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Cambridge Institute for Sustainability Leadership

Nutrition in the first 1,00

Micronutrient deficiencies (MNDs) in the “first 1000 days of life” (from conception to two years of age) are associated with adverse consequences, including perinatal complications, increased risk of morbidity and mortality, as well as poor child growth, development, and intellectual impairments which may persist into adulthood. Iron, zinc, vitamin A and calcium are the most problematic micronutrients in Sub-Saharan Africa (SSA) because diets are predominantly cereal-based with low consumption of animal-source foods.  Evidence-based strategies for addressing MNDs in the first 1000 days include: primary consumption of micronutrient-rich foods (both plant and animal source foods), fortification of staples foods, and supplementation.

Despite progress made over the years on maternal and child nutrition, MNDs are still widespread in SSA; over 40% of pregnant women and >50% of children below 5 years are anaemic. The primary food systems are failing to deliver affordable, safe, and nutritious foods, driving the growing triple burden of malnutrition in SSA which is characterised by the co-existence of undernutrition, MNDs, and overnutrition. To achieve sustained improvement in diets in the first 1000 days in SSA, there is a need to understand broad drivers of food consumption behaviour and how to engage policy makers and food system actors to co-develop sustainable food systems.

Applications in practice

  • Business strategies and models
  • Culture, capacity and leadership
  • Social and political change


Contribution to CISL’s core research themes

Inclusive and resilient societies


About the project

This project aims to understand factors underlying decisions on diets of children in the first 1000 days of life, thereby informing the development of strategies for achieving sustained improvement in diets in Sub-Saharan Africa. 

Key research questions for this Fellowship include:

  • With diverse influences including cultural norms, education, health campaigns, and commercial marketing, which messages do families trust, and which have the greatest impact on family decisions, household food choices, and maternal and child health?
  • What do we know about the effectiveness of different strategies for improving awareness of micronutrient deficiencies? What strategies have been used and adopted, and have they been successful? What challenges have been faced and how have they been addressed?
  • How can families be migrated from intellectual awareness of micronutrients to sustained changes in diet as an affordable and aspirational goal? What has been learned, and how does this inform future strategies?
  • What balance should be struck between delivering micronutrients via primary food consumption (e.g. eggs, plant-based and animal protein, and dairy) versus fortified products and supplements? Are there conditions in which one strategy should be emphasised above the other?

Impact and relevance  

This research will generate evidence, practical insights, and tools for engaging businesses to deliver sustainable, safe, affordable, and nutritious food in selected secondary cities in Kenya and Rwanda, with a special focus on nutrition in the first 1000 days of life.

Collaborators and funding

This work is supported by a philanthropic gift from Royal DSM through the Brighter Living Foundation.


Dr Florence Nabwire

Prince of Wales Fellow in Public Health Nutrition in Sub-Saharan Africa supported by Brighter Living Foundation


"Undernutrition is a long-standing public health problem in sub-Saharan Africa and overnutrition is an emerging issue especially in urban areas. To develop innovative strategies for addressing this growing double burden of malnutrition and micronutrient deficiencies, there is need to understand not only what people eat, but why and how they eat. “Without good data, we’re flying blind” – Kofi Annan."

Dr Florence Nabwire