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Background: Zinc biofortified wheat may be a sustainable strategy to increase zinc intake in areas where fortification and dietary diversification are not feasible or are limited by household purchasing power. This convergent mixed methods study aimed to explore the farmers’ and millers’ experiences and attitudes towards the production and processing of zinc biofortified wheat in Pakistan. Methods: A telephone survey was conducted with farmers (n = 418) who were provided with Zincol-2016 biofortified wheat seed for the 2019–2020 growing season, as part of a wheat grain micronutrient mapping study across Punjab Province. The survey explored the farmers’ experiences of growing Zincol-2016 and whether they opted to grow it again in the subsequent season. Semi-structured focus group discussions were undertaken in a separate group of farmers in Khyber Pakhtunkhwa (KP) province (n = 12) who grew Zincol-2016 for the BiZiFED2 RCT. Millers were also interviewed in KP, both those who had processed Zincol-2016 for the trial (n = 12) and those who had no experience of processing biofortified wheat (n = 12). Survey data were analyzed using descriptive statistics and transcripts of focus groups were analyzed using thematic analysis. Results: Nearly half of farmers who responded to the survey (47%) re-cultivated Zincol-2016 in the following season. The drivers for Zincol-2016 re-cultivation were seed availability (100%), grain yield and growth resistance (98%), quality of the flour from the previous harvest (97%) and nutritional benefit (94.5%). Discussions with farmers suggested that the main motivators for potential scale-up of biofortified wheat were the perceived quality of the grain, wheat, and flour. Millers saw it as an opportunity to expand their business. Farmers and millers valued the health benefits of the wheat. Challenges for scale-up include the need of additional support to produce it, unfamiliarity with the biofortification process, production costs, and external t

Selenium (Se) is an essential human micronutrient. Deficiency of Se decreases the activity of selenoproteins and can compromise immune and thyroid function and cognitive development, and increase risks from non-communicable diseases. The prevalence of Se deficiency is unknown in many countries, especially in sub-Saharan Africa (SSA). Here we report that the risk of Se deficiency in Malawi is large among a nationally representative population of 2,761 people. For example, 62.5% and 29.6% of women of reproductive age (WRA, n = 802) had plasma Se concentrations below the thresholds for the optimal activity of the selenoproteins glutathione peroxidase 3 (GPx3; <86.9 ng mL−1) and iodothyronine deiodinase (IDI; <64.8 ng mL−1), respectively. This is the first nationally representative evidence of widespread Se deficiency in SSA. Geostatistical modelling shows that Se deficiency risks are influenced by soil type, and also by proximity to Lake Malawi where more fish is likely to be consumed. Selenium deficiency should be quantified more widely in existing national micronutrient surveillance programmes in SSA given the marginal additional cost this would incur.

Background: Moringa oleifera (MO) and M. stenopetala (MS) (family Moringaceae; order Brassicales) are multipurpose tree/shrub species. They thrive under marginal environmental conditions and produce nutritious edible parts. The aim of this study was to determine the mineral composition of different parts of MO and MS growing in their natural environments and their potential role in alleviating human mineral micronutrient deficiencies (MND) in sub-Saharan Africa. Methods: Edible parts of MO (n = 146) and MS (n = 50), co-occurring cereals/vegetables and soils (n = 95) underneath their canopy were sampled from localities in southern Ethiopia and Kenya. The concentrations of seven mineral elements, namely, calcium (Ca), copper (Cu), iodine (I), iron (Fe), magnesium (Mg), selenium (Se), and zinc (Zn) in edible parts and soils were determined using inductively coupled plasma-mass spectrometry. Results: In Ethiopian crops, MS leaves contained the highest median concentrations of all elements except Cu and Zn, which were greater in Enset (a.k.a., false banana). In Kenya, Mo flowers and MS leaves had the highest median Se concentration of 1.56 mg kg-1 and 3.96 mg kg-1, respectively. The median concentration of Se in MS leaves was 7-fold, 10-fold, 23-fold, 117-fold and 147-fold more than that in brassica leaves, amaranth leaves, baobab fruits, sorghum grain and maize grain, respectively. The median Se concentration was 78-fold and 98-fold greater in MO seeds than in sorghum and maize grain, respectively. There was a strong relationship between soil total Se and potassium dihydrogen phosphate (KH2PO4)-extractable Se, and Se concentration in the leaves of MO and MS. Conclusion: This study confirms previous studies that Moringa is a good source of several of the measured mineral nutrients, and it includes the first wide assessment of Se and I concentrations in edible parts of MO and MS grown in various localities. Increasing the consumption of MO and MS, especially the leaves as

Use of zinc (Zn) fertilisers may be cost-effective in increasing crop yields and in alleviating dietary Zn deficiency. However, Zn fertilisers are underutilised in many countries despite the widespread occurrence of Zn-deficient soils. Here, increased Zn fertiliser-use scenarios were simulated for wheat production in Punjab and Sindh Provinces, Pakistan. Inputs and outputs were valued in terms of both potential yield gains as well as health gains in the population. Methods The current dietary Zn deficiency risk of 23.9 % in Pakistan was based on food supply and wheat grain surveys. “Disability-adjusted life years (DALYs) lost” are a common metric of disease burden; an estimated 245,000 DALYs y−1 are lost in Punjab and Sindh due to Zn deficiency. Baseline Zn fertiliser-use of 7.3 kt y−1 ZnSO4.H2O was obtained from published and industry sources. The wheat area currently receiving Zn fertilisers, and grain yield responses of 8 and 14 % in Punjab and Sindh, respectively, were based on a recent survey of >2500 farmers. Increased grain Zn concentrations under Zn fertilisation were estimated from literature data and converted to improved Zn intake in humans and ultimately a reduction in DALYs lost.

Moringa oleifera (MO) and M. stenopetala (MS) are two commonly cultivated species of the Moringaceae family. Some households in southern Ethiopia (S. ETH) and Kenya (KEN) plant MS and MO, respectively. The edible parts of these species are rich in amino acids, vitamins and minerals, especially selenium. Despite their nutritional value, Moringa is sometimes considered as a “famine food”. The aim of this study was to determine the extent of dietary utilization of these plants by Moringa Growing Households (MGHs). Moringa growing households were surveyed in 2015. Twenty-four and 56 heads of MGHs from S. ETH and KEN, respectively, were interviewed using semi-structured questionnaires. Subsistence agriculture was the main source of livelihood for all MGHs in S. ETH and 71% of those in KEN. All MGHs in S. ETH cultivated MS while those in KEN cultivated MO. Of the MGH heads in S. ETH, 71% had grown MS as long as they remember; the median cultivation period of MO in KEN was 15 years. All MGHs in S. ETH and 79% in KEN used Moringa leaves as a source of food. Forms of consumption of leaves were boiled fresh leaves, and leaf powder used in tea or mixed with other dishes. Other uses of Moringa include as medicine, fodder, shade, agroforestry, and as a source of income. Although MO and MS have multiple uses, MGHs face several challenges, including a lack of reliable information on nutritional and medicinal values, inadequate access to markets for their products, and pest and disease stresses to their plants. Research and development to address these challenges and to promote the use of these species in the fight against hidden hunger are necessary.

Widespread potential dietary deficiencies of calcium (Ca), iron (Fe), iodine (I), selenium (Se) and zinc (Zn) have been identified in Malawi. Several deficiencies are likely to be compounded by high phytic acid (PA) consumption. Rice (Oryzasativa) is commonly consumed in some Malawian populations, and its mineral micronutrient content is important for food security. The considerable irrigation requirements and flooded conditions of paddy soils can also introduce or mobilise potentially toxic elements including arsenic (As), cadmium (Cd) and lead (Pb). The aim of this study was to determine the mineral composition of rice sampled from farmers’ fields and markets in Malawi. Rice was sampled from 18 extension planning areas across Malawi with 21 white (i.e. polished) and 33 brown samples collected. Elemental composition was determined by inductively coupled plasma-mass spectrometry (ICP-MS). Arsenic speciation was performed using high-performance liquid chromatography (HPLC)-ICP-MS. Concentration of PA was determined using a PA-total phosphorus assay. Median total concentrations (mg kg−1, dry weight) of elements important for human nutrition in brown and white rice, respectively, were: Ca = 66.5 and 37.8; Cu = 3.65 and 2.49; Fe = 22.1 and 7.2; I = 0.006 and <0.005; Mg = 1130 and 265; Mn = 18.2 and 9.6; Se = 0.025 and 0.028; and Zn = 17.0 and 14.4. In brown and white rice samples, respectively, median PA concentrations were 5438 and 1906 mg kg−1, and median PA:Zn molar ratios were 29 and 13. Concentrations of potentially toxic elements (mg kg−1, dry weight) in brown and white rice samples, respectively, were: As = 0.030 and 0.006; Cd ≤ 0.002 and 0.006; Pb = 0.008 and 0.008. Approximately 95 % of As was found to be inorganic As, where this could be quantified. Malawian rice, like the more widely consumed staple grain maize, contains inadequate Ca, I, Se or Zn to meet dietary requirements. Biofortification strategies could significantly increase Se and Zn concentrations a

In this review, we examine the potential of Zn-enriched fertilisers to alleviate human dietary Zn deficiency. The focus is on ten African countries where dietary Zn supply is low and where fertiliser subsidies are routinely deployed on cereal crops. Scope Dietary Zn supply and deficiency prevalence were quantified from food supply and composition data. Typical effects of soil (granular) and foliar Zn applications on Zn concentrations in maize (Zea mays L.), rice (Oryza sativa L.) and wheat (Triticum aestivum L.) grains were based on a systematic literature review. Reductions in disease burdens attributable to Zn deficiency and cost-effectiveness were estimated using a disability-adjusted life years (DALYs) approach. Conclusions Baseline Zn supply in 2009 ranged from 7.1 (Zambia) to 11.9 (Mali) mg capita −1 day−1; prevalence of Zn deficiency ranged from 24 (Nigeria) to 66 % (Zambia). In reviewed studies, soil Zn application led to an increase in median Zn concentration in maize, rice and wheat grains of 23, 7 and 19 %; foliar application led to increases of 30, 25 and 63 %. Enriching granular fertilisers within current subsidy schemes would be most effective in Malawi, reducing DALYs lost due to Zn deficiency by 10 %. The cost per DALY saved ranged from US$ 624 to 5893 via granular fertilisers and from US$ 46 to 347 via foliar fertilisers. Foliar applications are likely to be more cost effective than soil applications due to fixation of Zn in the soil but may be more difficult to deploy. Zinc fertilisation is likely to be less cost-effective than breeding in the longer term although other micronutrients such as selenium could be incorporated.

Background: Dietary mineral deficiencies are widespread globally causing a large disease burden. However, estimates of deficiency prevalence are often only available at national scales or for small population sub-groups with limited relevance for policy makers. Methods: This study combines food supply data from the Third Integrated Household Survey of Malawi with locally-generated food crop composition data to derive estimates of dietary mineral supplies and prevalence of inadequate intakes in Malawi. Results: We estimate that >50 % of households in Malawi are at risk of energy, calcium (Ca), selenium (Se) and/or zinc (Zn) deficiencies due to inadequate dietary supplies, but supplies of iron (Fe), copper (Cu) and magnesium (Mg) are adequate for >80 % of households. Adequacy of iodine (I) is contingent on the use of iodised salt with <1 % of households getting adequate I supply from food alone. Hidden hunger is likely to be widespread: among households with adequate energy supply, 30, 56 and 27 % had inadequate supplies of Ca, Se and Zn, respectively. Over 80 % of the poorest households had inadequate dietary supplies of Ca and Zn compared to <30 % of the wealthiest households; >80 % of rural households living on low-pH soils had inadequate dietary Se supplies compared to 55 % on calcareous soils; concurrent inadequate supplies of Ca, Se and Zn were observed in >80 % of the poorest rural households living in areas with non-calcareous soils. Prevalence of inadequate dietary supplies was greater in rural than urban households for all nutrients except Fe. Interventions to address dietary mineral deficiencies were assessed. For example, an agronomic biofortification strategy could reduce the prevalence of inadequate dietary Se supplies from 82 to 14 % of households living in areas with low-pH soils, including from 95 to 21 % for the poorest subset of those households. If currently-used fertiliser alone were enriched with Se then the prevalence of inadequate supplies woul

Magnesium (Mg) is an essential mineral micronutrient in humans. Risks of dietary Mg deficiency are affected by the quantity of Mg ingested and its bioavailability, which is influenced by the consumption of other nutrients and ‘anti-nutrients’. Here, we assess global dietary Mg supplies and risks of dietary deficiency, including the influence of other nutrients. Food supply and food composition data were used to derive the amount of Mg available per capita at national levels. Supplies of Mg were compared with estimated national per capita average requirement ‘cut points’. In 2011, global weighted mean Mg supply was 613 ± 69 mg person–1 day–1 compared with a weighted estimated average requirement for Mg of 173 mg person–1 day–1. This indicates a low risk of dietary Mg deficiency of 0.26% based on supply. This contrasts with published data from national individual-level dietary surveys, which indicate greater Mg deficiency risks. However, individuals in high-income countries are likely to under-report food consumption, which could lead to overestimation of deficiency risks. Furthermore, estimates of deficiency risk based on supply do not account for potential inhibitors of Mg absorption, including calcium, phytic acid and oxalate, and do not consider household food wastage.

Dietary micronutrient deficiencies (MNDs) are widespread, yet their prevalence can be difficult to assess. Here, we estimate MND risks due to inadequate intakes for seven minerals in Africa using food supply and composition data, and consider the potential of food-based and agricultural interventions. Food Balance Sheets (FBSs) for 46 countries were integrated with food composition data to estimate per capita supply of calcium (Ca), copper (Cu), iron (Fe), iodine (I), magnesium (Mg), selenium (Se) and zinc (Zn), and also phytate. Deficiency risks were quantified using an estimated average requirement (EAR) ‘cut-point’ approach. Deficiency risks are highest for Ca (54% of the population), followed by Zn (40%), Se (28%) and I (19%, after accounting for iodized salt consumption). The risk of Cu (1%) and Mg (<1%) deficiency are low. Deficiency risks are generally lower in the north and west of Africa. Multiple MND risks are high in many countries. The population-weighted mean phytate supply is 2770 mg capita−1 day−1. Deficiency risks for Fe are lower than expected (5%). However, ‘cut-point’ approaches for Fe are sensitive to assumptions regarding requirements; e.g. estimates of Fe deficiency risks are 43% under very low bioavailability scenarios consistent with high-phytate, low-animal protein diets. Fertilization and breeding strategies could greatly reduce certain MNDs. For example, meeting HarvestPlus breeding targets for Zn would reduce dietary Zn deficiency risk by 90% based on supply data. Dietary diversification or direct fortification is likely to be needed to address Ca deficiency risks.

PR, IFPRI3; ISI, DGO

Background Dietary mineral deficiencies are widespread in Africa. Our previous studies in Malawi revealed population-level shortfalls in dietary calcium and selenium supply but adequate dietary magnesium (Mg) supply. Here we examine dietary Mg supply throughout Africa. Methods Food supply data from 1961 to 2007 were compiled using Food and Agriculture Organization (FAO) Food Balance Sheets (FBSs). Magnesium supply was estimated for each country using regional food Mg composition tables. Results Mean Mg supply in 2007 was 649 mg capita −1 d−1, ranging from 188 mg d−1 in Eritrea to 1,828 mg d−1 in Burkina Faso. Magnesium supply was greater in West Africa than in other regions, was dominated by sorghum, maize and wheat and was correlated with calorie supply. The World Health Organization (WHO) Estimated Average Requirement (EAR) for Mg (217 mg capita −1 d−1 for adult males) was exceeded in most countries. Using the EAR cut-point method, the risk of dietary Mg deficiency in Africa is <4 % and unlikely to be a major problem, assuming access to sufficient food and that phytic acid does not compromise Mg absorption. Conclusions Estimating Mg supply is highly sensitive to concentration data available for the primary staple crops. Given that soil factors profoundly affect crop Mg concentration, there is a need to increase the spatial resolution of food composition tables for the staple crops.

PR, IFPRI3; ISI, DGO

Widespread potential dietary deficiencies of calcium (Ca), iron (Fe), iodine (I), selenium (Se) and zinc (Zn) have been identified in Malawi. Several deficiencies are likely to be compounded by high phytic acid (PA) consumption. Rice (Oryzasativa) is commonly consumed in some Malawian populations, and its mineral micronutrient content is important for food security. The considerable irrigation requirements and flooded conditions of paddy soils can also introduce or mobilise potentially toxic elements including arsenic (As), cadmium (Cd) and lead (Pb). The aim of this study was to determine the mineral composition of rice sampled from farmers’ fields and markets in Malawi. Rice was sampled from 18 extension planning areas across Malawi with 21 white (i.e. polished) and 33 brown samples collected. Elemental composition was determined by inductively coupled plasma-mass spectrometry (ICP-MS). Arsenic speciation was performed using high-performance liquid chromatography (HPLC)-ICP-MS. Concentration of PA was determined using a PA-total phosphorus assay. Median total concentrations (mg kg−1, dry weight) of elements important for human nutrition in brown and white rice, respectively, were: Ca = 66.5 and 37.8; Cu = 3.65 and 2.49; Fe = 22.1 and 7.2; I = 0.006 and <0.005; Mg = 1130 and 265; Mn = 18.2 and 9.6; Se = 0.025 and 0.028; and Zn = 17.0 and 14.4. In brown and white rice samples, respectively, median PA concentrations were 5438 and 1906 mg kg−1, and median PA:Zn molar ratios were 29 and 13. Concentrations of potentially toxic elements (mg kg−1, dry weight) in brown and white rice samples, respectively, were: As = 0.030 and 0.006; Cd ≤ 0.002 and 0.006; Pb = 0.008 and 0.008. Approximately 95 % of As was found to be inorganic As, where this could be quantified. Malawian rice, like the more widely consumed staple grain maize, contains inadequate Ca, I, Se or Zn to meet dietary requirements. Biofortification strategies could significantly increase Se and Zn concentrations a

Dietary micronutrient deficiencies (MNDs) are widespread, yet their prevalence can be difficult to assess. Here, we estimate MND risks due to inadequate intakes for seven minerals in Africa using food supply and composition data, and consider the potential of food-based and agricultural interventions. Food Balance Sheets (FBSs) for 46 countries were integrated with food composition data to estimate per capita supply of calcium (Ca), copper (Cu), iron (Fe), iodine (I), magnesium (Mg), selenium (Se) and zinc (Zn), and also phytate. Deficiency risks were quantified using an estimated average requirement (EAR) ‘cut-point’ approach. Deficiency risks are highest for Ca (54% of the population), followed by Zn (40%), Se (28%) and I (19%, after accounting for iodized salt consumption). The risk of Cu (1%) and Mg (<1%) deficiency are low. Deficiency risks are generally lower in the north and west of Africa. Multiple MND risks are high in many countries. The population-weighted mean phytate supply is 2770 mg capita−1 day−1. Deficiency risks for Fe are lower than expected (5%). However, ‘cut-point’ approaches for Fe are sensitive to assumptions regarding requirements; e.g. estimates of Fe deficiency risks are 43% under very low bioavailability scenarios consistent with high-phytate, low-animal protein diets. Fertilization and breeding strategies could greatly reduce certain MNDs. For example, meeting HarvestPlus breeding targets for Zn would reduce dietary Zn deficiency risk by 90% based on supply data. Dietary diversification or direct fortification is likely to be needed to address Ca deficiency risks.

Background Dietary mineral deficiencies are widespread globally causing a large disease burden. However, estimates of deficiency prevalence are often only available at national scales or for small population sub-groups with limited relevance for policy makers. Methods This study combines food supply data from the Third Integrated Household Survey of Malawi with locally-generated food crop composition data to derive estimates of dietary mineral supplies and prevalence of inadequate intakes in Malawi. Results We estimate that >50 % of households in Malawi are at risk of energy, calcium (Ca), selenium (Se) and/or zinc (Zn) deficiencies due to inadequate dietary supplies, but supplies of iron (Fe), copper (Cu) and magnesium (Mg) are adequate for >80 % of households. Adequacy of iodine (I) is contingent on the use of iodised salt with <1 % of households getting adequate I supply from food alone. Hidden hunger is likely to be widespread: among households with adequate energy supply, 30, 56 and 27 % had inadequate supplies of Ca, Se and Zn, respectively. Over 80 % of the poorest households had inadequate dietary supplies of Ca and Zn compared to <30 % of the wealthiest households; >80 % of rural households living on low-pH soils had inadequate dietary Se supplies compared to 55 % on calcareous soils; concurrent inadequate supplies of Ca, Se and Zn were observed in >80 % of the poorest rural households living in areas with non-calcareous soils. Prevalence of inadequate dietary supplies was greater in rural than urban households for all nutrients except Fe. Interventions to address dietary mineral deficiencies were assessed. For example, an agronomic biofortification strategy could reduce the prevalence of inadequate dietary Se supplies from 82 to 14 % of households living in areas with low-pH soils, including from 95 to 21 % for the poorest subset of those households. If currently-used fertiliser alone were enriched with Se then the prevalence of inadequate supplies would f

There is a deficit of mineral micronutrients in global food systems, known as ‘hidden hunger’, especially in the global south. This review focuses on zinc (Zn) and iron (Fe), whose entry into food systems depends primarily on soil and crop factors. Approaches to increase dietary supplies of Zn and Fe include: (1) supplementation, (2) food fortification, (3) dietary diversification, and (4) crop biofortification, including breeding and fertilizer-based approaches. Supply-based estimates indicate that Zn deficiency might be more widespread than Fe deficiency in sub-Saharan Africa, although there are major knowledge gaps at an individual biomarker level. Recent analytical advances, including the use of stable isotopes of Zn and Fe, can play an increasing role in improving our understanding of the movement of micronutrients in food systems, and thereby help to reduce the immense human cost of ‘hidden hunger’.

Globally, more than 800 million people are undernourished while >2 billion people have one or more chronic micronutrient deficiencies (MNDs). More than 6% of global mortality and morbidity burdens are associated with undernourishment and MNDs. Here we show that, in 2011, 3.5 and 1.1 billion people were at risk of calcium (Ca) and zinc (Zn) deficiency respectively due to inadequate dietary supply. The global mean dietary supply of Ca and Zn in 2011 was 684 ± 211 and 16 ± 3 mg capita−1 d−1 (±SD) respectively. Between 1992 and 2011, global risk of deficiency of Ca and Zn decreased from 76 to 51%, and 22 to 16%, respectively. Approximately 90% of those at risk of Ca and Zn deficiency in 2011 were in Africa and Asia. To our knowledge, these are the first global estimates of dietary Ca deficiency risks based on food supply. We conclude that continuing to reduce Ca and Zn deficiency risks through dietary diversification and food and agricultural interventions including fortification, crop breeding and use of micronutrient fertilisers will remain a significant challenge.

Food supply and composition data can be combined to estimate micronutrient intakes and deficiency risks among populations. These estimates can be improved by using local crop composition data that can capture environmental influences including soil type. This study aimed to provide spatially resolved crop composition data for Malawi, where information is currently limited. Six hundred and fifty-two plant samples, representing 97 edible food items, were sampled from N150 sites in Malawi between 2011 and 2013. Samples were analysed by ICP-MS for up to 58 elements, including the essential minerals calcium (Ca), copper (Cu), iron (Fe), magnesium (Mg), selenium (Se) and zinc (Zn). Maize grain Ca, Cu, Fe, Mg, Se and Zn concentrations were greater from plants grown on calcareous soils than those from the more widespread low-pH soils. Leafy vegetables from calcareous soils had elevated leaf Ca, Cu, Fe and Se concentrations, but lower Zn concentrations. Several foods were found to accumulate high levels of Se, including the leaves of Moringa, a crop not previously been reported in East African food composition data sets. New estimates of national dietary mineral supplies were obtained for non-calcareous and calcareous soils. High risks of Ca (100%), Se (100%) and Zn (57%) dietary deficiencies are likely on non-calcareous soils. Deficiency risks on calcareous soils are high for Ca (97%), but lower for Se (34%) and Zn (31%). Risks of Cu, Fe and Mg deficiencies appear to be low on the basis of dietary supply levels.

Background In this review, we examine the potential of Zn-enriched fertilisers to alleviate human dietary Zn deficiency. The focus is on ten African countries where dietary Zn supply is low and where fertiliser subsidies are routinely deployed on cereal crops. Scope Dietary Zn supply and deficiency prevalence were quantified from food supply and composition data. Typical effects of soil (granular) and foliar Zn applications on Zn concentrations in maize (Zea mays L.), rice (Oryza sativa L.) and wheat (Triticum aestivum L.) grains were based on a systematic literature review. Reductions in disease burdens attributable to Zn deficiency and cost-effectiveness were estimated using a disability-adjusted life years (DALYs) approach. Conclusions Baseline Zn supply in 2009 ranged from 7.1 (Zambia) to 11.9 (Mali) mg capita−1 day−1; prevalence of Zn deficiency ranged from 24 (Nigeria) to 66 % (Zambia). In reviewed studies, soil Zn application led to an increase in median Zn concentration in maize, rice and wheat grains of 23, 7 and 19 %; foliar application led to increases of 30, 25 and 63 %. Enriching granular fertilisers within current subsidy schemes would be most effective in Malawi, reducing DALYs lost due to Zn deficiency by 10 %. The cost per DALY saved ranged from US$ 624 to 5893 via granular fertilisers and from US$ 46 to 347 via foliar fertilisers. Foliar applications are likely to be more cost effective than soil applications due to fixation of Zn in the soil but may be more difficult to deploy. Zinc fertilisation is likely to be less cost-effective than breeding in the longer term although other micronutrients such as selenium could be incorporated.

Selenium (Se) is an essential human micronutrient with critical roles in immune functioning and antioxidant defence. Estimates of dietary Se intakes and status are scarce for Africa although crop surveys indicate deficiency is probably widespread in Malawi. Here we show that Se deficiency is likely endemic in Malawi based on the Se status of adults consuming food from contrasting soil types. These data are consistent with food balance sheets and composition tables revealing that >80% of the Malawi population is at risk of dietary Se inadequacy. Risk of dietary Se inadequacy is >60% in seven other countries in Southern Africa, and 22% across Africa as a whole. Given that most Malawi soils cannot supply sufficient Se to crops for adequate human nutrition, the cost and benefits of interventions to alleviate Se deficiency should be determined; for example, Se-enriched nitrogen fertilisers could be adopted as in Finland.

Background and Aims: Use of zinc (Zn) fertilisers may be cost-effective in increasing crop yields and in alleviating dietary Zn deficiency. However, Zn fertilisers are underutilised in many countries despite the widespread occurrence of Zn-deficient soils. Here, increased Zn fertiliser-use scenarios were simulated for wheat production in Punjab and Sindh Provinces, Pakistan. Inputs and outputs were valued in terms of both potential yield gains as well as health gains in the population. Methods: The current dietary Zn deficiency risk of 23.9 % in Pakistan was based on food supply and wheat grain surveys. “Disability-adjusted life years (DALYs) lost” are a common metric of disease burden; an estimated 245,000 DALYs y-1 are lost in Punjab and Sindh due to Zn deficiency. Baseline Zn fertiliser-use of 7.3 kt y-1 ZnSO4.H2O was obtained from published and industry sources. The wheat area currently receiving Zn fertilisers, and grain yield responses of 8 and 14 % in Punjab and Sindh, respectively, were based on a recent survey of >2500 farmers. Increased grain Zn concentrations under Zn fertilisation were estimated from literature data and converted to improved Zn intake in humans and ultimately a reduction in DALYs lost. Results: Application of Zn fertilisers to the area currently under wheat production in Punjab and Sindh, at current soil:foliar usage ratios, could increase dietary Zn supply from ~12.6 to 14.6 mg capita-1 d-1, and almost halve the prevalence of Zn deficiency, assuming no other changes to food consumption. Gross wheat yield could increase by 2.0 and 0.6 Mt grain y-1 in Punjab and Sindh, respectively, representing an additional return of US$ >800 M and an annual increased grain supply of 19 kg capita-1. Conclusions: There are potential market- and subsidy-based incentives to increase Zn fertiliser-use in Pakistan. Benefit-Cost Ratios (BCRs) for yield alone are 13.3 and 17.5 for Punjab and Sindh, respectively. If each DALY is monetised at 1-to-3 times Gross