Biofortification with Zinc and Iron for Eliminating Deficiency in Pakistan (BiZIFED2) Zinc and iron deficiencies are a global public health problem, with the greatest burden occurring in low and middle-income countries. In Pakistan, over 40% of women are zinc deficient and over 20% have iron deficiency anaemia. These micronutrient deficiencies have negative consequences for maternal and child health, and it is imperative that sustainable and cost-effective solutions are found.  The project will investigate the potential of biofortification to reduce zinc and iron deficiencies in Pakistan. Biofortification is a process by which the nutritional quality of food crops is improved through conventional plant breeding techniques and addition of nutrient-rich fertilisers. HarvestPlus has developed a variety of wheat with significantly greater zinc and iron concentrations, compared to standard varieties. Wheat is the staple crop in Pakistan and most families consume chapatis (made from wheat flour) with every meal. Therefore, we believe that biofortified flour may benefit communities who cannot afford to consume a diverse range of foods.  The project has three main components, to be delivered over two years. The first component is a randomised controlled trial effectiveness study, to assess the impact of consuming biofortified flour on zinc and iron status. The participants will be 500 adolescent girls (aged 10-16 years) and 500 children (aged 1-5 years) living in a low-resource community in North West Pakistan. In phase 1 (months 1-6), the participants and their families will consume their usual locally purchased flour. The cost of the flour will be reimbursed as an incentive to participate in the study. In phase 2 (months 7-12), they will consume either biofortified flour (intervention group) or standard flour (control group), both of which will be grown locally. The participants will be randomly allocated to the intervention or control group and they will not know which flour they are consuming (nor will the research team). A range of biochemical measures will be taken to assess the impact of consuming biofortified flour on zinc and iron status. We will also record the incidence of diarrhoea and upper respiratory tract infections (in children), which are known to be associated with zinc deficiency.  The second component focuses on understanding wheat growing conditions in Pakistan, and supporting farmers to improve the yield and grain quality of biofortified wheat. Variations in soil fertility and grain quality will be mapped across Punjab Province, where 80% of Pakistan's wheat is grown. Computer modelling techniques will be used to predict which soil properties (e.g. soil organic matter, fertility) and management options would lead to optimal zinc concentrations in the wheat grain. Cost-benefit analyses will be conducted for different scenarios, such as standard vs. biofortified wheat, addition of zinc fertilisers, improved soil organic inputs etc.  The third component focuses on promoting the sustainable production and consumption of biofortified wheat in Pakistan. Mixed methods will be used to explore the views and perspectives of farmers (wheat producers) and community members (wheat flour consumers) to understand what factors influence their decisions to adopt biofortified wheat or not. Participants will be recruited from marginalised communities, who often have the poorest diets and may not access other types of nutrition interventions such as centralised flour fortification. The wheat market system in Pakistan will be mapped through consultations with a range of stakeholders. This information will be used to develop and pilot interventions to promote the sustainable production and consumption of biofortified wheat.  As well as intensive communication activities with farmers and consumer, findings will be disseminated to researchers, policy makers, donors, world-wide, through a comprehensive Pathways-to-Impact activities. The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world.