LUWERO, Uganda – At Joweria Sekiyanja’s house in tiny Mayilikiti village in central Uganda, a group of about 15 women are marveling at an assortment of goodies the mother has made to sell at local markets. There are twisted treats Sekiyanja calls “mummies,” doughnuts, cakes, packaged porridge and soft-drink bottles containing a bright orange liquid.

The common ingredient in all of them is orange-fleshed sweet potato (OFSP). The biofortified crop is enriched with beta-Carotene, which gives the potatoes their distinctive color. It has been called a “miracle” food that can be used to curb vitamin A deficiency (VAD).

Uganda is currently running an ambitious campaign to get people to make the potato a regular part of their diet. The shift could improve the country’s health, while offering lessons for other countries contending with VAD, and Sekiyanja is at the front line of that effort.

A Tough Sell

Sweet potatoes are a staple in Uganda, although the more widely grown and consumed indigenous crops, such as the white or yellow varieties, contain hardly any or none of the beneficial vitamin A carotenoids that include beta-Carotene. One small root – about 4oz (125g) – of a medium-sized OFSP variety, though, can fulfill the daily vitamin A requirements of a preschooler.

“We’re trying to teach people that it’s really, really nutritious,” Sekiyanja told News Deeply.

It is a tough sell, particularly because people find the orange flesh off-putting and do not fully understand the benefits. Sekiyanja is, herself, a converted skeptic. She said she has seen OFSP improve the health of her community. Now she wants to make sure other communities can share in the benefits.

VAD is the number one cause of preventable blindness in children, and in extreme cases can cause death. It can also lead to night blindness in pregnant women and maternal mortality, according to the World Health Organization.

In Uganda, 38 percent of children between 6 months and 5 years are deficient in vitamin A, according to the 2011 Uganda Demographic and Health Survey. At least 36 percent of women aged 15–49 are, too.

Uganda’s ministry of health, with support from United Nations agencies, gives vitamin A capsules to children aged 6 months to 5 years. But regularly delivering the capsules is difficult and costly – especially in rural areas.

That is where OFSP came in, according to Dr. Robert Mwanga. Mwanga shared the 2016 World Food Prize with two colleagues from the International Potato Center (CIP) for his work biofortifying OFSP. OFSP was first bred and released to farmers as early as 1999, though it really began to gain popularity in 2007. That’s when HarvestPlus began disseminating the potatoes to thousands of households across the country.

HarvestPlus, an international research organization, has been one of the main forces behind global biofortification efforts. In Uganda, they are working with partners to convince farmers to grow OFSP through “seed loans” – distributing OFSP vines that farmers pay for over time with money or by distributing their own vines. And they are encouraging people like Sekiyanja to market the product, using its nutritional value as a selling point. Sekiyanja said she is now making more than enough money to support her family selling the potatoes and the products she makes from them.

Success will be measured in whether more farmers are willing to grow the crop, whether more people will eat it and whether that translates to higher levels of vitamin A. The early results are promising.

HarvestPlus estimates there are now 2.25 million OFSP farmers in Uganda, and the adoption rate of farmers growing the crop rose from 4.2 percent in 2013 to 28.2 percent in 2017. In an evaluation of one program that ran between 2007 and 2009, making OFSP available led to a two-thirds increase in vitamin A intake among both younger and older children and doubled the intake among women.

Since VAD is a problem affecting much of sub-Saharan Africa, these results could have global implications. In 2014, researchers found a deficiency prevalence of about 42 percent among children under 5 in Africa.

HarvestPlus notes that OFSP should not be seen as a magic bullet for overcoming VAD, but as a complement to other strategies, such as the continued distribution of vitamin A capsules. But CIP and its partners have been buoyed by the early success. They hope to reach 10 million households in 17 sub-Saharan African countries by 2020.

Selling the Sweet Potato

Back in Uganda, officials acknowledged there is more to be done, both to increase distribution and consumption, but also to research the effects.

When it comes to eating the food, Sylvia Magezi, the Uganda country manager for HarvestPlus, said they had set their own goal of 1 million households by 2021. They have so far reached about 600,000 households, according to their internal data.

“So it still needs different efforts to address it and biofortification is a cost-effective and sustainable intervention that can do it,” Magezi said. “So people should be growing and consuming [OFSP] more.”

That means advocates are ramping up their efforts to promote behavior change.

Mwanga said they are pushing initiatives, including getting readers and manuals that educate primary students about OFSP into schools. It has been a struggle to integrate them into the curriculum, he said, but these kinds of sustained efforts to build awareness are critical. They are also running radio programs and live dramas touting the benefits of the potatoes.

“You know the reason people take beer or Coke is because somebody is all the time reaching them through radio or TV [or] billboards,” he said. “When it comes to something that saves lives, there is a project for maybe one year, two years, five years. After the project finishes nobody talks about this wonder food so that frustrates.”

Magezi said it will take time to convince people to transition away from other varieties of sweet potato that have been around much longer.

“They ask themselves, ‘Why is it orange?’,” she said. “Then you have to explain that it’s orange because of the beta-Carotene, the vitamin A.”