UNITED REPUBLIC OF TANZANIA

MINISTRY OF HEALTH

TANZANIA MAINLAND
Food-Based Dietar y Guidelines
for a Healthy Population
Technical Recommendations

With the technical assistance of

 Tanzania Mainland
Food-Based
Dietary Guidelines
Technical Recommendations

Ministry of Health
2023
© Ministry of Health, 2023

ISBN 978–9912–9806–0–0

Some rights reserved

The Ministry of Health of the United Republic of Tanzania encourages the use, reproduction
and dissemination of the material in this information product. Except for logos and third-
party content, the materials may be copied, downloaded or printed for personal use, private
study, and research and teaching purposes or for use in non-commercial products or services
provided the Ministry of Health is acknowledged as the source and copyright holder. Unless
otherwise stated, all images and photos (including background images and illustrations) should
acknowledge the original owners. It is the responsibility of the user to determine whether
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All requests for translation and adaptation rights, and for resale and their commercial use
rights, should be made via the Ministry of Health.

Disclaimer
These guidelines are designed to provide information to assist decision-making on appropriate
dietary and healthy practices and are based on the best available evidence at the time of the
development of this publication.

While reasonable efforts have been made to ensure that the content of this publication
is factually correct and properly referenced, the findings, interpretations and conclusions
expressed herein are those of the Tanzania Mainland Technical Working Group and the authors
based on their expertise and extensive scientific evidence review. The responsibility for the
interpretation and use of the materials lies with the reader. In no event shall the Ministry of
Health or its affiliates be liable for damages arising from the use of this publication.

The mention or depiction of specific companies or products of manufacturers, whether or not

these have been patented, does not imply endorsement of the Ministry of Health or of its
affiliates in preference to others of similar nature. In any use of this publication, there should
be no suggestion that the Ministry of Health and its affiliates endorse any specific organisation,
product or service.

Suggested citation
Ministry of Health of the United Republic of Tanzania. 2023. Tanzania Mainland Food-Based
Dietary Guidelines for a Healthy Population: Technical Recommendations. Ministry of Health:
Dodoma, Tanzania.

Photographs
Dr. Akwilina Mwanri: pages 20, 50, 63, 103 T, 103B and 96. Dr. Akwilina Mwanri and Said Juma:
pages 49 and 57. Anisa K. Suleiman: pages 99T, 158 B. Anna Nkinda: page 56 B, 62 B, 65, 171and
219. Khalid Abdul: page 79 B, Mariam Mwayela: page 164, Leah Shechambo: pages 87 and 99 B.
Dr. Mercy Chikoko: pages 23; 35, 43 T, 43 B, 48 T, 48 B, 52, 56 T, 58, 62 T, 69 T, 74, 79 T, 114 B,
126, 127,128 T, 129, 131, 133 B, 134, 136, 137 T, 137 B 140 T, 140 B, 141, 144 T, 144 B, 145, 147
T, 147 B, 154, 155, and 169. Professor Ludovick Kinabo: page 92. Rehema K. Mwalim: page 114
T. Said Juma: pages X, 13, 33, 34, 69 B, 70, 130 B; 196. Samwel Kitila: page 119, 123; 124 B and
159. Stella Kiambi: page H; Stella Kimambo, page 17, 22,44, 66, 149. FAO/Esther Amayo: pages 7,
124 T. TFNC: pages 51 and 73. www.pixabay.com: page 96, 128 B, 132 (4 photos), 133 (2 photos);
157, 158 T, 164 T, 165, 170.
Illustrations
Dr. Akwilina Mwanri + Said Juma: page 49. Akwilina Mwanri and Jackson Monela: page 71.
@FAO/Koji Soneka: pages 80, 143 and 152. @fao/ Shan Fischer: pages 36, 51, 64, 100, 111 B, 120, 121,
122, 150, 160,166 and 169 B. Rashid Mbago: pages 88, 156, 162 (3 images), and 163 (2 images). Dr.
Mercy Chikoko: pages 84, 86 T, 86 B, 125; 130 T, and 148. Dr. Mercy Chikoko and Anisa K Suleiman: page
142. Esther Amayo and Dr. Mercy Chikoko page 138. Peter Mabwe: page 115.

Note: T = top and B = bottom

Editor: Russel Brownlee

Cover design and layout: Katarina Zeravica

 TABLE OF CONTENTS

ACRONYMS & ABBREVIATIONS������������������������������������������������������������������������������������������� i

DEFINITION OF TERMS������������������������������������������������������������������������������������������������������� iii
FOREWORD������������������������������������������������������������������������������������������������������������������������� vi
ACKNOWLEDGEMENTS����������������������������������������������������������������������������������������������������� vii
MEMBERS OF THE TECHNICAL TEAM FOR THE DEVELOPMENT OF THE FBDGS���������� viii
OTHER PARTICIPANTS WHO WERE INVOLVED AT DIFFERENT STAGES�������������������������� ix

EXECUTIVE SUMMARY��������������������������������������������������������������������������������������������������������� 1

SECTION 1: About the Food-Based Dietary Guidelines for Tanzania Mainland����������� 7

1. Dietary and lifestyle practices affect nutrition and health status����������������������������������������8
2. Background to the Food-Based Dietary Guidelines development process��������������������� 14
2A The 10 step process of developing the Tanzania mainland FBDGs�������������������������������� 18

SECTION 2: Guidelines and recommendations�������������������������������������������������������������� 23

3. Introduction to food groups, the food guide and key nutrients��������������������������������������� 24
4. The dietary guidelines at a glance���������������������������������������������������������������������������������������� 33

GUIDELINE 1: Increase dietary diversity through consumption of six foods

groups daily, focusing on variety within the food groups to prevent
malnutrition and reduce the risk of NCDs������������������������������������������������������������� 35
5. Recommendation 1.1 Everybody, young and old, should enjoy eating a variety
of foods from different food groups every day to stay healthy and strong���������������� 36
6. Recommendation 1.2 Eat staples such as cereals, starchy roots, tubers, plantains
or green bananas every day for a strong and active body�������������������������������������������� 44
7. Recommendation 1.3 Eat different vegetables every day to prevent and reduce
the risk of diseases������������������������������������������������������������������������������������������������������������� 49
8. Recommendation 1.4 Eat at least two types of fruit every day for better health���������� 57
9. Recommendation 1.5 Eat pulses (legumes) or nuts and oily seeds every day for
good health������������������������������������������������������������������������������������������������������������������������� 64
10. Recommendation 1.6 Eat animal source foods every day to stay strong��������������������� 71
11. Recommendation 1.7 Choose unsaturated fats and oils and eat in small amounts��� 80

GUIDELINE 2: Attain optimal nutrition for pregnant and lactating mothers,

infants and children to ensure the mother’s wellbeing and the child’s
healthy growth and development�������������������������������������������������������������������������� 87
12. Recommendation 2.1 When pregnant or breastfeeding, eat a variety of foods
from the six food groups for your health and the health of your baby���������������������� 88
13. Recommendation 2.2 Feed your baby only breast milk for the first six months
of life and no food or water because mother’s milk contains all the nutrients
the baby needs����������������������������������������������������������������������������������������������������������������� 100
14. Recommendation 2.3 From six months, feed your baby a variety of foods from
animal sources, pulses, fruits and vegetables, and continue breastfeeding up
to 2 years of age or beyond for healthy growth and development of your baby���� 104
15. Recommendation 2.4 Give a variety of foods from the six food groups to
children between the ages of 2 and 5 to help them grow to their full potential������ 112
16. Recommendation 2.5 Provide healthy meals and snacks for school-aged
children throughout the day������������������������������������������������������������������������������������������� 115
16A. Recommendation 2.5A School-aged children should eat breakfast before
going to school to enable them to be productive and perform well������������������������� 120
16B. Recommendation 2.5B Encourage school-aged children to eat healthy
snacks such as fresh fruit, vegetables and nuts����������������������������������������������������������� 121
16C. Recommendation 2.5C Provide school-aged children with food when they are
at school to increase their learning ability�������������������������������������������������������������������� 122

GUIDELINE 3: Limit intake of deep-fried foods, saturated and trans fats,

sugar and salt���������������������������������������������������������������������������������������������������������� 125
17. Recommendation 3.1 Limit your intake of deep-fried foods to prevent heart
diseases, diabetes and obesity��������������������������������������������������������������������������������������� 126
18. Recommendation 3.2 Limit intake of ultraprocessed foods to reduce
cardio-vascular diseases, cancer, overweight and obesity, and early mortality������� 129
19. Recommendation 3.3 Limit intake of saturated fats and avoid intake of trans
fats to reduce the risk of cardiovascular diseases, increased cholesterol and
type 2 diabetes������������������������������������������������������������������������������������������������������������������ 138
20. Recommendation 3.4 Reduce intake of free sugars to prevent weight gain and
dental caries���������������������������������������������������������������������������������������������������������������������� 141
21. Recommendation 3.5 Reduce salt intake to reduce the risk of incident stroke,
fatal stroke and fatal coronary heart disease��������������������������������������������������������������� 145

GUIDELINE 4: Ensure a clean home environment and safe food and water����������� 150
22. Recommendation 4.1 Keep your home environment, food and water safe and
clean to prevent diseases������������������������������������������������������������������������������������������������ 150
23. Recommendation 4.2 Drink clean, safe water instead of sweetened drinks
every day for good health������������������������������������������������������������������������������������������������ 156

GUIDELINE 5: Keep an active lifestyle for optimal health and weight��������������������� 159
24. Recommendation 5 Be physically active every day to stay strong and keep a
healthy body weight��������������������������������������������������������������������������������������������������������� 160

GUIDELINE 6: Avoid risky behaviours such as using tobacco and drinking

alcohol to reduce the risk of diseases������������������������������������������������������������������ 165
25. Recommendation 6 Avoid drinking alcohol and using tobacco to reduce the
risk of diseases������������������������������������������������������������������������������������������������������������������ 166

SECTION 3: Implementing the FBDGs��������������������������������������������������������������������������� 171

26. Implementation partners�������������������������������������������������������������������������������������������������� 172

APPENDICES��������������������������������������������������������������������������������������������������������������������� 197
Appendix 1: Technical recommendations selected to guide formulation of messages� 197
Appendix 2: Nutrient requirements for pregnant, lactating and non-pregnant,
non-lactating women (18–49 years)������������������������������������������������������������������������������� 198
REFERENCES��������������������������������������������������������������������������������������������������������������������� 200
H Tanzania Mainland Food-Based Dietary Guidelines
ACRONYMS & ABBREVIATIONS
BMI Body mass index

CHD Coronary heart disease

COPD Chronic obstructive pulmonary disease

CSO Civil society organization

CVD Cardiovascular diseases

DALYs Disability-adjusted life years

DRNCDs Diet-related non-communicable diseases

FAO Food and Agriculture Organization of the United Nations

FBDGs Food-Based Dietary Guidelines

FBO Faith-based organization

FCT Food composition table

GDP Gross domestic product

HDL High-density lipoproteins

IYCF Infant and Young Child Feeding

LDL Low-density lipoproteins

LGA Local government authority

MDAs Ministries, departments and agencies

MoE Ministry of Education

MoH Ministry of Health

NBS National Bureau of Statistics

NCDs Non-communicable diseases

NCHS National Centre for Health Statistics

NGO Non-governmental organisation

NMNAP National Multisectoral Nutrition Action Plan

PO-RALG President’s Office Regional Administration and Local Government

SDG Sustainable Development Goal

Tanzania Mainland Food-Based Dietary Guidelines i

 STEPS STEP-wise approach to Surveillance

TAHEI Tanzanian Healthy Eating Index

TDHS-MIS Tanzania Demographic and Health Survey and Malaria Indicators Survey

TFA Trans-fatty acid

TFNC Tanzania Food and Nutrition Centre

TNNS Tanzania National Nutrition Survey

UNICEF United Nations Children’s Fund

URT United Republic of Tanzania

WASH Water, sanitation, and hygiene

WHO World Health Organization

ii Tanzania Mainland Food-Based Dietary Guidelines

 DEFINITION OF TERMS
Carotenoids: Any of the pigment physiological and psychological needs.
molecules, typically yellow, red, and
orange, that interact with chlorophylls Food-Based Dietary Guidelines:
inside chloroplasts when they absorb Evidence-based guidelines on healthy
light primarily for photosynthesis and eating habits and lifestyles aimed at
protection from photo-damage. providing a basis for public food and
nutrition, health and agricultural policies,
Diet: The range of foodstuffs (including and nutrition education programmes.
beverages and snacks) actually They provide advice on foods, food
consumed by an individual, household or groups and dietary patterns to provide
community. the nutrients necessary for health and
the prevention of diet-related diseases.
Energy balance: The difference between
energy intake and expenditure due to Hygiene: A set of practices performed
physical activity, basal metabolic rate to preserve health and conditions that
and the obligatory energy expenditure help to maintain health and prevent the
associated with digestion and processing spread of diseases.
of ingested foods. The value can be zero,
positive or negative. Lifestyle: A person’s way of living; the
things that a person or particular group
Energy expenditure: The amount of of people usually do (composed of
energy an individual uses to maintain motivations, needs, and wants) and which
essential body functions (respiration, are influenced by factors such as culture,
circulation, digestion) and engage in family, reference groups, and social class.
physical activities.
Macronutrients: A class of chemical
Energy intake: The amount of energy compounds that humans get from
consumed from foods and drink. eating food in relatively large quantities
to provide energy and maintain the
Exercise: Physical activity that is planned, body’s structures. The most common
structured and repetitive for conditioning macronutrients are carbohydrates, fat
any part of the body and used to improve and protein.
health and maintain fitness. Generally,
it involves an increase in heart rate and Metabolic equivalent of task (MET):
respiration. A MET is a ratio of working metabolic
rate relative to resting metabolic rate.
Food safety: Actions taken to ensure Metabolic rate is the rate of energy
that food will not cause harm to the expended per unit of time. It is one way
consumer when it is prepared and eaten to describe the intensity of an exercise or
according to its intended use. Food safety activity.
entails the proper handling, cooking,
and preservation of food to protect Micronutrients: Chemical elements or
consumers from food-borne illnesses. substances that humans get from eating
food that are essential in minute amounts
Food: Any substance consisting of to orchestrate a range of physiological
proteins, carbohydrates, fats, minerals functions for the growth and health of
and vitamins that, when consumed by an a living organism. They include vitamins
organism, sustains growth, maintenance and minerals.
and other vital processes to meet

Tanzania Mainland Food-Based Dietary Guidelines iii

 Minerals: Chemical elements in food For children aged 5–19:
required as essential nutrients by an
organism to perform functions necessary · Overweight is BMI-for-age greater
for life. than 1 standard deviation above the
WHO Growth Reference median.
Non-communicable disease (NCD):
A medical condition or disease that is · Obesity is greater than 2 standard
not caused by infectious agents (non- deviations above the WHO Growth
infectious or non-transmissible). NCDs Reference median.
can refer to chronic diseases that last Physical activity: Any bodily movement
for long periods of time and progress produced by skeletal muscles that
slowly. They result from a combination requires energy expenditure. Examples
of genetic, physiological, environmental, include walking, running, dancing, and
behavioural and dietary factors. doing household chores.
Nutrients: Compounds in foods Phytochemicals: A wide variety of
essential to life and health, providing the non-nutritive chemical compounds
body with energy, the building blocks found in plant foods that may have
for repair and growth and substances health benefits. Examples include
necessary to regulate chemical the flavonoids, phenolic acids and
processes. carotenoids.
Overweight and obesity: Conditions of Portion: The amount of food a person
abnormal or excessive fat accumulation eats in one sitting (whether at home,
in the body that may impair health. It is in a restaurant, or other eating places).
usually classified using body mass index Depending on the amount of food a
(BMI) defined as a person’s body weight person eats per meal, portion size may
in kilograms divided by the square of be one or more servings, as advised by
their height in metres (BMI = kg/m2). the Food Guide.
For adults: Sedentary behaviour: Any waking
behaviour characterized by an energy
· Overweight is a BMI greater than or expenditure of 1.5 METs or lower while
equal to 25 kg/m2. sitting, reclining, or lying. Most desk-
· Obesity is a BMI greater than or based office work, driving a car, and
equal to 30 kg/m2. watching television are examples of
sedentary behaviours. These can also
For children under the age of 5: apply to those unable to stand, such as
wheelchair users.
· Overweight is weight-for-
height greater than 2 standard Serving: A set standard amount of food
deviations above the WHO Child used to quantify daily recommended
Growth Standards median. amounts of food as per dietary guidelines.
A serving size may also represent
· Obesity is weight-for-height greater quantities used on a Nutrition Facts
than 3 standard deviations above label for food products. The serving size
the WHO Child Growth Standards standard measure can be set using food
median. weight or kilocalorie amounts, which are
sometimes converted from food weight
or kilocalorie amounts to household
measures such as cups or spoons. For
example, one serving can be half a cup

iv Tanzania Mainland Food-Based Dietary Guidelines

of cooked rice, providing 80 calories. A Vulnerable groups: Segments of the
portion that a person eats can be the population at risk of poor health and
same, larger or smaller than a serving. health care disparities. Vulnerability is the
degree to which a population, individual
Vitamins: A group of substances or organization is unable to anticipate,
needed in small quantities for the normal cope with, resist and recover from the
functioning of metabolism in the body. impacts of disasters or disease.
Vitamins usually cannot be synthesized
in the body but occur naturally in certain
foods.

Tanzania Mainland Food-Based Dietary Guidelines v

 FOREWORD

T
he Government of the United Republic of Tanzania is committed to improving the
nutrition and health status of all population groups. This is evident in the policies,
strategies, development plans and interventions aimed at reducing all forms of
malnutrition in the country. Like other developing countries, the United Republic of Tanzania
is experiencing multiple forms of malnutrition, leading to impaired cognitive development,
reduction in learning abilities, and negatively impacting labour productivity. Although there
is good progress in reducing the prevalence of stunting, the rapid increase in overweight
and obesity adds a new dimension to the strategies for addressing malnutrition. Some
of the contributing factors to this scenario include changing consumption patterns and
lifestyles, especially of those living in urban areas.

In response to this, the Ministry of Health, through the Tanzania Food and Nutrition
Centre (TFNC) and the Food and Agriculture Organization of the United Nations (FAO), has
developed the first national Food-Based Dietary Guidelines (FBDGs) for a Healthy Population
through a broad consultative process. The information collected through a literature review
generated an evidence report that showed gaps and needs for guidelines. FAO supported
this process by providing financial and technical assistance.

These FBDGs Technical Recommendations manual serve as the official document addressing
the principles and recommendations of a healthy diet and lifestyle. It will be an important
tool to support food and nutrition information and educational activities in the country. The
manual complements the existing efforts done through (i) nutrition-specific and nutrition-
sensitive interventions, (ii) guidelines on improving micronutrient nutrition, (iii) Infant and
Young Child Feeding Policy and Guidelines, and (iv) fortification strategies. It also supports
the implementation of the National Multisectoral Nutrition Action Plan (NMNAP II 2021–
2026). Furthermore, we envision that these guidelines will help to strengthen the linkages
between agricultural, nutrition and health.

The FBDGs Technical Recommendations manual is intended for technical people such as
nutritionists, researchers, development partners, community nutrition educators, health
personnel, teachers and other stakeholders working towards improving the nutrition and
health status of the general population of the United Republic of Tanzania. I, therefore, urge
all stakeholders to support the implementation of the FBDGs for the improved nutrition
and wellbeing of Tanzanians. I believe that the FBDGs will play a key role in improving the
food consumption patterns and nutrition outcomes of Tanzanians.

Prof. Abel N. Makubi

Permanent Secretary
Ministry of Health

vi Tanzania Mainland Food-Based Dietary Guidelines

 ACKNOWLEDGEMENTS

T
he Tanzania Mainland Food-Based Dietary Guidelines Technical Recommendations
manual is a result of support and dedication from the government, various institutions,
development partners and individuals. Our gratitude goes to all who were involved at
various levels. Sincere thanks to the Government of the United Republic of Tanzania for its
support throughout the process. We acknowledge the technical and financial support from
FAO Headquarters in Rome, the FAO Subregional Office for Southern Africa and the FAO
Country Office in the United Republic of Tanzania.

We acknowledge the technical direction and insights of Ms. Stella Kimambo (Food Security
and Nutrition Specialist for FAO Tanzania) and Dr. Mercy Chikoko (Nutrition Officer for the
FAO Subregional Office for Southern Africa), as well as the technical inputs provided by Dr.
Yenory Hernandez-Garbanzo, Dr. Ana Islas, and Dr. Ramani Wijesinha-Bettoni from the FAO
Food and Nutrition Division in Rome during the development of the dietary guidelines. Our
sincere gratitude goes to Mr. Fred Kafeero and Dr. Nyabenyi Tito Tipo, FAO Representatives
for the United Republic of Tanzania, for their overall support.

The process of developing the FBDGs was led by the Ministry of Health through the
Tanzania Food and Nutrition Centre (TFNC) with the support of the multisectoral FBDGs
Technical Team facilitated by the National TCP Project Coordinator (Maria Ngilisho). We
recognize and appreciate contributions by members of the FBDGs Technical Team from
various Government Ministries including the Ministry of Agriculture, Ministry of Education,
Ministry of Health, and the National Institute for Medical Research (NIMR). We also extend
our appreciation to the higher learning institutions, regional secretaries, civil society
organizations and the private sector for their valuable contributions.

We recognize the support from regional and district authorities in Iringa-Mafinga, Mwanza-
Sengerema and Dar es Salaam-Ubungo during the testing of messages. Furthermore, we
appreciate the groups of women who participated in the focus group discussions during
both the first and second rounds of testing of nutritional messages and graphics.

We also acknowledge support from TFNC Managing Director Dr. Germana H. Leyna, CHN
Department Director Dr. Ray Masumo; and the contributions of the Sokoine University of
Agriculture (SUA), in particular Prof. Joyce kinabo and Dr. Akwilina Mwanri, for leading the
evidence review and validation of the evidence that informed the FBDGs. Our gratitude goes
to Stellenbosch University, Division of Human Nutrition, for providing technical support in
the development and testing of messages and visual illustrations.

Finally, sincere thanks and appreciation to all key individuals and organizations that in one
way or another contributed to the development of these dietary guidelines.

Prof. Tumaini Nagu

Chief Medical Officer
Ministry of Health

Tanzania Mainland Food-Based Dietary Guidelines vii

 Members of the technical team for the development of the FBDGs

S/No Name Organization

1. Grace Moshi MoH

2. Shadrack Buswelu MoH

3. Maria Ngilisho TFNC

4. Adeline Munuo TFNC

5. Julieth J. Shine TFNC

6. Dr Rehema Mzimbiri TFNC

7 Hamza Mwangombale TFNC

8. Margareth Natai Ministry of Agriculture

9. Ruth Kuandika Ministry of Agriculture

10. Prof. Joyce Kinabo SUA

11. Dr Peter Mamiro SUA

12. Dr Akwilina W. Mwanri SUA
13. Dr Julius Ntwenya UDOM

14. Prof. Andrew Swai TDA/TANCDA

15. Gibson Kagaruki NIMR

16. Dr Waziri Ndonde FIAT/PAAT

17. Belinda Liana COUNSENUTH

18. Stella Kimambo FAO

viii Tanzania Mainland Food-Based Dietary Guidelines

 Other participants who were involved at different stages

S/No Name Organization

1. Valeria Milinga MoH

2. Prisca Wanjiro MoH

3. Rashid Mbago MoH

4. Simwanza Mrisho MoH

5. Elieth Deogratius MoH

6. Dr Kissa Kulwa SUA

7 Dr Theresia Jumbe SUA

8. Dr Mary Mayige NIMR

9. Maria Samlongo JKCI

10. David Mbumila TGGA

11. Dr Fatma Abdallah TFNC

12. Nyamizi Julius Ngassa TFNC
13. Aika Lekey TFNC

14. Wessy J. Meghji TFNC

15. Anna John TFNC

16. Rose Msaki TFNC

17. Abela Twinomujuni TFNC

18. Elizabeth Lyimo TFNC

19. Zahara Amiri TFNC

20. Erick Kibona TFNC

21. Jackson Monela TFNC

22. Samson Bakangana TFNC – Intern

23. Careen Magehema TFNC – Intern

24. Elizabeth Kalalu TFNC – Intern

25. Lilian Festo TFNC – Intern

26. Bilal Issa Wagela TFNC – Intern

Tanzania Mainland Food-Based Dietary Guidelines ix

x Tanzania Mainland Food-Based Dietary Guidelines
 EXECUTIVE SUMMARY

T
he United Republic of Tanzania In addition, there is over-consumption
is facing multiple burdens of of salt, contributing significantly to the
malnutrition in the form of stunting dramatic increase in hypertension (high
(34 percent), underweight (14.6 percent blood pressure), which is now affecting
of children below 5 years of age and 26 percent of adults in the age-range
7 percent of women) and overweight 25 to 64. An increase in fat intake is
and obesity (of whom 32 percent contributing to unhealthy accumulation
are women). In addition, there is of ‘bad’ blood lipids (also affecting 26
high prevalence of micronutrient percent of adults). Diabetes, caused by
deficiencies affecting all age groups. the failure of the body to manage glucose
However, detailed information is only levels in the blood, affects around 10
available for children below 5 years of percent of the population. The treatment
age and women of reproductive age. costs for DRNCDs are rapidly becoming
Information for other age categories a huge challenge for the national budget
(schoolchildren, adolescents, men and resources of the health sector in the
and the elderly) is limited. In 2015, the United Republic of Tanzania as well as
prevalence of anaemia was 58 percent households, and very little is being done
among children and 45 percent among to change dietary habits towards
women aged 15 to 49. Pregnant women increased consumption of fruits and
(57 percent) had the highest prevalence, vegetables and reduction of sugar, salt
especially pregnant adolescents. and (unhealthy) fats. Therefore, the FBDGs
will help to promote adequate intake and
Inadequate dietary intake and feeding diversity in terms of consuming various
practices contribute to malnutrition in foods from the six different food groups
the United Republic of Tanzania. The and limit consumption of sugar, salt and
diets are inadequate in micronutrients unhealthy fats.
and insufficiently diversified. Most diets
are monotonous, comprising only two or Food-based dietary guidelines are
three food items, sometimes from the science-based recommendations to
same food group (e.g. cereals or roots and guide healthy eating and lifestyle for
beans). Diets also tend to be extremely a healthy population. The Ministry of
limited in vegetables and fruits, where Health, through the Tanzania Food and
the quantities consumed are relatively Nutrition Centre (TFNC) and with technical
low compared to the recommended support from the Food and Agriculture
levels for health. The underlying causes Organization of the United Nations
of malnutrition in the United Republic (FAO), has therefore developed the first
of Tanzania include changes in eating national Food-Based Dietary Guidelines
habits and lifestyles (nutrition transition). (FBDGs) for a Healthy Population through
Individuals and households are changing broad consultation with stakeholders,
from consuming unrefined, traditional, including the public and an evidence
healthy diets to diets that are high in review process. The guidelines consider
calories and refined foods coupled with the nutrient needs, availability of foods
low physical activity levels. Consequently, to provide the nutrients, and cultural
there is increased prevalence of characteristics of the people of the United
overweight, obesity, and diet-related Republic of Tanzania. The basic principle
non-communicable diseases (DRNCDs). of the diet-based guidelines is that food

Tanzania Mainland Food-Based Dietary Guidelines 1

 consumption should provide all nutrients an active lifestyle and the sixth guideline
needed by the population. It is envisaged is on avoiding other risk behaviours.
that the FBDGs will guide the formulation
of food and nutrition policy, agriculture The six food groups in the Tanzania
production plans, food marketing Mainland FBDGs are (1) cereals, starchy
strategies as well as health promotion roots, tubers, plantains and green
policies related to water sanitation and bananas, (2) vegetables, (3) fruits, (4)
hygiene, physical activities, and reduction pulses, nuts and oil seeds, (5) animal-
of alcohol and tobacco consumption. source foods, (6) healthy fats and
oils. The groups are based on the key
These FBDGs have been developed in line nutrients that they supply to the diet and
with global nutritional recommendations their contribution to a healthy life. These
and complement the existing guidelines nutrients include carbohydrates, protein,
in the United Republic of Tanzania. The fats/oils, vitamins and minerals.
target audience of this FBDGs Technical
Manual includes nutrition and health The development of the FBDGs involved
professionals, educators, policy makers, several steps, namely:
researchers and other stakeholders
interested in promoting nutrition and i. Planning and formation of a
health in the United Republic of Tanzania. multisectoral technical team
The main purpose of the manual is to comprising members from various
guide the target audience to deliver sectors in the government and non-
adequate support and counselling to government organizations.
the public on lifestyle behaviours and ii. Situation analysis and evidence
appropriate dietary practices to ensure review, which generated a strong
consumption of a healthy, nutritionally scientific backing of the issues
adequate diet. It also aims to support related to nutrition and health in the
policies that will promote health and United Republic of Tanzania based
prevent illnesses. The material considers on credible, up-to-date sources of
good nutrition throughout the life cycle, information for the development
focusing on healthy people who are of the Tanzania FBDGs. This step
without serious medical conditions or identified key priority problems.
who require special diets. The FBDGs
are grounded on nutrient requirements, iii. Technical recommendations:
practicality, life cycle, cultural Ranking of the identified key priority
acceptability, user-friendliness and the problems preceded the development
foods people commonly eat. of recommendations. The ranking
criteria included the urgency for
There are six main guidelines with guidance if the problem was of
associated recommendations in the significance or an emerging public
Tanzania FBDGs (see Table 1). The first health concern, and the feasibility
guideline encourages consumption of of solving the problem through
foods from the six food groups daily to consumer messages or through the
promote health and wellbeing for all age FBDGs. The key priority problems
groups. The second guideline focuses on were undernutrition, inadequate
optimal nutrition for special population infant and young child feeding, food
groups. The third guideline focuses on safety and quality, lack of dietary
limiting or avoiding consumption of diversity, low consumption of fruits
foods from three food categories. The and vegetables, high prevalence of
fourth guideline focuses on food safety DRNCDs, and poor sanitation and
and hygiene, the fifth one is on keeping hygiene.

2 Tanzania Mainland Food-Based Dietary Guidelines

iv. Diet modelling using the FAO Diet stages of implementation. Different
Modelling package, which runs institutions will play key roles in the
on Excel Solver, helped to identify implementation of the FBDGs. The
the food groups and establish the Implementation plan outlines specific
proportions of typical quantities to mandates, roles and functions of
meet the nutrient requirements. each of the implementing partners.
v. Development of a graphic food guide
as a pictorial representation of food The key implementers include:
groups showing the proportion
recommended for consumption · Government ministries,
from each food group. departments and agencies (MDAs);
vi. Development of messages: · the President’s Office Regional
Communication, marketing and Administration and Local
behavioural sciences guided the Government (PO-RALG);
design of the key messages for
specific behaviour change based · communities;
on technical recommendations · development partners;
generated from the scientific
evidence, the gap between current · civil society organizations (CSOs);
norms/practices and the desired · non-government organizations
outcomes, and the feasibility of (NGOs) and faith-based
implementing actions prompted organizations (FBOs);
by key changes proposed in the
recommendations. The process · institutions of higher learning,
followed general rules governing training and research;
the development of messages to
· private-sector institutions;
ensure that the messages were
clear and easy to understand, action · the media; and
oriented (including calls to action),
· political parties.
positive and direct, short and
memorable, culturally acceptable,
realistic, and affordable.
vii. To ensure that the messages were
clear and understandable, the
team conducted field-testing of
messages and the graphic food
guide in selected regions involving
diverse participants to capture their
concerns and suggestions on the
messages and graphics.
The implementation plan for the
FBDGs adopts a multisectoral
approach as stipulated in the National
Multisectoral Nutrition Action Plan
(NMNAP). The Tanzania Food and
Nutrition Centre will provide overall
technical support and leadership at all

Tanzania Mainland Food-Based Dietary Guidelines 3

 Table 1. Summary of the dietary guidelines and recommendations

Guidelines A set of recommendations

1 Increase dietary diversity Recommendation 1.1: Everybody, young and old,
through consumption of should enjoy eating a variety of foods from different
six foods groups daily, food groups every day to stay healthy and strong.
focusing on variety
within the food groups to Recommendation 1.2: Eat staples such as
prevent malnutrition and cereals, starchy roots, tubers, plantains or green
reduce the risk of NCDs. bananas every day for a strong and active body.

Recommendation 1.3: Eat different vegetables

every day to prevent and reduce risk of diseases.

Recommendation 1.4: Eat at least two types of

fruit every day for better health.

Recommendation 1.5: Eat pulses (legumes), nuts

and oil seeds every day for good health.

Recommendation 1.6: Eat animal-source foods

every day to stay strong.

Recommendation 1.7: Choose unsaturated fats

and oils and eat in small amounts.

Continued on page 5

4 Tanzania Mainland Food-Based Dietary Guidelines

 Guidelines A set of recommendations
2 Attain optimal nutrition Recommendation 2.1: When pregnant or
for pregnant and lactating breastfeeding, eat a variety of foods from the six
mothers, infants and food groups for your health and the health of your
children to ensure the foetus or baby.
mother’s wellbeing and
the child’s healthy growth Recommendation 2.2: Feed your baby only breast
and development. milk for the first six months of life and no food
or water because mother’s milk contains all the
nutrients the baby needs.

Recommendation 2.3: From six months, feed

your baby a variety of foods from animal-source
foods, pulses, fruits and vegetables and continue
breastfeeding up to 2 years of age and beyond for
healthy growth and development of your baby.

Recommendation 2.4: Give a variety of foods from

the six food groups to children between the ages of
2 and 5 to help them grow to their full potential.

Recommendation 2.5: Provide healthy meals and

snacks for school-aged children throughout the
day.

Recommendation 2.5a: School-aged children

should eat breakfast before going to school to
enable them to be productive and perform well.

Recommendation 2.5b: Encourage school-aged

children to eat healthy snacks such as fresh fruits,
vegetables and nuts.

Recommendation 2.5c: Provide school-aged

children with food when they are at school to
increase their learning ability.

Continued on page 6

Tanzania Mainland Food-Based Dietary Guidelines 5

 Guidelines A set of recommendations
3 Limit intake of deep-fried Recommendation 3.1: Limit your intake of deep-
foods, saturated and fried foods to prevent heart diseases, diabetes and
trans fats, sugar and salt. obesity.

Recommendation 3.2: Limit intake of

ultraprocessed foods to reduce cardiovascular
diseases, cancer, overweight, obesity, and early
mortality.

Recommendation 3.3: Limit intake of saturated fats

and avoid intake of trans-fats to reduce the risk of
cardiovascular diseases, increased cholesterol and
type 2 diabetes.

Recommendation 3.4: Reduce intake of free sugars

to prevent weight gain and dental caries.

Recommendation 3.5: Reduce salt intake to reduce

the risk of incident stroke, fatal stroke, and fatal
coronary heart disease.

4 Ensure a clean home Recommendation 4.1: Keep your home environment,

environment and safe food and water safe and clean to prevent diseases.
food and water.
Recommendation 4.2: Drink clean, safe water instead
of sweetened drinks every day for good health.

5 Keep an active lifestyle Recommendation 5: Be physically active every day

for optimal health and to stay strong and maintain a healthy body weight.
weight.

6 Avoid other risk Recommendation 6: Avoid drinking alcohol and

behaviours such as using using tobacco to reduce the risk of diseases.
tobacco and drinking
alcohol to reduce the
risk of diseases.

6 Tanzania Mainland Food-Based Dietary Guidelines

 1
SECTION About the Food-
Based Dietary
Guidelines for
Tanzania Mainland

Tanzania Mainland Food-Based Dietary Guidelines 7

 1. DIETARY AND LIFESTYLE PRACTICES AFFECT
NUTRITION AND HEALTH STATUS
1.1 Nutrition indicators in Tanzania (57 percent) than for non-pregnant
The United Republic of Tanzania is facing women (44 percent). Pregnant teenagers
a burden of malnutrition in the form (15 to 19 years of age) had a much higher
of stunting, micronutrient deficiencies, prevalence of anaemia compared to
underweight, and overweight and other age groups (Sunguya et al., 2021)
obesity. (Table 2). Iron deficiency is the main
contributing factor for the observed high
The national surveys of 1996 to prevalence of anaemia, mainly due to low
2015 showed a high prevalence of intake of animal foods containing iron in a
undernutrition throughout the years, bioavailable form. It is possible that other
with more than one-third of children population groups, for example men,
below five years of age stunted. Although the elderly and adolescents, are equally
the trend shows a steady decrease affected; however, there is limited data
in stunting in children under 5 (from available for these population groups.
50 percent in 1991/92 to 34 percent
in 2015/16), the rates still remain 1.2 Obesity and Non Communicable
significantly high, affecting more than Diseases (NCDs) in Tanzania
three million children in this age group. Overweight and obesity has tripled from
Generally, it affects one in every three about 11 percent in TDHS 1991–1992
children by anthropometric failure to 28 percent in TDHS-MIS 2015–16
(Khamis et al., 2020). While wasting (MoHCDGEC et al., 2016) and 32 percent in
remains stagnant at 5 percent, there is TNNS 2019 (MoHCDGEC et al., 2019). The
an increase in overweight and obesity 2012 Tanzania STEPS Non-communicable
among all age groups. Disease Risk Factor Survey showed that
26 percent of adults were overweight or
The Tanzania National Nutrition Survey obese.
(MoHCDGEC et al., 2019) indicated that
about 7 percent of women of reproductive Overweight and obesity are risk factors
age were underweight, and this figure for several non-communicable diseases
has been ranging from 5 to 10 percent such as type 2 diabetes, heart diseases,
over decades. and some cancers. The same survey
showed that 9.1 percent of adults had
Deficiency of micronutrients is also diabetes and more than 25 percent had
highly prevalent among children and hypertension, raised cholesterol and
women. The Tanzania Demographic raised triglycerides (Mayige and Kagaruki,
and Health Survey and Malaria Indicator 2013).
Survey (MoHCDGEC et al., 2016) indicated
that about 58 percent of children 1.3 The cost of malnutrition and NCDs
were anaemic, with 30 percent having Malnutrition has implications on the
moderate anaemia. Higher prevalence attainment of at least 12 of the 17
was observed among children aged Sustainable Development Goals (SDGs),
between 6 and 24 months compared to including SDG Goal 2.
older ones. The prevalence of anaemia
among women aged between 15 and 49 The economic cost of malnutrition is
years was 45 percent in 2015–16, which estimated to contribute up to 11 percent
is very high, with variations across the loss in gross domestic product (GDP)
regions. However, the prevalence was every year in Asia and Africa. Globally,
much higher among pregnant women GDP per capita is seven percent lower

8 Tanzania Mainland Food-Based Dietary Guidelines

because some of the workers were high rates of premature births, low
stunted in childhood (Galasso and birth weight and neonatal and infant
Wagstaff, 2018). Stunted children have mortality.
poor cognitive functions, impairing their
school performance and achievements. • Iron deficiency can also impact a
child’s cognitive development and
Beyond the economic losses, globally, slow down learning.
malnutrition accounts for about
45 percent of all deaths among children
below five years of age, most of which • Iron deficiency can cause tiredness or
occur in low- and middle-income make a person feel weak impacting
countries (WHO, 2021d). productivity for adults and older
children.
Vitamin and mineral deficiencies have
significant social, economic, health and Under nutrition during foetal
life expectancy such as: development and early infancy has been
associated with the occurrence of diet-
• Every year, deficiencies of iron, related non-communicable diseases
vitamin A and folic acid cost the United (DRNCDs) in adulthood (Fall, 2013; WHO,
Republic of Tanzania over USD 518 2016a).
million – around 2.65 percent of the
country’s GDP (World Bank, 2012). Overweight and obesity and diet related
non-communicable diseases such as type
• Over 27 000 infant and 1 600 maternal 2 diabetes, heart diseases, and some
deaths annually attributable to cancers impact on life adjusted disability
vitamin and mineral deficiencies. years and are a major cause of death
(World Bank, 2012). Globally, iron among adults. According to the World
deficiency anaemia among pregnant Bank and the WHO, in 2019, 34 percent
women contributes to 20 percent of deaths among adults in Tanzania was
of all maternal deaths in addition to due to NCDs.

Tanzania Mainland Food-Based Dietary Guidelines 9

 Table 2: Nutrition indicators for Tanzania Mainland
Total (TDHS Trend Since
Category Rural Urban Total
2010) DHS 2010
Stunting (6–59
38.1 25.0 34.8 42.0
months)
Wasting (6–59
4.6 3.8 4.4 5
months)
Underweight 6–59
15.2 9.1 13.6 16
months
Overweight/obesity
3.5 4.1 3.7 5
(6–59 months)
Anemia (6–59
58.8 53.2 57.4 58.3
months)
Consumption of
minimum acceptable
21.3 38.7 26 56.8
diet (4+ food groups)
(6–23 months)
Minimum meal
frequency (6–23 41.3 35.8 40 33.9
months)
Consumed Vit A rich
73.1 81.4 75.3 61.5
foods (6–23 months)
Consumed Fe rich
29.5 50.5 35.2 29.2
foods (6–23 months)
Women of
Reproductive age
(15–49 years)

Overweight/obesity 20.2 41.5 28.1 21.2

Overweight 23.9 15.0 18.3 15.1

Obesity 5.2 17.6 9.8 6.1

Underweight 10.6 7.3 9.4 11.3

Anaemia 44.5 44.1 44.3 40

Households with
adequately iodized 74.5 93.4 80.6 59
salt
Urinary iodine
concentrations WRA 44.7 14.6 33.8 Nd*
<100µg/l

*Not determined
Sources: 1) MoHCDGEC, MoH, NBS, OCGS & ICF. 2016. Tanzania demographic and health survey and malaria indicator
survey (TDHS-MIS) 2015–16. Dar es Salaam and Rockville, Maryland, USA. 2) NBS (National Bureau of Statistics,
Tanzania) and ICF Macro. 2011. Tanzania Demographic and Health Survey 2010. Dar es Salaam, Tanzania.

10 Tanzania Mainland Food-Based Dietary Guidelines

1.4. Dietary patterns and practices nutrients and are low in animal-source
Dietary inadequacy and lack of diversity content (Kulwa, Mamiro and Kimanya,
constitute a common problem and are 2015). Most children in urban settings are
associated with low socioeconomic fed from complementary foods prepared
status, poor levels of education, lack at home. However, these consist mainly
of understanding of the role of food of cereals with limited micronutrient-
in health, and acute poverty. Dietary rich foods (Vitta et al., 2016). Data
patterns in the United Republic of shows that during the complementary
Tanzania vary by age and livelihood feeding period, most children experience
types and are increasingly examined diarrhoea. The occurrence of diarrheal
as predictors of disease outcomes in disease in the United Republic of Tanzania
various settings. In addition, the foods has been linked to contaminated water,
eaten in the country vary according to unhygienic practices in food preparation
agroecological zones due to differences and storage, poor environment and
in weather, vegetation, biodiversity and unsafe disposal of excreta (Kihupi et al.,
soil properties. 2016; MoHCDGEC et al., 2016).

The diet of Tanzanians is inadequate A large body of evidence indicates

in micronutrients and insufficiently that the long-term intake of a low-
diversified. A typical meal pattern starts quality diet contributes significantly to
with a light breakfast, followed by two hot most forms of malnutrition, including
meals that are heavily starch based. Meal stunting, micronutrient deficiencies and
frequency and food quality are reduced overweight and obesity (Krasevec et al.,
during the rainy season when compared 2017; Asghari et al., 2017). Increasing
to the harvest season (Ntwenya et prevalence of overweight and obesity is
al., 2015). Generally, Tanzanian food attributed to changes in eating habits and
patterns are characterized by high lifestyles, known as a nutrition transition.
intake of starchy foods, high frequency Individuals and households are changing
of consumption of vegetables (though from traditional meals and healthy diets
quantities consumed are relatively low to diets with calorie-dense and refined
compared to the recommended levels foods while adopting relatively more
for health), low intake of fruits and sedentary lifestyles with low physical
extremely limited intake of animal source activity levels.
foods (Safari, Timothy and Masanyiwa,
2020). The 2012 STEPS survey (Mayige 1.5 Physical inactivity, alcohol intake
and Kagaruki, 2013) showed that and smoking
97.2 percent of respondents had less In addition to unhealthy diets and
than the recommended five servings of sedentary behaviour, other lifestyle
fruits and vegetables per day. behaviours such as smoking and alcohol
intake predispose people to over weight
Inadequate feeding practices and limited and obesity, cardiovascular diseases,
dietary supply are known to contribute to cancer, stroke, and diabetes.
chronic malnutrition in children. Studies
have shown an increasing pattern of Physical activity
exclusive breastfeeding among infants The fourth leading risk factor for death
and young children. However, early around the world is physical inactivity,
introduction of complementary foods is which accounts for about 6 percent of all
still common (MoHCDGEC et al., 2016; deaths. Overweight and obesity account
Muhimbula, Kinabo and O’Sullivan., for 5 percent of deaths globally. High
2019) (Table 2). Furthermore, the blood pressure, tobacco use, and high
complementary foods lack diversity and blood sugar account for 13 percent,

Tanzania Mainland Food-Based Dietary Guidelines 11

 9 percent, and 6 percent of the deaths smokers (WHO, 2021c). It increases
respectively (WHO, 2009a). the risks of heart disease, stroke, and
cancers of the bladder, blood, cervix,
Regular physical activity reduces the risk colon and rectum, oesophagus, kidney,
of heart disease and stroke, diabetes, liver, and stomach (American Cancer
hypertension, colon cancer, breast Society, 2020). Tobacco-attributable
cancer, and depression (Lee et al., 2012; diseases include lung and heart diseases,
WHO, 2020a). chronic respiratory diseases, cancers,
and diabetes – all of which may increase
While most Tanzanians are physically the severity of COVID-19 (WHO, 2021c).
active, a high proportion of people living According to the STEPS survey (Mayige
in urban areas are not as active as those and Kagaruki, 2013), tobacco users in the
living in rural areas. In general, women United Republic of Tanzania were about
are less active than men, and children 16 percent, and the overall proportion of
living in urban area are especially current smokers was 14.1 percent (men
physically inactive (Mayige and Kagaruki, 26.0 percent and women 2.9 percent).
2013). According to the Global School- Second-hand smoke exposure was
Based Student Health Survey report reported by 17.5 percent of the studied
(MoHCDGEC, 2017), physical activity subjects.
among Tanzanian students was low: only
27.9 percent (24.8–31.2) were physically Alcohol consumption
active for a total of at least 60 minutes Alcohol consumption is one of the most
per day for five or more days. important risk factors for the burden of
disease and injury globally. It is the third
The evidence from developing countries highest risk for disease and disability
confirms that physical activity positively after childhood underweight and unsafe
influences other chronic disease risk sex (Rehm, 2011). It is estimated to cause
factors such as blood pressure, lipid from 20 percent to 50 percent of all
levels, and obesity. A systematic review cases of cirrhosis of the liver, epilepsy,
on the role of physical activity in poisonings, road traffic accidents,
prevention of hypertension (Diaz and violence, and several types of cancer.
Shimbo, 2013) reported that elimination Heavy alcohol drinking also increases the
of physical inactivity would remove risk of cardiovascular diseases (Iranpour
between 6 and 10 percent of the major and Nakhaee, 2019). Approximately
NCDs of coronary heart diseases, type 2 5 percent of the global burden of disease
diabetes, breast and colon cancers, while and injury is attributable to alcohol
also increasing life expectancy (although consumption. Globally, 7.6 percent of all
dose–response was not established) male deaths in 2012 were attributable to
(Lee et al., 2012). alcohol consumption compared to 4.0
percent of female deaths. Men also have
Smoking
a far greater rate of the total burden
Smoking is associated with increased risk
of disease expressed in disability-
of liver and colorectal cancer, diabetes,
adjusted life years (DALYs) attributable
and general body effects, including
to alcohol than women: DALYs for men is
inflammation and impaired immune
7.4 percent compared to 2.3 percent for
function (WHO, 2021c). Furthermore,
women (WHO 2014a). In Africa, alcohol
for older adults, it increases the risk
consumption has a large impact on the
of cancer, cardiovascular diseases
burden of disease and mortality, and it is
and impaired bone health. The risk of
estimated that in 2012 it was responsible
developing diabetes is 30–40 percent
for 6.4 percent of all deaths and
higher for active smokers than non-
4.7 percent of DALYS lost in Africa

12 Tanzania Mainland Food-Based Dietary Guidelines

(Ferreira-Borges, Parry and Babor, 2017). drank alcohol in the past 30 days). Among
Based on the STEPS survey (Mayige the 49 percent consumers of alcohol (who
and Kagaruki, 2013), 29 percent (men drank in the past 12 months), around
38.3 percent and women 20.9 percent) 11.4 percent (men 13.6 percent and
were categorised as current drinkers (i.e. women 8.2 percent) were daily drinkers.

Tanzania Mainland Food-Based Dietary Guidelines 13

 2. BACKGROUND TO THE FOOD-BASED DIETARY
GUIDELINES DEVELOPMENT PROCESS
2.1 Genesis of the FBDGs globally 2.2 Rationale for the Tanzania
In 1992, FAO and the WHO organized Mainland Food Based Dietary
an international conference on nutrition Guidelines
which aimed to identify and encourage There is strong evidence that
the use of strategies to improve nutritional undernutrition, overweight and obesity,
wellbeing. One of the strategies in the DRNCDs, and preventable hygiene
plan of action was to promote appropriate and sanitation-related morbidities are
diets and a healthy lifestyle (FAO and prevalent and causing harm to the
WHO, 1998). The plan also urged the Tanzanian people due to several factors.
governments to disseminate through
different media the dietary guidelines and • Poor infant and young child feeding
lifestyles relevant for different age groups practices, and poor hygiene and
and appropriate for each country. Food- sanitation practices, adding more
based dietary guidelines were therefore challenges to the already food
established to encourage the production insecure population.
and consumption of diversified and • Tanzanian diet lacks diversity, with
culturally acceptable diets; that is, it limited fruits and vegetables and
recognized the need for each nation to animal-source foods, leading to the
identify public health issues related to risk for malnutrition and DRNCDs.
local dietary patterns and to adopt local
strategies for their resolution to improve • Tanzanians are not benefiting
food consumption patterns and individual from the diverse foods the country
wellbeing. has. Although low diversity is
common, the evidence generated
Since then, FAO has been supporting shows that the United Republic
countries to develop FBDGs that are of Tanzania produces a diversity
culturally specific and based on their of crops ranging from tropical to
nutrition situation, food availability temperate crops, depending on the
and eating habits. The FBDGs help the elevation of the country (Ministry of
countries to advocate for the reduction Agriculture, 2017). In addition, it has
of several forms of malnutrition as they the third-highest cattle population
represent unique opportunities to impact in Africa and also ranks high for
diets and food systems. In 2021, about other animals such as goats and
100 countries had developed FBDGs, with chickens. However, consumption
nine countries in Africa. These countries of products from animals is limited
include Benin, Gabon, Namibia, South (ANSAF, 2017).
Africa, Sierra Leone, Seychelles, Nigeria • Unequal food distribution within
and Zambia. Other African countries the household.
that have started the process include the
• Increased availability and marketing
United Republic of Tanzania, Zimbabwe,
of products of low nutritional value.
Rwanda, Eswatini, Gambia, Ethiopia, and
Botswana. • Exposure to unclear and misleading
dietary information.
• Lifestyle behaviours such as
physical inactivity, smoking, and
alcohol and tobacco use put people

14 Tanzania Mainland Food-Based Dietary Guidelines

 at risk of non-communicable 2.3 Objectives of the FBDGs
diseases (Mayige and Kagaruki, The overall objective of the Tanzania
2013). FBDGs is to promote food diversity and
These multifaceted challenges highlight the improved health and wellbeing of
the need for consistent, simple and the Tanzanian population. The Tanzania
practical dietary guidance to enable Food-Based Dietary Guidelines address
populations to select healthy diets and the following priority problems:
healthy lifestyles. A diversified diet and
a healthy lifestyle can reduce the risk • undernutrition;
of malnutrition, non-communicable • inadequate infant and young child
diseases, and other illnesses while feeding;
prolonging active, high-quality living with • low consumption of fruits and
reduced health care expenditures and vegetables;
improved production.
• low consumption of animal source
Tanzania will benefit from the national foods;
FBDGs Technical Recommendations • poor food safety;
Manual as it will provide evidence-based
• poor sanitation and hygiene;
guidance and advice to the public to
encourage healthy eating and provide • diet-related non-communicable
harmonized nutrition messages. The diseases;
FBDGs will provide food-based dietary • sedentary lifestyle;
recommendations centred on six food
groups as well as guidance on safe food • alcohol consumption; and
preparation and storage, alcohol and • tobacco use.
tobacco use, and physical activity.
The Tanzania FBDGs will therefore
The Guidelines, accompanied by key
address the following specific objectives:
recommendations and food graphics, are
used to guide nutrition education and
• to improve and increase nutrient
behaviour change programs. Guidelines
intake through a diversified diet;
are also needed to inform the country’s
food, health, agriculture, education, social • to promote equal distribution of
protection policy development that affect foods within the household;
food production, processing, distribution, • to decrease consumption of sugar,
food availability, dietary habits and salt, trans fat, and saturated fat;
consumption patterns. The guidelines
also inform enabling environments • to improve the nutritional status of
that affect lifestyle patterns like infants and young children;
infrastructure and planning. • to increase knowledge of nutrition
and the relationship between food
Implementation of the FBDGs will and health;
contribute to improving the nutrition
• to improve food safety through
situation by addressing diet-related
hygiene, sanitation, and proper
conditions and lifestyle-related problems.
food handling; and
The Guidelines will also help to achieve
specific outcomes of the National • to promote healthy lifestyle
Multisectoral Nutrition Action Plan behaviours for non-communicable
(NMNAP). disease prevention.

Tanzania Mainland Food-Based Dietary Guidelines 15

 2.4 The intended targeted population to read technical documents.
The FBDGs considered good nutrition The FBDGs Technical Recommendation
throughout the lifecycle, and were Manual will be accompanied by a
developed for healthy people between Community Manual, which will offer a
the ages of 0 months and 65 years who simplified form of the material aimed
are without serious medical conditions or at the general public. In addition, other
require special diets. tailored communication and educational
materials required to convey/disseminate
The FBDGs include guidance for healthy the FBDGs to specific end-users based on
population groups with special nutritional the needs of each target audience will be
requirements based on their age and developed.
physiological status. These include
pregnant and lactating women, children 2.6 Guiding principles
from 0 to 59 months and school-aged The guiding principles of the FBDGs are
children from 5 to 18 years of age. grounded on food-based requirements
developed using diet modelling tools
2.5 The intended users of this document with nutrient-specific considerations.
The FBDGs are written for various users They are informed by up-to-date
from different sectors and professionals: science-based evidence on nutrition
and health status, food consumption
• Nutrition and health professionals, patterns, eating behaviours, and hygiene
educators and other stakeholders practices, together with international
interested in providing guidance nutrition recommendations. Other
and advice on healthy lifestyles. guiding principles include practicality,
• People in the field of agriculture nutrition sensitivity, cultural acceptability,
to promote the production and user-friendliness, and food-based
consumption of diversified foods requirements:
for improved nutrition, and to
guide the target audience on how Practicality
to convey diet-related information The food guide has been designed to
to the general public. be as hands-on as possible for use by
• Those who develop and implement the public. The foods recommended are
policies and programmes to locally available, culturally acceptable,
improve the nutrition status of the and accessible to most households.
public, as well as those who create The wording of the messages and the
an enabling environment for the graphics were tested to ensure they
public to follow recommendations were understood and conformed to the
for healthier diets and lifestyles. cultural context of the users.
This includes ministries related to
nutrition, agriculture, education, Nutrition-sensitive
food security, health, water, social All the messages in the FBDGs recognize
welfare, industry, planning, finance, the importance of dietary diversity along
and urban planning. the food system. None of the messages
can be achieved without linking nutrition
• Researchers and academics that to agriculture, health, and other sectors
monitor the implementation of the relevant to nutrition.
recommendations and to gather
evidence to be used for future
improvement of the guidelines.
• General population with the ability

16 Tanzania Mainland Food-Based Dietary Guidelines

Cultural acceptability 2.6.1 Policy framework and
The FBDGs take into consideration the environment
Tanzanian cultural context based on the A conducive policy environment is
prevailing patterns of food intake and necessary for smooth implementation
food habits to ensure the guidelines of the FBDGs. The Tanzania Food and
are acceptable for the population. Nutrition Policy and Health Policy strongly
Furthermore, the FBDGs were tested support the development of the FBDGs as
in three different regions in the United one of the approaches to guide healthy
Republic of Tanzania through focus- eating. In addition, the NMNAP, developed
group discussions to ensure that in 2016, is an implementation plan for
the recommendations are culturally the Food and Nutrition Policy. The Five-
accepted. Year National Development Plan (FYNDP)
2020/21–2025/26 (Ministry of Finance
User-friendly and Planning, 2016) included a section
The information contained in the FBDGs on food and nutrition security. Specific
is user friendly. The wording of the interventions include the promotion
main messages and illustrations were of nutrition programmes focusing
tested for understanding and confirmed on lifestyle and the production and
during focus-group discussions with consumption of diversified, nutritious
stakeholders in the selected three foods. Target indicators include reduction
representative regions in the United of stunting, anaemia, overweight
Republic of Tanzania. and obesity, and improved exclusive
breastfeeding.
Food-based
The FBDGs are grounded on food-based It is anticipated that different sectors will
requirements rather than nutrient- support implementation of the FBDGs for
specific considerations. The messages the improved nutrition and wellbeing of
encourage intake of a variety of nutrient- Tanzanians. The FBDGs are also in line
dense foods from each group to allow for with the National Strategic Plan for
flexibility in selection of foods based on Prevention and Control of Non-
personal preferences. Communicable Diseases 2021–2026,
which recognizes the importance of
addressing risk factors associated with
NCDs, such as reducing alcohol intake
and smoking. The FBDGs will complement
other existing guidelines in the United
Republic of Tanzania.

Tanzania Mainland Food-Based Dietary Guidelines 17

 2A THE 10 STEP PROCESS OF DEVELOPING THE
TANZANIA MAINLAND FBDGS
The FBDGs were developed by the Nutrition and Food Systems Division at
technical task team led by the Tanzania FAO headquarters, and the Department
Food and Nutrition Centre (TFNC), which of Food Technology, Nutrition and
is a research centre under the Ministry of Consumer Science at Sokoine University
Health. The task team received technical of Agriculture in Mainland Tanzania. The
guidance and support from the FAO development of the FBDGs followed
Country Office in the United Republic of the steps laid out in the FAO and WHO
Tanzania, the FAO Subregional Office for guidance manual for FBDG development
Southern Africa Nutrition Officers, the (FAO and WHO, 1998).

Source: Pena, M. & Molina, V. 1999. Food-based dietary guidelines and health promotion in Latin America. Washington,
DC, PAHO and Insitute of Nutrition of Central America and Panama.

Figure 1: FDBGs development process

18 Tanzania Mainland Food-Based Dietary Guidelines

2A.1 Planning and forming a technical and non-government organisations who
committee are interested in nutrition.
A multisectoral technical task team
comprising members from various The evidence review was done in
sectors in the government and non- 2018 and updated in 2021 to include
government organisations (NGOs) was other relevant documents published
recruited and trained on the process between 2018 and 2021. The updated
of developing and using the FBDGs. review included studies on published
The technical task team consisted of studies on adolescents and on the
26 experts from various institutions, link between NCDs and COVID-19. The
including the Ministry of Health, the priority problems remained the same
Ministry of Agriculture, the Ministry in the updated review, therefore the
of Education, research institutions, recommendations remained the same.
academia and NGOs. The trainers Nutritionists from FAO headquarters
included technical experts from FAO. and the subregional and country offices
After training and orientation, the team provided technical guidance throughout
started gathering evidence, which was a the evidence review process and
significant step in the process. reviewed the document.

2A.2 Situation analysis and evidence 2A.3 Development of technical

review recommendations
The technical task team conducted a The process of developing technical
situation analysis and evidence review recommendations was preceded by
to generate a strong scientific backing a ranking of the identified priority
for the issues related to nutrition and problems. The ranking exercise was
health in the United Republic of Tanzania based on the urgency for guidance,
based on credible, up-to-date sources based on an assessment of whether
of information. The review included all the problem was of significance or was
published and specific grey literature an emerging public health concern that
related to the topics. Some of the topics could be addressed through consumer
covered in the review included nutrition messages in the FBDGs or through
and health status, food systems, implementation of FBDGs in various
food consumption behaviour and sectors and settings.
dietary patterns, global guidelines and
recommendations, lifestyle behaviours The six priority problems identified
associated with nutrition and health, and were undernutrition, inadequate
food and nutrition-related policies. Each infant and young child feeding, food
of these topics formed a chapter in the safety and quality, lack of dietary
review document. From each chapter, diversity, low consumption of fruits
the team identified possible priority and vegetables, high prevalence of
problems to be addressed in the FBDGs. DRNCDs, and poor sanitation and
hygiene. Each priority problem was
After the review exercise, a validation analysed critically by looking into the
workshop was conducted to validate nutrients, foods contributing to those
the evidence, to review documents, to nutrients, and consumers’ knowledge,
generate a list of priority problems to be attitudes and practices related to the
addressed in the FBDGs and to draft a problem. In addition, a total of 24
list of technical recommendations. The technical recommendations to solve
workshop involved a broad range of key the problems were developed. Similar
stakeholders from different government recommendations were combined,
rephrased and ranked to select eight

Tanzania Mainland Food-Based Dietary Guidelines 19

 draft technical recommendations to to-action where appropriate), use direct
guide formulation of messages (Appendix tone/verb, are short and memorable, are
1). culturally acceptable, and are positive,
realistic, and affordable.
2A.4 Diet modelling
Diet modelling is a useful tool for The messages and visual illustrations
formulating optimised diets that meet included general food-related messages
certain nutrient criteria while being as for everybody, with specific messages
close as possible to current food habits. A for pregnant women, lactating women,
diet-modelling workshop was conducted infants, and schoolchildren. In addition,
to decide on population energy and messages related to sanitation and
nutrient goals for calculating energy hygiene, avoidance of smoking, limiting
requirements, establishing food groups, of alcohol consumption, and encouraging
and the proportion of typical quantities physical activities were included.
to be consumed. The FAO technical team
used the FAO Diet Modelling package,
which runs on Excel Solver, to carry
out the diet modelling. Diet modelling
helped to establish the proportion of
food groups for presentation in the
graphic food guide aimed at providing
the general population with a visual and
practical guide for the selection of foods
to best meet their nutrient requirements.
Food guides/graphics are usually based
on current nutrition recommendations,
information about foods commonly
consumed by the target population, and
nutrient content of those foods.

2A.5 Developing messages and the

related visual illustrations
With technical support from Stellenbosch
University in South Africa, key
messages for specific behaviour change 2A.6 Field testing of messages and
were developed based on technical related illustrations
recommendations generated from Key messages were translated into
scientific evidence, the gap between Kiswahili and, together with the visual
current norms/practices and the illustrations, were tested in three regions
desired outcomes, and the feasibility in Tanzania Mainland, namely, Iringa,
of following actions prompted by key Mwanza and Dar es Salaam. A total of 24
changes. Communication, marketing and focus-group discussions were conducted,
behavioural sciences guided the design with the respondents being women of
of the FBDGs messages. In addition, reproductive age. Data was transcribed
visual illustrations for each message and and translated into English then
a graphic food guide with images of the summarised and analysed. In January
food groups were developed. General 2021, a workshop was held with the
rules governing the development of technical task team to review the results of
messages were followed to ensure the analysis and adjust the key messages,
that messages are clear and easy to illustrations and the graphic food guide
understand, are action oriented (with call- based on suggestions received during the

20 Tanzania Mainland Food-Based Dietary Guidelines

field testing. There were slight changes of the TFNC. The FAO nutrition officers
in the wording of some of the messages from the Tanzania Office, the FAO
and in the illustrations to improve clarity. Subregional Office for Southern Africa,
The second round of message testing and the Food and Nutrition Division
involved similar groups of women in two at FAO headquarters reviewed the
wards of Ubungo district in Dar es Salaam document and provided suggestions
region. This was specific for the visual for improvement. Suggestions and
illustrations and for messages related to corrections were incorporated into
vegetable consumption, packed lunches the final document before validation.
for school children, and safe, clean water. Stakeholders commented on the
The messages were revised accordingly document during a validation workshop
and validated in a workshop that involved conducted in October 2021. Minor
different stakeholders. revisions were incorporated after the
workshop. The document was finally
2A.7 Drafting and review of the FBDGs professionally edited, typeset, printed
An FAO consultant drafted the FBDGs and launched as an official document in
document with support from the a national forum.
technical team under the leadership

Tanzania Mainland Food-Based Dietary Guidelines 21

 2
SECTION
Guidelines and
recommendations
 3. INTRODUCTION TO FOOD GROUPS, THE FOOD
GUIDE AND KEY NUTRIENTS
3.1 The six food groups for a healthy 3.2 The food guide graphic
diet The FBDGs include a graphic
Tanzania Mainland identified six food representation of samples of foods
groups based on the key nutrients and the proportion of foods to select
that they supply to the diet and their from each of the six food groups daily.
contribution to a healthy life. The It presents the local foods available in
groups are (1) cereals, starchy roots, all geographical locations in the United
tubers, plantains and green bananas, (2) Republic of Tanzania.
vegetables, (3) fruits, (4) pulses (legumes),
nuts, and oily seeds, (5) animal-source The food groups are arranged according
foods, (6) healthy fats and oils. to portion sizes obtained through diet
optimization modelling that meet the
Consumers are encouraged to consume recommended energy and nutrients per
food items from these six food groups day for each population group. The diet
daily due to their nutritional value and modelling calculated the amounts from
the vital functions they play in the body. the recommended food groups, serving
However, consumers are cautioned sizes and the nutrients this eating
to take the sixth group of oils and fats pattern will provide each day for each
in moderation because high intake of population group. Figure 2 represents
fats and oils can lead to adverse health the recommended food group intakes
outcomes (Hooper et al., 2015). for the general population based on 2300
calories.
A description of the food groups, the
main nutrients contained in each food The food guide graphic is represented
group, and some examples of commonly in a ‘plate’ model. This represents the
available foods in each group are usual way of eating in Tanzanian culture
presented in Table 3. and can easily be understood by the
general population. Food guide graphics
and tables for energy and key nutrients
calculated from diet models for specific
TANZANIA MAINLAND population groups are found in the
SIX FOOD GROUPS specific sections for these population
Contribution to Total amount total intake (%)
groups.
1. Cereals, starchy roots, tubers,
plantains and green bananas Animal-
source foods:
10%
Fruits: 17%
2. Vegetables

3. Fruits
Pulses, nuts Cereals,
and oil seeds: roots, tubers
4. Pulses (legumes), nuts and oily 18% and plantains:
36%
seeds
Vegetables:
5. Animal-source foods 17%

6. Healthy fats and oils Fats and

oils: 2%

Figure 2 Proportional contribution to

total intake from each food group for the
general population

24 Tanzania Mainland Food-Based Dietary Guidelines

The segments on the plate model The current FBDGs use six food groups
represent the proportion of each food and differ from the old food grouping
group that should be consumed every system as follows:
day. Illustrated foods within each food
group are a combination of available and • The additional group was created by
accessible foods from all agroecological breaking the pulses, nuts and animal-
regions of the United Republic of source food group into two groups –
Tanzania. Hence, availability and pulses and nuts, and animal-source
accessibility may be different regionally, food – to emphasize the important
and not all foods shown will be available roles these foods play in a diet.
to everyone. • Pulses, nuts, and seeds are key in
reducing the risk of NCDs. In addition,
The food guide is an educational tool to pulses nuts and seeds are good
teach the public how to eat a varied diet sources of plant-based proteins,
by choosing foods across the food groups micronutrients and fibre and are low in
and within the food groups. This tool can fat. Animal source foods are a source
also be used to inform policy makers and of wholesome and more bioavailable
leaders in agriculture on what types of protein and micronutrients.
foods need to be cultivated to improve
the nutritional status of the people. • Furthermore, oil and fats are regarded
as a food group and are separated
3.3 Foods not included in the six food from sugars and honey, but only a
groups small amount is recommended for
Free sugars, sugar-based sweeteners, consumption. This is because a small
non-sugar sweeteners, salty foods and amount of healthy oils is important for
ultraprocessed foods are not part of providing necessary fatty acids and
the recommended six food groups for helping the body absorb fat-soluble
Tanzania Mainland because they are vitamins.
harmful to health if consumed in large • Conversely, the sugar and honey
amounts. For example, free sugars and group contributes to calorie intake
sweeteners lack nutritive value and only and is therefore not included in
often replace nutritious foods. Although the food groups.
these categories are not a part of the six
food groups, they are included in the
guidelines to advise the public about the
negative health impacts if consumed in
large quantities.

3.4 The new food group system

compared to the old system
In previous food consumption guidelines
and education materials, for example, the
Tanzania Nutrition Guideline for People
Living with HIV (TFNC, 2016) and the
Infants and Young Child Feeding (IYCF)
Guidelines (TFNC, 2013), Tanzania used
five food groups, namely: (1) cereals,
green bananas, roots and tubers; (2)
pulses, nuts and animal-source food;
(3) fruits; (4) vegetables; and (5) sugar,
honey, fats and oils.

Tanzania Mainland Food-Based Dietary Guidelines 25

 Table 3: The six food groups, with key nutrients and examples

Food group Key nutrients Examples of food items

Cereals, starchy roots, Carbohydrates, Maize, wheat, rice, potatoes,

tubers, plantains and fibre, protein, fat, sweet potatoes, green bananas,
green bananas micronutrients (when plantains, cassava, yams
1 eaten as whole-grain sorghum, millet, bulrush millet
products cereals or in
biofortified or fortified
form)
Vegetables Fibre, pro-vitamin A, Sweet potato leaves
vitamin C, vitamin (matembele), cowpea leaves,
B9 (folic acid/folate), cassava leaves, amaranth leaves
vitamin B1 (thiamine), (mchicha), okra, African eggplant
2
vitamin B3 (niacin), (nyanyachungu), eggplant,
vitamin B6, vitamin nightshade (mnavu), spider plant
K, potassium, (mgagani), pumpkin leaves, kale,
phytochemicals, iron moringa leaves and flowers
Fruits Fibre, vitamin Mango, papaya, pineapple,
C, vitamin A, watermelon, guava, orange,
3 folate, potassium, soursop, avocado, passion fruit,
phytochemicals, sugar tamarind (ukwaju), baobab
(ubuyu), banana, jackfruit
Pulses (legumes), Protein, Dried kidney beans, soybeans,
nuts and seeds carbohydrates, cowpeas, green gram, pigeon
fibre, folate, B-group peas (mbaazi), chickpeas (dengu),
vitamins, vitamin bambara (njugumawe), peas
E, copper, iron, (njegere), groundnuts, sunflower
4 zinc, phosphorus, seeds, pumpkin seeds, cashew
magnesium, selenium, nuts
calcium, manganese,
phytochemicals,
healthy fats (nuts and
seeds)
Animal-source foods Protein, fats, Beef, mutton, goat, rabbit
iron, vitamin A, chicken, other poultry, mice,
B-vitamins, calcium, milk, fish, sardines, eggs, edible
5
zinc, magnesium, insects (kumbikumbi, senene)
phosphorous,
selenium
Plant oils from seeds (sunflower,
Essential fatty acids,
6 Healthy fats and oils simsim, groundnut), oils from
fat soluble vitamins
fish
Source: Lukmanji, Z., Hertzmark, E., Mlingi, N., Assey, V., Ndossi G., Fawzi W. 2008. Tanzania food composition
tables. Dar es Salaam, Tanzania, MUHAS, TFNC, HSPH.

26 Tanzania Mainland Food-Based Dietary Guidelines

3.5 Nutrients referred to as complex carbohydrates.
Food provides nutrients, which are They include starch polysaccharides,
substances that support growth and non-starch polysaccharides, and
the maintenance and repair of body glycogen:
tissues. The classes of nutrients required o Starches are digestible
for healthy body functioning include carbohydrates which the body
carbohydrates, proteins, lipids, vitamins, breaks down into glucose
and minerals (FAO, 2004). These nutrient for energy. Examples include
classes are not to be confused with the starches in cereals, roots, tubers,
food groups discussed in this publication. and pulses.
3.51 Carbohydrates o Non-starch polysaccharides are
carbohydrates which the human
Carbohydrates are made up of
body cannot break down (digest).
carbon, hydrogen, and oxygen (thus
Examples include cellulose,
“carbohydrate”). Carbohydrates are
hemicellulose, gums and pectin
classified according to the length of the
present in cell walls in vegetables,
sugar chain making up the carbohydrate
fruits, cereals (whole grains), nuts
(polymerization). They are divided
and seeds. They are also referred
initially into three principal groups,
to as dietary fibre, which plays
namely sugars, oligosaccharides, and
a very important role in human
polysaccharides (FAO, 1998):
health.
• Sugars: Short-chain carbohydrates
o Glycogen acts as an energy
with one to two chains
store in the body. The body
(monosaccharides, disaccharides)
makes glycogen from dietary
and polyols (sugar alcohols).
carbohydrates.
Monosaccharides are single
sugars and are the building blocks Carbohydrates are major energy
from which larger, more complex sources in all human diets. The
carbohydrates can be made, for current recommendation for dietary
example, glucose, fructose and carbohydrate intake ranges between
galactose, which are found mainly in 55 and 75 percent of total energy (WHO
fruits, honey and milk. Disaccharides and FAO, 2002). Thus, carbohydrates
are made up of two chemically joined would provide 1265 kcal to 1725 kcal for
sugar molecules, such as sucrose (a a 2300-kcal per day diet for the general
combination of glucose and fructose) population.
and lactose (a combination of glucose
and galactose) in milk. Polyols Good dietary carbohydrates include
(sugar alcohols) include sorbitol and whole cereal grains, pulses (legumes),
mannitol. vegetables and intact fruits. These foods
• Oligosaccharides: Carbohydrates also contain high amounts of dietary
made up of three to nine sugar chains. fibre. WHO and FAO (2002) further
They include malto-oligosaccharides, recommend that dietary intake of free
principally those occurring from sugars should be less than 10 percent of
the hydrolysis of starch, and other total energy.
oligosaccharides.
• Polysaccharides: Long-chain
carbohydrates with more than nine
chains of sugars. These are also

Tanzania Mainland Food-Based Dietary Guidelines 27

 Dietary fibre for example, haemoglobin and
lipoprotein.
Dietary fibre, while not a nutrient group • Providing an energy source (4 kcal/g).
but a polysaccharide carbohydrate, is
nevertheless an important component Protein requirements vary with age and
of a balanced diet. Fibre, also known as physiological status; hence, children,
roughage, includes the parts of plant pregnant women, and people recovering
foods the body cannot digest or absorb from infections and illness need more
and which therefore pass intact through protein (WHO, 2007).
the digestive system. Fibre is commonly
classified as soluble, which dissolves The main sources of proteins include
in water, or insoluble, which does not animal-source foods such as meat,
dissolve. Diets rich in fibre reduce glucose chicken, fish, milk and eggs as well as
and lipids in the blood and increase the plant sources such as pulses, nuts and
bulk of the stools, reducing constipation. seeds (beans, green grams, cowpeas,
The increased bulk in the diet also helps peas, pigeon peas, groundnuts).
create a feeling of satiety. Dietary fibre
There is a difference in protein quality
may reduce the risk of colorectal cancer
between animal and plant proteins.
(Kunzmann et al., 2015). According to the
Animal proteins provide all the essential
Global Burden of Diseases, exposure to
amino acids, while plant proteins
a diet low in fibre is defined as average
are deficient in some of the essential
daily consumption of less than 24 grams
amino acids. However, a combination
per day of fibre from all sources including
of complimentary plant proteins such
fruits, vegetables, grains, and pulses
as whole cereals with pulses or nuts
(legumes) (GBD, 2019).
improves the protein quality, thereby
providing the body with all essential
3.5.2 Protein amino acids (Monnet et al., 2019).

Protein is made up of amino acids. There Protein requirements are derived as

are 20 different amino acids needed in amounts per kilogram of body weight
the body but only nine of these must be for people whose weight is within the
supplied by the diet as the body is not acceptable range for height (adults) or age
able to synthesise these. These nine are (children) (WHO, 2007). Recommended
called essential amino acids. The other protein intake is 12–15 percent of energy
amino acids can be synthesised in the requirement per day. For a healthy
body from carbohydrates, fats or other adult, it is about 0.8 g/kg of ideal body
amino acids (National Research Council, weight (for a body weight of 60–70 kg it is
1989). The key functions of protein equivalent to 48–56 g).
include:
3.5.3 Fats and oils
• Helping to help build new cells.
There are three categories of fats:
• Aiding growth and repair of tissues. unsaturated fatty acids, saturated fatty
• Forming essential components of acids, and trans fats. These fats affect the
enzymes, hormones and antibodies body differently.
(for immune function).
• Maintaining the body's PH. All fats and oils are a mixture of saturated
fatty acids and unsaturated fatty acids
• Regulating water balance and (Orsavova et al., 2015). Vegetable oils
hydrostatic pressure.
that are liquid at room temperature
• Transporting material in the body, contain more monounsaturated and

28 Tanzania Mainland Food-Based Dietary Guidelines

polyunsaturated fatty acids. Fats that are Excess intake of fats and oils can lead to
solid at room temperature contain more obesity, while consuming trans fats and
saturated fatty acids and/or trans-fats. large amounts of saturated fats (butter,
Trans fats may be found in vegetable ghee), or fats from red meat and organ
oils that have been hydrogenated to meat, can lead to cardiovascular diseases
make them solid at room temperature. and cancer (WHO, 2015a; Abete et al.,
Trans fats are also found in vegetable 2014).
oils that have been heated at very high
temperatures for too long (Bhardwaj et 3.5.4 Vitamins
al., 2016).
Vitamins are essential nutrients that are
Saturated fats and trans fats tend to raise needed in small quantities to support
“bad” cholesterol levels in the blood, optimal health and to prevent deficiency
which in turn increases the risk of heart diseases. They are essential for numerous
disease (Orsavova et al., 2015; Abete body processes and for maintenance of
et al., 2014). In contrast, unsaturated the structure of the bone, nerves, eyes,
fats, when eaten in moderation, are blood and mucous membrane (WHO,
essential in promoting good health and 2005). Some vitamins, such as A, D, E and
preventing NCDs (FAO and WHO, 2010; K, are fat soluble, while others, such as
WHO, 2018d). C and B, are water soluble. Fat-soluble
vitamins can be stored in the body, while
Fats and oils provide essential fatty acids water-soluble vitamins are excreted in
that the body cannot produce on its own urine (Lykstad and Sharma, 2022).
and which must therefore come from
the diet. Essential fatty acids promote The water-soluble vitamins are heat
growth, transport fat-soluble vitamins (A, labile and can easily be destroyed
D, E, and K), provide storage components by heat, cooking or processing. Care
of cell membranes, protect vital body should therefore be taken during food
organs (e.g. the heart), provide energy, processing and cooking to preserve
and prevent dermatitis. vitamins.

Fats and oils are part of the macronutrient The vitamins of public health significance
group, together with proteins and in Tanzania include vitamin A and folic
carbohydrates. Fats and oils are energy acid. However, vitamin C is also an
dense, providing 9 kcal/g compared to important nutrient due to its functions in
4 kcal/g for protein and carbohydrates. the body.

The recommended total fat intake is less

Vitamin A
than 30 percent of energy requirement,
Vitamin A is essential in vision,
while saturated fat intake is less than
healthy epithelial tissue and growth,
10 percent of energy requirement. The fat
strengthening immunity and preventing
requirement in children (as a percentage
infections.
of energy intake) is higher than for adults
– children need 30–45 percent of energy Vitamin A deficiency contributes
from fat (FAO and WHO, 2010). to maternal mortality and to poor
pregnancy outcomes. It is one of the
Consumption of trans fats has no known
top causes of preventable blindness in
health benefits and there is no safe level
children. Vitamin A deficiency weakens
of consumption (Willet et al., 2019).
the body’s immune system and
increases the risk of death from common
childhood illnesses such as diarrhoea

Tanzania Mainland Food-Based Dietary Guidelines 29

 and respiratory infections. Vitamin A multiplication and maturation of red
deficiency increases the risk of diarrhoea, cells in the body. Its deficiency leads
and chronic diarrhoea leads to vitamin to a type of anaemia characterized by
A loss in young children (WHO, 2011b; abnormally large red blood cells. Folic
Imdad et al., 2010) acid deficiency increases homocysteine
levels in the blood, which is associated
Rich sources of vitamin A include liver, with an increased risk of heart disease
palm oil, dark green and yellow leafy and stroke (Czeizel et al., 2013; WHO,
vegetables, and fruits. 2005). Hence, folate prevents anaemia
and heart diseases for all the population
Vitamin C groups.
Vitamin C, also known as ascorbic acid, is
Low folate levels in pregnant women
necessary for the growth, development
can lead to birth abnormalities, such as
and repair of all body tissues. It is involved
neural tube defects (WHO, 2005; Czeizel
in many body functions, including
et al., 2013), and can also cause puerperal
the formation of collagen, the proper
sepsis, low birth weight, and preterm
functioning of the immune system,
birth (WHO, 2016a).
wound healing, and the maintenance of
cartilage, bones, and teeth. A wide variety of foods contain folate,
but it is present in relatively low amounts
Vitamin C is also important in aiding the
except in the liver. Diets that contain
absorption of iron, especially from plant-
adequate amounts of fresh green
based foods. Vitamin C is one of many
vegetables (i.e. in excess of 400 g per
antioxidants. Antioxidants are nutrients
day) are good sources of folate. Other
that block some of the damage caused
sources include pulses (legumes), nuts,
by free radicals (WHO, 2005).
liver, fortified wheat flour, and maize
Vitamin C deficiency is characterised by flour (WHO, 2005)
weakness, bleeding gums, prolonged
3.5.5 Minerals
wound healing and defective bone
growth (WHO, 2005). Minerals are inorganic substances
required by the body in small amounts
The body is not able to make vitamin C on
for a variety of functions. These functions
its own and it does not store vitamin C. It
include the formation of bones and teeth,
is therefore important to include plenty
constituents of body fluids and tissues,
of vitamin C-containing foods in the daily
components of enzyme systems, and
diet (WHO, 2005).
normal nerve activity.
Foods rich in vitamin C include citrus fruit,
Minerals of public health significance for
tamarind, baobab fruit, passion fruit and
the United Republic of Tanzania include
green leafy vegetables. However, this
iron and iodine. Zinc and calcium are also
vitamin is very susceptible to destruction
noted as increasingly important minerals
by atmospheric oxidation. It is therefore
due to their functions and inadequate
important to cook vegetables when they
consumption. Zinc intake is inadequate
are still fresh and limit exposure to air
among Tanzanian women and children
of chopped vegetables and fruits (WHO,
(Gowele et al., 2021; Stuetz et al., 2019).
2005).
Furthermore, zinc deficiency rises with
increasing prevalence of iron deficiency,
Folic acid meaning it is most likely to be high in the
Folate or folic acid is essential for the United Republic of Tanzania. Likewise,

30 Tanzania Mainland Food-Based Dietary Guidelines

calcium deficiency is likely to be high due eaten with bones. Very good sources of
to low intake of milk (Kinabo et al., 2016). plant-based calcium include baobab fruit
or leaves, moringa, amaranth, cowpeas,
cassava and tamarind leaves (FAO, 2019).
Iron
Other vegetables and pulses also provide
Iron is an essential element necessary
some calcium.
for the formation of haemoglobin, the
red pigment present in red blood cells.
Haemoglobin plays an important role Zinc
in the transportation of oxygen to the Zinc is essential for growth, bone
tissues. Reduction in haemoglobin in metabolism, activation of enzymes,
the blood leads to anaemia, a condition and releasing vitamin A from the liver.
characterised by paleness, unexplained Zinc plays a central role in the immune
tiredness and increased susceptibility to system, protein synthesis, wound
infections (WHO, 2005). healing, DNA synthesis and cell division
(WHO, 2005). It supports normal growth
Iron deficiency is common, especially and development during pregnancy,
among women of reproductive age childhood, and adolescence.
and children. During pregnancy, iron
deficiency increases the risk of low The clinical features of severe zinc
birth weight and maternal mortality deficiency in humans are growth
(WHO, 2005). In children, it impairs retardation, delayed sexual and bone
learning ability, reduces concentration, maturation, skin lesions, diarrhoea,
and increases vulnerability to infection alopecia, impaired appetite, increased
(Jáuregui-Lobera, 2014). susceptibility to infections mediated
via defects in the immune system, and
Iron is plentifully available in green leafy the appearance of behavioural changes
vegetables and in pulses (legumes), (WHO, 2005).
but the absorption of iron from these
plant-based foods is limited, so vitamin Main sources include meat, liver, seafood
C-rich foods must be consumed daily to (especially oysters) milk, whole-grain
improve iron absorption. Iron that is easy cereals, and pulses (legumes). Other
for the body to absorb is obtained from sources are processed cereals with low
meat, eggs, liver, and poultry. Fortified extraction rates, polished rice, chicken,
cereals also supply iron (WHO, 2005). fish, roots and tubers, green leafy
vegetables, and fruits.
Calcium
Calcium salts provide rigidity to the Iodine
skeleton and calcium ions play a role in Iodine makes thyroid hormones in
many, if not most, metabolic processes the body, which are important for
(WHO, 2005). metabolism. The main physiological
actions of thyroid hormones are growth
Calcium is one of the main bone-forming and development. Specifically, these
minerals, and an appropriate supply is hormones play a major role in the growth
essential at all stages of life. Sufficient and development of the brain and the
intake of vitamin D and calcium together central nervous system in humans from
reduces the risk of osteoporotic fracture the 15th week of gestation to three years
in older people (WHO, 2005). of age. These hormones also control
carbohydrate, fat, protein, vitamin, and
Dietary animal sources of calcium include mineral metabolic processes in the body
milk, cheese, yoghurt, and small fish when (WHO, 2005).

Tanzania Mainland Food-Based Dietary Guidelines 31

 Iodine deficiency disorders may result 3.5.6 Water
in impaired cognitive development and
function, hypothyroidism, congenital Water, though not considered a nutrient,
anomalies, cretinism, or endemic goitre. is essential for life (Jéquier and Constant,
Iodine intake is below the required 2010). It is important in the body for the
amount in 57 million children in Africa following functions:
(Hailu et al., 2016). Global estimates
• carrying nutrient and waste products;
show that iodine deficiency lowers
the total intellectual capacity by 10 to • maintaining the structure of large
molecules like proteins and glycogen;
15 percentage points. Iodine deficiency
in pregnancy causes mental impairment • taking part in metabolic reactions;
in approximately 20 million babies every • acting as a solvent for minerals,
year. vitamins and amino acids;
• providing lubrication and cushioning
The WHO, UNICEF and the International around joints, eyes and the spinal
Council for the Control of Iodine cord;
Deficiency Disorders (ICCIDD) Global • regulating body temperature; and
Network recommend an intake of • maintaining blood volume.
150 μg iodine/day for adults and 220–
290 μg/day for pregnant and lactating The body is continuously losing water
women (WHO, 2014b). through sweat, urine and faeces, which
must be replaced by drinking enough
Dietary sources of iodine include iodized clean and safe water. Contaminated
salt and other foods like marine fish, water can transmit diseases such as
shellfish, eggs, meat, milk, cereal grains, diarrhoea, cholera, dysentery, typhoid
pulses (legumes) and freshwater fish. and polio. Diarrhoea diseases can lead
The iodine content of these food sources to malnutrition and reduce immune
depends on the iodine content of the soil resistance in infants and young children,
or the environment. which in turn may increase the risk of
prolonged and recurrent diarrhoea
(Marino, 2007).

32 Tanzania Mainland Food-Based Dietary Guidelines

4. THE DIETARY GUIDELINES AT A GLANCE
The Tanzania FBDGs are structured around six guidelines:

• Guideline 1 is about increasing dietary diversity through consumption of the six

food groups daily to promote health and wellbeing for all age groups.
• Guideline 2 encourages optimal nutrition for populations with special needs
(pregnant and lactating women, infants, and young children, as well as school-
aged children).
• Guideline 3 contains a set of recommendations on limiting calories from sugars,
saturated fats, trans fats, ultraprocessed foods and reducing salt intake for all
age groups.
• Guideline 4 provides guidance on keeping food, water and home environment
clean to support better nutrition and healthy outcomes for all age groups.
• Guideline 5 promotes an active lifestyle for healthy weight for all age groups.
• Guideline 6 is on limiting alcohol consumption and restricting tobacco use to
reduce non-communicable disease (NCD) risks for all age groups.

Each guideline is accompanied by key recommendations intended to inform individuals

and households on how to choose combinations of foods and beverages as well as
behaviours to promote health and prevent malnutrition. In each recommendation,
there are specific tips to help the consumers practise a healthy lifestyle.

Tanzania Mainland Food-Based Dietary Guidelines 33

34 Tanzania Mainland Food-Based Dietary Guidelines
GUIDELINE 1: Increase dietary
diversity through consumption of
six foods groups daily, focusing on
variety within the food groups to
prevent malnutrition and reduce
the risk of NCDs

Tanzania Mainland Food-Based Dietary Guidelines 35

 5. RECOMMENDATION 1.1
EVERYBODY, YOUNG AND OLD, SHOULD ENJOY EATING A VARIETY OF
FOODS FROM DIFFERENT FOOD GROUPS EVERY DAY TO STAY HEALTHY
AND STRONG

5.1 What is a diversified diet? In addition, within each food group,

Eating diversified foods means eating different foods provide different
different foods from the six food groups types and amounts of nutrients and
in the right proportions every day. Dietary phytochemicals. For example, although
diversity also means eating different food vegetables are a great source of vitamin
within each food group regularly. C, only dark-green leafy vegetables and
orange-coloured vegetables contain
The human body requires more than 50 large quantities of pro-vitamin A (Slavin
different nutrients and phytochemicals and Lloyd, 2012). All fish, milk and meat
to stay healthy. There is no single food provide the body with protein, however,
or food group that supplies all the daily milk and small fish like sardines (when
energy and nutrient requirements for eaten with bones) contain a lot of calcium,
infants, children, and adults (breast milk while liver is the richest source of iron in
is an exception but is only applicable to this food group.
the first six months of life) (Ballard and
Morrow, 2013). Thus, eating from each of the six groups,
and choosing a variety of foods within
Each food group contains key nutrients each group (depending on availability
it can supply to the body. It is therefore and affordability), will help people get all
important to eat a variety of foods from the nutrients they need.
each of the six food groups to meet these
nutrient needs.

36 Tanzania Mainland Food-Based Dietary Guidelines

5.2 Benefits of a diversified diet According to the Global Burden of
A diversified diet provides the body Disease report (GBD, 2017) risk factors
with the different essential nutrients associated with diet are based on a mix
and phytochemicals it needs to stay of foods and food groups:
nourished and maintain basic body
functions such as breathing, body Diets that lower the risks are:
temperature regulation and blood
circulation. They also strengthen the • diets high in fruits, vegetables, pulses
immune system so that the body can (legumes), whole grains, nuts, seeds,
resist diseases (WHO and FAO, 2002; and milk; and
Ruel, 2003; Arimond and Ruel, 2004). • diets low in red meat, processed meat
and sugar-sweetened beverages).
• Macronutrients provide energy,
support growth and development, Diets that increase the risks are:
produce and utilize hormones, and
• diets low in fibre, calcium, seafood,
protect organs.
omega-3 fatty acids, polyunsaturated
• Micronutrients are needed in fatty acids, and diets high in trans-
small quantities and support the fatty acids and salt.
body’s unique functions, such as
5.3 Food groups and recommended
being able to see, contracting and
quantity per day for Tanzania
relaxing muscles, healing wounds,
Table 4 shows the food groups,
strengthening immunity and clotting
recommended quantity and number
the blood.
of servings to be consumed per day by
• Phytochemicals are substances found the general population based on the
in plants that fight infections and energy requirement of 2300 kilocalories
maintain a healthy blood pressure. per day, calculated using diet
Eating a variety of foods from the six modelling. However, specific dietary
groups in the right amounts helps to recommendations for special groups
maintain a healthy body weight and like pregnant and lactating women,
reduces the risk of diseases such as children below the age of 5, and school
diabetes, heart disease and cancers. children are provided in Guideline 2.
This is necessary to take into account
the increased needs for nutrients during
these physiological states.

Tanzania Mainland Food-Based Dietary Guidelines 37

38
Table 4 Optimized key nutrient intake for the general population of Tanzania Mainland

Fat
Zinc

Iron
Vit C

Food
Fibre

Folate

drates

Energy

weight
Protein
Calcium

Carbohy-
Vit-A-RAE
Food groups

(g) (kcal) (g) (g) (g) (mg) (mg) (mg) (mcg) (mcg) (mg) (g)

Servings per day

Cereals, starchy roots,
tubers, plantains and 4 580 822 15 1.6 182.6 57.7 2.1 1.5 40.2 54.9 28.6 8.2
green bananas

Vegetables 2 280 134 13 0.9 15.6 750.5 10.8 1.2 589.6 127.3 52.1 6.6

Tanzania Mainland Food-Based Dietary Guidelines

Fruits 2 280 206 3 4.6 35.6 46.8 1.2 0.5 213.5 68.0 87.1 5.8
Pulses (legumes)nuts
3 290 410 27 8.0 48.3 100.0 7.3 3.3 0.0 354.2 2.9 18.5
and oily seeds
Animal-source Foods 2 155 270 40 11.9 0.8 126.1 3.8 5.2 43.6 23.8 0.6 0.0
Fats and oil 2 28 252 0 28.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Total - 1613 2312* 97.5 55.0 337.1 1083.1 25.2 11.9 886.9 628.6 171.3 39.2
*217 kcal came from discretionary calories that are not part of the six food groups.
5.4 Serving sizes for each food group A serving size can also be translated
A serving size is a recommended, to household measures such as cups,
standardised amount of food from each spoons and other everyday utensils
of the six food groups to help guide for easy measurement during cooking,
the public on the amounts to eat. Diet serving, or eating. Table 5 shows the
modelling for the Tanzania Mainland translation of the standard kilocalorie
provides a model of standard serving amount to an average food weight
sizes for the six food groups based within the food group as well as
on the kilocalorie amounts shown in household measures.
Table 5.
The proportional contribution of each
A serving size can also be translated to of the six food groups to a target of
food weights. However, food weights 2,300 kcal per day was determined
per serving may vary within the same through diet modelling, while the
food groups, depending on the energy optimisation process determined the
density, specifically for animal-source number of serving sizes for each of the
foods and fruits. For example, 185 g six food groups. The diet modelling also
of whole milk with 3.5 percent fat will considered energy and nutrient intake
provide the same calories as 57 g of recommendations for the population
lean meat (120 kcal). Likewise, for fruits, groups, commonly consumed foods,
270 g of watermelon will provide about and dietary pattern. Based on the
80 kcal, equivalent to 50 g of avocado or kilocalorie serving definition, the diet
75 g of ripe banana. model also provided the food weight
equivalents of a serving in grams.

Tanzania Mainland Food-Based Dietary Guidelines 39

 Table 5 One serving size standard measure of different food groups

Average
Standard Total
food
1 serving Common household measures servings
weight
kcal for one serving size equivalent sizes per
(g) per
day
serving

Cereals, • About 1 cup of rice or pasta

starchy • 1 cup boiled diced sweet potato,
cassava, yams, plantain or green
roots,
banana
tubers, 200 145 4
• ¾ cup of cooked ugali (stiff porridge)
plantains • About 145 g of cereals, roots, tubers,
and green plantains
bananas

• 1 cup (one big serving spoon)

cooked vegetables
Vegetables 60 140 • 2 cups raw leafy or salad vegetables 2
• About 140 g cooked vegetables

• One medium banana or apple; one

large orange or peach; two small
tangerines or plums
• 1 cup cut fruit like papaya or mango;
1 cup small fruit like berries, java
plums, grapes
Fruits 80 140 2
• A piece of pineapple
• A piece of watermelon
• ¼ cup baobab or tamarind pulp
(with no sugar added)
• ½ small avocado
• About 140 g of fruit
• ½ cup cooked beans, bambara, soya
beans or cowpeas
• 1/3 tablespoons peanuts or seeds
like flax, chia, sunflower and
Pulses, nuts
pumpkin
and oily 120 100 3
• 1½ teaspoon peanut butter or
seeds peanut flour
• 1/3 cup coconut milk
• About 100 g of pulses or 30 g** of
nuts and seeds

Continued on page 41

40 Tanzania Mainland Food-Based Dietary Guidelines

 Average
Standard Total
food
1 serving Common household measures servings
weight
kcal for one serving size equivalent sizes per
(g) per
day
serving
• Two eggs (95 g)
• Two matchbox size (~60 g) red meat
(beef, goat, sheep); beef liver and
insects
60-100* 2
Animal- • Three matchboxes size (~90 g) fish,
source 120 poultry or rabbit
foods • four dice-size pieces of cheese
(30 g)
• 1 cup milk or sour milk (245 g)
200-
• ¾ cup or one small tub yoghurt (200
250 g* g)
Healthy fats
130 14 1 tablespoon (15 ml) of cooking oil 2
and oils
* Food weights for animal and animal-source foods that provide 120 kcal
vary a lot, given the different energy densities of foods from this food group.
** Nuts are energy dense, thus requiring lower amounts than pulses per
serving.
Notes
Each food guideline has a detailed food exchange list for one serving size
with calorie, weight and house measures for common food items in each
food group.

HOW TO USE THE SERVING SIZE RECOMMENDATIONS

The following suggested diet outline provides an example of how to spread the
total servings shown in Table 5 throughout the day.

Cereal, roots, tubers, and plantains Pulses, nuts and seeds (three
(four servings per day): servings per day:
• 1 cup cooked sweet potato in the • ½ cup of cooked beans in ½ of a cup
morning, and of coconut milk for lunch, and
• 2 cups rice in the afternoon, and • Three tablespoons of groundnuts
• one plantain in the evening as a snack
Animal-source foods (two servings
Vegetables (two servings per day): per day):
• 1 cup cooked amaranth leaves for • ½ a cup of milk for tea, and
lunch, and
• Pick any one of the foods in the
• 1 cup cooked okra for dinner given amounts for dinner (e.g. two
Fruits (two servings per day): eggs or three matchboxes of fish)
• One orange for breakfast, and
• One mango or a cup of cut papaya Fats and oils:
or mabungo as a snack in the • 2 x 15-ml tablespoons of cooking oil
afternoon or evening per person per day (added to meals
when cooking)

Tanzania Mainland Food-Based Dietary Guidelines 41

 Table 6 Example of a diversified diet for a day chosen from the six food groups

Meal Name Food examples Number of servings per food group**

CRTP PNS ASF Veg Fruit Oil

•1 cup boiled yam
or sweet potato
1 -
or cassava or
green banana
Breakfast
•A glass of milk
1
(250 ml)

• An orange 1

•1.5 cups ugali 2

•1 cup cooked
Lunch sweet potato 1 *
leaves

•90 g sardines 1 *

•A fruit (e.g.
a piece of
watermelon or 1
Mid-morning or a ripe banana or
afternoon snack mango)
•3 tablespoons
1
nuts
•1 cup beans 2 *
•1 cup amaranth
1 *
leaves
Dinner

•1 cup rice 1

Total per day from all six food groups 4 3 2 2 2 *

* Fats and oils are added to meals during cooking. The total amount should not exceeded.
** Food group abbreviations:
1. CRTP - Cereals, roots, tubers and plantains
2. PNS - Pulses, nuts and seeds
3. ASF - Animal-source foods
4. Veg - Vegetables
5. Fruit - Fruits
6. Oils - Fats and oils

42 Tanzania Mainland Food-Based Dietary Guidelines

 5.5 Key messages for eating a variety of foods from
the six food groups

1. Everybody, young and old, should enjoy eating a variety

of foods from different food groups every day to stay healthy
and strong.
2. Eat staples such as cereals, starchy roots, tubers or plantains every day
for a strong and active body. Make whole-grain products a major part of
your staples.
3. Eat different coloured vegetables every day to prevent and reduce the
risk of diseases.
4. Eat at least two different fruits every day for better health.
5. Eat pulses, such as beans, lentils, peas or nuts every day for good health.
6. Eat animal-source foods, including seafood, meat, milk or eggs, every
day to stay strong.
7. Limit your intake of deep-fried and highly processed foods that contain
fat, sugar and salt to prevent diseases such as high blood pressure,
diabetes and heart diseases.

5.6 Tips for eating diversified meals

1. Choose different types of staples in a week, including whole grains, green

bananas, starchy roots, and tubers.
2. Make your plate colourful. Combine different coloured vegetables, roots,
tubers, and pulses in your meals.
3. Eat mixed food. Adding different food groups to relish is a great way to
eat many food groups in one meal.
4. Share a variety of meals with the whole family.
5. Planning your meals ahead can help you eat a greater variety of foods.
6. Grow different types of vegetables and fruits in a backyard garden for a
continued supply of a variety of foods.
7. Keep animals such as chickens, rabbits, goats and fish to help you access
animal-source foods easily.
8. Store food safely to ensure a sustainable supply of various
food types.
9. Avoid drinking tea during or soon after a meal. Tea
binds dietary iron and makes it unavailable.
10. Eat the right amounts food from each food group.

Tanzania Mainland Food-Based Dietary Guidelines 43

 6. RECOMMENDATION 1.2
EAT STAPLES SUCH AS CEREALS, STARCHY ROOTS, TUBERS, PLANTAINS OR
GREEN BANANAS EVERY DAY FOR A STRONG AND ACTIVE BODY
6.1 What are the starchy staples? grains. However, cereal grains may be
Cereals, starchy roots and tubers and contaminated with mycotoxins.
green bananas are starchy staples that
make the main part of a meal. These 6.2 Mycotoxins in grain cereals
include maize, sorghum, rice, wheat, Mycotoxins are compounds produced by
millet, cassava, yam, potatoes, sweet moulds that are usually found in the soil
potato, and green bananas, among and can contaminate crops in the field or
others. Non-starchy roots such as carrots after harvesting.
are excluded from this group and are
classified as vegetables. Mycotoxins can contaminate cereals
such as maize, sorghum, millet and other
When the grains retain all their parts, like grains (Neme and Mohammed, 2017;
the hull and bran, they are considered Tola and Kebede, 2016; FAO, 2004c).
wholegrain. When flours or meals are The common mycotoxins in the United
made from unprocessed grains, without Republic of Tanzania are fumonisins and
being bleached or whitened, they are aflatoxin (Kimanya et al., 2008).
also considered wholegrain.
Aflatoxin is also found in nuts, pulses
Refined or dehulled grains are grains that (legumes) and spices. It may also be
have had the outer hulls removed, such as present in milk and meat from the animals
white rice, white maize flour, white bread, that have consumed feeds contaminated
white bleached wheat flour, and white with it (Nakavuma et al., 2020).
pasta. The process of dehulling removes
the bran and seed germ, making refined Eating foods contaminated with
grain products less nutritious than whole moderate to high levels of aflatoxin can
cause severe illness and sometimes

44 Tanzania Mainland Food-Based Dietary Guidelines

death. Long-term exposure to low levels (List sources: Anitha et al., 2020; Ayalew et al., 2017;
Kamala et al., 2018; Nyamete, Bennink and Mugula,
of aflatoxin increases the risk of liver 2016; Seetha et al., 2017; Siwela et al., 2005; Suleiman,
cancer and is also associated with low Rosentrater and Chove, 2017).
birth weight, impaired child growth, and
immune suppression (Kimanya et al., 6.3 Benefits of eating cereals, roots
2021; Mollay et al., 2020). tubers, green bananas and plantains
Cereals, starchy roots and tubers,
Tanzanian children are at a higher risk of plantains, and green bananas are staple
exposure to aflatoxin than adults. This is foods that provide carbohydrates as the
because maize and groundnuts (the main primary energy source for the body.
sources of dietary aflatoxins) are used as
the main ingredients of complementary Whole grains such as brown rice and
foods. Reliance on maize as a staple unhulled maize flour (dona) provide
presents high risks of exposure to dietary fibre and some nutrients, such as
aflatoxins and fumonisins (Kimanya et al., iron, zinc, copper, magnesium, selenium,
2008; Wild, Miller and Groopman, 2015). and B vitamins.
It is therefore important to eat a variety
of staples to reduce the risk. Fibre reduces the risk of developing
various conditions, including heart
High temperatures, moisture content, disease, diabetes, diverticular disease,
heavy rains, and poor grain handling and constipation. High intake of dietary
practices during harvesting and fibre has been linked to a lower risk of
transportation accelerate mycotoxin heart disease (Pereira et al., 2004). In
contamination (Massomo, 2020; Neme addition, dietary fibres found in whole
and Ibrahim, 2017). It can also happen grains and other plant-based foods
when foods are stored for too long protect against colorectal cancer, weight
at high temperatures and in a humid gain, overweight, and obesity (WCRF,
environment. 2018). Higher fibre intake has also
been linked to a lower risk of metabolic
Recommendations to reduce syndrome, a combination of factors that
mycotoxins in cereals include: increases the risk of developing heart
disease and diabetes. These factors
• ensuring hygienic precautions during include high blood pressure, high insulin
harvesting, storage and processing levels, excess weight (especially around
of agricultural crops and feedstuffs;
the abdomen), high levels of triglycerides,
• hand sorting to remove and low levels of HDL (good) cholesterol
contaminated grains; (Mayor, 2019; McKeown et al., 2004). Fibre
• rapid drying on platforms to avoid intake is also associated with reduced
direct contact with soil; risk of some disorders of the gastro-
• proper shelling methods; intestinal tract, including constipation
and diverticulosis.
• use of clean and aerated storage
structures; 6.4 Consumption pattern of cereals,
• controlling insect damage; starchy roots and tubers, and green
• good transportation practices; bananas in Tanzania
Tanzanian diet is mainly made up of
• avoiding long storage periods;
refined starchy staples with a small
• washing and winnowing maize amount of vegetables or pulses (legumes)
grains; and as a relish.
• avoiding feeding animals
contaminated crop residues.

Tanzania Mainland Food-Based Dietary Guidelines 45

 Starch-based foods account for nearly Staples make up a big part of
70 percent of the calorie share, pulses carbohydrate intake. Therefore, as
(beans) 6.2 percent, fat 5.1 percent, part of healthy staple consumption,
animal-source food 2.3 percent and the GDB recommends that at least
fruits 0.9 percent (Cochrane and 125 g per day should be from whole
D’Souza, 2015). However, there are grains. This is equivalent to one serving
variations in regions and zones, mainly of the staples, or two slices of brown
due to climatic conditions, therefore it bread, a cup of brown rice or a cup
is important to eat the different kinds of of sorghum or whole maize ugali
cereals that are locally available. (thickened or stiff porridge) (GBD, 2019).

Maize and wheat contribute the highest 6.6 Recommended intake for Tanzania
calories of all the cereal staples. To mainland
improve micronutrient contents, bulk- The diet modelling carried out for the
produced maize and wheat flour are Tanzanian FBDGs recommends a daily
fortified with folic acid and iron. intake of 822 kcal for an adult person,
which is equivalent to one serving of the
6.5 Global guidance on how much staples, or about four servings of cereals
starchy staples to eat every day per day (about 145 g and approximately
The Global Burden of Disease Study 200 kcal per serving). These amounts
(GBD, 2019) recommends that about can be estimated using a cup, small bowl,
55–75 percent of daily energy intake serving spoon or a fist. At least one of
should come from carbohydrates. For the four servings should be whole grains.
a 2,000 kcal diet this is about 1,100 Kcal
to 1,500 kcal for total carbohydrates.

46 Tanzania Mainland Food-Based Dietary Guidelines

Table 7 One serving size equivalents and key nutrients a serving provides as per
Tanzania Mainland modelling

Make four servings daily by picking or combining any of the options from this table
One serving
Nutrient values per serving
measure
Avg.
Pro- Cal- Fi-
Cooked foods Grams* serving Folate Iron Zinc Vit A
Cups*/ tein cium bre
(g) (rounded)
size
(rounded)
kcal (g) (mcg) (mg) (mg) (mg) (g) (mcg)

Ugali (stiff
3/4 cup 161 210 5.3 1.6 0.2 3.2 0.2 2.1 0
porridge)
Rice 1 cup 160 205 4.2 8.6 0.9 8 0.7 0.9 0
Sweet potato
1 cup 200 225 2.9 65.5 2.0 51.9 0.7 6 6.1
(boiled)
Cassava
1 cup 132 210 1.6 21.0 0.9 56.5 0.4 2.5 1.7
(boiled) diced

Plantains
(ripe, boiled - 150 200 1.65 19.5 1.2 9 0.15 3.3 58.5
without salt)

Plantains
(green, 1 cup 154 179 1.2 40 0.9 3.1 0.2 3.5 69.3
boiled)
Yams 1 1/4 cup 170 230 3.4 29.7 1.4 43.9 1.0 7.3 4.2
Irish potato
1 1/2 cup 230 187 4.3 25.4 1.9 23.3 0.7 4.2 2.5
(boiled)
Pasta 1 cup 124 190 6.7 6.2 0.6 12.4 0.7 2.0 0
Bread (thick
3 slices 90 225 8 40.5 1.8 44.1 1.3 5.6 0
slice)
White bread
rolls, small
3 small
rolls (5 cm 75 200 6.8 21 0.9 19.5 0.6 2 0
rolls
square, 5 cm
high)
Fried potato
70 223* 2.4 21 0.6 12.6 0.4 2.7 0
chips/fries*
The cup measures and food weights are based on USDA (240 ml cup measure) and occasionally
Australian food composition tables (FCTs). The kilocalorie output is based on the Mainland diet model
FCT.
* One fast food order of chips more than doubles the number of calories (427 kcal) for the same
150 g of other starchy foods. In addition, chips have high a fat content, which is discussed under the
guideline to limit intake of oils, fats, salt and sugars.

Tanzania Mainland Food-Based Dietary Guidelines 47

 6.6 Key messages for eating staples
1. Eat four servings of staples per day and make at least
one serving wholegrain for a strong and active body.
2. Eat different varieties of cereals, starchy roots, tubers,
plantains and green bananas throughout the week as a
good source of energy and vitamins.
3. Make staples one-third of your plate, not all of your plate.
4. Choose fortified maize or wheat flour over unfortified
products.
5. Sort to remove mouldy or discoloured grains before processing as they
may contain harmful toxins.

6.7 Tips for increasing intake of whole grain cereals and eating a
variety of staples

1. Replace refined grains such as white maize and rice with whole grains
such as unrefined maize, sorghum ugali and brown rice whenever
possible.
2. Include whole grains in your daily meals to get fibre that aids
digestion and reduces the risks of overweight and NCDs.
3. Make starchy foods part of a meal, taken together
pulses or animal source foods, and vegetables.
4. Add a variety of starchy roots and tubers such as sweet
potato, cassava, yams, and taro to your diet.

48 Tanzania Mainland Food-Based Dietary Guidelines

7. RECOMMENDATION 1.3
EAT DIFFERENT VEGETABLES EVERY DAY TO PREVENT AND REDUCE THE
RISK OF DISEASES
7.1 What are vegetables? 7.2 Benefits of eating vegetables
Vegetables include parts of a plant such Vegetables provide vitamins and minerals
as leaves, flowers, stems and roots in without excess calories. Different
different colours. Vegetables can be vegetables contain different amounts
fresh, dried, frozen or canned. of nutrients, so it is important to eat a
variety of vegetables every day to meet
Examples of vegetables include sweet various nutrient needs. For example,
potatoes leaves (matembele), cowpea dark-green leafy vegetables (amaranth,
leaves (majani ya kunde), cassava sweet potato leaves, cowpea leaves) are
leaves (kisamvu), amaranth leaves good sources of iron, while orange or red
(mchicha), okra (bamia), African eggplant coloured vegetables (carrots, tomatoes)
(nyanyachungu), eggplant (biringanya), contain high amounts of carotene, a
nightshade (mnavu), spider plant precursor for vitamin A (Willet et al.,
(mgagani), pumpkin leaves (majani ya 2019; Slavin and Lloyd, 2012).
maboga), tomatoes, and sweet peppers.
Examples of root vegetables are radishes, Vegetables also contain vitamin C, which
carrots, beetroots, and onions. is important for iron absorption, among
other functions. However, more than
Potatoes, yams and cassava and green 50 percent of Vitamin C may be lost
maize are not part of vegetables because during cooking due to heat destruction
of their high starch content. and leaching, especially when cooking
water is discarded, which is a common
Vegetables are a great source of vitamins practice in the United Republic of
such as pro-vitamin A, vitamin C, and folic Tanzania. Vitamin C is water-soluble
acid (one of the B vitamins). They are also and is sensitive to both temperature
rich in minerals such as iron, potassium, and oxygen, so it is easily degraded
and magnesium. Vegetables provide during cooking. A combination of high
dietary fibre as well as phytochemicals. temperatures and long cooking duration
results in severe losses of vitamin C (Tian
et al., 2016). These FBDGs recommend
the following for cooking vegetables:

Tanzania Mainland Food-Based Dietary Guidelines 49

 • Wash vegetables before chopping. Vegetables also contain phytochemicals
• Cover pot when cooking. that protect the body from certain
cancers. They are rich in dietary
• Cook at a low temperature and for a fibre, which promotes healthy bowel
short period. movements. Adequate vegetable
• Do not discard cooking water. intake has been shown to reduce the
risk of obesity, heart disease, stroke
• Prepare vegetables closer to
and common types of cancer (Williams
consumption time so they are not left
and Hord, 2005; Nour et al., 2018;
standing for a long time (which can
Hartley et al., 2013). Consuming at least
lead to oxidation and loss of nutrient
400 g of fruits and vegetables (about four
value).
to five servings) every day reduces blood
pressure and decreases the risks of heart
disease and stroke (WHO, 2003; WHO,
2015a). Vegetables also have low energy
density.

50 Tanzania Mainland Food-Based Dietary Guidelines

7.3 Vegetable consumption in the 7.5 Recommendation for Tanzania
United Republic of Tanzania According to diet modeling for Tanzania,
Vegetables are commonly consumed, eating at least two servings (280 g)
especially by women and children, but of different vegetables per day is
only in relatively small amounts, so recommended for Tanzania Mainland.
vegetables do not contribute significantly
to the overall nutrient intake (Kinabo One serving of vegetables provides about
et al., 2016; Keding, 2011; Mayige and 60 kcal and about 140 g. Using household
Kagaruki, 2013). A study in rural settings utensils, this is about:
reported that only a small proportion
• 1 cup or 2 serving spoons of cooked
of women reached recommended daily
vegetables; or
intakes for vitamin A (27 percent), iron
(17 percent), and zinc (7 percent). The • 1 cup of hard vegetables such as
amount of dark-green leafy vegetables carrots, green beans, or green peas;
consumed was the main determinant of or
vitamin A and iron intake by women and • 2 cups of raw leafy vegetables or salad
corresponded to higher haemoglobin, vegetables.
serum retinol and iron status (Stuetz, et
al., 2019). High intake of vegetables is
therefore important to reduce iron and
vitamin A deficiencies, which are highly
prevalent in the United Republic of
Tanzania.

7.4 Global guidance on how much

vegetables to eat every day
According to the GBD study, a diet low
in vegetables is defined as an average
daily consumption of less than 360 g of
vegetables (fresh, frozen, cooked, canned To make two total servings per day,
or dried vegetables) (GBD, 2019). The choose and combine any of the
Healthy Reference Diet proposed by the vegetables from the list in Table 8 to
EAT Lancet Commission recommends make the two servings per day. Consider
consumption of 300 g/day of vegetables the nutrient composition of vegetables
(range 200–600 g), consisting of 100 g as detailed in Table 8.
each of dark-green vegetables, red and
orange vegetables, and other vegetables
(Willett et al., 2019). Both GBD and Eat
Lancet exclude pulses (legumes) and
salted or pickled vegetables, juices, nuts
and seeds, and starchy vegetables such
as potatoes, cassava, and fresh corn from
this vegetable group.

Tanzania Mainland Food-Based Dietary Guidelines 51

 One cup raw
or cooked
hard
vegetables

Carrots, beetroot, green peas, green beans, radishes, cabbage,

broccoli, celery, etc.

Two cups raw

leafy, or soft
vegetables
and salads

Leafy vegetables: cowpeas, beans, pumpkin, sweet potato, cassava,

moringa, okra and baobab leaves, amaranth leaves, blackjack,
Chinese cabbage, mustard greens

One cup
cooked leafy
and soft
vegetables
Leafy vegetables: cowpeas, beans, pumpkin, sweet potato, cassava,
moringa and okra leaves, amaranth leaves, blackjack, Chinese
cabbage, and mustard greens

Soft vegetables: mushrooms, eggplants, etc.

52 Tanzania Mainland Food-Based Dietary Guidelines

 Table 8 List of vegetables and estimated amounts in grams and key nutrients provided per serving

Make two vegetable servings daily by picking any of the vegetable amounts below. Each food
amount is one serving equivalent.
One-serve
measures One-serving food weight and nutrient values from the Mainland Diet
Food
(rounded Model FCT (rounded values)
description
values)
Cup Food Energy Vit C Vit A Iron Folate Calcium Zinc Fibre
(15 ml
(250 Weight
Tbsp) (kcal) (mg) (mcg) (mg) (mcg) (mg) (mg) (g)
ml) (g)

Cowpea leaves,
1 160 10 69.8 38.4 227.2 6.4 108.6 424.6 0.6 6
boiled

Cassava leaves,
1 160 10 162.4 26.2 432.8 7 99.2 441.8 0.8 6
boiled

Amaranth leaves,
1 132 8 57 25 301 6.4 55.4 501.6 0.8 2
boiled

Cooked okra (lady’s

1 160 10 36 26 22.4 0.4 73.6 124 0.6 4
fingers)
Boiled okra leaves 1 160 10 68.2 24.2 85 0.8 99.2 475.2 1.2 8.2
Boiled green beans 1 125 8 54 14.6 30.8 1.2 45.8 60 0.4 3.4

Baobab, leaves
1 160 10 118.8 32 626 5 78.4 501.4 1.2 12.2
boiled*
Cooked moringa/
1 136 10 81.6 42.2 4106 3.2 31.2 784 1 2.8
drumstick leaves

Tanzania Mainland Food-Based Dietary Guidelines

Continued on page 54

53
54
Make two vegetable servings daily by picking any of the vegetable amounts below. Each food
amount is one serving equivalent.
One-serve
measures One-serving food weight and nutrient values from the Mainland Diet
Food
(rounded Model FCT (rounded values)
description
values)
Cup Food Energy Vit C Vit A Iron Folate Calcium Zinc Fibre
(15 ml
(250 Weight
Tbsp) (kcal) (mg) (mcg) (mg) (mcg) (mg) (mg) (g)
ml) (g)
Cooked Chinese
1 170 12 22.2 76.6 379.2 1.4 112.2 178.6 0.4 1.8
cabbage*
Boiled green
1 140 10 36 35.4 865.2 1.2 12.6 165.2 0.2 2.8
mustard*

Cooked green peas 1 160 10 68 76.6 83.2 3.2 46.4 68 0.6 4.4

Tanzania Mainland Food-Based Dietary Guidelines

Cooked pumpkin
1 244 16 48.8 12 264 1.4 - 36.8 - 2.6
mashed*

Raw tomato 1 148 10 32 43.8 77 0.8 31.4 19.2 1 2

Raw onion 1 160 10 60 16.4 0 0.4 25.6 40.2 0.4 2.8

Onion boiled 1 160 10 72 6.8 0 0.4 16 46.4 0.4 3.6

Boiled sweet potato

2 128 8 68 6.4 592.6 0.8 53.8 184 0.2 3
leaves
Boiled pumpkin
2 142 10 42 6.6 258.4 2.6 27 504 0.2 3.6
leaves

Continued on page 55
 Make two vegetable servings daily by picking any of the vegetable amounts below. Each food
amount is one serving equivalent.
One-serve
measures One-serving food weight and nutrient values from the Mainland Diet
Food
(rounded Model FCT (rounded values)
description
values)
Cup Food Energy Vit C Vit A Iron Folate Calcium Zinc Fibre
(15 ml
(250 Weight
Tbsp) (kcal) (mg) (mcg) (mg) (mcg) (mg) (mg) (g)
ml) (g)

Cooked eggplant 2 200 14 64 8.2 5 1.6 30.6 26.4 0.2 5.6

Raw carrot,
2 256 18 104 15.2 2137.6 0.8 48.6 84 0.6 7.2
chopped*

Raw cucumber 2 208 14 32 5.8 10.4 0.6 14.6 33.2 0.4 1

Raw moringa 2 Tb
20 2 76 4.25 4725 24 - 500 - 5
powder* spoon

Cooked kale/rape* 1 130 8 46 23.2 189.8 1 84.6 195 0.4 5.2

2 Tb
Seaweed dried* 28 2 102 24.2 - 3.6 - 101.2 - 10.2
spoon
Seaweed cooked in
1 96 6 58 28.8 216 1.6 94 61.4 1 0.2
oil*
* Values based on USDA FCT and Food Exchange list.
- values not available

Tanzania Mainland Food-Based Dietary Guidelines

55
 7.5 Key messages for eating vegetables
1. Eat at least two servings (280 g) of seasonally available
vegetables every day.
2. Choose different coloured vegetables throughout the
week to increase the variety of nutrients. A variety of colours
will provide different types of phytochemicals.
3. To enhance absorption of pro-vitamin A, add a small amount (1–2
teaspoons) of vegetable oil when cooking leafy green or yellow
vegetables.
4. Choose fresh or frozen vegetables rather than vegetable juices.

7.6 Tips for eating a variety of vegetables every day

1. Wash vegetables with clean water just before cutting/chopping to
prevent loss of nutrients.
2. Cover and cook for a short time in a small amount of water at low
temperature to preserve nutrients.
3. Avoid discarding water after boiling vegetables.
4. Buy fresh vegetables in-season for better value and quality.
5. Start your own home vegetable garden to increase accessibility of
vegetables every day.
6. Include cucumbers, mushrooms, tomatoes, pumpkin and carrots as part
of vegetables.
7. Do not add bicarbonate of soda (magadi) or ash (majivu) to cooking
vegetables as it destroys some nutrients.
8. Do not overcook vegetables as heat destroys some
vitamins.
9. Eat vegetables such as cucumber, carrots and
tomatoes as a snack.
10. Preserve vegetables by drying so they can be
enjoyed when out of season.

56 Tanzania Mainland Food-Based Dietary Guidelines

8. RECOMMENDATION 1.4
EAT AT LEAST TWO TYPES OF FRUIT EVERY DAY FOR BETTER HEALTH
8.1 What are fruits? It’s best to eat fruits in their whole form
Fruits are the sweet, soft and fleshy rather than making them into juices. The
product of a tree or other plants that process of making juices discards healthy
contain seeds and are eaten as food. dietary fibre. If it is necessary that fruits
are taken in the form of liquid, then
Examples of fruits include mangoes, blend the whole fruit and no additional
papayas, bananas, pineapples, guavas, sugar should be added as the fruit juice
watermelons, avocados, oranges, lemons contains natural sugars.
and wild fruits such as tamarind (ukwaju),
baobab (ubuyu) and jackfruit (fenesi). The 8.3 Fruit consumption in Tanzania
fruits can be fresh, canned, frozen, or Fruits are for everyone – men, women,
dried. children, and the ageing. However, more
than 90 percent of Tanzania’s population
8.2 Benefits of fruits do not meet the recommended amount
Adequate fruit intake decreases the risk of fruit intake per day. In addition,
of high blood pressure, heart diseases, Tanzanian adults, especially men in
and some cancers (Kjøllesdal et al., 2016; rural areas, do not consider fruits as
Hartley et al., 2013). important components of a diet (Safari,
Timothy and Masanyiwa, 2020; Lyana
They are good sources of minerals and and Manimbulu, 2014; Kinabo et.al,
vitamins such as vitamin A, vitamin C, 2016).
folate, and potassium. Orange-coloured
fruits, such as papaya and mango, are 8.4 Global guidance on how much fruit
good sources of vitamin A, which helps to eat every day
prevent night blindness. The WHO and FAO recommend 400–
500 g per day, or ≥ 400 g per day of
Fruits improve body immunity. Fruits fruit and vegetables (WHO, 2003).
also contain fibre which is beneficial to Similarly, the World Cancer Research
health (Wallace et al., 2020; Hartley et al., Fund (WCRF, 2018) recommends at least
2013; Hosseini et al., 2018). five portions or servings (approximately

Tanzania Mainland Food-Based Dietary Guidelines 57

 80 g per serving) per day of a variety of provides approximately 80 kcal. One
non-starchy vegetables and fruit (giving serving of fruit is about 140 grams,
an approximate total of 400 g per day). equivalent to one large orange or
The Global Burden of Disease report one medium-sized banana, apple, or
defines a diet low in fruit as an average mango, or half of a small avocado. For
daily consumption of less than 250 g small fruits, the serving size can be two
per day of fruit (fresh, frozen, cooked, fruits, for example, two small guavas,
canned, or dried, excluding fruit juices peaches, tangerines, plums, kiwifruits,
and salted or pickled fruits) (GBD 2017). or apricots. A serving of small fruits
The EAT Lancet Commission proposes can also be measured as a handful,
an average daily fruit consumption for example, a handful of tamarind
of 200 g per day of fruits (range or baobab fruit. For berries and diced
100–300 g) (Willett et al., 2019). fruits, such as papaya, watermelon, and
mango, one serving is one cup. Choose
8.5 Recommendation for Tanzania fruits from the list in Table 9 while
Individuals should eat two servings watching calorie the contribution from
per day (a total of 280 g). One serving each fruit.

58 Tanzania Mainland Food-Based Dietary Guidelines

 Table 9 Fruits and estimated amount in grams and key nutrients per serving

Consume two servings of fruits daily by choosing any of the two fruit options below. Each food
amount is one serving equivalent.
Food weight and nutrient values from the Mainland Diet Model FCT
Food One-serve measures
or otherwise specified (values are rounded up)
description
Measure Serving Energy Vit C Vit A Iron Folate Calcium Zinc Fibre
Size size (g) (kcal) (mg) (mcg) (mg) (mcg) (mg) (mg) (g)

1 medium
Banana, white flesh 120 120 13 5 <1 23 8.4 0.2 2.4
(17–19 cm)

1 medium (7
Apple, raw, with skin 140 75 6 4 <1 4 8.4 <1 3.4
cm diameter)

1 large (7.5–8
Orange 185 80 87 14 <1 62 57 <1 3.1
cm diameter)

Peaches (yellow)* 1 large 175 70 12 28 0.4 7 10.5 <1 2.6

Small pear* 1 150 85 7 1.5 <1 11 13.5 <1
2 small (5–6
Tangerines* 150 84 40 51 <1 24 55.5 <1
cm)
Guava, raw, without
2 110 65 287 39 <1 8 25.3 <1 6.2
refuse‡
Granadilla/passion
fruit, raw, without 5 fruits 90 87 27 58 1.4 13 10.8 0.1 9
refuse*

Tanzania Mainland Food-Based Dietary Guidelines

Continued on page 60

59
 60
Consume two servings of fruits daily by choosing any of the two fruit options below. Each food
amount is one serving equivalent.
Food weight and nutrient values from the Mainland Diet Model FCT
Food One-serve measures
or otherwise specified (values are rounded up)
description
Measure Serving Energy Vit C Vit A Iron Folate Calcium Zinc Fibre
Size size (g) (kcal) (mg) (mcg) (mg) (mcg) (mg) (mg) (g)

Tamarind (ripe, raw) _+ 30 75 3.1 0.3 <1 5 45.3 <1 5,5

Baobab (pulp)† _+ 45 136 111 2.6 2.5 NA 124.1 <1 3.1

African locust bean,
_+ 30g 86 67 58 1 NA 34 0.28 3.6
fruit, pulp, raw
Grapes* 1 cup 90 60.3 4 4.5 0.3 3.6 12.6 0 0.8

Tanzania Mainland Food-Based Dietary Guidelines

1 cup diced fruit
(papaya, other cut 1 cup 145 51.9 84 116 1.0 36.3 29.6 <1 2.8
fruits)
Peaches 1 cup
1 cup 154 60 10 25 9.5 9.2 <1 2.3
(sliced)*
Mango (orange
1 cup 165 106.2 60 276 1.1 42 28.5 <1 3.5
flesh), raw
Watermelon, raw 1.5 cups 230 67.2 17 96 <1 8.8 16.1 <1 0.8
African black plum/
Java plum (wild), _+ 71.4 80 7.1 trace 0.8 NA NA 17.9 0.0
ripe raw (WA)
Jackfruit* _+ 84.2 80 11.5 4.2 0.2 24.0 20.2 0.1 1.3

Continued on page 61
 Consume two servings of fruits daily by choosing any of the two fruit options below. Each food
amount is one serving equivalent.
Food weight and nutrient values from the Mainland Diet Model FCT
Food One-serve measures
or otherwise specified (values are rounded up)
description
Measure Serving Energy Vit C Vit A Iron Folate Calcium Zinc Fibre
Size size (g) (kcal) (mg) (mcg) (mg) (mcg) (mg) (mg) (g)
Custard apple/sweet
_+ 87.5 80 31.5 0.2 0.6 NA NA 20.6 NA
apple, raw (DM)
Soursop, raw (WA) _+ 103.9 80 62.3 0.0 0.4 6.0 6.2 20.8 0.2
Pomegranate raw
_+ 102.3 80 15.4 2.0 0.7 24.0 24.6 12.3 0.4
(DM)
Avocado, pulp, raw
_+ 51.9 80 7.3 3.1 0.4 35.3 18.3 7.8 0.3
(DM)
Dates (DM) _+ 53.6 80 7.5 1.1 0.2 25.0 13.4 12.9 0.1

Star fruit, raw (WA) _+ 60.6 80 77.0 0.0 0.9 NA NA 14.5 0.6

Pears, raw * _+ 140.4 80 6.0 1.4 0.3 7.0 9.8 12.6 0.1

Java plums, raw * _+ 133.3 80 19.1 0.0 0.3 NA NA 25.3 NA

* USDA Food Composition Table sources
† FCT only has values for baobab pulp (without seeds). Eat baobab with little or no sugar to get the health benefits.
‡ “Refuse” is the part of the fruit that is not consumed, for example, the skin and seeds.
DM Diet model
WA West Africa Food Composition Table
_+ Cup or household measurements not available or could not be estimated
NA Data not available
Note: Other fruits like shoki-shoki, bilimbi, rambutan, durian, wild rubber vine (eaten with little or no sugar), fracassis, mobola plum, jelly palm, and

Tanzania Mainland Food-Based Dietary Guidelines

pomelo also provide plenty of vitamins and minerals.

61
 8.6 Key messages for eating fruits
1. Eat two servings of fruits every day.
2. Choose different coloured fruits throughout the week to
increase the variety of phytonutrients consumed.
3. Eat fresh fruit in place of fruit juices.
4. Wash fruit with clean water before eating to prevent
diseases.
5. Consume wild fruits such as baobab, tamarind and wild loquat when
available as they are rich in vitamin C and calcium.
6. Limit processed fruit juices because they contain high amounts of
added sugars and lack dietary fibre. Rather drink blended whole fruit or
smoothies.

8.7 Tips for eating two types of fruits per day

1. Eat varieties of seasonally available fruits every day.
2. Eat fruit as snacks between meals instead of deep-fried foods,
sweets or sweetened beverages.
3. Add a serving of fruit to your breakfast or meals.
4. Include varieties of wild fruits such as baobab,
tamarind, ntalali, mabungo, and furu.
5. Grow your own fruit trees.

62 Tanzania Mainland Food-Based Dietary Guidelines

Tanzania Mainland Food-Based Dietary Guidelines 63
 9. RECOMMENDATION 1.5
EAT PULSES (LEGUMES) OR NUTS AND OILY SEEDS EVERY DAY FOR GOOD
HEALTH
9.1 What are pulses, nuts and oil seeds? immune function. They are recognized
Pulses are the dried seeds of the legume for their protein, but they have more
plants. Legumes are plants with seedpods fat than protein (making them a great
that have two halves. They include beans, source of unsaturated fats). Unsaturated
lentils and all types of peas, such as fats are healthy fats that help reduce
pigeon peas (mbaazi), chickpeas (dengu), bad cholesterol in the body and reduce
cowpeas (kunde), green gram (choroko), the risk of heart disease. The nutrients in
and bambara (njugumawe). nuts and seeds makes them a healthy
option.
Nuts are dry single-seeded fruits enclosed
inside an outer layer. Nuts are energy Since pulses are great sources of
dense due to their oil content. Examples iron, because of this, they are key to
of nuts include groundnuts and cashew preventing iron deficiency anaemia,
nuts. especially in low-income countries. They
should be soaked overnight, drained,
Oil seeds include pumpkin seeds, and cooked with fresh water to enhance
sunflower seeds and sesame seeds. the availability of iron. This process can
reduce the amount of phytic acid, which
9.2 Benefits of eating pulses, nuts and oil prevents the iron from being released
seeds from the food and absorbed by the body.
Pulses, nuts, and oil seeds are affordable Iron from beans, lentils, and peas is best
sources of protein. They are also a absorbed by the body when taken with
good source of iron, zinc, phosphorus, foods that contain vitamin C (such as
magnesium, B vitamins, folate and green leafy vegetables and citrus fruits)
dietary fibre. or when eaten with meat, fish and other
seafood. Vitamin C helps to change the
Nuts and oil seeds provide proteins, iron in beans to a more absorbable form.
vitamin E, niacin, and minerals such as
selenium, iron, zinc, magnesium and
copper that help to improve the body’s

64 Tanzania Mainland Food-Based Dietary Guidelines

 9.3 Coconut and coconut milk
Coconut milk is an aqueous extract of
grated coconut kernel. It is commonly
obtained through hand squeezing of
grated coconut. It is traditionaly added
when cooking vegetables, beans,
cassava, sweet potatoes, plantains
and rice. Coconut is a high calorie food
due to the presence of lipids, sugars
and protein, with most of the calories
coming from fats (Nadeeshani et al.,
Pulses are affordable sources of protein. 2015).
Plant-based proteins, unlike proteins
About 90 percent of the fats are saturated
from animal sources, do not contain all
fats, with most being the medium and
the amino acids that make up complete
short-chain triglycerides (Nadeeshani et
proteins. However, when foods are eaten
al., 2015; Deen et al., 2021). The saturated
in combination, such as maize and beans,
fatty acid content is significantly greater
or beans and rice, the amino acids from
than in other commonly consumed
two food groups will make the protein
vegetable oils, so it should be consumed
complete.
in moderation (Deen et al., 2021).
Pulses contain fibre, folate and Apart from fats, sugars and proteins,
phytochemicals that are beneficial to coconut milk also contains carbohydrates,
the functioning of the heart. The fibres fibre, vitamins and minerals (including
in pulses help to lower blood cholesterol folate, iron, calcium, zinc, vitamin C,
even without weight changes and may selenium, copper, magnesium and
prevent sharp rises in blood sugar, both manganese).
of which are risk factors for cardio-
vascular diseases. A meta-analysis of In a systematic review that included
mostly observational studies showed eight clinical trials and 13 observational
that eating pulses about four times per studies, it was observed that the
week was associated with a 14 percent consumption of coconut flesh or squeezed
reduced risk of coronary artery disease coconut does not lead to adverse
(Marventano et al., 2017). cardiovascular outcomes. However, in
intervention studies, replacing coconut
Since pulses, nuts and seeds are oil with unsaturated fats affected the
affordable sources of proteins, iron, blood lipid profiles, thereby reducing the
healthy fats and micronutrients, they risk of cardiovascular diseases (Eyres et
should also be offered as complementary al., 2016).
foods to infants and young children from
6 to 24 months to increase their iron, In another systematic review and meta-
protein, and micronutrient intake. analysis, consumption of coconut oil
increased low-density lipoprotein (LDL)
In the United Republic of Tanzania, cholesterol and also increased high-
pulses are commonly consumed in all density lipoprotein (HDL) cholesterol
the regions among adults. Pulses are also compared with non-tropical vegetable
the main protein source in institutions oils. However, it did not significantly affect
such as schools, prisons and colleges. markers of glycemia, inflammation, and
adiposity compared with non-tropical
vegetable oils (Neelakantan, Seah and
van Dam, 2020).

Tanzania Mainland Food-Based Dietary Guidelines 65

 The WHO (2018d) recommends that serving is 120 kcal. Given the different
intake of saturated fats should be less than energy densities between pulses, nuts
10 percent of total energy intake. Based and oil seeds, the serving sizes can vary
on the Tanzania Mainland diet model, for considerably. For instance, one serving of
a 2300-kcal diet, 10 percent is equivalent pulses is about 100 g and provides about
to 230 kcal. 130 kcal, whereas one serving of nuts
and oil seeds is about 30 g and provides
Based on the food composition table the same 130 kcal.
(FCT) used for the Mainland diet model
and the USDA Food Composition Table, One serving is equivalent to either of the
one cup (226 g) of coconut milk provides following:
445 kcal in total, of which 384 kcal is
saturated fats, thus exceeding the total • ½ cup cooked lentils, cowpeas, or
recommended maximum of saturated beans
fats. It is therefore recommended that • ½ cup cooked bambara
the intake of coconut milk be limited • 1/3 cup coconut milk
to a third of a cup (about 85 ml) or less
• 3 tablespoons (27–30 g) of sesame
per day. This amount provides 148 kcal,
seeds, dehulled sunflower seeds, or
which is about one serving from the pumpkin seeds (dried and shelled)
pulses, nuts and seeds group.
• 3 tablespoons cashew nuts, peanuts
9.4 How much pulses, nuts and oil or almonds
seeds to consume per day • 1½ tablepoons peanut butter or
According to diet modelling for Tanzania, peanut flour or cashew nut flour
three servings of pulses, nuts and oils
seeds are recommended every day. One

66 Tanzania Mainland Food-Based Dietary Guidelines

 Table 10 Pulses, nuts and oil seeds household measure serving size equivalents and estimated key nutrients amounts

Consume three servings daily by choosing any of the foods below. Each food amount
listed is one serving equivalent.
Food weight and nutrient values from the Mainland Diet Model
one-serve measures
FCT or otherwise specified (values are rounded up)
Food description
1 serve Energy Protein Iron Folate Calcium Zinc Fibre
1 serving
food
measure
weight
(g) (Kcal) (mg) (mg) (mcg) (mg) (mg) (g)

Cowpeas ½ cup 80 94 6.3 1.8 61.8 20.6 1.2 4.5

Boiled red kidney

½ cup 90 111 8.6 2.5 66.6 39.6 0.81 8.4
beans*

White beans ½ cup 90 111 7.4 1.6 65.7 20.7 1.1 3.4

Pulses
Bambara nuts boiled ½ cup 90 125 6.7 0.9 missing 18.5 1 1.3

Soya beans ½ cup 85 151 11.8 2.4 69.7 72.7 1.6 3.4

Coconut milk† ¹/3 cup 75 148 1.6 2 11.3 12.8 0.5 1.7

Continued on page 68

Tanzania Mainland Food-Based Dietary Guidelines

67
68
Consume three servings daily by choosing any of the foods below. Each food amount
listed is one serving equivalent.
Food weight and nutrient values from the Mainland Diet Model
one-serve measures
FCT or otherwise specified (values are rounded up)
Food description
1 serve Energy Protein Iron Folate Calcium Zinc Fibre
1 serving
food
measure
weight
(g) (Kcal) (mg) (mg) (mcg) (mg) (mg) (g)

Dry roasted peanuts* 3 tablespoons 27 159 6.5 0.4 26.2 15.7 0.756 2.3

Peanuts raw* 3 tablespoons 27 153 7 1.3 64.8 24.8 0.9 2.3

Seeds, flax, chia 13– 2.8–

3 tablespoons 25–30 145–175 4.8–5.7 1–1.14 59–71 18–21
sunflower* roasted 1.6 3.3

Tanzania Mainland Food-Based Dietary Guidelines

Pumpkin and squash
3 tablespoons 30 145* 9 2.6 17.4 13.8 2.3 1.8
seeds (shelled), dried*

Nuts and seeds

1½
Sesame seeds 25 144 4.6 3 24 245.8 1.9 3
tablespoons
1½
Peanut butter* 24 134 5.3 0.5 8.4 13 0.6 1.4
tablespoon
* Calculated from the USDA FCT. The rest are calculated from the Mainland Diet Model FCT.
† Given the high amounts of fat (especially saturated fats) and lower amounts of other nutrients, limit intake of coconut milk to one serving per day.
Choose other pulses, nuts and seed options to make a second serving from this food group.
 9.5 Key messages for eating pulses, nuts and oily
seeds
1. Eat pulses such as beans, peas, lentils, cowpeas, pigeon
peas, and soya daily.
2. Eat a handful of unsalted nuts or oil seeds every day as
a snack.
3. Eat pulses, nuts or seeds together with fruits or
vegetables. Vitamin C in fruits and vegetables enhances iron absorption.
4. Feed cooked beans, lentils and peas to infants and young children aged
6–24 months to increase iron and protein intake.
5. Include pulses (legumes), nuts, and oil seeds in the diet of pregnant and
lactating women.

9.6 Tips for eating three servings of pulses, nuts and oil seeds
every day
1. Soak beans overnight to get rid of gas-producing antinutrients
and make them easier to cook.
2. Add the paste and/or flours of nuts or oil seeds to your
relish, vegetables and porridge.
3. Avoid adding soda or ash when cooking pulses.
4. Mix pulses with whole grains to improve protein
quality.

Tanzania Mainland Food-Based Dietary Guidelines 69

70 Tanzania Mainland Food-Based Dietary Guidelines
10. RECOMMENDATION 1.6
EAT ANIMAL SOURCE FOODS EVERY DAY TO STAY STRONG
10.1 What are animal and animal- options among animal-source foods
source foods? due to their healthy fatty acids and oils.
Animal and animal-source foods are They are associated with a reduced risk
foods derived from animals, fish and of cardiovascular diseases and stroke.
insects. They include red and white meat, Insects are rich in micronutrients and are
fish, sardines, octopus, organ meats, cheap to produce. Farming them is more
blood, egg, milk, and insects. environmentally friendly than farming
other animal-source foods.
White meat includes meat from chicken,
ducks, pigeons, birds and fish. Red meat 10.2 Benefits of eating animal-source
includes beef, goat, mutton, and pork. foods
• They are rich in proteins.
Animal products such as butter, ghee, • They have a complete profile of amino
lard and icecream are excluded from this acids, thus providing the body with
food group and are classified as oils and higher quality protein than the plant-
fats because of their high fat content. based proteins found in pulses, nuts,
and seeds.
Processed meats are not included in this
group because they are risk factors for • They are a good source of iron, zinc,
developing chronic diseases. and vitamins A and B, which are
especially important for growth and
When eating from this food group, select development.
seafood and insects as much as you can, • They have bioavailable iron and can
take milk and milk products daily, and eat prevent iron-deficiency anaemia.
white meat regularly.
• They aid in the growth and repair of
Limit intake of red meat and avoid eating tissues.
processed meats. • They help to build the framework
(collagen) of bones and teeth, tendons
Fish, poultry, and insects are the healthiest
and ligaments, and blood vessels.

Tanzania Mainland Food-Based Dietary Guidelines 71

 • Excess protein that is not used for any (Ramos-Elorduy, 1997).
of these functions is usually broken
down and converted to energy. Studies have shown that in insects such as
crickets, grasshoppers and mealworms,
Eggs: Eating an egg can greatly improve
micronutrients like copper, zinc,
the quality of a child’s diet and reduce
manganese, magnesium and calcium
stunting (Iannotti et al., 2017). Eggs,
are more readily available for absorption
though high in cholesterol, are not
than the same nutrients found in beef.
associated with the risk of heart disease
Some insects, like crickets, contain more
or stroke, except in people with diabetes
omega-6 and omega-3 than beef. Insects
(Rong et al., 2013), and consuming up to
also contain comparatively high amounts
one egg per day may decrease the risk of
of iron, zinc, manganese, selenium and
stroke (Alexander et al., 2016).
phosphorus (Rumpold and Schluter,
Fish: Fish provides protein, healthy fats 2013).
that are good for the heart and normal
Grasshoppers provide 12–73 g of protein
cell functions, and a range of other
per 100 g while winged termites provide
important nutrients such as vitamin A
32–37 g per 100 g (Hlongwane, Slotow
and calcium (Willet et al., 2019). Eating
and Munyai, 2020; Bukkens,1997).
at least two servings of fish per week
during pregnancy can promote brain
development of the foetus. Fish also
helps with a child’s brain development
(Oken, et al., 2008). Eating sardines or
small fish with bones provides additional
benefits as a source of calcium.

White meat: White meat from chicken,

poultry and birds (without skin) and fish,
including small fish eaten with bones,
are healthier options than red meat such
as beef, lamb and pork. White meat is
lower in saturated fat than red meat.

Edible insects: Insects are good sources

of complete protein and high levels of
Figure 3 Protein content of animal-
vitamin B12, iron, zinc, fibre, essential source foods
amino acids, omega-3 and omega-6
Sources: Hlongwane, et al., 2020; Bukkens,1997,
fatty acids, and antioxidants. By weight, Oibiokpa et al., 2018, Ramos-Elorduy, 1997]
insects contain higher amounts of
protein than traditional sources of
protein such as meat, dairy products Milk: Fresh milk, fermented milk and
and seeds (Hlongwane, Slotow and yoghurt are the three most important
Munyai, 2020; Oibiokpa et al., 2018). forms of milk available in the United
Republic of Tanzania. Milk and milk
Insects contain between 12 g and 77 g products are the good sources of calcium,
of protein per 100 g (Hlongwane, Slotow which helps build strong bones. They
and Munyai, 2020) while fish, chicken also supply protein, riboflavin (vitamin
and beef contain between 13 g and 31 g B2), cobalamin (vitamin B12), retinol
of protein. Protein digestibility of insects (vitamin A) and potassium. Milk fat
ranges from 76 percent to 98 percent serves as a vehicle for the important fat-
soluble vitamins A, D, E and K. However,

72 Tanzania Mainland Food-Based Dietary Guidelines

milk fat contains mainly saturated fat, so 10.3 Consumption patterns of animal-
skimmed or low-fat milk is a better option source foods in Tanzania Mainland
for those on a low-fat diet. Whole milk or In the United Republic of Tanzania,
milk fat is good for growing children. consumption of animal-source foods
is low in all population groups. In the
Red meat: Although red meat contains rural areas, less than 20 percent of the
more B vitamins, iron and zinc than households reported having consumed
white meat, people are advised to limit meat, eggs or milk, despite most of these
their consumption of red meat as high foods being available in most areas
consumption has been correlated with (Khamis et al., 2020; Ochieng et al., 2017;
an increased risk of NCDs. Red meat Kinabo et al., 2016).
contains higher amounts of saturated
fats than white meat, which can lead to 10.4 How much animal-source foods
heart disease. Saturated fats are found to eat
in white marbling (intramuscular fat) of Based on the Tanzania Diet model, it is
the red meat and in the skin of poultry, recommended that individuals consume
as well as in milk cream and cheese. two servings of animal-source foods
Red meats also contain trans-fats, which per day. One serving is equivalent to
increase the risk of coronary heart 135 kcal per day, which is between 60–
disease. 100 g depending on the food.

When eating animal source foods, The amount of animal-source foods can
choosing fish and chicken or duck over be estimated using the size of the palm
red meat is recommended. Higher or other measures. For example:
intakes of poultry, fish and nuts have • two eggs (~95 g and 135 kcal)
been shown to be associated with a
significantly lower risk of coronary heart • two matchbox size pieces of red meat
disease (WHO, 2015a; Abete et al., 2014). (beef, goat, sheep), beef liver. Limit
intake to less than 160 g equivalent
Processed meats: Processed meat is per week to help protect against
meat that has been transformed through heart disease and some cancer
salting, curing, fermentation, smoking or • three matchboxes size pieces (or
other processes to enhance flavour or size of a palm*) fish, poultry or rabbit
improve preservation. Nitrite is the most (~90 g and ~130 to ~135 kcal)
commonly used meat preservative in
• 1 serving spoon sardines canned in
processed meat (WCRF, 2018). Examples tomato, drained (68 g and 121 kcal)
of processed meat are luncheon meats,
corned beef, sausages, hot dog sausages, • ½ cup insects (different types), dried
burgers, smoked/cured products, and (50 to 100 g and 135 to 220 kcal)
beef salami. • 1 cup milk or sour milk (245 g and
~123 Kcal)
The WHO places the risk of eating
processed meat in the same category as • ¾ cup or one small tub yoghurt (200 g
and ~114 kcal)
smoking (WHO, 2015). The Global Burden
of Disease report defines exposure to • 1/3 cup cheese, shredded (40 g and
a diet high in processed meat as an 161.1 kcal)
average daily consumption greater than • four dice-size pieces of cheese (30 g
22.5 grams of processed meat (GBD, and ~135 kcal)
2019). Thus, avoiding processed meats is
recommended.

Tanzania Mainland Food-Based Dietary Guidelines 73

 One-serving equivalents of animal-source foods are shown in Tables 11a and 11b.
* The palm comprises the underside of the human hand; a linear measurement
approximating the width of the palm of the hand, from 6.3 to 10.2 cm.

74 Tanzania Mainland Food-Based Dietary Guidelines

 Table 11a: Red meat, poultry, eggs and insects: household measure serving size equivalents and estimated key nutrition amounts

1 Vitamin
Food description Energy Protein Iron Folate Zinc Calcium
serving B12
food
weight (kcal) (g) (g) (mcg) (g) (m) (mg)

Beef meat, lean, boiled*

65 137 23 2.3 5.2 4 0.9 4.6
(without salt)

Red
meat
Goat meat, boiled* (without
65 135 17.0 2.3 2.9 3.3 0.7 8.3
salt)

Rabbit meat, stewed or grilled 70 135 22.0 1.2 3 1.7 7.0 13.3

Rabbit
Chicken liver, braised*
80 135 22.0 9.6 596.8 3.5 19.2 12
(without salt)
Chicken, light meat, flesh,

Poultry
95 135 29.5 0.6 5.7 1.0 0.2 9.5
boiled* (without salt)

Eggs, hard-boiled (2 large) 100 135 12.6 1.7 38 1.2 0.7 53

Eggs
Continued on page 76

Tanzania Mainland Food-Based Dietary Guidelines

75
 76
1 Vitamin
Food description Energy Protein Iron Folate Zinc Calcium
serving B12
food
weight (kcal) (g) (g) (mcg) (g) (m) (mg)

Anchovy steamed 85 135 23.5 3.2 6 2.2 0.7 109.7

Fish
Tilapia, steamed 115 135 25.4 1.4 23 1.1 1.7 23

Sardine, steamed* (without

101 130 24.3 1.8 3.2 2.0 11.1 89.7
salt)
Mackerel, boiled* (without
107 130 20.7 0.7 0.7 0.5 2.0 29.1
salt)

Tanzania Mainland Food-Based Dietary Guidelines

Tuna, boiled* (without salt) 82 130 24.0 0.9 10.7 0.5 4.2 14.8

Swordfish, cooked, dry heat 79 130 18.5 0.4 1.6 0.6 1.3 4.7

Barracuda, steamed* (without

133 130 29.8 1.1 9.3 0.8 2.7 41.2
salt)

Other fish to choose from are whitebait, trevallies, pilchards, herring, kippers, eels, mussels and kingfish.

Continued on page 76
 1 Vitamin
Food description Energy Protein Iron Folate Zinc Calcium
serving B12
food
weight (kcal) (g) (g) (mcg) (g) (m) (mg)

Flying ants 50 257** 21 11 47 4.9 NA 56

Mopane worms (cooked) 140 135 19.7 9.8 5 4.5 7 54

Grasshoppers (cooked) 100 145 21 5 NA NA NA NA

Insects
Mole crickets blanched 105 137 16 44 NA NA NA 79.8

Grasshoppers, locusts and

50 217 27 13 185 6.9 6 122
crickets (dry)
NA = No value available in the food composition table.

* To match and reach adequate intake of the key nutrients, the quantity gives a higher than targeted energy.

Sources: General food groups: FAO, 2019. Insects: FAO, 2019; Hlongwane et al., 2020; Van Huis et al., 2013; Steiner-Asiedu et al., 1993.

Tanzania Mainland Food-Based Dietary Guidelines

77
 78
Table 11b: Milk and milk products: household measure serving size equivalents and estimated key nutrient amounts

Food description 1 serving Energy Protein Iron Folate Zinc Calcium B12 Fibre
Measure food
weight (kcal) (g) (g) (mcg) (mg) (mg) (mcg) (g)

Cow milk 2 percent

1 cup 245 122.5 8.1 0 12.3 1.2 294 1.2 0
low fat*
Cow milk 3.5
percent fat (whole 1 cup 245 158 8.3 0.1 24.5 1 294 1.5 0
milk)
2 small
Yoghurt, low fat* 200 114 8 0 22 1.8 308 NA 0

Tanzania Mainland Food-Based Dietary Guidelines

tins**

Yoghurt, low fat* ¾ cup 200 114 8 0 22 1.8 308 NA 0

Yoghurt, whole
¾ cup 185 135.1 7 0.2 22.2 1.1 281.2 0.6 0
milk, plain

Cheese shredded* ¹/3 cup 40 161.1 9.2 0.1 10.8 1.5 283.9 0.4 0

* FDC 2020 (USDA) sources

** Smallest tin of commercial yogurt is 100 g
NA = no value available in the food composition table.
Source: FAO. 2019. FAO/INFOODS Food Composition Table for Western Africa. 2019: User Guide & Condensed Food Composition Table. Rome.
 10.5 Key messages for healthy eating of animal-
source foods
1. Eat at least two servings of fish, poultry, milk, or egg every
day.
2. Eat fish as often as possible each week. One or two servings
should be from fatty fish, such as Nile perch (sangara).
3. Choose small fish eaten with bones, such as fresh sardines,
to get the benefits of calcium.
4. Eat more white meat, insects, and eggs than red meat. White meat,
such as fish and poultry (without skin), are lower in saturated fat than
red meat.
5. Limit intake of red meat to less than 160 g (size of two palms) per week.
6. Avoid eating processed meats such as sausages, luncheon meats,
polony and ham.
7. Avoid eating cheese with a lot of salt.
8. Limit intake of ice cream, butter, and cream which are high in fat, sugar
and salt.
9. Pregnant and lactating women should take special care to include
poultry and meats in their diet.
10. Offer poultry, meats and eggs to infants and young children aged 6–24
months.
11. Give plain, full-cream milk only to children above one year whenever
possible.

10.6 Tips for healthy intake of animal-source foods

1. Add an egg or milk to porridge or meals intended for children.
2. Eat unsweetened yoghurt and add fresh fruit to reduce sugar intake.
3. Use low-fat or skim milk to lower the amount of saturated fat for adults.
4. Use milk and milk products with little or no added sugar.
5. Share fish, sardines, chicken, milk, eggs and meat with
everyone in your family.
6. Trim fat off the fish, meats and discard poultry skin
before eating.
7. Grill, pan-fry, steam, boil or bake instead of deep
frying.
8. Cook meat thoroughly to prevent food-borne illnesses.

Tanzania Mainland Food-Based Dietary Guidelines 79

 11. RECOMMENDATION 1.7
CHOOSE UNSATURATED FATS AND OILS AND EAT IN SMALL AMOUNTS
11.1 What are fats and oils? good health and preventing NCDs, while
Fats and oils are extracted from plant others are linked to negative health
and animal sources. Oils are liquid and effects (and thus are not included in the
fats are solid at room temperature. six food groups). Knowing the difference
is important to determine which fats to
Oils from plant sources are usually avoid, which to eat in moderation and
referred to as vegetable oils. Vegetable which fats to limit.
oils include oils from sunflowers,
groundnuts, canola, olives, coconuts, 11.2.1 Unsaturated fats
palm and other nuts, oil seeds, and other
plant oils. Unsaturated fatty acids (unsaturated
fats) are made up of one or more double
Animal-source fats include butter, ghee, bonds in their fatty acid chain. The double
lard, and fish oil. bonds allow saturated fats to remain
liquid at room temperature but can also
Other examples of fats are margarine, be found in solid foods.
mayonnaise, shortening, coconut cream
and coconut flesh. Unsaturated fats are usually referred
to as good or healthy fats. Unsaturated
11.2 Types of fats and oils fats are therefore part of the six food
All fats are made up of carbon, hydrogen, groups for a healthy diet when taken
and oxygen molecules. The difference in moderation. The two main types of
between the fats is their chemical unsaturated fats are monounsaturated
structure, particularly in the number of fats and polyunsaturated fats:
double bonds in the fatty acid chain.
• Monounsaturated fatty acids
There are three types of fats – unsaturated (MUFAs) are made up of one
fats, saturated fats and trans-fatty acids. double bond. Some sources of
Some fats are essential in promoting MUFAs include peanut, canola,

80 Tanzania Mainland Food-Based Dietary Guidelines

 groundnut, olive, sunflower and turns a liquid unsaturated oil into a solid
safflower oils, most nuts, and fat (trans fatty acid) by adding hydrogen
avocados. Chicken and poultry also to the double bonds of unsaturated oil.
contain MUFAs.
Trans fats are common ingredients found
• Polyunsaturated fatty acids
(PUFAs) are made up of more in ultraprocessed foods such as snack
than one double bond. These foods, fried food, frozen pizza, pies and
fats are sources of omega-3 and cookies (WHO, 2021b).
omega-6 fatty acids. Sources include
corn, soybean, sunflower, and Trans fats are also found in margarine,
cottonseed oils. Nuts such as walnuts fat spreads, mayonnaise and shortening.
and pine nuts and seeds such They are referred to as partially
as sesame, flaxseed, sunflower, hydrogenated oils in the ingredients list.
pumpkin and chia seeds also contain
PUFAs. Cod liver oil and oily fish They are inexpensive to produce and
such as sardines, kippers, mackerel, give food products a desirable taste and
salmon, herring, pilchards, eels, texture.
whitebait and tuna are also sources
of PUFAs (WHO, 2018d). Naturally occurring trans fats are found
in ruminant fat in dairy and meat
11.2.2 Saturated fats products (WHO, 2021b). Eating products
with trans fats increases the risk of
Saturated fats have no double bonds
developing heart disease and stroke
in the fatty chain. They are “saturated”
(Islam et al., 2019). The WHO is working
with hydrogen atoms, which means they
with countries to eliminate industrially
naturally have the greatest number of
produced trans-fatty acids (WHO 2021b).
hydrogen atoms possible. With a few
exceptions, saturated fats are usually
solid at room temperature.

Saturated fats mostly come from animal

sources and include butter, ghee,
and cream. In beef and poultry, white
marbling and the skin of the poultry
contain large amounts of saturated
fats. Some plant oils, such as palm and
coconut, have saturated fats. Other
sources of saturated fats are coconut
cream, coconut flesh and coconut milk. Figure 4 Product ingredients list showing
trans fats and hydrogenated oils
The WHO recommends that total
fat intake be less than 30 percent 11.3 The importance of fats and oils
of the total daily energy intake and 11.3.1 Oils and fats are necessary for the
that saturated fat intake be less than functioning of the human body.
10 percent of the total daily energy intake
(FAO and WHO, 2010). They play various key roles:

11.2.3 Trans fats • Fats and oils provide essential fatty

acids. Common examples of essential
Trans fats occur in both natural and
fatty acids are omega-3 and omega-6.
artificial forms. The artificial trans fats are
The body cannot produce essential
created in an industrial process known
fatty acids on its own, so they must
as partial hydrogenation. Hydrogenation
come from the diet. Very good

Tanzania Mainland Food-Based Dietary Guidelines 81

 sources of essential fatty acids are development during pregnancy and
fish, flaxseed oil and walnuts. the early stages of an infant’s life.
• Fats and oils help the body to absorb The role of long-chain omega-3 fatty
the fat-soluble vitamins A, D, E, and acids as structural components for
K. Many women and children in the the development of the brain and the
United Republic of Tanzania are central nervous system is now
deficient in Vitamin A. recognized (FAO and WHO, 2010).

• Fats are an energy source for the Fats and fatty acids are important for cell
body. They provide more energy membrane functions and control gene
than other food groups. Fat typically transcription during pregnancy.
contains around 9 kcal of energy
per gram while carbohydrates and
proteins provide 4 kcal. Therefore, TAKE UNSATURATED FATS
excessive intake of oils and fats can IN MODERATION
contribute to significant weight gain
over a short period of time. While unsaturated fats are
• Fats help slow down the passage healthier than saturated fats
of food from the stomach, thereby and trans fats, just like all other
helping a person to feel full and
satisfied for a longer period. They oils and fats, they have higher
also make food delicious. concentrations of calories than
Of the three types of fats, unsaturated other food groups. Therefore,
fats are better for the body and help
to promote good health when taken in excessive intake of oils and fats
moderation, while trans fats are harmful can contribute to weight gain.
and should be avoided. Limiting the
intake of saturated fats is also essential
for better health.
11.3.3 Unsaturated fats reduce the
risk of developing non-communicable
11.3.2 Unsaturated fats are critical to a diseases
child’s cognitive development
Unsaturated fatty acids are crucial to Unsaturated fats, especially the long-
proper development and survival during chain polyunsaturated fatty acids alpha-
the early stages of life (embryonic linolenic acid, eicosapentaenoic acid
development, early growth after birth (EPA) and docosahexaenoic acid (DHA),
and through infancy and childhood). contribute to the prevention of coronary
heart diseases (Ghamarzad et al., 2021).
Fatty acids are important for brain
and cognitive development, especially 11.4 Health risks of excessive intake of
in infants and children (FAO and saturated and trans fats
WHO, 2010). There is a positive
relationship between polyunsaturated 11.4.1 Saturated fats
fatty acid status and cognition, growth
and executive function in children Excessive intake of saturated fat,
(Adjepong et al., 2018; Jumbe et al., 2016; especially from animal sources, can raise
Hahn et al., 2015). the bad cholesterol and the risk of heart
disease (Clifton and Keogh, 2017).
Unsaturated fatty acids are considered
key nutrients that affect the embryo’s There is a possible relationship between
intake of saturated fats and increased

82 Tanzania Mainland Food-Based Dietary Guidelines

risk of diabetes. On the other hand, there • Trans fats have no known health
is convincing evidence that replacing benefits and there is no safe level of
saturated fats with polyunsaturated consumption (Islam et al., 2019).
fats decreases the risk of cardiovascular • The Global Burden of Disease report
heart diseases (FAO, 2010b). Reducing defines a high trans-fatty acid diet
fat intake from processed foods which as one that has an average daily
contain lots of fat is important for keeping consumption greater than 0.5 percent
the bad cholesterol or LDL at a normal of trans-fats from all sources, mainly
level. Evidence shows that taking in palm partially hydrogenated vegetable oils
oil from processed foods raises the LDL and processed ruminant products
(Sun et al., 2015). (Willet et al., 2019). For a 2200-kcal
diet, this is equivalent to 1 g of fat,
Many studies, including a systematic
which is less than one teaspoon (note
review of 15 studies with over 59,000
that one teaspoon of oil is about 5 g).
participants, found that cutting down on
Most ultraprocessed foods contain
saturated fat led to a 17 percent reduction
more than this amount per serving.
in the risk of coronary heart diseases
In countries with laws on labelling,
(including heart disease and strokes),
companies are only required to
but found no effects on the risk of dying
report amounts of more than 0.5 g
(Hooper et al., 2015). Furthermore, the
per serving.
study found no clear health benefits of
replacing saturated fats with starchy
foods or protein. Changing the type 11.5 Global guidance on recommended
of fat, replacing saturated fats with amounts of healthy fats and oils
polyunsaturated fats, seems to protect The WHO recommends that total fat
the body better, reducing the risk of heart intake be less than 30 percent of total
and vascular problems. The greater the energy intake to avoid weight gain. It
decrease in saturated fat, and the more further states that saturated fat intake
serum total cholesterol is reduced, the should be less than 10 percent of total
greater the protection. energy (FAO, 2010a; WHO, 2018e). FAO
and WHO recommend that dietary
fat should contribute a minimum
11.4.2 Trans fats
15 percent of total energy requirements
• Avoid consumption of trans-fats or per day of essential fatty acids and fat-
partially hydrogenated vegetable soluble vitamins (FAO, 2010) to enable
oils to prevent heart diseases. (FAO, the body to meet the requirements for
2010a; GBD, 2017). dietary fat and to ensure adequate intake
of essential fatty acids and fat-soluble
• These fats raise the LDLs and lower vitamins.
the good cholesterol or HDLs (GBD,
2019). In the rural setting of Tanzania Mainland,
• There is probable evidence that fat and oil intake contributes about
trans-fatty acids increase the risk of 9–14 percent of energy intake (Kinabo
metabolic syndrome components et al., 2016). Most of the cooking oil is
that increase the chance of developing palm and sunflower oil. There could be
type 2 diabetes (FAO, 2010a; GBD, a higher intake of oils and fats in urban
2017). Other metabolic syndromes areas where there is a high frequency
include inflammation and endothelial of consumption of deep-fried foods in
dysfunction (Mozaffarian, Aro and schools (FAO, 2007).
Willett, 2009).

Tanzania Mainland Food-Based Dietary Guidelines 83

 In addition, fats and oils also come 11.6 Recommended fat intakes for
from processed foods like biscuits and Tanzania
potato crisps and from meat and other Based on the diet modelling for Tanzania
foods. In practice, therefore, only a mainland, this guideline recommends
small amount of oil should be used for about 28 g or 2 tablespoons of added
cooking to ensure less than 30 percent oil to foods per day. Intake of saturated
energy intake is from this group. fats such as ghee, palm oil, or coconut oil
should be limited to about 1 teaspoon
(5 g).

84 Tanzania Mainland Food-Based Dietary Guidelines

Table 12 Fats and oils household measure serving size equivalents and estimated key
nutrient amounts

Carbohydrate
Household

Vit A-RAE
measure

Calcium
One serving

Serving

Protein
Energy

Folate

Fibre
Iron

Zinc
size

Fat
of fats and
oils

15 ml
(g) kcal (g) (g) (g) (mg) (mg) (mg) (mcg) (mcg) (g)
tbsp
Coconut oil 1 14 126 0 14 0 0 0 0 0 0 0
Cottonseed
1 14 126 0 14 0 0 0 0 0 0 0
oil
Groundnut
1 14 126 0 14 0 0 0 0 0 0 0
oil
Palm oil, red 1 14 126 0 14 0 0 0 0 800 0 0
Palm oil,
1 14 126 0 14 0 0 0 0 0 0 0
refined
Shea butter 1 14 126 0 14 0 0 0 0 0 0 0
Soya oil 1 14 126 0 14 0 0 0 0 0 0 0
Vegetable oil 1 14 126 0 14 0 0 0 0 0 0 0
Butter, from
1 14 100 0.4 11 0 2.4 0 0 96 0 0
cow's milk
Margarine,
1 14 102 0.1 11.5 0 0 0 0 115 0 0
fortified

Tanzania Mainland Food-Based Dietary Guidelines 85

 11.7 Key messages for healthy eating of unsaturated
oils and fats

1. Use 28 g or 2 tablespoons of added oils to food per day.

2. Choose liquid vegetable oils (e.g. sunflower, groundnut,
olive, sesame (simsim) and avoid palm oil, coconut oil,
butter or ghee.
3. Eat oily fish and oily seeds and nuts often to get essential fatty acids.
4. Avoid intake of trans fats mostly found in ultraprocessed foods and
fried fast foods.
5. Use coconut milk in moderation; not more than one-third of a cup
per person per day.

11.8 Tips for eating small amounts of unsaturated oils and fats
1. Stir-fry foods instead of deep-frying foods.
2. Cut out visible fats from meats and discard poultry skin before
cooking. Animal fats contain large amounts of saturated fats.
3. Choose lean cuts of meats with less visible white streaks of fat.
4. Do not add extra oil or fat when cooking meats and poultry.
5. Avoid processed foods containing trans-fatty acids.
6. Read food labels and avoid buying foods with
partially hydrogenated oils in the ingredients list.
Partially hydrogenated oils are made industrially in
commercial settings to boost flavour and increase
shelf life.

86 Tanzania Mainland Food-Based Dietary Guidelines

GUIDELINE 2: Attain optimal nutrition
for pregnant and lactating mothers, infants
and children to ensure the mother’s
wellbeing and the child’s healthy growth
and development

Tanzania Mainland Food-Based Dietary Guidelines 87

 12. RECOMMENDATION 2.1
WHEN PREGNANT OR BREASTFEEDING, EAT A VARIETY OF FOODS FROM
THE SIX FOOD GROUPS FOR YOUR HEALTH AND THE HEALTH OF YOUR
BABY
The first 1,000 days refers to the period Thus, pregnant and lactating women
from conception until the baby is two need additional energy, protein, vitamins
years old. This period has a lifelong (A, D, B3, B6, B9, B12, C) and minerals
effect on health and wellbeing. Providing (iron, calcium, selenium, zinc) to support
good nutrition to the foetus in the womb their health and survival, and to sustain
and through early life is essential for a growth of the foetus (Jouanne et al., 2021;
child’s future health. What a mother eats, Gernand et al., 2016).
her weight and her lifestyle habits can
influence the development of the baby’s 12.1 Benefits of adequate nutrient
metabolism, brain and immune system intake
as well as its general growth. Adequate nutrient intake during
pregnancy coupled with exclusive breast
Poor nutrition during pregnancy and early feeding and optimal complementary
life can lead to obesity, heart disease and feeding is good for the child in the
stroke later in in the child’s life. following ways:

Pregnant women are at risk of • enhances foetal development and

micronutrient deficiencies, especially growth;
iron, iodine, calcium, folic acid, and • ensures healthy birth weight;
vitamin A (FAO, 2004a). Micronutrient
deficiencies, particularly of vitamin A and • reduces the risk of birth defects;
iron, can lead to maternal deaths. • reduces the risk of stunting;
• promotes good brain development

88 Tanzania Mainland Food-Based Dietary Guidelines

 for the foetus and child improves the body and to the baby. In addition,
school enrolment and attendance; proteins support the increased growth of
• improves cognitive and academic breast tissue.
performance; and
Protein requirements vary during the
• improves the health of children various stages of pregnancy. Additional
throughout their lifecycle. requirements during pregnancy are 1 g,
9 g and 3 g during the first, second and
12.2 Nutrient needs during pregnancy third trimesters respectively (FAO, WHO
and UNU, 2007).
Energy requirements
A pregnant woman needs extra energy In light of the findings of some literature
to support the changing metabolism of indicating neonatal death associated
her body, the growth of the foetus, the with supplements that are high in
status of the placenta, and maternal protein (34 percent of protein: energy),
tissues (Institute of Medicine, 1990). it is recommended that the additional
Pregnant women require extra energy protein requirements must come from
to maintain adequate maternal weight, normal foods and not from commercially
body composition and physical activity prepared protein supplements (WHO,
during pregnancy (FAO, WHO and UNU, FAO and UNU 2007).
1981; FAO, WHO and UNU, 2001).
Iron
It is recommended that pregnant women
Women need extra iron during pregnancy
consume an additional 360 kcal per day
for the proper development of their babies
in the second semester and 475 kcal per
and to prevent anemia. Iron-deficiency
day over and above the non-pregnancy
anaemia during pregnancy increases
energy intake level (FAO, 2004b).
maternal mortality and incidences of low
However, the energy requirement may
birth weight.
vary depending on the woman’s age,
body weight, and activity level. Iron is needed for the baby’s haemoglobin
synthesis, mental function, and to
Protein requirements provide immunity against diseases during
Proteins are building blocks of life, pregnancy and after birth. Insufficient
present in every cell of the body. After iron intake during pregnancy is associated
someone eats proteins, the body breaks with increased cardiovascular risk of the
them down into individual amino acids, child at adulthood (Alwan et al., 2015).
which are then used to build, maintain
and repair tissues, bones, muscles, Iron is obtained from plant and animal-
cartilage skin and build cells. source foods. However, the bioavailability
of iron from plant foods is poor, so
Thus, protein is essential during consumption of vitamin C-rich foods
pregnancy for the growth and (such as citrus fruits, tamarind, baobab
development of a baby’s tissues and and guava) is recommended to improve
organs, including the brain. Protein is iron absorption. It is also important for
important for uterine tissue development pregnant women to take animal source
needed to accommodate and nourish a foods in addition to plant sources.
growing baby. Blood volume and supply
increase during pregnancy to support the Folic acid (vitamin B9)
growing baby and protein is essential in Folic acid is important during periods of
facilitating the transport of blood around rapid growth, such as during pregnancy

Tanzania Mainland Food-Based Dietary Guidelines 89

 and fetal development, particularly 2014, to 21.4 percent in TDHS 2015–16,
during the first trimester. Low folate and further to 28.5 percent in 2018.
levels in pregnant women lead to birth The prevalence of anaemia significantly
abnormalities, such as neural tube decreased from 44.8 percent in 2015–
defects, anencephaly and spina bifida, in 2016 to 28.8 percent in 2018 at national
which the baby’s spinal cord and brain level.
fail to develop properly (Czeizel et al.,
2013; Fanzo, 2013). Folic acid is required
Vitamin A
to make healthy red blood cells (Fanzo,
During pregnancy, vitamin A is important
2013), so it plays an important role in
in foetal growth and development
preventing maternal anaemia during
(Gutierrez-Mazariegos et al, 2011).
pregnancy. Adequate folic acid prevents
Inadequate intake of Vitamin A can lead
low birth weight and preterm birth (WHO,
to night blindness and preterm delivery
2012b; WHO 2016b). Folate also helps
(West, 2003).
to form DNA and RNA and is involved in
protein metabolism. In Tanzania Mainland, prevalence of
vitamin A deficiency among women of
Iron and folate supplementation reproductive age is about 42 percent
It is recommended that pregnant (NBS and ICF Macro, 2011).
women should take iron and folic acid
supplements throughout pregnancy and Good sources of vitamin A include
continue for up to three months after liver, eggs, fish, red palm oil, mangoes,
delivery (WHO, 2016b; WHO, 2016d). papayas, carrots, pumpkins, orange-
fleshed sweet potatoes, and dark green
• Folic acid supplementation for the leafy vegetables such as cowpea leaves,
prevention of neural tube defects spinach and amaranth.
is only beneficial pre-pregnancy
and during the first 28 days. Where Calcium
possible, women should take folic Calcium is important in pregnant
acid supplements before conception women to help prevent pre-eclampsia
(WHO, 2016b; WHO, 2016d). (WHO, 2013). Insufficient calcium intake
• It is important for women who are during pregnancy has been linked to the
pregnant or plan to become pregnant development of maternal hypertension,
to have their iron levels checked and an important cause of maternal
to bring any symptoms of anaemia to morbidity, foetal growth restriction (FGR),
medical attention and preterm birth (Duley, 2009; WHO,
2013).
The use of iron and folate
supplementation for pregnant women is Dietary sources of calcium include milk,
among the interventions that have been yoghurt, small saltwater and freshwater
used in the United Republic of Tanzania fish (sardines) when eaten with bones.
for a long time. In the 2015/16 TDHS-MIS Other sources such as dark-green leafy
(MoHCDGEC et al., 2016) it was observed vegetables, baobab pulp and pulses also
that 20 percent of women aged 15–49 provide some calcium.
took iron tablets or syrup for at least
90 days during their last pregnancy. The
proportion of pregnant women taking Vitamin D
iron and folic acid supplements has Vitamin D is needed during pregnancy
increased over time from 3.5 percent to reduce the risk of pre-eclampsia,
in TDHS 2010 to 17.5 percent in TNNS gestational diabetes mellitus, preterm

90 Tanzania Mainland Food-Based Dietary Guidelines

birth, low birth weight and other tissue- and FAO, 2004). During pregnancy,
specific conditions (FAO and WHO, iodine requirements increase by about
2004). Maternal vitamin D intake during 50 percent due to maternal thyroid
pregnancy is important to ensure stimulation, an increase in renal iodine
adequate vitamin D status in the infant clearance and iodine transfer to the foetus
during the neonatal period to prevent for synthesis of fetal thyroid hormones
neonatal hypocalcemia, early onset of (Jouanne et al., 2021). The recommended
rickets and long-term consequences for daily intake of iodine to provide for the
the bone and other health outcomes of needs of the foetus is 250µg (WHO et al.,
the offspring (Fuleihan et al., 2015). 2007).

Vitamin D is found in oily fish such as Iodine deficiency in pregnant women

salmon, sardines, herring and mackerel, can lead to maternal and foetal
as well as in liver and egg yolks. It can hypothyroidism. Other effects of iodine
also be produced in the skin through deficiency during pregnancy include
exposure to sunlight. spontaneous abortion, stillbirth,
congenital anomalies, perinatal mortality,
decreased intelligence and cretinism
Zinc
(WHO, UNICEF and ICCIDD, 2007; Pearce,
Zinc is essential for embryogenesis
2017).
(formation and development of an
embryo), fetal growth and protein Iodine needs are met by simply eating
synthesis. Poor maternal zinc status fish and other seafood, meat, milk and
has been associated with foetal loss, eggs, and using iodised salt of less than
congenital malformations, intrauterine 5 mg per day.
growth retardation, reduced birth
weight, and prolonged labour (Chaffee
and King, 2012; Raimi et al., 2012). Zinc 12.2.1 Recommendations for pregnant
requirement during pregnancy increases women
significantly in the third trimester (FAO Pregnant women should eat a variety
and WHO, 2004). of foods from all the six food groups as
stated in the dietary guidelines for the
general population, with emphasis on
Food sources are adequate to provide eating additional amounts of animal-
zinc requirements during pregnancy. The source foods, pulses, nuts, seeds, fruits,
best sources of zinc are lean red meat, vegetables, and whole grains to get
whole-grain cereals, pulses (legumes). energy and the key nutrients needed
Other sources include processed cereals during pregnancy (WHO, 2016a).
with low extraction rates, polished rice,
chicken, pork or meat with high fat Pregnant women should take an
content, fish, roots and tubers, green additional 360 kcal per day in the second
leafy vegetables and fruits. Zinc from semester and 475 kcal per day in the
animal sources is highly bio-available for third (FAO, 2004b). However, depending
the body (FAO and WHO, 2004). on the woman’s age, body weight, and
activity level, the energy requirement will
vary. Pregnant women should therefore
Iodine consume carbohydrate-rich foods such
Iodine is required for thyroid hormone as whole grains, roots, tubers, pulses,
synthesis. Thyroid hormone is important nuts and seeds. Not only are these
in the growth and development of the foods rich in carbohydrates, they are
brain and central nervous system of also rich in other important nutrients
the foetus and young children (WHO such as vitamins, minerals, fibre and

Tanzania Mainland Food-Based Dietary Guidelines 91

 some proteins. Nutrient requirements In addition to a diversified diet, pregnant
for lactating women are summarized in women need to make sure they drink
Appendix 2. enough water and have sufficient
exercise and physical activity. Keeping
Pregnant women should add foods rich physically active during pregnancy
in protein from animal-source foods prevents excessive weight gain (WHO,
such as liver, meat, chicken, fish and eggs 2016b).
and plant sources such as pulses, nuts
and seeds. It is important for pregnant Pregnant woman should have periodic
women to eat more animal and animal weight check-ups to ensure appropriate
products because they contain more weight gain. A well-nourished woman is
bioavailable protein as well as iron and expected to gain about 10 to 12 kg during
zinc. pregnancy. Women who are overweight
or obese before conception should gain
Pregnant women should eat dark- less weight, ranging from 5 to 11 kg,
green vegetables and orange-coloured depending on preconception or early
fruits and vegetables such as pumpkin, pregnancy weight.
amaranth, sweet potato leaves, papaya,
mango, orange flesh, sweet potatoes, Pregnant woman should have periodic
yellow pumpkins, pumpkin flowers health checkups for blood pressure and
and carrots for vitamin A and other key anaemia.
micronutrients.

Pregnant women should take daily oral 12.2.2 Recommended intake during
iron and folic acid supplementation with pregnancy
30 mg to 60 mg of elemental iron and The diet modelling for pregnant women
400 mcg (0.4 mg) of folic acid from the aims to maximize micronutrient intake
clinic or as prescribed by the doctor to and additional calorie requirements
prevent maternal anaemia, puerperal during pregnancy. The serving sizes and
sepsis, low birth weight, and preterm birth nutrients supplied by the recommended
(WHO, 2016b). Where possible, women diet model are shown in Table 13.
should take folic acid supplements before
conception.

92 Tanzania Mainland Food-Based Dietary Guidelines

 Table 13 Recommended daily intake and the nutrients this eating pattern provides for pregnant women

Fat
Zinc

Iron

Fibre
Folate

Niacin

Energy
Protein
Calcium
Thiamin
Vitamin C

Riboflavin
Vitamin B6

Magnesium

Food weight
Carbohydrate
Vitamin A-RAE

Servings per day

(g) (kcal) (g) (g) (g) (g) (mg) (mg) (mg) (mg) (mcg) (mg) (mg) (mg) (mg) (mcg) (mg)

Total nutrient intake 1898.0 2624.3 100.8 64.5 388.6 43.1 1114.0 26.1 518.1 12.3 998.7 1.2 1.6 16.9 2.2 669.5 218.6

Cereals, starchy
roots tubers,
4.5 652 925.1 17.1 1.8 205.4 9.2 65.0 2.3 106.2 1.7 45.2 0.2 0.3 2.6 0.4 61.8 32.2
plantains and green
bananas
Vegetables 2 281 134.3 12.7 0.9 15.6 6.6 750.5 10.8 121.5 1.2 589.6 0.2 0.6 2.0 0.4 127.3 52.1

Fruits 3 413 308.9 3.9 6.9 53.4 8.7 70.3 1.8 79.5 0.7 320.3 0.1 0.2 2.2 0.7 102.0 130.7

Pulses, nuts and oily

3 293 410.2 27.1 8.0 48.3 18.5 100.0 7.3 175.1 3.3 0.0 0.6 0.2 3.9 0.4 354.2 2.9
seeds

Animal-source foods 2 155 270.1 39.8 11.9 0.8 0.0 126.1 3.8 35.2 5.2 43.6 0.1 0.4 6.1 0.2 23.8 0.6

Fats and oil 2.5 35 315.0 0.0 35.0 0 0 0 0 0 0 0 0 0 0 0 0 0

Sugary foods and

1.5 69 260.7 0.1 0.0 65.1 0.0 2.2 0.1 0.4 0.1 0.0 0.0 0.0 0.0 0.0 0.4 0.1
sweets

Tanzania Mainland Food-Based Dietary Guidelines

93
 12.2.3 Nutrient requirements for Vitamin A
lactating women Infants are usually born with low body
Eating a variety of foods from the six stores of vitamin A. Maternal dietary
food groups is important for everyone, intake is an important determinant of
including breastfeeding women. breast milk vitamin A concentration and
However, breastfeeding women require an infant’s vitamin A status (Bahreynian,
additional calories, proteins and Saleki and Kelishadi, 2017; Gannon,
nutrients such as vitamin A, zinc, folate Jones and Mehta, 2020). Mothers are,
and vitamin C to maintain the mother’s therefore, encouraged to exclusively
health and support milk production. breastfeed for the first six months
These requirements can be met with a postpartum. It is recommended that
small extra meal each day (FAO, 2004a; mothers who are breastfeeding should
FAO, 1981). consume enough vitamin A to replace
the amount lost through breastfeeding.
Thus, the increments in basal and
Energy
safe recommended intakes during
Breastfeeding women need additional
lactation are 180 mg RE and 350 mg RE,
calories as the production of milk and
respectively. This additional vitamin A
breastfeeding burns up a lot of energy.
intake is reduced after the infant reaches
While energy needs for breastfeeding the age of six months or when solid foods
are met from the fat that was stored are introduced (FAO and WHO, 2004).
during pregnancy, during exclusive
breastfeeding in the first six months, Iron
women need an additional 505 kcal In lactating women, the daily iron loss in
per day on top of their pre-pregnancy milk is about 0.3 mg. Together with the
requirements (FAO, 1981; Dewey, 1997). basal iron loss of 0.8 mg, the total iron
Undernourished women and those requirements during the lactation period
with insufficient gestational weight gain amount to 1.1 mg/day (FAO and WHO,
should add 675 kcal per day during the 2004). Lactating women should take iron
first six months of lactation. After six and folic acid supplementation for at
months, the energy requirements for least three months after delivery (WHO,
milk production are dependent on the 2016a).
rates of milk production influenced by
the baby’s age and breastmilk intake,
the mother’s activity levels, body size, Folic acid
and the percentage of the mother’s body Folic acid is naturally found in the breast
milk of people who are well-nourished.
fat reserved during pregnancy (Dewey,
Milk folate content can be maintained at
1997). Extra calorie intake may be a level that prevents the development of
obtained from additional healthy snacks folate inadequacy in exclusively breast-
such as fruits or nuts. fed infants, but often at the expense of
maternal folate stores (Smith, Picciano
and Deering, 1983; O’Connor, Green and
Protein Picciano, 1997). Loss of folate in milk
Breastfeeding women need about therefore increases the folate for breast
25 g/day of extra protein to maintain feeding women. An increased intake of
adequate nutrition during lactation. up to 25 percent (i.e. from 400 mcg per
These requirements can be met with an day for a normal person to 500 mcg) is
extra small meal each day (FAO, WHO recommended (FAO and WHO, 2004).
and UNU, 2007).

94 Tanzania Mainland Food-Based Dietary Guidelines

The folate concentration in breast retardation (FAO and WHO, 2004). The
milk increases progressively from iodine requirements of lactating women
colostrum to mature milk (O’Connor are nearly double those of healthy adult
et al., 1997). Milk folate concentrations women to meet their own requirements
are generally higher in hind milk (at the and for the baby to receive sufficient
end of feeding) than in foremilk (at the iodine from the milk to synthesise thyroid
beginning of feeding) (Smith, 1983). It is
hormones (FAO and WHO, 2004). The
therefore important to empty one breast
first. Reported changes in milk folate iodine content of human milk is variable
concentrations with the progression and depends on maternal intake (Becker
of lactation are not consistent; some et al., 2006; Segura, Ansótegui and Díaz-
researchers found a gradual increase Gómez, 2016). Iodised table salt (the
as lactation progresses (Tamura and source of iodine recommended for all
Picciano, 2006). individuals) only contributes half of the
required intake during lactation (Segura,
Zinc Ansótegui and Díaz-Gómez, 2016), so
An adequate supply of zinc is essential increased consumption of other sources
for the normal growth and development of iodine like sea fish is recommended.
of the fetus and infant postpartum.
Some studies show that zinc intake is Vitamin C
associated with infant weight gain and During lactation, 20 mg/day of vitamin C
achieved weight at 4 months of age. It was is secreted in milk. Vitamin C levels are
further indicated that there is a positive higher in colostrum by 10 to 20 mg/L
association of cumulative zinc intake compared with mature milk. Levels are
from breast milk with the achieved infant relatively stable until after 12 months
weight at age 4 months and with weight postpartum when they begin to decrease
gain from birth to the age of 4 months slightly and reach 30 percent of previous
(Dumrongwongsiri et al., 2021). levels by 18 to 24 months postpartum
(FAO and WHO, 2004). For an assumed
Although women are encouraged to absorption efficiency of 85 percent, the
consume more zinc-rich food during mother will require an extra 25 mg per
lactation, studies have shown that zinc day. It is therefore recommended that
content in breast milk is sustained tightly the RNI should be set at 70 mg/day to
and is not affected by maternal zinc fulfil the needs of both the mother and
status, dietary zinc intake, or ingestion infant during lactation (FAO and WHO,
of zinc-rich supplements (Amuistere et 2004). The vitamin C concentration in
al., 2018; FAO and WHO, 2004). While milk is positive correlated with maternal
zinc concentration in human milk is not intake of vitamin C from food (Hoppu et
high, it is enough to satisfy the needs of al., 2005). The vitamin C concentration in
the child due to its high bioavailability. It milk is positive correlated with maternal
is recommended that lactating women intake of vitamin C from food (Hoppu et
should increase their zinc intake by 50 al., 2005).
percent (Segura, Ansótegui and Díaz-
Gómez, 2016).

Iodine
Iodine deficiency occurring during foetal
and neonatal growth and development
leads to irreversible damage of the
brain and central nervous system and,
consequently, to irreversible mental

Tanzania Mainland Food-Based Dietary Guidelines 95

 MYTHBUSTER! MATERNAL DIET AND MILK QUALITY
Although the quality of milk is not affected by the mother’s diet quality1 (WHO,
1985; Prentice et al., 1989; Hartmann et al., 1985; Greiner, 1994) a healthy,
varied diet with extra amounts of foods rich in these nutrients is important
as the mother will have to replace the nutrients lost through breastfeeding.

If nutrient intake is lower than the total demand for both maternal
maintenance needs and milk production, the mother's body will mobilize
available nutrients from body tissues to maintain a constant breastmilk
quality and quantity. Thus, additional nutrients are important for mothers’
healthy weight, proper function of the body, body repair and protection
against diseases.

1
Studies have found that there is no dose response relationship between diet and human lactation and that, in general,
reductions in the quality and quantity of breast milk, and reductions in infant growth have been difficult to find even among
malnourished women who breastfeed for long periods. Further, empirical evidence has not been able to demonstrate
reduced energy or protein levels in breast milk of malnourished women. Some of the reasons for constant breast milk
quality is that the woman’s metabolic rate becomes more efficient during breastfeeding and at times the woman’s body will
mobilise available nutrients from her own body tissues to meet produce breastmilk in case of low dietary nutrient intakes
(WHO, 1985; Prentice et al., 1988; Illingworth et al., 1986; Frigerio et al., 1991; Whitehead, 1979; Deem, 1931; Hartmann et
al., 1985; Spring et al., 1985; Prentice et al., 1986; Greiner, 1994).

12.2.4 Recommendations for lactating The diet modelling for lactating women
women aimed to maximize micronutrient intake
and additional calorie requirements
• Lactating women should follow the during breastfeeding. The serving
dietary recommendations by eating sizes and nutrients supplied by the
a variety of foods from the six food recommended diet model are shown in
groups described in the guidelines Table 14.
for the general population.
• Lactating women need an additional
505 kcal and 25 g of protein as well
as additional folate, zinc, calcium, and
vitamin A to support their health and
wellbeing (FAO, 2004).
• Lactating woman should increase
intake of foods rich in vitamin A,
such as orange-coloured fruits and
vegetables.
• Lactating women should continue
to take iron and folic acid
supplementation for at least three
months after delivery (WHO, 2013).
• Eat eggs or thoroughly cooked beef,
chicken, pork, fish, or lamb daily for B
vitamins, vitamin D, iron and protein.

96 Tanzania Mainland Food-Based Dietary Guidelines

 Table 14 Recommended daily food intake amounts and nutrients for lactating women

Fat
Zinc

Iron

Fibre
Folate

Niacin

Energy
Protein
Calcium
Thiamin
Vitamin C

Riboflavin
Vitamin B6

Magnesium

Food weight
Carbohydrate
Vitamin A-RAE

Servings per day

(g) (kcal) (g) (g) (g) (g) (mg) (mg) (mg) (mg) (mcg) (mg) (mg) (mg) (mg) (mcg) (mg)

Total nutrient
2066.0 2822.4 114.5 64.4 423.6 45.1 1159.7 27.5 550.4 14.0 1019.6 1.2 1.8 19.0 2.3 689.1 225.9
intakes

Cereals, starchy
roots tubers,
5.5 797 1130.7 21.0 2.3 251.0 11.2 79.4 2.9 129.9 2.1 55.3 0.2 0.3 3.2 0.5 75.6 39.3
plantains and
green bananas
Vegetables 2.0 281 134.3 12.7 0.9 15.6 6.6 750.5 10.8 121.5 1.2 589.6 0.2 0.6 2.0 0.4 127.3 52.1

Fruits 3.0 413 308.9 3.9 6.9 53.4 8.7 70.3 1.8 79.5 0.7 320.3 0.1 0.2 2.2 0.7 102.0 130.7

Pulses, nuts and

3.0 293 410.2 27.1 8.0 48.3 18.5 100.0 7.3 175.1 3.3 0.0 0.6 0.2 3.9 0.4 354.2 2.9
oily seeds

Animal-source
2.5 193 337.6 49.8 14.9 1.0 0.0 157.7 4.7 44.0 6.5 54.5 0.1 0.5 7.6 0.3 29.7 0.8
foods

Fats and oils 2.3 32 283.5 0.0 31.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Sugary foods and

1.3 58 217.2 0.1 0.0 54.2 0.0 1.8 0.1 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.1
sweets

Tanzania Mainland Food-Based Dietary Guidelines

97
 12.3 Foods and habits to avoid during women should not take any medicine
pregnancy and lactation without medical advice, as some of
them could be harmful to the foetus
• Excess intake of beverages containing or baby.
caffeine, such as tea and coffee, • Smoking, using tobacco and
adversely affects foetal growth, so consuming alcohol should be avoided.
should be avoided.
• Food beliefs and taboos such as
• Beverages such as tea bind dietary avoiding animal-source foods (e.g.
iron and make it unavailable, so they eggs) or restricting consumption of
should be avoided. citrus fruits (e.g. lemons) should be
• Consult a doctor when taking discouraged.
medication. Pregnant and lactating • Avoid harmful drugs.

98 Tanzania Mainland Food-Based Dietary Guidelines

 12.4 Key messages for healthy eating during
pregnancy and lactation
1. Eating a variety of foods from the six food groups is
important for everyone in the family, but caring for and
feeding a baby from your own body requires more food.
2. Eat more than usual from the variety of foods from all the
six food groups to keep yourself and the baby healthy.
3. Eat more liver, eggs, meat, poultry, fish, leafy vegetables, fruits and
pulses for baby growth and development.
4. When pregnant, eat extra half servings of whole grains (free of
mycotoxins), roots, tubers, and pulses to support the weight gain
needed during pregnancy.
5. When breastfeeding, add extra servings of whole grains, roots, tubers
and pulses to replenish energy lost through breastfeeding.
6. Always use iodized salt.
7. Avoid smoking and alcohol consumption as it will harm your baby and
yourself.
8. Take iron and folate supplements every day as given by the clinic to
prevent birth defects and anaemia.
9. Drink plenty of water when pregnant and breastfeeding.

12.5 Tips for nutrition during pregnancy and lactation

1. Eat more leafy greens for folate and vitamin A.
2. Eat more citrus fruits, papayas, mangoes, and pineapples for vitamin C.
3. Eat more orange fruits and vegetables and orange fresh sweet potatoes
for vitamin A.
4. Choose lentils, peas, groundnuts, and sunflower seeds for folate,
selenium and zinc.
5. Use iodized salt when cooking, but in small amounts.
6. Eat more meat, poultry, fish, and fresh or fermented milk while pregnant
and breastfeeding.
7. Eat an extra meal and two snacks in addition
to regular meals to support pregnancy and
breastfeeding.
8. Avoid tobacco, alcohol and unprescribed drugs or
supplements.
9. Eat foods that are fortified with iron, such as wheat
and corn flour.

Tanzania Mainland Food-Based Dietary Guidelines 99

 13. RECOMMENDATION 2.2
FEED YOUR BABY ONLY BREAST MILK FOR THE FIRST SIX MONTHS OF LIFE
AND NO FOOD OR WATER BECAUSE MOTHER’S MILK CONTAINS ALL THE
NUTRIENTS THE BABY NEEDS

13.1 Breast milk levels of secretory immunoglobulin A

Breast milk contains complete nutrition (SIgA) found in colostrum helps protect
for infants. Infants from birth to six the newborn’s digestive tract and protects
months get their entire nutrient and against viruses and bacteria (De Vries et
water requirements from the mother’s al., 2018; Toscano et al., 2017).
breast milk, so they do not need
additional liquid or food (UNICEF, 2016; Colostrum also helps babies make their
Victora et al., 2016). Giving water to the first bowel movements and get rid of
the meconium – the tar-like faeces
baby reduces breastfeeding and may
that collect in the bowels before birth
cause diarrhoea. – thereby helping to prevent new-born
jaundice (De Vries et al., 2018; Toscano et
13.2 Importance of colostrum in breast al., 2017).
milk for the baby
Breastfeeding should start as early Colostrum also contains nutrients like
as within one hour after delivery. It is protein and vitamin A, and growth factors
important for babies to be given “first (UNICEF and WHO, 2018).
milk” (colostrum) within the first hour of
birth (WHO, 2019a; UNICEF, 2016). Colostrum comes in very small amounts
and the flow is slow so that a baby can
Colostrum is rich in protective antibodies learn the skill of breastfeeding, which
and white blood cells that help the require a baby to suck, breathe and
baby’s immune system fight harmful swallow at the same time.
microorganisms. It is important that
infants receive colostrum and no other
foods because it helps protect them
against infections and illness. The high

100 Tanzania Mainland Food-Based Dietary Guidelines

13.3 The importance of exclusive as diarrhoea and upper respiratory
breastfeeding for six months tract infections. Babies who are
Breastfeeding has benefits for the child exclusively breastfed are less likely
as well as for the mother. to get diarrhoea and other illnesses
because breast milk is clean and
For the child: protects infants against infections
(Sanker et al., 2015).
• According to the WHO, healthy
dietary practices start early in life. • Breastfeeding provides warmth,
Breastfeeding fosters healthy growth closeness and contact, which helps the
and improves cognitive development. physical and emotional development
It makes babies develop better of the child (UNICEF, 2020).
resistance to common childhood • Breastfeeding also protects infants
diseases or illnesses such as diarrhoea from vulnerability to allergic reactions
and other bowel diseases, respiratory (Lodge et al., 2015).
and ear infections, and malaria.
• Breastfeeding promotes proper jaw,
• Exclusive breastfeeding may have teeth and speech development –
longer-term health benefits, such the action of breastfeeding helps
as reducing the risk of becoming the child’s jaw to develop as well as
overweight or obese and developing muscles such as the tongue. This
NCDs later in life (UNICEF, 2016; assists with clear speech, protects
Sankar et al, 2015, Horta et al., 2015a). against dental caries and reduces the
• Breast milk provides all the nutrients risk of orthodontic problems (Karimi,
and fluids that the baby needs for 2019; Tham, R. et al., 2015; Victora et
growth and development in the first al., 2016; UNICEF, 2013; Agarwal et al.,
six months. It also has several special 2012; Abate, et al., 2020).
components such as growth factors,
enzymes, hormones and anti-infective For the mothers:
factors (Jackson and Nazar, 2006)
• Breastfeeding is associated with
• The nutrients in breast milk, including
lower cardiovascular disease risk,
protein, fat and calcium, are more
including high blood pressure and
easily digested by the baby than those
high cholesterol (Victora et al., 2016;
from animal milk. The iron content in
Rameez, Sadana and Kaur, 2019).
cow milk is insufficient for nourishing
a baby. • Breastfeeding delays a new
pregnancy and helps the uterus to
• Breastfeeding is associated with return to its previous size, which in
better cognitive development and turn helps to reduce bleeding and
improved performance in intelligence may help to prevent anaemia (Kramer
tests (UNICEF, 2016; Horta et al., and Kakuma, 2012; Chowdhury et al.,
2015a) 2015).
• Breast milk provides good quality • Breastfeeding also reduces the risk
proteins, fats, vitamins, calcium, iron of ovarian cancer, breast cancer, and
and other minerals. type 2 diabetes mellitus (Chowdhury
• The gut flora and the low pH of et al., 2015).
breastmilk inhibits the growth of • Breast milk is readily available, does
pathogens. not require any special preparation,
• Breast milk has components which saves time and makes night feeding
protect the infant from infections such easier.

Tanzania Mainland Food-Based Dietary Guidelines 101

 • Breastfeeding delays the return of hours after delivery. About 59 percent
fertility. Mothers who breastfeed of the women practised exclusive
exclusively and frequently have less breastfeeding. At age 4–5 months, only
than a 2 percent risk of becoming 27 percent were on exclusive
pregnant in the first six months breastfeeding compared to 84 percent
postpartum, provided that they at 0–1 month and 59 percent at
still have amenorrhoea (WHO, 2–3 months. In some instances, infants
2016; Kramer and Kakuma, 2012). of below six months consume liquids
(water 11 percent and other milk
13.4 Signs that a baby is receiving 4 percent) other than breast milk and
enough breast milk about 22 percent of infants under six
The mother can look for the following months are fed complementary foods
signs to make sure she is giving her baby in addition to breast milk. Trends
enough milk: of exclusive breastfeeding show an
increasing pattern (MoHCDGEC et al.,
• The baby will have at least six to 2016):
eight very wet nappies/diapers in
24 hours from day five. (Babies’ urine • 1991–92: 26 percent
frequency increases from two wet • 2004–05: 41 percent
nappies on day two to three to four
wet diapers on day three and four). • 2010: 50 percent

• The baby’s urine is clear as water a • 2015–6: 59 percent

few days after birth. This means that exclusive breastfeeding
• The baby will produce bright yellow is partially practised.
stools from the fifth day. The first few
days after birth the baby’s stool is a
dark green, almost black as the baby
MYTHBUSTER!
There is a myth that a baby feels
passes meconium during that time.
thirsty in hot weather and should be
Frequency of passing stools varies
given water.
from baby to baby. A baby may also
change the frequency as she or he This is not true, as breast milk
grows older. contains enough water to quench a
• The baby will have good skin colour baby’s thirst!
and muscle tone.
• The baby will be alert, responsive and
contented.
• The baby will gain weight and grow
in length and head circumference
starting with regaining their birth
weight by 10 to 14 days old.

13.5 Breastfeeding practice in the

United Republic of Tanzania
Almost all women (98 percent) in the
United Republic of Tanzania breastfeed
their children. About 51 percent of
infants are breastfed within one hour
and 93 percent are breastfed within 24

102 Tanzania Mainland Food-Based Dietary Guidelines

 13.6 Key messages for exclusive breastfeeding
1. Breastfeed babies exclusively on demand from
immediately after birth to six months of age because
breast milk contains all the food and water the baby
needs. Breastfeeding responsively ensures that babies
will receive all they need to grow well and remain healthy.
2. Do not give babies any water, tea, honey, sugar water,
salt, juice or any other foods before six months to reduce
the risk of diarrhoea, infections or death.
3. Breastfeed as soon as possible within the first hour of birth to boost
the child’s immunity from colostrum (first milk) and prevent newborn
deaths (WHO, 2017b). The colostrum is the baby’s first shot of natural
immunization.

13.7 Tips for exclusive breastfeeding

1. Initiate breastfeeding immediately after birth or within the first hour
to stimulate breast milk production and promote better milk flow.
2. Breastfeed your baby when it shows a sign of hunger without counting
the hours after the last breastfeeding.
3. Breast milk can stay at room temperature for up to four hours. If you
have to be away from the baby for a while, express breast milk into a
clean container and leave it covered for the baby.
4. Breastfeed your baby until your breast is empty
before shifting to another breast.
5. There are signs to let you know if the baby is
getting enough breast milk. These signs have
been explained in section 13.4.

Tanzania Mainland Food-Based Dietary Guidelines 103

 Credit: Adapted from UNICEF & URC/CHS

14. RECOMMENDATION 2.3

FROM SIX MONTHS, FEED YOUR BABY A VARIETY OF FOODS FROM
ANIMAL SOURCES, PULSES, FRUITS AND VEGETABLES, AND CONTINUE
BREASTFEEDING UP TO 2 YEARS OF AGE OR BEYOND FOR HEALTHY
GROWTH AND DEVELOPMENT OF YOUR BABY
From birth until 6 months, breast milk provides all the nutrients and energy required
for the growth and development of the infant.

As per table 15 and Figure 5, the nutritional needs of an infant increase significantly
after 6 months of age and the child, therefore, needs other foods in addition to breast
milk to supplement its energy, protein, vitamin and mineral requirements. Feeding the
child with other foods in addition to breastfeeding is known as complementary feeding

.
Figure 5 Gaps to be filled by
complementary foods for a
breastfed child from 12 to 23
months

Source: WHO. 2009b. Infant and young

child feeding: model chapter for textbooks
for medical students and allied health
professionals. Geneva.

104 Tanzania Mainland Food-Based Dietary Guidelines

Table 15 Estimate of daily energy and nutritional requirements compared to what is
provided by breastmilk

Vitamin A gap
Energy from

Iron needed

(µg RE/day)
(µg RE/day)

(µg RE/day)
Energy gap
breastmilk

breastmilk

breastmilk
Vitamin A
Iron from
Child age
(months)

(mg/day)

(mg/day)

(mg/day)
Iron gap

Vitamin
needed

needed
Energy

A from
(kcal)

(kcal)

(kcal)
0–2 405 405 0 1.18 0.05 0* 400 365 0*
3–5 500 500 0 0.9 0.05 0* 400 390 0*
6–8 600 400 200 0.79 0.04 0.75 400 340 60
9–11 700 400 300 0.65 0.04 0.61 400 310 90
12–23 900 350 550 0.5 0.04 0.46 400 280 120

*Although breast milk does not supply enough vitamin A and iron, the gap between iron and vitamin
A is zero in the first six months because this gap is covered from the baby’s birth stores.

Sources: 1) WHO. 2006b. Food and nutrition policy for schools: a tool for the development of school
nutrition programmes in the European region. Geneva. 2) WHO. 2009b. Infant and young child feeding:
model chapter for textbooks for medical students and allied health professionals. Geneva.

14.1 Complementary feeding b) Adequate in nutrient density –

Complementary foods are foods given meaning that it is not bulky and that
in addition to breast milk to infants and it is derived from all food groups
young children aged 6 to 24 months. providing sufficient energy, protein
and micronutrients.
During the period of complementary
feeding, the baby gradually becomes c) Safe – meaning that it is hygienically
prepared and fed with clean hands
accustomed to eating family foods. It is
using clean utensils and not bottles.
important that mothers and caregivers
start complementary feeding at six d) Properly fed – meaning that children
months. are fed according to their age,
appetite and satiety. Children should
Give the child foods from all six food be actively encouraged, even during
groups to get all the nutrients required illness, to consume sufficient food,
by the growing body with emphasis on using fingers, spoons and self-
iron rich foods. feeding suitable for age.

Cow’s milk should not be given to babies Caregivers should interact with the
under 12 months, and adding honey, child, respond to their hunger signals
sugar, and salt to complementary foods and select appropriate foods. Safe
is not recommended. food preparation, storage and hygienic
practices are also crucial to preventing
Complementary feeding should be: the spread of disease and ensuring that
good nutrition reaches and remains in
a) Timely – meaning that it is introduced children’s bodies (UNICEF, 2016).
at the age of 6 months when the need
for energy and nutrients exceeds
what is provided from exclusive
breastfeeding.

Tanzania Mainland Food-Based Dietary Guidelines 105

 - Give foods rich in vitamin A, such
as orange- and yellow-coloured
fruits (mangoes, papaya),
vegetables, grains, roots, and
tubers (e.g. orange-flesh sweet
potatoes, carrots). Liver and
dark-green leafy vegetables are
also rich in vitamin A. Vitamin A
deficiency is prevalent among
infants and children in the United
Republic of Tanzania
14.2 Benefits of adequate • Give infants pureed foods at first.
complementary foods Make the food thicker as the child
gets older and develops. Foods such
• From the age of 6 months, the as whole grapes, raw carrots, and
baby needs breast milk and nuts can cause choking and should
complementary foods to promote not be given to children when they
health, support growth and enhance are still learning to chew food
development. Provision of adequate properly.
complementary foods prevents
• Cow’s milk should not be given
malnutrition.
to babies under 12 months of
• Complementary feeding is needed age. Adding honey, sugar and salt
to provide energy and essential to complementary foods is not
nutrients for continuing growth and recommended.
development.
• Start at six months with small
amounts of food and increase
14.3 Recommendation on starting gradually as the child gets older.
complementary foods after six months
• Caregivers should interact with the
Follow these guidelines recommended
child and respond to their hunger
by UNICEF (2020):
signals. Caregivers should feed
• Continue frequent, on-demand the children slowly and patiently,
breastfeeding until 2 years of age or encouraging them to eat but not
beyond. forcing them. It is also recommended
• After six months of exclusive that the caregiver talks to the child
breastfeeding, introduce safe, and maintains eye contact during
adequate, complementary foods. feeding times.
• Children should eat a variety of foods • When a child is ill, they should be
from the six food groups in sufficient offered more fluids, including breast
quantities. milk and soft favourite foods for
- Give children iron-rich foods quicker recovery and prevention of
such as pureed or mashed fish, weight loss.
meats and poultry, especially • Clean hands with soap and clean
liver, pulses, and iron-fortified water before, during and after food
cereals to address the issue of preparation and feeding the baby.
iron-deficiency anaemia which
• Caregivers should also wash hands
is prevalent among infants and
with soap and clean water after
children in the United Republic of
visiting the toilet or helping a child
Tanzania.
use the toilet as well as after changing

106 Tanzania Mainland Food-Based Dietary Guidelines

 a baby’s dirty nappy. months received semisolid foods, meal
• All cooking and feeding utensils and frequencies, including snacks, were
containers should be clean. lower than the recommended values
of 2–3 times for breastfed infants 6–8
• Food should be offered to children months old and 3–4 times for breastfed
immediately after cooking while it’s infants 9–11 months old (MoHCDGEC et
still warm. Feeding children food al., 2016).
that has been sitting out at room
temperature for more than two hours 14.5 Amounts of food to give to young
is not recommended. children
14.4 Current infant and young child The amount of food to give to young
feeding practice in the United Republic children after six months varies according
of Tanzania to the age of the child (Table 16).
Inadequate feeding practices and
limited dietary supply are known to MYTHBUSTER!
contribute to chronic malnutrition in An exclusively breast-fed baby crying is a sign
Tanzanian children. Early initiation of that the infant is not satisfied with breast
milk.
complementary feeding before a child is
6 months is a common practice. Reasons This is not true! Breast milk contains all
the nutrients and water the baby requires
given by caregivers for early initiating from birth to 6 months.
complementary feeding include to stop
frequent child crying, which is perceived Make sure to empty one breast before
offering the other breast in order to quench
by mothers as a sign that the infant is the baby’s thirst and get all the nutrients
not satisfied with breast milk. Although that come at different times from when
the majority of the children aged 6–8 breast in full until it is empty.

Table 16 Guidance on the quality, frequency and amount of food to offer children aged
6–23 months

Child age Texture Frequency Amount of food

Start with thick, well Start with 2–3 tablespoons
6–8 mashed, semi-solid, per feed, increasing
• 2–3 meals per day
months blended or pureed gradually to ½ cup (125 ml)
foods per meal
Finely chopped or • 3–4 meals per day
9–11 mashed foods and • Depending on child’s
½ cup (125 ml) per meal
months foods that baby can appetite, 1–2 snacks
pick up may be offered
• 3–4 meals per day
Family foods,
12–23 • Depending on child’s ¾ cup (190 ml) to 1 cup (250
chopped or mashed if
months appetite, 1–2 snacks ml) per meal
necessary
may be offered
Three meals (at least 1 full
• A variety of foods from
2–5 years Family foods cup per meal) plus healthy
all the six food groups
snacks in between meals
Note: If a baby over 12 months is not breastfed, give an addition 1–2 cups of milk per day and one to
two extra meals per day.
Source: UNICEF. 2020. Improving young children’s diets during the complementary feeding period. UNICEF
programming guidance. New York.

Tanzania Mainland Food-Based Dietary Guidelines 107

 108
Table 17 Recommended daily food intake amounts and the nutrients this eating pattern will provide children aged 6–8 months

Fat

day
Zinc

Iron
Fibre

Folate

Energy
Protein
Calcium
6–8 months
Vitamin A

Food weight

Servings per
Carbohydrate
(g) kcal (g) (g) (g) (mg) (mg) (mg) (mcg) (mcg) (mg)

Total nutrient intake 206.5 6.5 6.9 28.1 70.0 1.6 0.8 58.5 36.3 2.7

Animal and animal products 0.1 9.7 16.9 2.5 0.7 0.0 7.9 0.2 0.3 2.7 1.5 0.0
Cereals, tubers, roots and plantains 0.4 120.2 104.0 2.0 0.3 22.9 8.1 0.3 0.2 5.6 7.9 1.1

Tanzania Mainland Food-Based Dietary Guidelines

Fats and oil 0.4 5.3 47.3 0.0 5.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Fruits 0.1 17.2 12.9 0.2 0.3 2.2 2.9 0.1 0.0 13.3 4.2 0.4

Pulses, beans, nuts and seeds 0.1 12.2 17.1 1.1 0.3 2.0 4.2 0.3 0.1 0.0 14.8 0.8

Sugary foods and sweets 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Vegetables 0.1 17.6 8.4 0.8 0.1 1.0 46.9 0.7 0.1 36.9 8.0 0.4
 Table 18 Recommended daily food intake amounts and the nutrients this eating pattern will provide children aged 9–11 months

Fat

day
Zinc

Iron
Fibre

Folate

Energy
Protein
Calcium
9–11 months
Vitamin A

Food weight

Servings per
Carbohydrate
(g) (kcal) (g) (g) (g) (mg) (mg) (mg) (mcg) (mcg) (mg)

Total nutrient intake 327.9 11.8 11.9 41.0 134.6 3.0 1.4 113.3 67.4 4.6

Animal and animal products 0.3 19.3 33.8 5.0 1.5 0.1 15.8 0.5 0.7 5.4 3.0 0.0
Cereals, tubers, roots and plantains 0.5 160.3 138.7 2.6 0.3 30.5 10.8 0.4 0.2 7.4 10.5 1.5

Fats and oil 0.6 8.8 78.8 0.0 8.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Fruits 0.3 34.4 25.7 0.3 0.6 4.5 5.9 0.1 0.1 26.7 8.5 0.7

Pulses, beans, nuts and seeds 0.3 24.4 34.2 2.3 0.7 4.0 8.3 0.6 0.3 0.0 29.5 1.5

Sugary foods and sweets 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Vegetables 0.3 35.1 16.8 1.6 0.1 2.0 93.8 1.3 0.2 73.7 15.9 0.8

Tanzania Mainland Food-Based Dietary Guidelines

109
 110
Table 19 Recommended daily food intake amounts and the nutrients this eating pattern will provide children aged 12-23 months

Fat

day
Zinc

Iron
Fibre

Folate

Energy
Protein
Calcium
12–23 months
Vitamin A

Food weight

Servings per
Carbohydrate
(g) (kcal) (g) (g) (g) (mg) (mg) (mg) (mcg) (mcg) (mg)

Total nutrient intake 521.2 17.3 18.7 66.7 248.0 5.3 2.0 217.3 126.6 8.5

Animal and animal products 0.25 19.3 33.8 5.0 1.5 0.1 15.8 0.5 0.7 5.4 3.0 0.0

Tanzania Mainland Food-Based Dietary Guidelines

Cereals, tubers, roots and plantains 0.75 240.4 208.0 3.9 0.5 45.8 16.2 0.6 0.4 11.1 15.8 2.3

Fats and oil 1 14.0 126.0 0.0 14.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Fruits 0.5 68.9 51.5 0.7 1.1 8.9 11.7 0.3 0.1 53.4 17.0 1.5

Pulses, beans, nuts and seeds 0.5 48.8 68.4 4.5 1.3 8.1 16.7 1.2 0.6 0.0 59.0 3.1

Sugary foods and sweets 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Vegetables 0.5 70.3 33.6 3.2 0.2 3.9 187.6 2.7 0.3 147.4 31.8 1.6
 14.6 Key messages for feeding a baby
1. From six months, give children a variety of foods from
the six different food groups and continue breastfeeding to
support their growth and development.
2. Give beans, peas, lentils, nuts and seeds to infants and
young children daily from 6 months of age.
3. Give green leafy vegetables and yellow- or orange-coloured vegetables
and fruits daily to infants and young children. Add a little vegetable oil
to vegetables. Oil helps with vitamin A absorption.
4. Give children clean and safe water to drink. Do not give infants and
young children honey, tea, sugary drinks or salty foods.
5. Give prepared foods immediately after cooking and cooling.
6. Give food 2–3 times a day for infants 6–8 months old, while continuing
to breastfeed.
7. Give food 3–4 times a day for infants and young children between 9–24
months, while continuing to breastfeed.
8. When a child is ill, offer them more fluid including breastmilk and
favourite foods from 6 months of age.
9. Offer a variety of starchy foods such as orange-fleshed sweet potato,
cassava, and provitamin A maize, in addition to rice to children over 6
months.
10. Prepare foods for infants and young children with clean and safe water.

14.7 Tips for for feeding a baby

1. Introduce only one new food at a time, then combine foods later.
2. Introduce iron-rich foods such as pureed meats, liver, kidney, egg yolk,
fish, and chicken to babies after six months of exclusive breastfeeding
daily.
3. Give fatty fish regularly, taking care to remove the
bones.
4. Choose vegetable oils such as sunflower and
peanut oils.
5. Give avocado for healthy fats.
6. Give prepared foods immediately after cooking.

Tanzania Mainland Food-Based Dietary Guidelines 111

 Credit: Adapted from UNICEF & URC/CHS

15. RECOMMENDATION 2.4

GIVE A VARIETY OF FOODS FROM THE SIX FOOD GROUPS TO CHILDREN
BETWEEN THE AGES OF 2 AND 5 TO HELP THEM GROW TO THEIR FULL
POTENTIAL
15.1 Importance of a variety of foods Children need a diversified diet from all
for this age group six food groups to provide the energy and
From 2 years of age, children start to nutrients they need for continued growth
choose their own food and can feed and development. Inadequate nutrition
themselves. They can eat family meals at this stage is associated with high risks
and some can start to eat outside the of illness and infections, which can have
home (UNICEF, 2020; FAO, 2004a). lifelong consequences on education
attainment and health (UNICEF, 2020).
Good nutrition for children 2 to 5 years
of age is important to meet the needs of Encourage children to eat from all the
rapid physical growth and development food groups, especially during sickness
(UNICEF, 2020). (FAO, 2004a).

112 Tanzania Mainland Food-Based Dietary Guidelines

Table 20 Recommended daily food intake amounts and the nutrients this eating pattern
will provide children aged 2–5 years

Carbohydrate
Servings per

Food weight

Vitamin A
Children 2–5 years

Calcium
Protein
Energy

Folate

Fibre
Iron

Zinc
day

Fat

(mcg)

(mcg)
(kcal)

(mg)

(mg)

(mg)

(mg)
(g)

(g)

(g)

(g)
Total
nutrient 1193 44 41 154 493 11 5.4 460 252 17
intake
Cereals,
tubers,
2 289 411 7.6 0.8 91.2 28.8 1.0 0.8 20.1 27.4 4.1
roots and
plantains
Pulses,
beans,
1 98 137 9.0 2.7 16.1 33.3 2.4 1.1 0.0 118.1 6.2
nuts and
seeds
Animal
and animal 1 77 135 20.0 6.0 0.4 63.2 1.9 2.6 21.8 11.9 0.0
products

Vegetables 1 140 67 6.3 0.4 7.9 347.2 5.2 0.6 307.8 62.9 3.3

Fruits 1 139 105 1.3 3.1 16.5 20.0 0.6 0.3 110.1 31.4 2.9

Fats and
2 28 252 0.0 28.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
oil
Sugary
foods and 0.5 23 87 0.0 0.0 21.7 0.7 0.0 0.0 0.0 0.1 0.0
sweets

Tanzania Mainland Food-Based Dietary Guidelines 113

 15.2 Key messages for feeding children aged 2 to 5
1. Give family meals that contain a variety of foods from the
six food groups to ensure a child gets all the nutrients they
require.
2. Give a child three meals and one or two nutritious snacks
a day.
3. Include fish or animal-source foods such as eggs, poultry, meat and
milk products.
4. Give children orange-coloured vegetables, fruits and tubers such as
papaya, ripe mango, pumpkin, pumpkin flowers, orange-fleshed sweet
potatoes, whole grain yellow maize, and dark leafy vegetables.
5. Give children pulses, nuts and seeds. Adding pulses or nut powders is a
great way to add nutrients to a child’s meals.
6. Avoid adding too much spice, sugar and salt to a child’s food.

15.3 Tips for quality, frequency and amount of food to offer children
aged 2 to 5
1. Serve a child’s food on his or her own plate or bowl to ensure children
eat enough food.
2. Give fatty fish regularly, taking care to remove the bones.
3. Grow and use biofortified crops like orange-fleshed sweet potatoes,
yellow maize and biofortified beans.
4. Add nutrient-rich food powders like bean, nut and fish powders and
moringa powder to children’s meals. Adding moringa
is a great way to fortify and enrich a child’s meals
because the moringa leaf contains a much higher
nutritional value of iron, calcium and complete
protein, as well as vitamins A, C, B2, B6 and
various minerals compared to other foods. The
moringa tree grows easily and quickly.

114 Tanzania Mainland Food-Based Dietary Guidelines

16. RECOMMENDATION 2.5
PROVIDE HEALTHY MEALS AND SNACKS FOR SCHOOL-AGED CHILDREN
THROUGHOUT THE DAY
16.1 Dietary needs for children aged 6 16.2 Importance of a diversified diet
to 9. Good nutrition during this age is
Like adults, children from 5 years of age essential as it provides a second
need to eat a variety of foods in sufficient window of opportunity for growth
quantities. Since their brains and bodies and development. Children in this age
are still developing, special attention group require good nutrition to improve
should be given to nutrients that support learning (UNICEF, 2021; FAO, 2004a) and
their growth and development such help shape positive dietary practises
as protein, iron, calcium, vitamin A, B that can continue into adulthood
vitamins and healthy fats. (UNICEF, 2021).

In addition, children cannot do well In addition, good nutrition at these

in school if they do not get enough ages impacts on current and future
nutritious food. Children need nutritious nutritional status, including breaking the
meals and snacks throughout the day in intergenerational cycle of malnutrition
order to stay focused and learn. (UNICEF, 2021). Good dietary practices
during this stage reduce the risk of
A healthy meal for school children overweight and obesity and dental
reduces micronutrient deficiency, carries (WHO, 2006b). If maintained,
prevents overweight and obesity, positive dietary practices developed at
improves school enrollment and this stage and continued into adulthood
attendance, increases cognitive and may reduce the risk of chronic diseases
later in life (WHO, 2006b).
academic performance, and contributes
to gender equity in access to education.
Children need to drink milk and eat
eggs often to support bone growth and
health.

Tanzania Mainland Food-Based Dietary Guidelines 115

 Table 21 Recommended daily food intake amounts and the nutrients this eating pattern
will provide children aged 6–9 years

Carbohydrate
Servings per

Food weight

Vitamin A
Children 6–9 years

Calcium
Protein
Energy

Folate

Fibre
Iron

Zinc
day

Fat

(mcg)

(mcg)
(kcal)

(mg)

(mg)

(mg)

(mg)
(g)

(g)

(g)

(g)
Total
nutrient 1661 65 46 232 971 20 8 855 485 31
intake
Cereals,
tubers,
3 435 617 11.4 1.2 136.9 43.3 1.6 1.1 30.1 41.2 6.1
roots and
plantains
Pulses,
beans,
2 195 273 18.0 5.3 32.2 66.7 4.9 2.2 0.0 236.2 12.4
nuts and
seeds
Animal
and animal 1 77 135 19.9 6.0 0.4 63.1 1.9 2.6 21.8 11.9 0.0
products

Fruits 2 276 206 2.6 4.6 35.6 46.8 1.2 0.5 213.5 68.0 5.8

Vegetables 2 281 134 12.7 0.9 15.6 750.5 10.8 1.2 589.6 127.3 6.6

Fats and
2 28 252 0.0 28.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
oil
Sugary
foods and 0.3 12 43 0.0 0.0 10.8 0.4 0.0 0.0 0.0 0.1 0.0
sweets

16.3 Dietary needs for children and development as it establishes dietary

adolescents aged 10 to 18 and lifestyle habits that continue into
Children between 10 to 18 years require adulthood.
additional nutrients due to the growth
spurt both in height and weight during During puberty and adolescence, energy
this period (FAO, 2004; WHO, 2006a). needs increase, especially for boys
because of physical activity (FAO, 2004).
Children aged 10 to 18 years need a Girls need additional iron (more than
healthy diet as this period is another double) compared to boys and men
window of opportunity for catch-up when they start to menstruate and will
growth after stunting in early childhood continue to need it well into adulthood
(UNICEF, 2021; FAO, 2004; WHO, 2021c; to prevent anaemia (FAO, 2004; WHO,
WHO, 2006a). During these years, good 2006c).
nutrition is important for psychosocial

116 Tanzania Mainland Food-Based Dietary Guidelines

Table 22 Recommended daily food intake amounts and the nutrients this eating pattern
will provide girls aged 10–18 years

Carbohydrate
Servings per

Food weight

Vitamin A
Calcium
Protein
Energy

Folate

Fibre
Iron

Zinc
day

Fat
Girls 10–18

(mcg)

(mcg)
(kcal)

(mg)

(mg)

(mg)

(mg)
(g)

(g)

(g)

(g)
Total
nutrient 2387 101 55 350 1096 26 12 897 642 41
intake
Cereals,
tubers,
5 724 1028 19 2 228 72 3 2 50 69 10
roots and
plantains
Pulses,
beans,
3 293 410 27 8 48 100 7 3 0 354 19
nuts and
seeds
Animal
and animal 2 155 270 40 12 1 126 4 5 44 24 0
products

Fruits 2 276 206 3 5 36 47 1 0 214 68 6

Vegetables 2 281 134 13 1 16 751 11 1 590 127 7

Fats and
2 28 252 0 28 0 0 0 0 0 0 0
oil
Sugary
foods and 0.5 23 87 0 0 22 1 0 0 0 0 0
sweets

Tanzania Mainland Food-Based Dietary Guidelines 117

 Table 23 Recommended daily food intake amounts and the nutrients this eating pattern
will provide boys aged 10–18 years

Carbohydrate
Servings per

Food weight

Vitamin A
Calcium
Protein
Energy

Folate

Fibre
Iron

Zinc
day

Fat
Boys 10–18

(mcg)

(mcg)
(kcal)

(mg)

(mg)

(mg)

(mg)
(g)

(g)

(g)

(g)
Total
nutrient 2846 106 65 435 1135 27 13 1014 690 46
intake
Cereals,
tubers,
6 869 1234 23 2 274 87 3 2 60 82 12
roots and
plantains
Pulses,
beans,
3 293 410 27 8 48 100 7 3 0 354 19
nuts and
seeds
Animal
and animal 2 155 270 40 12 1 126 4 5 44 24 0
products

Fruits 3 413 309 4 7 53 70 2 1 320 102 9

Vegetables 2 281 134 13 1 16 751 11 1 590 127 7

Fats and
2.5 35 315 0 35 0 0 0 0 0 0 0
oil
Sugary
foods and 1 46 174 0 0 43 1 0 0 0 0 0
sweets

118 Tanzania Mainland Food-Based Dietary Guidelines

16.4 The situation for school-aged Increased consumption of deep-fried
children foods and sweetened beverages in the
There is limited national data on urban setting in Tanzania Mainland
food consumption behaviour among has fuelled the increased prevalence
schoolchildren in the United Republic of overweight and obesity among
of Tanzania. However, the study schoolchildren. Snacks made primarily
in urban and peri urban areas in from fried potatoes, fried wheat- and
Dar es Salaam reported that most rice-based buns, fried cassava and
Tanzanian schoolchildren leave home banana, sweetened and/or coloured
without eating breakfast. In addition, beverages, and candies are commonly
very few purchase any food until school sold in school premises (FAO, 2007). This
recess at around 10 am. practice predisposes children to high
consumption of fat and sugar. Similar
Barriers to eating breakfast at home types of snacks are also sold within the
included long commuting times to get neighbourhoods of their homes.
to school by public transport and the
early commencement of school sessions.
Some pupils were required to be at
school at 7 am to participate in chores
around the school grounds (FAO, 2007).
In this guideline, it is recommended that
children eat a healthy breakfast at home
before going to school.

Tanzania Mainland Food-Based Dietary Guidelines 119

 16A. RECOMMENDATION 2.5A
SCHOOL-AGED CHILDREN SHOULD EAT BREAKFAST BEFORE GOING TO
SCHOOL TO ENABLE THEM TO BE PRODUCTIVE AND PERFORM WELL

16A.1 The importance of eating school or do not eat much at midday (FAO,
breakfast 2004). If children do not eat breakfast,
Breakfast is a very important meal they will be hungry and will not be able to
for everyone, including school-aged concentrate and learn at school (UNICEF,
children. It is required for energy in the 2019).
morning and for good schoolwork. Eating
breakfast is associated with a reduced Increased frequency of habitual breakfast
risk of becoming overweight or obese was consistently positively associated
and with a reduction in the body mass with academic performance (Adolphus,
index of children and adolescents (De La Lawton and Dye, 2013).
Hunty, Gibson and Ashwell, 2013).
Children who habitually consume
Breakfast is especially important if breakfast are more likely to have
children have to walk a long distance to adequate micronutrients and energy
intake (Intiful and Lartey, 2014).

120 Tanzania Mainland Food-Based Dietary Guidelines

16B. RECOMMENDATION 2.5B
ENCOURAGE SCHOOL-AGED CHILDREN TO EAT HEALTHY SNACKS SUCH AS
FRESH FRUIT, VEGETABLES AND NUTS

16B.1 The importance of a healthy Children do not need sweets, sugary

snack drinks or ultraprocessed snacks. While
In addition to balanced meals, school these may be readily available and
children should consume healthy snacks. convenient to take to school, they only
Healthy snacks include fresh fruit (e.g. provide empty calories – meaning energy
bananas, mangos, apples, oranges, without valuable nutrients – and displace
guavas), vegetables (e.g. tomato, carrots), healthy foods that support growth and
or nuts and seeds (e.g. peanuts, cashew development.
nuts, sesame seeds, pumpkin seeds).
Consumption of healthy snacks increases
intake of essential nutrients required for
growth and development.

Tanzania Mainland Food-Based Dietary Guidelines 121

 16C. RECOMMENDATION 2.5C
PROVIDE SCHOOL-AGED CHILDREN WITH FOOD WHEN THEY ARE AT
SCHOOL TO INCREASE THEIR LEARNING ABILITY
16C.1 Importance of providing a lunch • Healthy lunches or snacks for school
box for school children help children stay alert and able to
Children between the ages of 5 and 18 concentrate.
spend most of the day at school. It is
therefore important to provide a healthy • Healthy lunches or snacks for school
meal for these children while they are give children the nutrition they need
in school in addition to a diversified during the day.
breakfast before going to school and a • Carrying food from home is less
wholesome meal when they get back expensive, more convenient and
from school. That way, the children stay
more hygienic.
nourished throughout the day.
• When a parent/caregiver packs a
In the United Republic of Tanzania, few child’s lunch, they will always know
schools provide school meals. When what the child will be eating. If
there are no school meals, children are children are given money to buy
given money to buy something to eat,
food, parents and caregivers are not
in most cases a sweetened beverage or
deep-fried snack. It is uncommon for there to monitor what they buy or
parents to pack food for their children. eat. The likelihood of children buying
unhealthy snacks or food is very high.
This guideline recommends that parents • School lunches help set healthy eating
should provide a healthy packed lunch to habits for them in the future.
school children for the following reasons:

122 Tanzania Mainland Food-Based Dietary Guidelines

16C.2 Points to consider when packing • Consider food safety. Since most of the
school lunch for children packed foods may not be refrigerated,
pack non-perisable foods that do not
• Packed lunch should contain a variety require refrigeration after two hours.
of foods, such as vegetables (e.g. • Include water to stay hydrated and
carrots, cucumbers), fruits, whole to avoid children buying or drinking
grains (e.g. chapatti, bread, popcorn) sweetened beverages.
and plant proteins (e.g. nuts and
seeds).

Tanzania Mainland Food-Based Dietary Guidelines 123

 16.5 Key messages for providing healthy meals and
snacks to school-aged children throughout the day

1. Provide children with a healthy breakfast, lunch, and snacks

every day.
2. Add protein-rich foods like boiled eggs, nuts, and seeds to
children’s snacks.
3. Add liver, eggs, meat, poultry and fish to children’s meals.
4. Add milk to children’s meals every day.
5. Limit children’s intake of salty snacks, fried foods and sweets.
6. Replace children’s sugary drinks with safe and clean water.

16.6 Tips for providing healthy meals and snacks to school-aged

children
1. Offer home-cooked meals and snacks instead of sweets or
ultraprocessed foods.
2. Pack healthy snacks such as fruit, plain yoghurt and wholewheat
bread with peanut butter and unsalted nuts instead of packaged
ultraprocessed foods.
3. Encourage children to eat whole foods instead of ultraprocessed foods.
4. Replace sugary beverages with water or unsweetened
milk.
5. Avoid giving foods that are high in fats such as
pizza, deep-fried chips and doughnuts.
6. Instead of fruit juice, offer whole fruits.
7. Cook children’s food with minimal salt to avoid
excess intake.

124 Tanzania Mainland Food-Based Dietary Guidelines

GUIDELINE 3: Limit intake of deep-fried
foods, saturated and trans fats, sugar and
salt

Tanzania Mainland Food-Based Dietary Guidelines 125

 17. RECOMMENDATION 3.1
LIMIT YOUR INTAKE OF DEEP-FRIED FOODS TO PREVENT HEART DISEASES,
DIABETES AND OBESITY
Fried foods such as chips, samosas, had a 28 percent increased risk of stroke
kachoris and maandazi are popular, and heart attack, a 22 percent heightened
whether cooked at home or commercially risk of coronary heart disease and a
prepared, because of their taste and ease 37 percent heightened risk of heart failure
of cooking. However, there are some when compared with people who ate the
serious health risks associated with over- least amount of fried foods. These risks
consumption of these foods. substantially increased by 3 percent,
2 percent, and 12 percent, respectively, in
17.1 Why fried foods are unhealthy tandem with each additional 114 g (half
There are four main reasons why eating cup) weekly serving (Qin et al., 2021).
a lot of fried foods negatively affects
health: Another study that looked at 70,842
women from the Nurses’ Health Study
(1984–2010) and 40,789 men from
1. Frequent fried-food consumption is
the Health Professionals Follow-Up
associated with a risk of type 2 diabetes
Study (1986–2010) found a significant
and coronary artery disease
association of increased risk of type 2
Various studies have found an increased
diabetes and moderate association with
risk of eating fried foods with type 2
coronary artery disease (Cahill et al.,
diabetes and cardiovascular events such
2014). Similar findings were observed in
as stroke and heart attack.
other populations (Honerlaw et al., 2020)
A recent meta-analysis of 17 different
studies, involving more than 562,000 2. Deep-fried foods are high in fat and
participants, found that people who ate calories
the highest amount of fried food per week Fried foods, whether homemade or

126 Tanzania Mainland Food-Based Dietary Guidelines

commercially made, are higher in fat and 4. Commercially fried foods contain
calories than the same foods cooked with trans fats, which are harmful to health
other methods such as boiling, steaming Fried foods in fast food restaurants,
and grilling. When foods are deep fried in other commercially made fried foods and
oil, they lose water and absorb fat, which ultraprocessed foods use hydrogenated
increases their calorie content. oils, which are high in trans fats. Fast food
restaurants use hydrogenated oils as
Eating fried foods easily adds calories they are stable during long periods of
to one’s diet due to the higher energy frying and repeated frying without the
density of fat. One gram of fat gives need to change oils. Hydrogenated
9 kcal, whereas 1 g of carbohydrates oils also give food a satisfying taste
and proteins provides only 4 kcal. Frying and crunch. Ultraprocessed food
foods may add more calories than a manufacturers use trans fats in foods
person requires per day. High intake of because they are cheaper to produce,
calories leads to overweight and obesity. increase shelf life, and improve taste and
texture.
Depending on the type of oils used, deep
frying can increase the intake of saturated Although widely used, trans fats are
fats, which have negative health effects. associated with an increased risk of heart
Since frying replaces water in the food diseases, type 2 diabetes and obesity and
with fat, frying increases fat content in have no known health benefits (WHO and
food. Fats and oils high in saturated fats FAO, 2002; GBD, 2017; GBD 2019; WHO,
include palm oil, coconut oil, ghee and 2021b).
butter (FAO and WHO, 2010).

3. Frying causes the production of

chemical by-products involved in the
body’s inflammatory response
During frying, vegetable oils break down
and change their composition due to
high temperatures (Boskou et al., 2006;
Choe and Min, 2007). The chemical by-
products of this oil breakdown cause
inflammatory responses in the body
(Qin et al., 2021; Boskou et al., 2006). In
addition, the high heat of frying causes
hydrogenation of vegetable oils, creating
trans-fatty acids, even in home cooking
(Choe and Min, 2007).

It is therefore not recommended that

people re-use oil used for frying to cook
other foods. It is important to discard
leftover oil after deep frying and avoid
reusing used cooking oils.

Tanzania Mainland Food-Based Dietary Guidelines 127

 17.2 Key messages for limiting intake of
fried foods
1. Avoid buying or cooking fried foods. Choose
alternatives such as baked, boiled or grilled products.
2. Avoid reusing oil because reheating oils creates trans-
fatty acids.
3. Grill or stir-fry instead of deep frying.

17.3 Tips for reducing intake of fried foods

For those occasional times you have to fry foods:

1. Never let the food go brown or burn during frying.

2. Use vegetable oils when you fry.
3. Drain excess oil from food before eating or use
a paper towel to remove excess fat.
4. Make consumption of home-fried foods an
occasional treat just a few days a month.

128 Tanzania Mainland Food-Based Dietary Guidelines

18. RECOMMENDATION 3.2
LIMIT INTAKE OF ULTRAPROCESSED FOODS TO REDUCE CARDIO-
VASCULAR DISEASES, CANCER, OVERWEIGHT AND OBESITY, AND EARLY
MORTALITY
18.1 The NOVA food groups
The degree to which a food is processed makes some foods unhealthy. The NOVA
food classification system categorises foods into four groups according to the nature,
purpose, and extent of the processing the food undergoes after it is separated from
nature (Monteiro et al., 2016).

Tanzania Mainland Food-Based Dietary Guidelines 129

 Group 1: Unprocessed or minimally processed foods

Unprocessed foods are edible parts of

plants and animals in their natural state
without going through any alterations after
removal from nature.

Examples of unprocessed foods include

plants such as seeds, fruits, leaves, stems,
roots and animal products such as meat,
muscle, offal, eggs and fresh milk. Other
foods include fungi, algae and water.

Minimally processed foods are natural

foods that have gone through basic
processes such as drying, crushing, filtering
and packaging. Other such processes
include removal of unwanted parts,
grinding, fractioning, filtering, roasting,
boiling, pasteurization, refrigeration,
freezing, placing in containers, and non-
alcoholic fermentation.

Examples of minimally processed foods

include:

• milled and packaged grain flours;

• dried herbs, vegetables, fruits;
• frozen fresh meats, poultry, fish;
• frozen fruits and vegetables;
• boiled and fried meat or fish (without
salt added); and
• pasteurised milk.

The purpose of processing is to increase shelf life and storability and enhance the
edibility and digestibility of food. Minimally processed foods do not have sugar, salt,
oil or other substances added. This food moves very quickly from the farm where it is
harvested to the shop where it is sold or to the place where it is consumed.

Unprocessed or minimally processed foods are wholesome and nutrient dense. Make
unprocessed or minimally processed foods a major part of your diet. Use unprocessed
or minimally processed foods to make delicious, wholesome and healthy meals.

Sources: Educhange, 2018; Heart and Stroke Foundation, 2021; Monteiro et al., 2019; Reardon, et al., 2021

130 Tanzania Mainland Food-Based Dietary Guidelines

Group 2: Processed culinary ingredients

Processed culinary ingredients are

extracted and purified from natural foods
(minimally processed food) through
pressing, refining, grinding, crushing,
pulverizing and refining.

They are typically not eaten on their own

but are mainly used as condiments in
homes and restaurants to season or add
taste to natural foods when making freshly
prepared dishes and drinks.

This group does not include ingredients

that underwent further modifications,
such as hydrogenated fats (margarine,
other spreads or other trans fats) or
modified starches as these are considered
ultraprocessed foods (Monteiro et al.,
2019).

Examples of processed culinary ingredients

include:

• salt;
• sugar;
• cooking oil;
• honey;
• apple cider vinegar; and
• maple syrup.

Processed culinary ingredients typically consist of only one macronutrient in highly

purified form (mainly fat, sugar or carbohydrate) and therefore have low nutrient
density. Thus, limit use and consumption of this group.

Tanzania Mainland Food-Based Dietary Guidelines 131

 Group 3: Processed foods

Processed foods are simple food products

made by adding Group 2 foods like salt,
sugar, and oil to natural or minimally
processed foods (Group 1 foods).

Most processed foods have two or three

ingredients. These foods are recognizable
as modified versions of Group 1 foods and
retain most constituents of the original
food.

Processed foods can have some additives

to preserve their original properties or
prevent spoilage and increase food safety,
for example, adding antioxidants to fruits
in syrup or adding preservatives to dried
salted meats.

Examples of processed foods include:

• canned or bottled vegetables, fruits

and pulses in brine (salt water) or
vinegar;
• canning of fish or bottling of fruits
preserved in syrup;
• cured, dried or smoked fish or
meat (with added salt and other
ingredients);
• tinned fish preserved in oil;
• salted or sugared nuts and seeds;
• simple non-alcoholic fermentation
like beer, sweet beer (tongwa), wine
and cider;
• bakery freshly made bread;
• cheese; and
• fortified foods like flours with added
nutrients such as vitamin A, calcium
or vitamin D.
Large amounts of sugar, salt or oil can make processed foods nutritionally unbalanced.
Therefore, just like processed culinary ingredients, they should be used sparingly
and only occasionally. Make delicious dishes and meals from natural and minimally
processed foods as a basis of the diet.

Sources: Educhange, 2018; Heart and Stroke Foundation, 2021; Monteiro et al., 2016; Monteiro et al.,
2019

132 Tanzania Mainland Food-Based Dietary Guidelines

Group 4: Ultraprocessed foods

Ultraprocessed foods are industrial

formulations usually with five or more
ingredients produced through a series of
processes.

In addition to sugar, salt, oils and fats,

they contain other substances that are not
commonly used in home food preparation,
such as non-sugar preservatives,
sweeteners, colourants, flavourings and
emulsifiers (Monteiro et al., 2016).

The industrial formulation of these foods is

made entirely or mostly from substances
extracted from foods such as oils, fats,
sugars, starches and protein, or derived
from food constituents or synthesized in
laboratories. Thus, ultraprocessed foods
have little or no natural foods from Group
1.

These products are designed to be highly

palatable and contain high amounts of
sugar, salt, fat (mainly trans fats), and
chemical additives.

Some examples include:

• beverages like sugary drinks;

• confectioneries like biscuits and
cakes;
• snacks like crisps and sweets;
• Processed meats like corned beef;
• Baby food and milk formula; and
• Condiments like instant gravy and
and stock cubes

(See Table 24 for a detailed list)

Due to high levels of trans fats, salt, sugar and chemical additives, ultraprocessed
foods are linked to several non-communicable diseases and ill health. Because of
their negative effects, ultraprocessed foods are discussed further below.

The processing and ingredients used to make ultraprocessed foods are nutritionally
unbalanced (Moss, 2013; Brownell, 2012). However, it is important to note that
added vitamins and minerals do not make highly processed foods healthy as they
do not contain the numerous beneficial phytochemicals and nutrients that natural or
unprocessed foods do.

Tanzania Mainland Food-Based Dietary Guidelines 133

 18.2 How to recognise ultraprocessed Fats: hydrogenated (trans fats) or
foods interesterified oils derived from further
You can identify ultraprocessed foods processing of food constituents, such as
by looking at factors such as their natural oils.
ingredients, preparation instructions,
packaging and taste. 18.2.3 Preparation
Ultraprocessed foods are usually ready
18.2.1 Contain substances or ingredients to eat or require little preparation. They
only found in ultraprocessed foods are mostly ready-to-consume or to heat
Ultraprocessed foods tend to contain up, require very little preparation to
substances or ingredients not found in be palatable, and are low in cost with
shops or kitchens for ordinary cooking. a long shelf life (Monteiro et al., 2016).
These include dyes and other artificial They are widely available through
colours, flavour or flavour enhancers, retail food vendors, grocery stores and
non-sugar sweeteners, sequestrants, supermarkets.
humectants, PH regulators, emulsifiers,
stabilizers and preservatives. Food 18.2.4 Packaging and taste
additives also include gelling, thickening, Ultraprocessed foods are packed in
firming, bulking, anti-bulking, anti- attractive packaging with aggressive
foaming, anti-caking, glazing, polishing, marketing and health claims. Various
bleaching, colour retention, and chemical additives are added to give
carbonating agents (FAO and WHO, them intense sensory properties that
2017a; FAO and WHO, 2022; Monteiro make the food especially attractive to
et al., 2016). In some countries its not a see, taste, smell, and or touch (Monteiro
requirement to include processing aids et al., 2019).
on food labels.

Since ultraprocessed foods have little or

no natural foods, they use additives to
imitate sensory qualities of natural foods
or culinary preparations of these foods.
Ultraprocessed foods also use these
additives to disguise undesirable sensory
qualities of the final product.

18.2.2 Contain ingredients extracted

from nutrient components
Ultraprocessed foods also contain
ingredients extracted from nutrient
components such as sugars, proteins and
fats (Monteiro et al., 2016, 2019).

Sugars: fructose, high-fructose corn

syrup, fruit juice concentrates, invert
sugar, maltodextrin, dextrose, lactose.

Proteins: hydrolysed proteins, soya

protein isolate, gluten, casein, whey
protein and mechanically separated
meat.

134 Tanzania Mainland Food-Based Dietary Guidelines

Table 24 Examples of ultraprocessed foods

Beverages Snacks
• Carbonated drinks, soft drinks, • Crisps, chips* and other sweet, fatty or
sodas beverages salty snacks
• Sweetened drinks such as • packaged snacks
concentrates
• Sweets, candy, chocolates
• Juices, including fruit flavoured
• Some energy bars
juices
• Energy drinks, fruit drinks, milk
drinks, fruit yoghurts, cocoa
drinks
• Ready to drink tea, coffee and
hot chocolate mix

Baby foods Meats

• Canned and bottled foods like • Reconstituted meats such as sausages,
purees hotdogs, burgers, salami
• Baby cereals • Corned beef or chicken
• Infant formulas, follow-on milk

Condiments Confectionaries
• Stock cubes and gravy granules • Long shelf-life packaged baked goods
such as biscuits, cookies, cakes, pastries,
• Salad dressings, mayonnaise
pies
• Packaged soup powders or
• Crackers
liquids
• Cake mixes, premixed pancakes
• Instant soups, sauces, gravy
and gravy mixes • Mass-produced packaged breads and
buns (long life)
• Packages sauces such as
tomato sauce, soy sauce, • Breakfast cereals
oyster sauce, instant sauces
• Soups
• Instant noodles, pasta and rice
• Yeast extracts
Meals Health and slimming products
• Many fast-food restaurant • Powdered or “fortified” meal and dish
foods* substitutes
• Ready-to-eat packaged • Ice cream, frozen desserts,
meals and snack foods
sold in shops (pizzas, pies, • Sugared and flavoured yoghurts and
pastas), nuggets (fish/meat) dairy drinks

Continued on page 136

Tanzania Mainland Food-Based Dietary Guidelines 135

 *Most restaurant fast foods are ultraprocessed foods as they use hydrogenated oils. Although
fast-food chips may look much the same as home-cooked chips, their formulations and the
ingredients used in their pre-preparation and cooking render them ultraprocessed.
Monteiro et al., (2016) note that Group 4 also includes foods from Groups 1 or 3 that have
additives, such as plain yoghurt with added artificial sweeteners and bread with added
emulsifiers. In addition, alcoholic drinks fermented and then distilled to make alcohol such as
whisky, gin, rum and vodka are also considered Group 4 foods.

18.3 Limiting consumption of of exposure to various chemical

ultraprocessed foods additives (Chen et al., 2020).
There are several compelling reasons • Heat treatment, food additives, food
why ultraprocessed foods should be colouring, preservatives, and food
avoided: packaging, in particular, can cause
headaches, allergies, cancer and DNA
• Indulging in foods high in fat and
damage (genotoxicity) (Schnabel et
sugar can add excessive calories to
al., 2019; Chen et al., 2020).
a person’s diet, which can lead to
overweight and obesity. • Eating less saturated fat, sugar, salt
and highly processed foods can lower
• Frequent consumption of unhealthy
a person’s risk of developing NCDs
ultraprocessed food increases
such as diabetes, stroke, and heart
calorie intake without providing
disease.
many nutrients, fibre, vitamins and
minerals (Chen et al., 2020; Micha et
al., 2017).
• Consuming more ultraprocessed
foods is associated with higher
overall cancer risk and breast
cancer risk, thus reducing overall
intake of ultraprocessed foods is
recommended (Monteiro et al., 2019).
• It is known that consumption of sugar-
sweetened beverages contributes to
the prevalence of type 2 diabetes,
partly due to weight gain. It can also
be a result of high dietary glycaemic
load, leading to inflammation, insulin
resistance and impaired beta-cell
function (Hu and Malik, 2010).
• Ultraprocessed foods also contain
food additives, increasing the risk

136 Tanzania Mainland Food-Based Dietary Guidelines

 18.4 Key messages for avoiding the consumption of
ultraprocessed foods
1. Limit intake of ultraprocessed foods.
2. Limit intake of sugar-sweetened beverages such as carbonated
drinks and fruit-flavoured juice drinks.
3. Read food labels and avoid foods with ingredients such
as emulsifiers, flavouring, flavour enhancers, colouring and
texturisers.

18.5 Tips for avoiding the consumption of ultraprocessed foods

1. Avoid foods with long list of ingredients containing more than five ingredients,
including salt, trans fats (hydrogenated oils) and sugar.
2. Avoid foods with ingredients not found in homes or used in cooking
homemade food.
3. Avoid food labels with unrecognizable components or with very unfamiliar
names.
4. Avoid foods with any ingredient extracted from nutrient components like
sugar (e.g. lactose or fructose), protein (e.g. casein) or fat like hydrogenated
oils (trans fats). These ingredients end with “ose” (lactose, fructose) or “ein”
(casein).
5. Avoid foods with ingredients like nitrates, nitrites, benzoates, saccharin and
sorbates.
6. “Fresh food” with a long shelf life may indicate the presence of preservatives.
Check the label and avoid foods with preservatives such as sodium benzoate,
nitrate, sulphite, BHA and BHT.
7. Watch out; ultraprocessed foods are often marketed as healthy, natural or
organic. While these words may describe the original ingredients, they do
not refer to the process of how the food was made. Remember, an organic,
natural cookie is still an ultraprocessed food.
8. Do not get swayed by aggressive marketing and branding,
attractive packaging and the low cost as you pay a high cost
with your health.
9. Cook more often: make delicious meals with fresh
ingredients. Heating up frozen pre-made foods does
not count.
10. Make fresh, natural or minimally processed foods the
basis of your diet.

Tanzania Mainland Food-Based Dietary Guidelines 137

 19. RECOMMENDATION 3.3
LIMIT INTAKE OF SATURATED FATS AND AVOID INTAKE OF TRANS FATS
TO REDUCE THE RISK OF CARDIOVASCULAR DISEASES, INCREASED
CHOLESTEROL AND TYPE 2 DIABETES
19.1 Unhealthy fats causes the oils to become solid at
room temperature. TFAs are also
19.1.1 Saturated fats
found naturally in very low amounts in
Saturated fats are made of carbon,
ruminant fat in dairy and meat products
hydrogen and oxygen atoms with no
(WHO, 2018d).
double bond in their structure, making
them solid at room temperature with Ultraprocessed foods contain industrially
few exceptions. made trans fats, which are sometimes
called “partially hydrogenated oils” in the
The major sources of saturated fats are
ingredients list.
meats and meat products such as fatty
beef or goat, poultry skin, butter, ghee, Other major examples of artificial trans
lard and cheese. Some plant-based oils, fats in addition to ultraprocessed foods
such as palm oil, palm kernel oil and include fried fast foods, commercially
coconut oil, also have saturated fats packaged snack foods, frozen pizzas,
(WHO, 2020b). packaged frozen meals, pies and cookies
(WHO, 2018d). Deep-fried foods at
19.1.2 Trans fats household level can convert natural
The majority of trans-fatty acids (TFAs) unsaturated vegetable oil to trans fats.
are chemically altered vegetable oils
(unsaturated fats) created through Products brought from shops and used at
industrial processing of partial home that contain industrial trans fats are
hydrogenation, where hydrogen margarine, fat spreads, mayonnaise and
atoms are added to the unsaturated vegetable shortening. These vegetable-
vegetable oil. The trans configuration of based fats are solid at room temperature
unsaturated fats with added hydrogen because of partial hydrogenation.

138 Tanzania Mainland Food-Based Dietary Guidelines

As described earlier in Recommendation decreasing HDL (good) cholesterol,
1. 7, while unsaturated fats confer health thereby affecting the arteries through
benefits when taken in moderation, fatty deposits (WHO 2021b; GBD,
industrial trans fats increase coronary 2017; GBD, 2019; FAO 2010a).
heart disease (CHD) risk factors and CHD • TFAs are also associated with a higher
events. risk of developing type 2 diabetes.
Studies have shown that TFA could
19.2 Health risks of eating more than
impair insulin sensitivity and affect
17 g of saturated fats
Multiple studies have found that limiting glucose metabolism. (Wang et al.,
intake of saturated fats and replacing 2015).
saturated fats with unsaturated fats • Trans fats have no known health
decreases the risk of CHDs. Saturated benefits and there is no safe level
fats, and especially palmitic acids (C16:0), of consumption (WHO 2021b; GBD
have negative health effects as they
2019).
increase LDL cholesterol (FAO and WHO,
2010; Willett et al., 2019).

The WHO recommends that saturated

fat intake be less than 10 percent of
total energy (WHO, 2018e). Less than
10 percent of total energy translates to
less than 220 kcal, which is equivalent to
24 g or 2 tablespoons of fat.

The GBD (2019) defines exposure to high

intakes of saturated fat as over 7 percent
of total energy intake which is about
154 kcal for a 2200-kcal diet translating
to 17 g of saturated fats (1.5 tablespoons)
from all food sources. Taking in more
than these amounts increases the risk of
CHDs.

Given that the recommended intake of

total added fats for Tanzania Mainland is
28 g, it is beneficial to use unsaturated
fats like groundnut, sunflower and olive
oils instead of saturated fats like ghee,
butter, cream, palm and coconut oil. Figure 6 Product ingredients list showing
trans fats and hydrogenated oils
19.3 Trans fats and non-communicable
diseases In the Global Burden of Disease Study
Eating products with artificially made (GBD, 2019), exposure to a diet high
trans fats, even in small quantities, is in TFAs is defined as an average daily
harmful to health: consumption greater than 0.5 percent
of total energy from trans fat from all
• Trans fats increase cardiovascular sources, mainly partially hydrogenated
heart disease risk factors, such as vegetable oils and ruminant products
the risk of heart attacks and stroke. (Willet et al., 2019). Less than 0.5 percent
This is because trans fats increase of total energy is equivalent to 1 g of fat.
LDL (so-called bad cholesterol) while

Tanzania Mainland Food-Based Dietary Guidelines 139

 Given that 1 teaspoon of oil is about 5 g, list. Ultraprocessed foods use trans
consumption of trans fats of over one- fats because they are inexpensive
fifth of a teaspoon will be harmful. to produce and give food products a
desirable taste and texture.
With the increased risks of heart attack
and stroke caused by trans fats, adding A product may claim that it contains no
partially hydrogenated oils (trans fats) trans fats as long as the content is less
to foods is no longer permitted in the than 0.5 g per serving. However, if a
United States of America, while in the packaged product contains two or more
United Kingdom of Great Britain and servings, a person could unknowingly
Northern Ireland, some supermarkets consume more than 1 g of trans fat by
have voluntarily removed partially eating the whole product. For example,
hydrogenated vegetable oil from all their if a serving is defined as 50 g and the
shop-brand products. As similar laws product is 100 g or more, the total
have not been enacted in the United amount of trans fat a person would eat
Republic of Tanzania, consumers are if they ate the whole product would be
advised to avoid eating foods with trans 1 g or more. One gram of trans fat is the
fats. It is very important to be on the threshold at which trans fats increase
lookout for trans fats in manufactured the risk of CHDs. Consumers need to
food products. refer to the ingredients list and check
for partially hydrogenated oils. If the
The trans fats in ultraprocessed product has partially hydrogenated oils,
foods are sometimes called “partially then the product is not trans-fat free
hydrogenated oils” in the ingredients (GBD, 2017).

19.4 Key messages for limiting intake intake of

unhealthy fats and avoiding trans fats
1. Replace saturated fats with unsaturated fats to decrease
NCD risks.
2. Reduce intake of saturated fats to less than 10 percent of
total energy.
3. Avoid trans fats as they increase the risk of NCDs.
4. There are no known health benefits of trans fats, while the risks are
high.

19.5 Tips for replacing saturated fats with unsaturated fats and
avoiding trans fats
1. Choose liquid vegetable oil like sunflower, groundnut,
olive and canola oils instead of solid fats, palm oil,
coconut oil, butter or ghee.
2. Read the ingredients list before buying packaged
products.
3. Avoid products containing partially hydrogenated
oils or trans fats.

140 Tanzania Mainland Food-Based Dietary Guidelines

20. RECOMMENDATION 3.4
REDUCE INTAKE OF FREE SUGARS TO PREVENT WEIGHT GAIN AND
DENTAL CARIES
20.1 What are sugars? 20.2 Sources of sugar
Sugar is one of the three principal dietary Sugars are found naturally in foods,
carbohydrates with three major sub- mainly in intact fruit and vegetables, and
groups: monosaccharides, disaccharides in milk (lactose and galactose). These
and polyols. Monosaccharides include sugars are part of a healthy diet when
glucose, galactose and fructose. consumed from fresh or unprocessed
Disaccharides include sucrose, lactose fruit, vegetables and milk. Although sugar
and trehalose. Polyols are sugar alcohols cane, dried dates, honey and 100 percent
with components such as sorbitol and fruit juice have naturally occurring sugars,
mannitol (FAO, 1998). they contain high amounts of sugars and
should be consumed in moderation.
Sugars, like other carbohydrates, provide
the body with energy. Carbohydrates, Other sugars are manufactured as
including polysaccharides like starch, sweeteners. Sweeteners include products
are digested and broken down into used for sweetening foods or drinks and
glucose. Human body cells prefer glucose are derived from sources such as:
as an energy source (Howarth, Gleeson
and Attwell, 2012; Mergenthaler et al., • sugar crops (sugar beets, sugar cane,
sugar palm);
2013). Even though cells need glucose to
• cereals (maize);
survive, consuming too much can cause
many health problems. • fruits;
• milk;
• insect activity (honey);
• the sap of certain species of maple
trees; and
• sweet sorghum when cultivated
explicitly for making syrup.

Tanzania Mainland Food-Based Dietary Guidelines 141

 These sweeteners exist either in a Typically, sweeteners are used to make
crystallized state as sugar or in thick food more palatable and to assist in food
liquid form as syrups. They include a wide preservation. These sweeteners are also
variety of monosaccharides (glucose and referred to as free sugars.
fructose) and disaccharides (sucrose and
saccharose).

What are free sugars?

Free sugars are sweeteners used for sweetening foods or drinks by a manufacturer,
a cook or a consumer. They include sugars naturally present in honey, syrups,
fruit juices and fruit juice concentrates (WHO, 2015c).

Free sugars are typically found in:

• flour and sugar confections such as cakes, biscuits, pastries and doughnuts;
• candies, gum, jelly, jam and chocolate;
• sugar-sweetened carbonated beverages, soft drinks and fruit juices; and
• sugar cane, sugar cane juice and sweetened tea.

20.3 Health effects of consuming • There is an association between high

sugary foods consumption of sugar-sweetened
Sugary foods and drinks have minimal beverages and increased risk of type
nutritional value and displace nutritious 2 diabetes (WHO, 2016c). Sugar-
foods. Excessive amounts of sugar are sweetened beverages are directly
harmful to health in several ways: linked to the increased risk of diabetes
• Increased risk of obesity, type 2 independent of obesity – meaning
diabetes, high blood cholesterol, high a person who drinks a lot of sugary
blood pressure, stroke, coronary drinks could develop type 2 diabetes
heart disease, and cancer (Malik and even if that person is not overweight.
Hu, 2019; Willett et al., 2019).
• Sugary drinks promote weight gain 20.4 How much sugar is too much?
and obesity (WHO, 2016c, Ruanpeng Consumption of more than 12 teaspoons
et al., 2017). (50 g) of sweeteners (free sugars) per
• Sweets, sugary foods and drinks day in the form of sugar-sweetened
cause dental caries (cavities) (WHO; beverages, baked goods, confections and
2015a; Gibney, 2019.) sweeteners added to food and drinks at
home is considered too much sugar.

142 Tanzania Mainland Food-Based Dietary Guidelines

A diet high in sugar-sweetened For example, one bottle or can (330 ml)
beverages is defined as an average of soft drink can contain 12 or more
daily consumption greater than 2.5 g teaspoons of sugar, exceeding the
of beverages with ≥50 kcal per 226.8 g recommended daily amount.
serving (GBD, 2019).

DO YOU KNOW HOW

MUCH SUGAR IS IN YOUR
BEVERAGES?
Sodas and fruit-flavoured drinks in
250–330 ml cans or bottles have
between 5 and 9 teaspoons (25–
45 g) of sugar. Even drinks that
taste sour rather than sweet can
have very high sugar content.

20.4.1 Recommended amounts of added is 5 percent of total daily caloric

sugars per day intake based on a 2000-calorie diet
(WHO, 2015c). Since sugar has no
• The WHO recommends that nutritional value and has adverse
added sugar intake be less than metabolic effects, a recent EAT Lancet
12 teaspoons (50 g), which is Commission paper also suggests
10 percent of total daily caloric intake. keeping intake of sugar to less than
• For additional health benefits, 5 percent of energy intake (Willett et
sugar intake should be kept under al., 2019).
6 teaspoons (25 grams), which

Tanzania Mainland Food-Based Dietary Guidelines 143

 20.5 Key messages for reducing consumption of free
sugars
1. Limit intake of sugar-sweetened beverages, such as
carbonated drinks and fruit-flavoured juice drinks.
2. Choose clean and safe water or unsweetened coffee or
tea instead of sugary drinks.
3. Choose to eat fresh fruits or vegetables instead of
sugary snacks or sweets

20.6 Tips for reducing consumption of free sugars

1. Choose more natural foods over processed foods as
processed foods can contain a lot of sugar.
2. Avoid processed foods or condiments with added
sugar, for example, tomato sauce.
3. Add less sugar to your tea, hot beverages and other
foods.

144 Tanzania Mainland Food-Based Dietary Guidelines

21. RECOMMENDATION 3.5
REDUCE SALT INTAKE TO REDUCE THE RISK OF INCIDENT STROKE, FATAL
STROKE AND FATAL CORONARY HEART DISEASE

21.1 Salt and salty foods Such foods include:

Salt is composed mostly of the chemical
compound sodium chloride. When you • Stock cubes and gravy granules.
eat salt, the sodium and the chloride • Salad dressings, mayonnaise.
(chlorine) separate and the sodium • Packaged soup powders or mix
becomes available for your body to use. and liquids, instant noodles, soups,
Salt is the main source of sodium in the sauces.
diets. Sodium is also a mineral naturally • Yeast extracts like Marmite and Bovril.
occurring in whole foods like fresh • Packaged baked goods, biscuits,
vegetables, pulses (legumes), and fruits. cookies, cakes, and pastries, pies,
crackers (sold on shelves and with a
In the body, it is necessary for absorption long shelf life).
and transportation of nutrients and • Mass-produced packaged breads and
maintaining the right balance of fluids buns (long life).
and blood pressure. However, intake of • Other baby food products (canned
too much sodium or salt can lead to poor and cereals).
fluid balance and higher blood pressure, • Prepared and ready-to-heat products
which can cause heart attack or stroke, including pre-prepared pies, pasta
and damage to the eyes and kidneys. and pizza dishes; nuggets (fish/meat).
• Packaged sauces like tomato sauces,
soya sauce, oyster sauce, instant
21.1.1 Examples of foods high in salt sauces.
Consuming highly processed foods that • Many fast-food restaurants foods.
contain high amounts of salt can easily • Ready-to-eat packaged meals and
increase the intake of salt over the snack foods sold in shops.
recommended daily limit.

Tanzania Mainland Food-Based Dietary Guidelines 145

 Health effects of high salt consumption recommendation on reducing sodium
• High salt intake is associated with an intake for controlling blood pressure in
increased prevalence of hypertension children. The recommended maximum
and cardiovascular diseases level of intake of 2 g per day of sodium
(Hendriksen et al., 2014). in adults should be adjusted downward
• Intake of too much salt is associated based on the energy requirements of
with higher risks of stroke, fatal children relative to those of adults (WHO,
stroke, and fatal coronary heart 2012a). The maximum amount of 5 g
disease (WHO, 2012a). of salt per day includes all the salt that
is added to foods that are purchased
• In addition, high-salt diets have been and the salt used in the foods cooked at
linked to an increase in oxidative home.
stress and a reduction in the enzyme
(ACE2 expression) responsible In sub-Saharan Africa, salt intake
for regulating blood pressure in is above the WHO’s recommended
the kidneys (Bernardi, Toffoli and maximum intake (Hendriksen et al.,
Zennaro, 2012). 2014). Processed foods in general (e.g.
bread and bakery products, processed
Recommended amount of salt intake meat products, and cheese) contribute
The WHO strongly recommends a significantly to salt intake. Ready-to-eat
reduction of the total salt intake for adults meals may also have high salt levels.
to less than 5 g (1 teaspoon) per day to keep People in urban areas also tend to eat
the sodium level lower than 2 g per day. more frequently outside the home
This amount will reduce blood pressure (e.g. restaurants, fast-food outlets, and
and risk of cardiovascular disease, stroke workplace canteens) where the salt
and coronary heart disease in adults content of meals may also be high.
(WHO, 2012a). The WHO has a strong

146 Tanzania Mainland Food-Based Dietary Guidelines

 21.2 Key messages for reducing consumption of salt
1. Use less salt when cooking and when eating.
2. Choose more natural foods over processed foods as
processed foods contain a lot of salt,
3. Use iodized salt.
4. Pay attention to other food labels that mean salt, like monosodium
glutamate, and any other name containing the word sodium.

21.3 Tips for reducing consumption of salt

1. Use more herbs and spices to bring out the flavour in food rather than
salt.
2. Instead of salt, squeeze lime or lemon over fish and
vegetables.
3. Avoid keeping extra salt on the dining table.
4. Limit intake of ultraprocessed food.
5. Choose packed foods labelled “No sodium” or “No
salt added” when available.

Tanzania Mainland Food-Based Dietary Guidelines 147

GUIDELINE 4: Ensure a clean home
environment and safe food and water
 22. RECOMMENDATION 4.1
KEEP YOUR HOME ENVIRONMENT, FOOD AND WATER SAFE AND CLEAN
TO PREVENT DISEASES
22.1 What is food safety? to babies, young children, the elderly
Food safety refers to handling, preparing, or the sick, it is especially dangerous
and storing food in ways that prevent because they may lose so much water
food-borne illnesses. Foodborne that they die.
illnesses and food poisoning happen • Vomiting.
when a person gets sick by eating foods
contaminated with germs or toxins. • Nausea (person feels as though he/
she wants to vomit).
Different kinds of bacteria can cause • Stomach cramp or pains.
food poisoning, for example, Salmonella,
Staphylococcus, Clostridium, Shigella, • Fever (high body temperature).
Campylobacter and Bacillus. Some • Headache.
viruses also cause food poisoning.
• General body weakness.
Food poisoning can result from eating
or drinking germ-contaminated food Though everyone can get sick, pregnant
or water. Different types of germs take women, young children, older adults,
different lengths of time between being and those who have weakened immune
ingested and the onset of the disease. systems are at greater risk for developing
foodborne illness.
Gastrointestinal diseases can cause all or
a few of the following conditions: 22.2 The situation in the United
Republic of Tanzania
• Frequent watery bowel movements, The country has done well to achieve
known as diarrhoea or runny tummy. broad self-sufficiency in basic foodstuffs,
This can be very serious. If it continues but rapid urbanisation poses a
untreated for more than a day, the severe future food security challenge,
bowel movements remove too much particularly for the poorer disadvantaged
water from the body and the person people in towns and cities in terms of
gets dehydrated. When this happens food affordability, stability and food

150 Tanzania Mainland Food-Based Dietary Guidelines

safety. Unsafe water used for the many reasons for cleaning, but the most
cleaning and processing of food, poor important reason is to ensure that all
food-production processes and food surfaces and equipment that come into
handling (including inappropriate use of contact with food are not contaminated
agricultural chemicals), the absence of with microbes, their toxins or other
adequate food storage infrastructure, contaminants. Another reason is to
and inadequate or poorly enforced prevent pests such as rats, flies and
regulatory standards all contribute to a cockroaches from being attracted to
high-risk environment. Inadequate food the kitchen.
safety and unhygienic practices can
result in illness and sometimes lead to It is important to keep the environment
death (Wenban-Smith, Faße, and Grote, free of human, animal and food waste
2016). at all times. Improper disposal of
faeces and waste and poor hygiene
Chronic diarrhoea among young are risk factors for diarrheal diseases.
children has been associated with Human faeces and urine carry harmful
the occurrence of stunting and other bacteria. Other types of solid waste that
forms of undernutrition. Unsafe food can be problematic include food waste,
creates a vicious cycle of disease and leftover food, meat and fish parts, and
undernutrition, particularly affecting vegetable peelings. These can attract
infants, young children, elderly, and the flies, roaches, rats, and other pests that
sick. Diarrhoea in infants and young could spread diseases.
children can lead to malnutrition and
reduce immune resistance, which in Contamination can happen when
turn increases the risk of prolonged and food makes contact with unclean or
recurrent diarrhoea (Marino, 2007). dirty hands. Proper hand washing is
an important step in preventing food
22.3 Five keys to safer food poisoning. It is important to wash
Food safety relies heavily on good hands with soap and clean water
hygiene. Hygiene refers to the before handling and preparing food,
conditions or practices that are used before eating, after using the toilet,
to maintain health and prevent disease after changing a nappy, and before
through cleanliness. There are five keys and after caring for the sick. Washing
to keeping food safe: hands properly and frequently can
greatly reduce the spreading of germs
• keep clean; that could cause diarrhoea, cholera,
• cook thoroughly; hepatitis, typhoid and polio.
• keep food at safe temperatures;
• separate raw and cooked; and 22.3.2 Cook thoroughly
• use safe water and raw materials. Bacteria grow most rapidly in
temperatures between 5 °C and
22.3.1 Keep clean 60 °C. To kill bacteria and pathogens
A clean environment is one that is free naturally present in food, cook the food
from dirt and its effects. It encompasses on high heat to reach the minimum
safe food and water supply, proper recommended internal temperatures
waste disposal, clean air, and few before removing the food from the
pests such as flies, cockroaches and heat source. Internal temperatures
mosquitoes. Maintaining a clean vary between foods from 63 °C to 74 °C
environment helps keep diseases away (USDA, 2021).
and fosters society’s welfare. There are

Tanzania Mainland Food-Based Dietary Guidelines 151

 Some animal-source foods such as meats, • Refrigerate or freeze cooked foods
milk, fish and poultry carry harmful within two hours or one hour in warm
germs. When these foods are not cooked weather.
thoroughly, the germs survive and get • Keep foods in the refrigerator
ingested, leading to illness. Cook meat and between 1 °C and 5 °C or in the freezer
poultry until the juices are clear. Ideally, below 0 °C. Freezing will keep food up
use a thermometer and make sure they to six months or more.
have reached an internal temperature of
70 °C.

Bring foods like soups and stews to boil

for over five minutes to kill germs. Reheat
cooked food thoroughly before eating.

22.3.3 Keep food at safe temperatures

Germs thrive and multiply quickly in
warm and humid conditions between
5 °C and 60 °C, with some doubling in
number in as little as 20 minutes. Keeping
foods below 5 °C can slow bacterial
growth. Foods do not have to smell bad
to have been contaminated with germs.

Cooked foods should not be left at room

temperature for more than two hours.
Do not keep perishable food outside the
fridge for over an hour in warm weather
(over 32 °C) (Ghamrawy, 2019; WHO,
2006e). • Do not store foods for too long, even
in the fridge. Refrigerate leftover
Keep cooked food piping hot (more than food for up to three days and reheat
60 °C) before serving or eating. thoroughly before consumption.
Serve food immediately while still hot. • Do not thaw frozen food at room
Cooked food should be eaten right away, temperature.
and leftovers should be stored in a food-
safe closed-lid container and put away If there is no refrigerator:
in a refrigerator. Discard all refrigerated • prepare food in smaller quantities
cooked foods or leftovers older than that can be finished during the meal
three days. and avoid having excess leftovers.
• Do not keep cooked or perishable
When leaving food out, always keep the foods for more than two hours, and
food covered to keep it safe from bugs in warmer weather (32 °C and above)
and rodents. do not keep food for over an hour.
• Share leftovers with others within
Refrigerate perishable foods immediately one or two hours of cooking to avoid
where a fridge is available: wasting food.
• Refrigerate or freeze meat, poultry, • Cook raw meat, poultry and fresh fish
eggs and other perishables as soon as soon as it is bought or slaughtered.
as you get them home from the store Do not let them stand for more than
or farm. two hours before cooking. Once

152 Tanzania Mainland Food-Based Dietary Guidelines

 cooked, apply the same rules as Food production, distribution,
cooked foods (WHO, 2006e). marketing, processing and preparation
environments expose food to a number
22.3.4 Separate raw and cooked foods of microorganisms both useful and
Germs that are naturally present harmful. A large proportion of food-
in raw meats, poultry and fish can borne disease incidents are caused
be transferred to other foods upon by foods improperly prepared or
contact. Keep raw meats, poultry and mishandled at home, in food service
fish separated from fresh fruit and establishments or at markets (FAO,
vegetables and other cooked foods. 2010b; FAO, 2017; FAO and WHO 2021).

Use a different cutting board or plate Foods highly susceptible to

for fruits and vegetables and another contamination are vegetables, fruits,
one for raw meat, poultry and seafood. meat, dairy and fish due to high contents
If not possible to have separate cutting of micronutrients and phytochemicals
boards, cut fruit and vegetables first much loved by microorganisms. Direct
before cutting raw animal source foods and indirect outcomes associated with
to prevent germs from touching fruit consumption of contaminated foods
and vegetables. include gastrointestinal diseases,
cancer and metabolic/physiological
Always wash knives and cutting boards disorders as well as spoilage leading to
or surfaces with soap and hot water food and nutrient losses.
after preparing raw animal foods.
Aflatoxin contamination is also common
Never place cooked food on a plate in cereal grains such as maize, sorghum,
that previously held raw meat, poultry, millet and pulses (legumes). Aflatoxins
seafood or eggs. are poisonous substances produced
by naturally occurring moulds. It is
22.3.5 Use safe water and raw materials common in foods such as groundnuts,
Raw materials (food ingredients), tree nuts, spices, maize, and sorghum
including water and ice, may be (WHO, 2018a; Kimanya et al., 2008).
contaminated. Food contamination Aflatoxin contamination of food can
refers to the presence in food of harmful occur both before and after harvesting.
chemicals and microorganisms that can If food is not properly stored and is
cause illness. Examples are biological, kept in warm and humid environments,
physical and chemical contaminants, moulds can grow.
including natural occurring toxins (e.g.
aflatoxins) (Rather et al., 2017). Ways to keep raw materials safe include
selecting fresh and wholesome foods,
while avoiding damaged, mouldy or
rotting foods and not using food past
the expiry date.

Tanzania Mainland Food-Based Dietary Guidelines 153

 22.4 Key messages for keeping food, water and the
home environment safe
1. Wash your hands thoroughly with soap and clean running
water:
• before preparing, serving and eating food;
• after visiting the toilet, changing a baby’s nappy and caring
for a sick person; and
• after completing household tasks such as cleaning toilets and rubbish
pits.
2. Wash food containers, cutting boards, and utensils with soap and
clean water before and after each use.
3. Keep fresh fruits and vegetables and prepared foods away from raw
meats, poultry, and fish to avoid cross-contamination.
4. Cook meats, poultry, and fish thoroughly.
5. Boil raw milk before drinking.
6. Do not leave cooked food out at room temperature for more than two
hours.
7. Prepare foods for infants and young children with clean and safe
water.
8. Clean surfaces and knives with soap and safe water before cutting
fruits and vegetables, especially if these are to be eaten raw or cooked
at low heat.
9. Wash fruits and vegetables with clean and safe water before preparing
or eating.
10. Prepared foods should be stored in food-safe containers.
11. Avoid using plastic bags to store prepared foods as it is likely that the
bags are not sanitary. Plastics that are not food-safe tend to leach
harmful chemicals into the food.

154 Tanzania Mainland Food-Based Dietary Guidelines

22.5 Tips for keeping food, water and the home environment safe
1. Eat food immediately after cooking. Don’t let it sit around.
2. Read the labels of packed foods to know the expiry date.
3. Clean chopping boards with running water and soap before and after use.
4. Do not dry your hands on your clothes as this can easily transfer microbes.
5. Use clean towels to clean up during food preparation and serving.
6. Prepare and cook the amount of food that you intend to consume to avoid
leftovers.
7. Do not taste foods with any utensil used to either mix or stir
foods.
8. Store tableware away from dust.
9. Sort cereals and nuts to remove contaminated grains.
10. Ensure hygienic precautions during harvesting, storage
and processing of agricultural crops and foodstuff.

Tanzania Mainland Food-Based Dietary Guidelines 155

 23. RECOMMENDATION 4.2
DRINK CLEAN, SAFE WATER INSTEAD OF SWEETENED DRINKS EVERY DAY
FOR GOOD HEALTH
Water makes up the major portion of 23.1 What is clean and safe water?
the human body (50 to 70 percent). It is Clean and safe water is free from disease-
a major constituent of blood and other causing agents like bacteria, parasites and
vital body fluids. viruses and harmful chemical substances
such as industrial wastes, heavy metals,
Although it is not defined as a nutrient, pesticides and excess fluoride. The
it is as important as all other nutrients. It most common use of this term applies
absorbs and transports nutrients around to drinking water, but it could also apply
the body, removes waste products, to water for other uses.
regulates body temperature, helps in
food digestion, and acts as a lubricant There are several ways to make unsafe
(spinal fluid, synovial fluid and mucous water clean and safe for human
secretions). consumption, including:

The body is continuously losing water • Boiling: Boiling is the surest method
through sweat, urine and faeces, which to kill disease-causing organisms,
must be replaced by drinking enough including viruses, bacteria, and
clean and safe water. Feeling thirsty parasites. Boiling water to a rolling
is a signal that the body is already boil is a satisfactory method of
dehydrated. Therefore, it is important purifying water, though it does not
to form the habit of drinking sufficient remove chemical contaminants. In
water every day, instead of only when addition to killing all disease-causing
thirsty. organisms, it also removes temporary
hardness. Store the boiled water

156 Tanzania Mainland Food-Based Dietary Guidelines

 in sterilized containers with tight rainwater and bottled water. Access to
covers (WHO, 2015b; WHO, 2017). improved sources of water in the United
• Disinfectants: If boiling is not possible, Republic of Tanzania has improved
you can make small quantities of substantially since the 2010 TDHS (from
filtered and settled water safer to 57 percent to 61 percent). By contrast,
drink using a chemical disinfectant more than half (52 percent) of Tanzania
such as unscented household Mainland rural households obtain their
chlorine bleach (WHO, 2017). It is drinking water from unimproved sources
important to follow the instructions such as surface water and unprotected
for disinfecting drinking water that dug wells. About 6 in 10 households (62
are written on the label of the bleach. percent) did not treat their water before
drinking, but more than one-third (36
The availability of clean, safe drinking percent) used an appropriate treatment
water helps people avoid water-borne method (e.g. boiling, bleaching, filtering
diseases such as cholera, diarrhoea, or solar disinfecting) (MoHCDGEC et al.,
dysentery, typhoid and hepatitis. Clean 2016).
and safe water is essential not only to
remain safe but also to maintain good It is estimated that the United Republic
health. of Tanzania spends 70 percent of its
health budget on preventable diseases
23.2 The current water situation related to water, sanitation, and hygiene
The 2015 Tanzania Demographic (WASH) as the majority (81 percent) of
and Health Survey (MoHCDGEC et the population does not have access to
al., 2016) reported that nearly 9 in 10 improved sanitation and 51 percent and
Tanzania Mainland urban households 14 percent of the population in rural
(86 percent) obtain their drinking water areas and urban areas, respectively, do
from improved sources such as piped not have access to clean drinking water
water, public taps, standpipes, tube (UNICEF, 2017; MoHCDGEC et al., 2016,
wells, protected dug wells and springs, 2015/16).

Tanzania Mainland Food-Based Dietary Guidelines 157

 23.3 Key messages for safe and clean water
1. Boil or treat water before drinking.
2. Allow water to settle then decant (pour) to another
container or filter before boiling.
3. Store drinking water in a clean, covered container to avoid
recontamination.
4. Drink an adequate amount of water (six to eight glasses or two litres
per day).
5. Avoid soft drinks and sweetened drinks.

23.4 Tips for drinking safe and clean water

1. Choose plain water as your beverage as often as possible.
2. Carry water with you to get access to safe and clean
water.
3. Drink water even when you are not thirsty.
4. Increase water intake in hot weather and with
increased activity.

158 Tanzania Mainland Food-Based Dietary Guidelines

GUIDELINE 5: Keep an active lifestyle
for optimal health and weight

Tanzania Mainland Food-Based Dietary Guidelines 159

 24. RECOMMENDATION 5
BE PHYSICALLY ACTIVE EVERY DAY TO STAY STRONG AND KEEP A HEALTHY
BODY WEIGHT
24.1 What are physical activities and • aerobic activity (walking, dancing,
exercise? swimming, riding a bicycle);
Physical activity refers to any voluntary • strength (anaerobic) exercises (push-
bodily movement produced by skeletal ups, squats, pull-ups);
muscles that require energy expenditure
(WHO, 2018b). Some examples of physical • flexibility exercises – range of motion
activity include daily chores around the (yoga, stretching, pilates); and
house, farming, fishing, walking, cycling, • functional balance exercises (standing
dancing, and exercise. with one leg, tai chi, muscle strength
exercise).
Physical activity undertaken throughout
the life cycle reduces the risk of NCDs
such as cardiovascular disease, diabetes 24.2 Benefits of physical activities
and cancer and their risk factors such as Being active daily and exercising regularly
raised blood pressure, raised blood sugar can help maintain a healthy body weight
and overweight. In addition, physical when combined with a healthy diet.
activity is a key determinant of energy Physical activities use up energy and
expenditure and thus is fundamental to burn calories. When energy-rich food
energy balance and weight control. is consumed in excess of the body’s
requirements, it leads to weight gain.
Exercise is a type of physical activity When less energy is consumed compared
that is planned, structured, repetitive to body requirements, it leads to weight
and purposeful in order to maintain or loss. One way to burn excess calories is
improve one’s physical fitness. Examples through moving the body more. This can
of exercise include: be through regular exercise or through
other physical activities. It is important to

160 Tanzania Mainland Food-Based Dietary Guidelines

ensure that daily energy intake balances Effects of sedentary behaviour
out daily energy expenditure to achieve Physical inactivity is estimated to be
a zero balance of energy, which enables the main cause of approximately
maintenance of a healthy weight. 21–25 percent of breast and colon
cancers, 27 percent of diabetes and
In addition to maintaining a healthy 30 percent of ischemic heart disease
weight, engaging in at least 150 to 300 (WHO, 2009a). The evidence from
minutes of physical activity per week developing countries confirms that
at moderate intensity, while keeping physical activity positively influences
active daily, can help to reduce the risk other chronic disease risk factors such as
of hypertension, stroke, heart attack, blood pressure, lipid levels, and obesity. A
diabetes, depression, and certain cancers systematic review on the role of physical
(WHO, 2020a). It also reduces stress, activity in prevention of hypertension
elevates mood, improves memory and (Diaz and Shimbo, 2013) reported that
learning, and strengthens the bones. elimination of physical inactivity would
remove between 6 percent and 10
Other benefits of regular physical percent of the major NCDs of coronary
activities: heart diseases, type 2 diabetes, breast
cancer and colon cancer while increasing
• Increases strength and stamina and
life expectancy (Lee et al., 2012).
elevates “good” cholesterol levels.
• Essential for maintaining ideal body 24.4 Recommendations for physical
weight and composition by burning activities for different age groups
excess calories. The WHO (2020) recommends the
following physical activities for each age
• A major modifiable risk factor in
group:
reduction of non-communicable
chronic diseases such as type 2 24.4.1 During pregnancy and lactation
diabetes, high blood pressure, heart
disease, osteoporosis, arthritis, and Pregnant women are advised to do at
certain types of cancers. least 150 minutes of moderate intensity
• Improves flexibility and builds strong in week while keeping active daily.
Physical activity can include walking or
muscles, bones, and joints, thus
performing daily household chores.
reducing the risk of falls and injuries
However, they should avoid vigorously
in the elderly. intense exercises and consult their
• Improves mood, sense of well-being medical attendants for confirmation to
and self-esteem, thus warding off prevent unnecessary falls and traumas.
depression.
Pregnant and postpartum women
should limit the amount of time spent
24.3 What is sedentary behaviour? being sedentary. Replacing sedentary
At the lower end of the physical activity time with physical activity of any intensity
range is sedentary behaviour, which (including light intensity) provides health
is defined as any waking behaviour benefits.
characterised by low energy expenditure
(of 1.5 METS or lower) while sitting, Being physically active during pregnancy
reclining or lying. Examples include desk- has been associated with preventing
based office work, watching television, excessive gestational weight gain,
working or playing on a computer or gestational diabetes, gestational
mobile device, sitting down chatting, hypertension, and prenatal depression.
reading a book, selling items, and driving It has also been shown to lower
a car. instrument delivery.

Tanzania Mainland Food-Based Dietary Guidelines 161

 24.4.2 Infants 0–12 months 24.4.4 Preschoolers (3–4 yrs)
Pre-schoolers should have at least 180
minutes (three hours) of physical activities
spread throughout the day. Of this, at
least 60 minutes should be exercise of
moderate to vigorous intensity.

This particular age group should have

limited on-screen time – an hour or less
is better for a child’s good health and
development (WHO, 2019b).
Infants should be as active as possible
under the supervision of parents or 24.4.5 Children 5–17 years
caretakers throughout the day when they
are awake. Activities such as grasping,
pushing, pulling, reaching out, crawling,
and moving their heads, limbs and bodies
can be ways to keep them active. Include
at least 30 minutes of tummy time, which
can be spread throughout the day (WHO,
2020a). Children and young people aged 5–17
years old should accumulate at least 60
24.4.3 Toddlers (1–2 yrs) minutes of moderate to vigorous physical
activity daily.

Physical activity of amounts greater than

60 minutes daily will provide additional
health benefits.

Most daily physical activity should be

aerobic. Vigorous-intensity activities
should be incorporated, including those
Toddlers should have at least 180 that strengthen muscle and bone, at least
minutes (three hours) of physical activity three times per week.
spread throughout the day. Activities
Limit the amount of time spent being
can include standing up, running and sedentary, in particular recreational
rolling, chasing-ball games, jumping, screen time.
playing in water and riding a bike.

For 1-year-olds, sedentary screen time 24.4.6 Young people and adults 18–64
(such as watching TV or videos, playing years
computer games) is not recommended. Adults aged 18–64 years should do
For children of age 2 years, sedentary at least 150 minutes of moderate-
screen time should not be more than intensity aerobic physical activity spread
one hour; less than one hour is better. throughout the week or do at least
Engaging in reading and storytelling with 75 minutes of vigorous-intensity aerobic
a caregiver is encouraged when the child physical activity throughout the week, or
is not active or playing” (WHO, 2020a). an equivalent combination of moderate
and vigorous activity.

162 Tanzania Mainland Food-Based Dietary Guidelines

Aerobic activity should be performed in Adults of this age group with poor
bouts of at least 10 minutes duration. mobility should perform physical activity
to enhance balance and prevent falls on
For additional health benefits, adults three or more days per week.
should increase their moderate-intensity
aerobic physical activity to 300 minutes Muscle-strengthening activities involving
per week or engage in 150 minutes major muscle groups should be done on
of vigorous-intensity aerobic physical two or more days every week.
activity per week or an equivalent
combination of moderate and vigorous When adults of this age group cannot do
activity. the recommended amounts of physical
activity due to health conditions, they
Muscle-strengthening activities should should be as physically active as their
be done involving major muscle groups abilities and conditions allow.
at least twice a week.

24.4.7 Older people 65 years old and

above

Adults aged 65 years and above should

do at least 150 minutes of moderate-
intensity aerobic physical activity
throughout the week or do at least
75 minutes of vigorous-intensity aerobic
physical activity throughout the week, or
an equivalent combination of moderate-
and vigorous-intensity activity.

Aerobic activity should be performed in

bouts of at least 10 minutes duration.

For additional health benefits, adults

aged 65 years and above should increase
their moderate-intensity aerobic physical
activity to 300 minutes per week or
engage in 150 minutes of vigorous-
intensity aerobic physical activity per
week, or an equivalent combination of
moderate and vigorous-intensity activity.

Tanzania Mainland Food-Based Dietary Guidelines 163

 24.5 Key messages for increased physical activities
1. Adults from 18 years and older should do at least 150 to
300 minutes a week of moderate physical activity to keep
the body healthy.
2. Pregnant women should do at least 150 to 300 minutes
a week of moderate physical activity to keep their bodies
healthy.
3. Keep babies and young children active daily under adult supervision.
4. Keep children aged 1 to 4 years active for at least 180 minutes a day.
5. Children aged 5 to 17 years should do at least 60 minutes a day of
moderate to vigorous physical activity.
6. Limit recreational screen time (television, computer, video games,
among others) to no more than two hours per day.
7. Do muscle-strengthening activities at least twice a week.
8. Choose to be active every day.

24.6 Tips for being physically active

1. Enjoy your favourite activities such as soccer, dancing, walking, and
biking with your friends and family.
2. Perform activity in bouts of at least 10 minutes duration.
3. Walk or bike to your destination instead of taking motorized
transportation.
4. Take the stairs instead of elevators.
5. Take a break from sitting and get up and move around.
6. Every bit helps. You can break up your physical activity into two or
three parts each day to fit your schedule.
7. Be active together. Being active with someone else
will keep you accountable and motivated.
8. If physically inactive, start gradually, increasing
the duration and frequency of moderate-intensity
activity before considering increasing the intensity
to vigorous-intensity activity.

164 Tanzania Mainland Food-Based Dietary Guidelines

GUIDELINE 6: Avoid risky behaviours
such as using tobacco and drinking alcohol
to reduce the risk of diseases

Tanzania Mainland Food-Based Dietary Guidelines 165

 25. RECOMMENDATION 6
AVOID DRINKING ALCOHOL AND USING TOBACCO TO REDUCE THE RISK
OF DISEASES

25.1 What is alcohol? 25.2 Effects of alcohol consumption

Alcohol is a product of the fermentation
of grains, fruits, or other sources of sugar 25.2.1 Alcohol is a risk factor for
with yeast and or bacteria. Fermentation premature mortality and disability
is the anaerobic breakdown of sugar
molecules into simpler compounds. For Drinking too much alcohol in one session
example, wine is made from the sugar can lead to drowsiness (sleepiness),
in grapes, beer from the sugar in malted respiratory depression (where breathing
barley, cider from the sugar in apples, and becomes slow, shallow or stops entirely),
vodka from the sugar in potatoes, beets coma or even death.
or other plants. There are also locally
According to the WHO (2018c), alcohol
made brews which include bamboo wine
consumption contributes to three million
(ulanzi), banana wine (mbege), fermented
deaths globally each year and results in
cereals (komoni), coconut wine (tembo),
poor health and disabilities for millions of
and cashew nut wine (uraka).
people. Overall, the harmful use of alcohol
is responsible for 5.1 percent of the global
burden of disease. Alcohol is the leading
risk factor for premature mortality and
disability among those aged 15 to 49
years, accounting for 10 percent of all
deaths in this age group (WHO, 2018c).
Alcohol has effects on every organ in the

166 Tanzania Mainland Food-Based Dietary Guidelines

body and these effects depend on the 25.2.4 Foetal alcohol syndrome and pre-
blood-alcohol concentration over time. It term birth complications
may lead to several serious psychosocial
problems and accidents (Traversy and These are conditions caused by alcohol
Chaput, 2015). A systematic review consumption during pregnancy. Alcohol
reported that even a small amount of use by the mother has been shown
alcohol is harmful, so it is important to to be detrimental to the health and
abstain (Iranpour and Nakhaee, 2019). development of neonates (Iranpour and
Nakhaee, 2019). Alcohol consumption
Similarly, the World Cancer Research Fund also increases the risk of preterm delivery
recommends that for the prevention of and low birth weight (Addila et al., 2021).
cancer, it is best to abstain (WCRF, 2018).

25.2.5 Alcohol and nutrition

25.2.2 Alcohol and cancer risk
Consumption of alcohol promotes
Alcohol consumption has been identified metabolic changes and weight gain,
as carcinogenic for the cancers of the increasing the risk of cardiovascular
colorectum, female breast, larynx, liver, diseases, altering the lipid profile,
oesophagus, oral cavity, and pharynx and promoting hypertension. Alcohol
(WCRF, 2018). The higher the rate of contains 7 kcal per gram, which is more
consumption of alcohol, the greater the than the 4 kcal contained in one gram
risk for these cancers. Increased risk is of carbohydrates and protein. However,
evident even among light to moderate because alcohol consumption does
drinkers (up to two drinks a day), who not provide vitamins and minerals, its
represented one in seven of all new calories are considered empty (Tofollo,
cancers in 2020 and more than 100,000 Aguiar-Nemer and Silva-Fonseca, 2013).
cases worldwide (Rumgay et al., 2021, When large amounts of alcohol are
WCRF/AICR, 2018). Thus, the World consumed, the body perceives that its
Cancer Research Fund recommends that energy needs have been met, decreasing
for the prevention of cancer, it is best to its demand for other foods (Tofollo,
abstain (WCRF, 2018). Aguiar-Nemer and Silva-Fonseca, 2013).
This leads to multiple deficiencies of
25.2.3 Alcohol and other NCDs vitamins and minerals.
Alcohol consumption has detrimental Alcohol contributes to malnutrition by
effects on hypertension, cardiac replacing foods needed for essential
dysrhythmias, and haemorrhagic stroke, nutrients and by interfering with the
regardless of the drinking pattern (Rehm et absorption, storage and metabolism of
al., 2011). People who regularly consume the essential nutrients (Bishehsari et al.,
more than two alcoholic drinks (one 2017).
drink contains about 30 ml of ethanol)
are at a higher risk for hypertension and The energy content of alcohol represents
stroke. Excessive alcohol intake weakens extra calories. This effect seems to add to
the heart muscle and damages the liver, the overfeeding associated with a high-
brain, and peripheral nerves. fat diet, increasing the chances of weight
gain (Azevedo et al., 2021; De Aguiar,
2013).

Tanzania Mainland Food-Based Dietary Guidelines 167

 Alcohol also affects mucosal immunity with ADHD may also have trouble
by suppressing one of the intestine’s focusing their attention on a single task
main lines of defence against bacteria or sitting still for long periods (Huang et
(Bishehsari et al., 2017). al., 2018).

25.2.6 Other effects of alcohol 25.5 Passive smoking

Passive smoking (which means inhalation
Abuse of alcohol may lead to violence, of tobacco smoke from the surrounding
increased incidence of psychological air) is equally bad for children and non-
problems that lead to mental disorders, smoking adults. It is responsible for
interpersonal violence and risk of causing excess cases of sudden infant
accident (Iranpour and Nakhaee, 2019). death syndrome, lower respiratory
infections in infancy, asthma, middle ear
infections, meningitis and streptococcus
25.3 What is smoking? pneumonia (Ferrence, 2010; Cao et al.,
Smoking is the act of inhaling and exhaling 2015; WCRF, 2018).
the fumes of burning plant material. A
variety of plant materials are smoked,
including marijuana and hashish, but the 25.6 Smoking and alcohol intake in the
act is most commonly associated with United Republic of Tanzania
tobacco as smoked in a cigarette, cigar, In addition to genetic predispositions,
or pipe. unhealthy diets and sedentary lifestyles,
other risk factors for NCDs in the United
Republic of Tanzania included excessive
25.4 Effects of smoking alcohol consumption and smoking (Shayo
and Mugusi, 2011; Njelekela et al., 2009).
25.4.1 Increased risk of NCDs According to the STEPS survey (Mayige
and Kagaruki, 2013), about 16 percent
Smoking causes cancer, heart disease, of the population use tobacco and
stroke, lung diseases, diabetes, and 4.1 percent are smokers (men
chronic obstructive pulmonary disease 26.0 percent and women 2.9 percent).
(COPD), which includes emphysema and Second-hand smoke exposure in at
chronic bronchitis (CDC, 2020; American least one day in the past week in the
Cancer Society, 2020). People who smoke home was reported by 17.5 percent of
and drink heavily have a much higher the population. Furthermore, alcohol
risk of developing oral cancer (mouth drinking is also common, with about one
and lip) and the pharynx (Pelucchi et al., in three men and one in four women
2006). Smoking also increases the risk drinking alcohol.
of tuberculosis, certain eye diseases,
and problems of the immune system, According to the Global Adults Tobacco
including rheumatoid arthritis (CDC, Survey of 2018 (NBS, 2020), 8.7 percent
2020). of adults across the survey currently use
tobacco. Of these current tobacco users,
25.4.2 Smoking may cause ADHD 74.2 percent smoked tobacco only,
21.7 percent used smokeless tobacco
Smoking during pregnancy may only, and 4.2 percent were dual users.
cause attention deficit hyperactivity Significant difference exists between
disorder (ADHD) in the child. ADHD is a male and female smokers, as about
mental health disorder that can cause 14.6 percent of males were current
above-normal levels of hyperactive tobacco users, while only 3.2 percent
and impulsive behaviours. People of females were current tobacco users.

168 Tanzania Mainland Food-Based Dietary Guidelines

It was observed in the same survey is also high exposure to tobacco smoke
that about 5.2 percent smoked daily at workplaces (33 percent), restaurants
and about 50 percent initiated smoking (31 percent), bars (77 percent) and at
before age 20. Although the current home (14 percent) (NBS, 2020).
policy restricts smoking in public, there

25.7 Key messages for avoiding alcohol and tobacco

use
1. Avoid drinking alcohol and using tobacco to reduce the risk of
diseases.
2. Avoid places where people drink alcohol or smoke.

25.8 Tips for avoiding drinking alcohol and using tobacco

1. Choose to associate more with people who are non-drinkers and
non-smokers.
2. Create new recreational activities to replace drinking
alcohol or smoking.
3. Distract yourself from drinking alcohol or using tobacco
by staying focused.
4. Do not allow friends or visitors to use tobacco in your
home.

Tanzania Mainland Food-Based Dietary Guidelines 169

170 Tanzania Mainland Food-Based Dietary Guidelines
 3
SECTION
Implementing
the FBDGs

Tanzania Mainland Food-Based Dietary Guidelines 171

 26. IMPLEMENTATION PARTNERS
The implementation of the guidelines will follow a multisectoral approach as stipulated
in the existing National Multisectoral Nutrition Action Plan (NMNAP), with the Tanzania
Food and Nutrition Centre (TFNC) providing overall technical support and leadership.
This arrangement is necessary to ensure effective and efficient implementation.

Source: Adapted from NMNAP II (Prime Minister’s Office (2022).

Figure 7 FBDGs coordination structure

26.1 Key actors for implementation of • the media; and

the FBDGs • political parties.
The key implementers of the FBDGs
include: The specific mandates and functions of
each of these implementing partners
• government ministries, departments are described under three sections – the
and agencies (MDAs); ministries, local government authorities,
and other implementers.
• regional administrations and local
government authorities (LGAs); 26.2 Ministries, departments and
• communities, development partners agencies
and civil society organizations (CSOs), Table 25 describes the mandates and
including NGOs and faith-based functions of different ministries and
organizations (FBOs); departments in implementing FBDGs.
• institutions of higher learning,
training and research;
• private-sector institutions;

172 Tanzania Mainland Food-Based Dietary Guidelines

Table 25 Mandates and functions of the FBDGs implementation partners

Ministries, departments and Specific responsibilities for the ministries,

agencies departments, and agencies in line with their
mandates
1. The Prime Minister’s Office • Coordinate the overall national response on
implementation of FBDGs.
• Ensure effective contribution by ministries,
departments and agencies to the
implementation of FBDGs.
• Support the multisectoral response to
improve utilisation of FBDGs and ensure that
interventions to improve implementation
of FBDGs are adequately mainstreamed
in policies and strategies of the key line
ministries.
• Provide oversight for governance and
accountability of all sectors and actors in
implementation of FBDGs.

2. President’s Office: Ministry of • Guide and monitor the integration of

Regional Administration and interventions to improve implementation of
Local Government the FBDGs in regional and local government
authorities plans and bylaws.
• Coordinate and facilitate capacity
development of regional and local government
administrations to plan and implement
programmes to improve consumption of
adequate diets at the community level.
• Coordinate and monitor implementation
of FBDGs by all actors in regional and local
government authorities using the principle of
the three ones: One plan, one coordinating
mechanism and one monitoring and
evaluation framework.

President’s Office: Ministry • Prioritize implementation of FBDGs to

of Public Service and Good improve consumption of diverse foods and
Governance promote healthy lifestyles in the ongoing
government structural/institutional reforms.
3. Ministry of Health • Supervise, monitor and coordinate
implementation of the FBDGs to improve diet
diversity and nutrient intake to all individuals.
• Promote desirable and supportive behaviour-
change strategies that promote consumption
of healthier foods and a healthy lifestyle.

Continued on page 174

Tanzania Mainland Food-Based Dietary Guidelines 173

 4. Community development, • Promote consumption of diversified foods
women, special groups among women and special groups.
5. Ministry of Agriculture • Ensure that national food security plans
and programmes have explicit objectives
to improve consumption of adequate diets
based on the recommendations presented in
the FBDGs.
• Promote and support increased production
and consumption of diverse, nutritious and
safe food to improve nutrition status.
• Promote production and dissemination
of varieties of crops, including varieties
of biofortified fruits and vegetables and
promotion of home gardening to ensure
consumption of nutrient-rich foods as
suggested in the FBDGs.

6. Ministry of Livestock and • Promote and support increased production

Fisheries and consumption of livestock, fish and related
products to improve the nutrition status of
Tanzanians.
• Ensure mainstreaming of food and nutrition
topics in livestock and fisheries training
programmes.
• Facilitate good marketing of livestock and
fisheries products across the country.
• Ensure storage, transportation and safety of
animal and fisheries products.

7. Ministry of Human • Establish safe food environments in all areas

Settlement (Urban Planning to ensure easy accessibility to nutritious
Unit) foods.
• Create safe environments for physical activity,
such as footpaths, access to public transport,
and parks with lighting.
• Promote and develop environments,
including infrastructure, that support healthy
eating and physical activity for infants,
children and young people and their families,
including older people.
• Develop bylaws to promote adequate
production of fruits and vegetables in urban
areas.
• Develop bylaws to protect consumer exposure
(especially children) to ultraprocessed foods
and unsafe drinks.
Continued on page 175

174 Tanzania Mainland Food-Based Dietary Guidelines

8. Ministry of Water and • Ensure sustainable supply of adequate safe
Irrigation and clean water up to household level.
• Promote safe water, sanitation and hygiene
practices for improved nutrition outcomes.
• Ensure sustainable water supply for irrigation,
especially for home gardens.

9. Ministry of Education • Integrate food and nutrition topics in school

and college curricula to impart knowledge
and skills on food choice, selection and
consumption in line with the FBDGs.
• Promote implementation of the FBDGs in
schools, colleges and other educational
institutions to improve food services provided
by these institutions.
• Promote physical activity, healthy lifestyles
and appropriate food consumption at all
levels of the education system.
10. Ministry of Energy and • Promote better and cheaper energy in
Minerals both rural and urban areas to reduce
women’s workload, prevent environmental
degradation, and improve nutritional
outcomes in households.
• Promote better and cheaper energy in
both rural and urban areas to ensure best
preparation practices of diversified foods.
• Protect consumers from risks associated with
contamination of food and water sources
with hazardous minerals.

11. Ministry of Natural Resource • Ensure integration of interventions to

Management improve healthy diets and nutritional rights
of communities surrounding wildlife and
forest reserves in their plans.
• Promote increased small-scale production
and processing of quality honey, fruits and
animal products to enhance diversity of diets
and to ensure desirable nutritional outcomes
at household level.

Continued on page 176

Tanzania Mainland Food-Based Dietary Guidelines 175

 12. Ministry of Industry and • Promote increased processing, storage
Trade and marketing of agricultural, livestock and
fisheries products to ensure availability of
nutritious foods throughout the year.
• Promote increased nutrition-relevant small
and medium enterprise (SME) participation in
the food industry subsector.
• Promote consumer protection against
ultraprocessed foods and trans fats.
• Promote traceability of ultraprocessed foods.
• Ensure imported and exported food products
meet the minimum food standards.

13. Ministry of Finance and Trade • Mobilize and allocate funds to improve
interventions geared to promoting
implementation of the FBDGs.
• Expedite timely disbursement of allocated
funds to the responsible sectors and
institutions for implementation of the FBDGs.
• Monitor public expenditure on implementation
of interventions to improve utilisation of the
FBDGs, with specific reference to NMNAP-II.

14. The Ministry Responsible for • Sensitize employers and the national labour
Labour force to adhere to good nutrition practices and
consumption of diversified diets as stipulated
in the FBDGs.
• Monitor the status of nutrition of the labour
force and take appropriate action to improve
the situation based on the requirements and
recommendations of the FBDGs.
• Promote workplace nutrition services,
including the food environment and physical
activities, to improve the wellbeing of the
working population.

15. Ministry Responsible for • Strengthen enforcement of laws and

Home Affairs regulations that facilitate implementation
of interventions that promoted good
utilisation of food in the country based on the
recommendations of the FBDGs.
• Ensure that the food and nutrition rights of
people under confinement/custody, including
prisoners, are met. These rights include
adequate access to health services, healthy
nutritious diets and safe water for drinking,
hygiene, sanitation, and physical exercise.

Continued on page 177

176 Tanzania Mainland Food-Based Dietary Guidelines

16. Ministry Responsible for • Increase media coverage of food and nutrition
Culture and Sports issues to promote awareness and adoption of
the FBDGs.
• Promote traditions and customs that positively
impact on good food and nutrition practices,
including production and consumption of
indigenous nutritious foods and engaging in
physical activities, including sports.
• Promote sports for healthy lifestyle for the
prevention of overweight, obesity and other
DRNCDs at all levels in the country.
• Integrate dietary practices and other nutrition
issues in sports development programmes.

17. Ministries Responsible for • Infrastructure development, especially in

Infrastructure Development urban settings, should facilitate physical
exercises, such as walking, jogging and cycling.
• Ensure clean environment for fresh air and
limited pollution.
• Create good market infrastructure for
accessing diversified foods.
18. Tanzania Food and Nutrition • To provide technical advice and support to
Centre regions, local government authorities (LGAs),
and the private sector on the implementation
of the FBDGs.
• To monitor and evaluate implementation of
FBDGs at various levels.

19. Tanzania Bureau of Standards • Ensure nutritional concerns are addressed in

the development and monitoring of quality and
standards of food products as stipulated in the
FBDGs.

Tanzania Mainland Food-Based Dietary Guidelines 177

 26.3 Local government authorities interventions to implement the
(region, district, ward, village and FBDGs.
street) • Conduct training for members of the
Specific responsibilities for LGAs in line Council Nutrition Steering Committee
with their mandates are as follows: to ensure a common understanding
of the guidelines and impart skills for
26.3.1 Regional Nutrition Steering dissemination of the FBDGs to the
Committee communities.
• Support and ensure community
• Provide knowledge to communities involvement and participation
and other stakeholders on the in activities geared towards
implementation of the FBDGs. implementation of recommendations
• Supervise and monitor interventions stipulated in the FBDGs.
to implement FBDGs. • Allocate sufficient resources for the
• Provide technical advice and support implementation of the FBDGs at the
to local government authorities in district level.
implementation of the FBDGs.
26.3.3 Ward and village/mtaa levels
• In collaboration with other institutions,
provide technical support and • Identify unique and context-specific
supportive supervision to districts in opportunities and challenges
implementation of the FBDGs. at the respective level for the
• Collect and compile data for implementation of FBDGs.
monitoring and evaluating the • Empower members of the
implementation of the FBDGs. committee with knowledge and
skills to understand the FBDGs. To
26.3.2 Council Nutrition Steering ensure that activities related to the
Committee implementation of the FBDGs are
integrated in ward/village/mtaa plans
• Integrate interventions to implement and strategies.
FBDGs in local government
• Ensure adequate community
authorities’ development plans.
sensitization to practise the
• Plan, coordinate, monitor, and recommendations of the FBDGs.
evaluate implementation of
• Mobilize resources for the
interventions to improve dietary
implementation of the FBDGs.
practices as stipulated in the FBDGs.
• Coordinate, monitor and evaluate
• Promote and support communities
interventions to improve
to participate in the implementation
implementation of the FBDGs
of FBDGs activities to improve health
recommendations.
and wellbeing.
• Mobilize resources for the
implementation of FBDGs.
• Integrate interventions to improve
dietary practices and other lifestyle
aspects in the Comprehensive Council
Health Plans.
• Monitor and supervise the

178 Tanzania Mainland Food-Based Dietary Guidelines

26.4 Other implementers 26.4.3 Professional bodies and
associations
26.4.1 Higher learning, training and
specialized research institutions
• Advocate for appropriate practices
• Review and update curricula for pre- of the recommendations stipulated
service, in-service and continuing in the FBDGs.
education to ensure that FBDGs are • Provide professional guidance in
adequately integrated. dissemination and implementation
• Mobilize funding for research of food- of the FBDGs recommendations.
based approaches for addressing all • Conduct research, set professional
forms of malnutrition. standards and participate in the
• Conduct research to identify drivers/ development of appropriate food-
enhancers and bottlenecks of based approaches in curricula for
adherence to recommendations pre-service, in-service and continuing
stipulated in the FBDGs. education.

• Provide technical advice • Support outreach activities on

and consultancy services on implementation of the FBDGs in
implementation of the FBDGs. communities.

26.4.2 Civil society organizations, NGOs, 26.4.4 Political parties

faith-based organizations, community-
based organizations, and political Political parties are in a unique position
parties to promote nutrition improvement, given
their reach and influence in mobilizing
for social goals. In implementing of the
• Provide financial and technical FBDGs, political parties will:
support.
• incorporate implementation of the
• Advocate for the prioritization healthy lifestyle interventions issues
of implementation of the FBDGs in their election manifestos and
in national, regional, LGA and campaigns;
community development plans.
• support mobilization for healthy
• Mobilize communities and lifestyle interventions;
households to adhere to
recommendations stipulated in the • support initiatives for improvement
FBDGs. of healthy lifestyles in the community;
and
• Support capacity development for
dissemination and implementation • advocate for the prioritization of
of the FBDGs at all levels. implementation of the healthy
lifestyle interventions in national,
• Integrate activities targeting regional, LGA, and community
communities and households for development plans.
the implementation of the FBDGs in
programmes and projects.
26.4.5 Private-sector institutions

The private sector will partner with

government in the implementation of
healthy lifestyle interventions at all levels.

Tanzania Mainland Food-Based Dietary Guidelines 179

 Specific contributions could include: and prioritise the implementation of
the FBDGs in their global and national
• increasing investments in production, agendas. Their role will include:
processing, storage and marketing
of high-value nutritious and healthy • mobilizing for technical and financial
products and in the provision of resources for implementation,
essential basic social services (food, capacity development, monitoring
health, water, sanitation and hygiene) and evaluating the implementation
for improvement of healthy lifestyle; of the FBDGs; and
• investing in production and marketing • contributing their international
of appropriate low-cost labour-saving experience, norms and standards,
technologies that enhance healthy and evidence-based guidance and
lifestyle improvement at community insights to the implementation of the
level; FBDGs.
• integrating healthy lifestyle
interventions in corporate social 26.5 The framework for the
responsibility plans and activities; Implementation Plan
• initiating and improving workplace This Implementation Plan framework is
implementation of the healthy outcomes focused and action oriented
lifestyle intervention programmes for so that all the stakeholders can work
their labour force; and towards a common set of results. Its
development has begun the process of
• ensuring compliance with all national intersectoral and interagency action,
laws, regulations, guidelines and including the private sector. This will
international protocols for protection continue during the implementation
of consumer rights, health and the phase.
environment.
The framework for the Implementation
Plan of the Tanzania FBDGs includes the
26.4.6 The media (print, radio, TV, social following actions (as elaborated in Tables
media, and online communications) 26–33):

The mass media will be responsible for: • Develop and implement a

comprehensive communication
• translating complicated FBDGs plan to ensure consistent FBDGs
recommendations into simple messaging.
language and disseminating it to • Promote FBDGs issues into the school
a wider population using various curriculum in the United Republic of
channels; and Tanzania.
• advocating and creating awareness • Identify and develop activities for
to influence positive practices in promoting FBDGs in health care
adopting recommendations of the settings.
FBDGs.
• Initiate development and
implementation of a range of social
26.4.7 Development partners marketing strategies to facilitate
behavioural changes supporting
Development partners, including the UN healthy eating, healthy action and
agencies and multilateral and bilateral healthy weight.
organizations, will advocate for, promote
• Develop and expand community

180 Tanzania Mainland Food-Based Dietary Guidelines

 action programmes for FBDGs implementation plan really comes alive.
advocacy. The tables detail the desired outcomes
• Develop and implement a strategy to and the specific actions identified to
increase the capacity and capability reach these outcomes. Institutions and
of trained health professionals organizations have been identified to
and community health workers to take part in the specified actions, as have
disseminate FBDGs. milestones and measures of progress
towards the outcomes. The final column
• Encourage the private sector and identifies timelines and resources for
industries to implement the FBDGs the plan. The timelines use three one-
strategy. year phases, giving the plan a three-
• Establish a database on the year timeline. Phase one indicates that
nutritional status of the population action will be initiated in the first year
and their dietary practices, which will of implementation. Phase two actions
give adequate information to suggest will be initiated in the second year and
suitable modifications. phase three actions in the third year of
the implementation.
• Develop an FBDGs Monitoring and
Evaluating Plan. An implementation steering group will
The specific actions outlined in Tables be established to provide leadership and
26–33 are based on the outcome results expert advice to the Ministry of Health
we are aiming for. This is where the during the implementation phase.

Tanzania Mainland Food-Based Dietary Guidelines 181

 Table 26 Implementation Plan: Objective 1

Objective 1: Public policy communication

Time
Progress
frame /
Outcome Specific actions Agencies milestones and
resourcing
measures
Sectors work Document the TFNC, DPG Database of
collaboratively and stakeholder stakeholders to
in a coordinated groups that could be completed.
manner to have an influence
incorporate key on FBDGs Phase 1
messages and implementation
recommendations in the United
of the FBDGs into Republic of
country policies, Tanzania.
programmes and Form an TFNC, Ministry Interagency
plans for agriculture, interagency of Health (MoH), groups (national,
food security, steering group for Presidents regional and
nutrition, health and the cross-sectoral Office, Regional local) to be
social protection implementation Administration established.
policies, prioritising of FBDGs, with and Local
those with high members from Government (PO- A staged Phase 1
needs based on the the DRNCDs RALG), regional approach to
wider determinants Technical Working and district joint work
of health. Group. councils programmes to
be developed.

Engage the TFNC, MoH, Private sector

private sector and private sector and industry
food industries and industry participation in
to implement implementation Phase 1
FBDGs. of the plan.

Multi-way strategic Undertake MoH, MoE, TFNC Joint planning

alignment of collaborative initiated.
policies and planning between
priorities between MoH, MoE,
MoH, Ministry of TFNC for FBDGs
Phase 1
Education (MoE) implementation.
and TFNC in place
to progress FBDGs
implementation
issues.

Continued on page 183

182 Tanzania Mainland Food-Based Dietary Guidelines

Healthy public Implement MoH,NGOs Nutrition Phase 1
policy in the areas FBDGs in settings and physical
of nutrition and such as schools, activity policy
physical activity preschools, implemented in
developed and churches, range of settings.
supportive mosques, Systematic audit
environments hospitals, processes and
created. health services, specific policies
and tertiary developed and
institutions. implemented.

Tanzania Mainland Food-Based Dietary Guidelines 183

 Table 27 Implementation Plan: Objective 2

Objective 2: Create supportive environments

Time
Progress
frame /
Outcome Specific actions Agencies milestones and
resourcing
measures
Increased profile
Identify social TFNC, MoH Options to be
of healthy influencers as considered and
food and change agents agreed actions to
physical activity
for healthier be implemented.
Phase 1
through media, food choices and
advertising, andphysical activity in
promotion. media, advertising
and promotions.
Improved access Assess the TFNC, MoH, Feasibility study
to healthy food accessibility of NGOs completed and
in preschools fruit, breakfast recommendations
and schools. programmes for rollout
and gardening in made based on
schools as a model evaluation. Phase 1
to improve student Rollout undertaken
access to healthy as recommended.
food.

Reduced salt, Food service TFNC, MoH, Best practice

sugar, fat industry adopts industry adopted.
content of best practice
commercially preparation,
Phase 1
prepared foods. cooking and
serving techniques
consistent with the
FBDGs.

Continued on page 185

184 Tanzania Mainland Food-Based Dietary Guidelines

choices are Undertake regional TFNC,MoH Scans completed at
affordable, ecological scans the regional level.
available, and regarding access Access improved.
accessible. to healthy food
Increased opportunities
consumption (mapping access to
of vegetables food in a deprived
and fruits in area). Action taken
the Tanzanian to improve access. Phase 1
population. Promote TFNC, MoH, Consumption
consumption of NGOs monitored
vegetables and in National
fruits in a variety Nutrition Survey
of settings, for and Tanzania
example, schools, Demographic
workplaces, Health Survey.
and community
settings.
Environments Develop and TFNC, MoH Walking and Cycling
promote and implement a Strategy developed
support physical Walking and and implemented.
activity and/or Cycling Strategy.
healthy eating. Final plan
Phase 2
addresses needs
of priority groups,
and messages are
consistent with
FBDGs.
Develop regional TFNC Number and
physical activity coverage of plans.
plans.
Phase 2

Develop district- TFNC, MoH, Networks

level alliances and PORALG, LGAs, developed.
networks between NGOs
health agencies Phase 2
and LGAs to inform Regional
and influence councils
district planning.
Continued on page 186

Tanzania Mainland Food-Based Dietary Guidelines 185

 Run forums to TFNC, MoH, Several forums
foster identification PORALG, LGAs, held. Participant
of nutrition, NGOs evaluation
physical activity, Regional indicates increased
and obesity as councils awareness of Phase 2
priorities for LGAs. nutrition and
physical activity as
priority issues for
LGAs.
Develop and TFNC, MoH, Successful
expand existing NGOs programmes
settings-based expanded (number
programmes and coverage) and
promoting new programmes
healthy food and developed.
physical activity.
Phase 1–3
Settings include
early childhood
centres, schools,
workplaces, health
care facilities,
shopping centres,
and markets.
Promote nutrition, TFNC, MoH The monitoring
physical activity process indicates
and obesity issues success of
to preschools and promotion. Phase 2
schools, prioritising
those with high-
need populations.
Work with schools TFNC, MoH, Number of
to become Health MOE Health Promoting
Promoting Schools Schools identifying
and to include nutrition, physical Phase 1
nutrition, physical activity and obesity
activity and obesity as priorities.
issues as a priority.

186 Tanzania Mainland Food-Based Dietary Guidelines

Table 28 Implementation Plan: Objective 3

Objective 3: Strengthen community action

Time
Progress
frame /
Outcome Specific actions Agencies milestones and
resourcing
measures
Communities are Support TFNC, MoH Investment
actively involved community action increased for
and successful by resourcing high-need groups
in supporting, key community (number and
promoting and people to promote coverage). Phase 1
influencing the healthy food and
availability of physical activity,
healthy food prioritising high-
and physical need communities.
activity in their Support TFNC, MoH, Research collated
communities. communities NGOs and disseminated
to develop about successful
nutrition and initiatives (number
physical activity and coverage).
programmes Phase 1
in key settings
of significance
and high-need
communities.

Disseminate TFNC, MoH Mechanism to

information share information
about evaluated, established within
successful and between
community agencies.
action initiatives, Phase 1
especially those
effective in
achieving health
gain in high-need
groups.
Support TFNC, NGOs Number and
community coverage of
initiatives that programmes.
promote healthy
Phase 2
eating and
physical activity
(e.g. community
gardens).

Tanzania Mainland Food-Based Dietary Guidelines 187

 Table 29 Implementation Plan: Objective 4

Objective 4: Develop personal skills (including

industry, education and wider workforce involved in
promoting nutrition and physical activity)
Time
Progress
frame /
Outcome Specific actions Agencies milestones and
resourcing
measures
Increased Stocktake existing TFNC, MoH Stocktake to be
knowledge community- done.
and skills in based education
families and opportunities. Phase 1
communities
about improving
nutrition,
increasing
Develop TFNC, MoH Number and
physical activity
community- coverage of
and reducing
based education education
obesity.
programmes programmes.
aimed at increasing
knowledge and Phase 1
skills of community
members about
nutrition and
physical activities.

Increased Train employers TFNC, MoH Number and

knowledge and other key coverage
of employers stakeholders in of training
and other key workplaces to programmes.
stakeholders in promote the key
settings such messages of food Phase 1
as workplaces and nutrition
about improving guidelines and
nutrition and physical activity
increasing guidelines.
physical activity.
Continued on page 189

188 Tanzania Mainland Food-Based Dietary Guidelines

Increased Establish nutrition TFNC, MoH, Nutrition and
knowledge and physical education sector physical activity
and skills of activity training guidelines
teachers to course content. included in tertiary Phase 1
deliver nutrition instruction course
and physical content.
activity in the
curriculum.
Make training TFNC, MoH, NGOs Number and
available to early Education sector coverage of
childhood centres professional
and schoolteachers development Phase 1
on the key sessions
messages of the conducted.
FBDGs.
Increase the Train food vendors TFNC, MoH, food Number and
knowledge and in best practice industry, coverage
skills of workers food preparation, NGOs of training
in the food and cooking and opportunities.
physical activity serving techniques
industries about consistent with the Phase 1
improving FBDGs.
nutrition and
increasing
physical activity.

Train physical NGOs, MoH Number and

activity industry coverage
(gym/fitness of training
clubs) employees opportunities. Phase 2
in the key FBDGs
messages.

Tanzania Mainland Food-Based Dietary Guidelines 189

 Table 30 Implementation Plan: Objective 5

Objective 5: Reorient health services

Time
Progress
frame /
Outcome Specific actions Agencies milestones and
resourcing
measures
Improved Create a list of TFNC, MoH List of
availability and all evidence- evidence-based
access by high- based weight loss programmes to be
need groups to programmes and developed.
affordable and services to develop Phase 2
appropriate new programmes
programmes and services to
and services meet consumer
for weight need.
loss (including Collaborate with TFNC, MoH Guidelines
maintenance). NCDs department developed.
of the MoH to Treatment
develop service guidelines
guidelines and consistent with
training packages food and nutrition
for providers on guidelines.
the treatment of
overweight and
Phase 2
obesity. Ensure
guidelines are
effective for high-
need groups
including children
and link to existing
nutrition and
physical activity
guidelines.
FBDGs models Build nutrition and TFNC, MoH, PO- Changes in
of health are physical activity RALG practice signalled
integrated indicators into in annual reports.
into health Multisectoral
sector planning Nutrition
Phase 1
to improve Information
nutrition, Systems (MNIS).
increase physical
activity and
reduce obesity.
Continued on page 191

190 Tanzania Mainland Food-Based Dietary Guidelines

Use FBDGs TFNC, MoH, PO- Changes in
models of health RALG practice signalled
to prioritise and in annual reports.
plan services and
programmes to Phase 1–3
improve nutrition,
increase physical
activity, and reduce
obesity.

Tanzania Mainland Food-Based Dietary Guidelines 191

 Table 31 Implementation Plan: Objective 6

Objective 6: Monitor, research and evaluate

Time
Progress
frame /
Outcome Specific actions Agencies milestones and
resourcing
measures
Improved Develop Tanzanian TFNC TAHEI developed.
availability of Healthy Eating
research and Index (TAHEI)
information based on the Phase 1–2
to support FBDGs using the
evidence-based food consumption
approaches and data.
interventions
Develop a brief TFNC A brief food quality
to improve
food quality screening tool
nutrition,
screening tool scoring developed.
increase physical
scoring for the
activity and
important TAHEI
reduce obesity.
components to Phase 1–2
enable evaluation
for counselling.

Update key tools, TFNC, MoH Updated Tanzania

including the Health Monitor
National Nutrition includes relevant
Survey. information. Phase 2–3

Investigate TFNC, MoH, Other sources of

other sources NBS data identified.
of monitoring
information, such Phase 2–3
as the National
Bureau of Statistics
(NBS).
Independently TFNC, MoH Evaluation
evaluate framework
implementation of developed
FBDGs. and evaluation Phase 3
completed. Results
published and
promoted widely.

192 Tanzania Mainland Food-Based Dietary Guidelines

Table 32 Implementation Plan: Objective 7

Objective 7: Communication
Time
Progress
frame /
Outcome Specific actions Agencies milestones and
resourcing
measures
Tanzanians Develop and TFNC, MoH Communication
aware of key implement a plan developed
messages of communication and implemented.
FBDGs. plan to deliver
clear, consistent
messages about Phase 1
nutrition, physical
activity and healthy
weight for a variety
of audiences and
settings.
Develop media TFNC, MoH Guidelines
guidelines for developed.
promotion of key
messages from
FBDGs.
Phase 1

Evaluate TFNC, MoH Communication

effectiveness of plan evaluated.
communication
plan and modify
if necessary Phase 1–3
according to
results (pre- and
post-evaluation
required).
Continued on page 194

Tanzania Mainland Food-Based Dietary Guidelines 193

 Initiate the TFNC, MoH Social marketing
development and plan developed
implementation and implemented.
of a range of
social marketing
strategies
to facilitate Phase 1
behavioural
changes
supporting healthy
eating, healthy
action and healthy
weight.
Tracking survey
to monitor reach,
knowledge and
awareness, uptake
of messages,
and change of
behaviour.

194 Tanzania Mainland Food-Based Dietary Guidelines

Table 33 Implementation Plan: Objective 8

Objective 8: Workforce (health and physical activity)

Progress Time
Outcome Specific actions Agencies milestones and frame /
measures resourcing
The United Undertake needs TFNC, MoH Needs assessment
Republic of assessment to completed and
Tanzania has identify training existing training
a healthy and needs of healthy opportunities
physically active and physically active identified.
workforce workforce. Database of Phase 1
with an workforce training
understanding opportunities
of nutrition developed and
and physical distributed.
activity issues
and guidelines Work with tertiary TFNC, MoH, Consideration given
and is able to institutions to Education to nutrition and
implement include nutrition sector physical activity
effective and physical activity training being
approaches to in relevant health included in relevant
support health training curricula, curricula.
gain. e.g., medical,
nursing. Include Phase 3
physical activity
components within
nutrition training
and nutrition
components within
physical activity
training.
Increase support of TFNC, MoH, Number and
existing evaluated NGOs coverage of training
community training programmes
programmes that supported.
provide nutrition
and physical activity Phase 2
training and support
to community
workers working
with high-need
groups.

Tanzania Mainland Food-Based Dietary Guidelines 195

196 Tanzania Mainland Food-Based Dietary Guidelines
 APPENDICES
APPENDIX 1: TECHNICAL RECOMMENDATIONS SELECTED TO GUIDE
FORMULATION OF MESSAGES

No. Technical Recommendation to Solve the Problem

1 Increase food diversity / Increase consumption of varieties of foods / Increase

consumption of varieties of locally available foods
2 Reduce intake of high processed foods / Limit consumption of high fat, salty and
sugary convenience foods
3 Increase physical activity / Maintain normal weight

4 Increase intake of fruits and vegetables / Increase intake of fruits vegetables and
fibres / Increase consumption of fruits and vegetables (fresh and dried) / Eat
whole fruit instead of fruit juice
5 Practising good food hygiene and sanitation during food preparation / Use safe
food handling and sanitation practices (clean and safe water) / Wash hands
properly using soap/ash at all critical times (before and after meals, before meal
preparations, after use of latrines, after cleaning/changing diaper) / Wash hands
using running water / Separate cooked and uncooked foods
6 Improve methods of cooking to preserve micronutrients / Use cooking methods
that preserve nutrients / Use appropriate cooking time for vegetables and other
foods
7 Increase consumption of meat by children / Give diversified complementary
food after 6 months up to 23 months
8 Pack healthy food for school children / Prepare healthy school meals (school
feeding programmes)

Tanzania Mainland Food-Based Dietary Guidelines 197

198
APPENDIX 2: NUTRIENT REQUIREMENTS FOR PREGNANT, LACTATING AND NON-PREGNANT, NON-
LACTATING WOMEN (18–49 YEARS)

Recommended intake per day

19-50 years PREGNANT LACTATING

Nutrients (not 1st 2nd 3rd 0-3 4-6 7-12
pregnant) trimester trimester trimester months months months
Energy (kcal/day) 2300 - 2660 2775 2805 2805 2760
Protein (g/day) 41 66 61
Vitamin A (ug RE/day) 270 370 + s** 450 + s* 450
Iron 15% bio-availability 20 n, s, d 10
(mg/day) 12% bio-availability 25 n, s, d 12
10% bio-availability 29 n, s, d 15

Tanzania Mainland Food-Based Dietary Guidelines

5% bio-availability 59 n, s, d 30
Folate (µg/day) 400 600 + s*** 500
Zinc High bio-availability 3 3.4 4.2 6 5.8 5.3 4.3
(mg/day) Moderate bio-
4.9 5.5 7 10 9.5 8.8 7.2
availability
Low availability 9.8 11 14 20 19 17.5 14.4
Selenium (µg/day) 26 26 28 30 35 35 42
Calcium (mg/day) 1000 1000 1000 1200 1000
Vitamin C (mg/day) 45 55 70
Magnesium (mg/day) 220 220 270
Iodine (µg/day) 150 200 200
Thiamine (mg/day) 1.1 1.4 1.5
Riboflavin (mg/day) 1.1 1.4 1.6
Niacin (mg NE/day) 14 18 17
Continued on page 199
 Vitamin B6 1.3 1.9 2.0
n: No figures are given for dietary iron requirements in pregnant women because the iron balance in pregnancy depends not
only on the properties of the diet but also on the amounts of stored iron.
s: The increased iron requirement cannot be obtained from the diet and thus daily supplemental iron and folic is recommended
during pregnancy and for at least three months after delivery (WHO, 2012b).
s**: Pregnant women should take Vitamin A supplementation in addition to diet.
s*: A single dose of 200,000 IU should be taken no later than eight weeks after delivery in addition to diet.
s*** Pregnant women take daily oral folic acid supplementation and, where possible, women should take folic acid supplements
before conception.
Energy and all other nutrients listed above can be met by eating a variety of foods.
NB: Calcium: No calcium levels for first and second trimester given, hence pre-pregnancy levels are assumed.
NB: Selenium: No selenium levels for first trimester given, hence pre-pregnancy levels are assumed.
Sources: FAO and WHO, 2004; FAO, WHO and UNU, 2001; FAO, WHO and UNU, 2007

Tanzania Mainland Food-Based Dietary Guidelines

199
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