieving the target of reducing anaemia among women of reproductive age, with 49.5% of women aged 15 to 49 years now affected. Meanwhile, some progress has been made towards achieving the low birth weight target with 16.8% of infants having a low weight at birth. The Gambia is 'on course' for the exclusive breastfeeding target, with 53.6% of infants aged 0 to 5 months exclusively breastfed. The Gambia has made some progress towards achieving the target for stunting, but 17.5% of children under 5 years of age are still affected, which is lower than the average for the Africa region (30.7%). The Gambia has also made some progress towards achieving the target for wasting but 5.1% of children under 5 years of age are still affected, which is lower than the average for the Africa region (6.0%). The prevalence of overweight children under 5 years of age is 2.1% and the Gambia is 'off course' to prevent the figure from increasing.

This organization  has shown limited progress towards achieving the diet-related non-communicable disease (NCD) targets. 17.4% of adult (aged 18 years and over) women and 7.1% of adult men are living with obesity. The Gambia's obesity prevalence is lower than the regional average of 20.8% for women and 9.2% for men. At the same time, diabetes is estimated to affect 9.4% of adult women and 11.6% of adult men.Under-nutrition traps individuals and society in the vicious cycle of poverty.

Our theory of change therefore is when we finally see women , men and children who are not malnourished due to lack of balanced diet and vitamin intakes. We believe it is not justified for tens of thousands of people to be abandoned or neglected when it is time for National vitamin A and multi-vitamin intakes.

Biotechnology is an important tool which can ensure the production of

crop that will have longer shelf live, drought resistant, high saline
tolerance, ability to withstand adverse conditions among others. The
Gambia among the low-income West African countries, where agriculture is
practiced by two-thirds of its citizens and couple with global
population which is now around 7 billion predicted to rise to 9 billion
by 2050, the Gambian government really needs to act fast and positively
in welcoming genetically modified crops if it"s to be able to feed its
population now roughly around 2 million people. Application of
Biotechnology in crop and animal farming through genetic engineering has
led to the development of crops with desirable characteristics such as
crop varieties that cope better with drought and salinity, crops that
more resistant to pest and diseases and crops that use nutrients more
efficiently. This can help transform The Gambia into a country with a
robust agriculture capable of not feeding the nation but also generating
substantial foreign exchange.

Through Agricultural biotechnology, this looming crisis can be averted eradicating malnutrition by ensuring food self-sufficiency through the production of resistant crops to pests and diseases, having longer shelf-lives, higher nutritional content and palatability, higher yields and early maturity period, tolerant to adverse weather and soil conditions. Achieving food sufficiency which is a direct consequence of a flourishing agricultural sector will facilitate a shift from other natural resources as a source of foreign exchange thus promoting economic diversity through agriculture.

We incorporate diversity, equity and inclusivity into our work in various ways. To start with, in distributing vitamins, we do not exclude individuals or group based on their economic or social status. We try to make sure that everyone in the remote rural communities is covered since they have been neglected for a very long time before the commencement of our solutions in 2016.

Diversity is defined as the presence of differences within a given setting. This may include gender, race, ethnicity, religion, nationality, sexual orientation, place of practice, and practice type. It is the way people are different and yet the same at the individual and group levels. Organizational diversity requires examining the makeup of a group to ensure that multiple perspectives are represented.

Equity refers to an approach that ensures that everyone has access to
the same opportunities. It recognizes that advantages and barriers exist
and that, as a result, everyone does not start from the same place. It
is a process that begins by acknowledging that unequal starting place
and works to correct and address the imbalance. Equity ensures that all
people have the opportunity to grow, contribute, and develop, regardless
of their identity. Basically, it is the fair and just treatment of all
members of a community. It requires commitment and deliberate attention
to strategic priorities, resources, respect, and civility, with ongoing
action and assessment of progress toward achieving specified goals.

Inclusivity refers to the intentional, ongoing effort to ensure that diverse people with different identities are able to fully participate in all aspects of the work of an organization, including leadership positions and decision-making processes. It refers to the way that diverse individuals are valued as respected members and are welcomed in an organization and/or community

We want to assure you that, in the distribution of vitamins in remote rural communities, all these are adhered to by our organization, and this had led to some positive news which has attracted government officials, diplomats, educationists and society in general to our activities in rural communities.

As a charitable organization in The Gambia, we are not allowed to engage in business activities, but we can do anything legitimate to raise funds. In view of this, we have some business ventures that yield money for the organization such as the possession of a business centre where schools, students, corporations type, print, photocopy or publish their materials.

Another way we raise funds for our projects is through Embassies in The Gambia.  These foreign embassies advertise project funding activities on a yearly basis and we usually submit project proposals if the advertised one is in line with our objectives.

Our clients and beneficiaries need our items and projects because, in our location, which is a Peri-urban center, those engaged in our activities are not many and due to our track records in the field which is very positive, people prefer to deal with us than others in our field.

To start with, we plan to expand those areas of business so that more revenues can be generated to enable us serve our clients and beneficiaries better.

We also plan to raise capital through grants from funders to implement our projects and once those projects are completed, the equipment will be further used to train more beneficiaries. These beneficiaries will support the organization in marketing some of the things that have been produced.

We aim to establish a technical secondary school which will be implemented as a project to train intelligent indigent students in both academic and vocational subjects. The students will only have to pay an affordable amount for competitive education enjoyed by their urban counterparts.

Though we cannot say we are financially sustainable, but we have received support from the Embassies of Japan, Australia and Canada based in The Gambia to implement various projects bordering on poverty alleviation for women and girls.
We believe that in the future, due to our recognition so far due to our successful project implementation activities, we shall apply for donations which, when received, will help us to expand our fundraising activities whereby, when approached by vulnerable individuals to implement projects on their behalf, we will have funds to do so.