www.gainhealth.org Assessing potential for parboil rice fortification with zinc Nutritious Rice Value Chain Project
www.gainhealth.org
Assessing potential for parboil
rice fortification with zinc
Nutritious Rice Value Chain Project
2
•Micronutrient malnutrition results in an
estimated US$1 billion loss in economic
productivity in Bangladesh, annually1
•Zinc deficiency is the most prevalent
micronutrient deficiency in Bangladesh—
affects 45% of preschool-age children and
57% of women2
•Low dietary diversity is associated with
inadequate nutrient intakes in Bangladesh3
•Rice is widely consumed across the country.
Upwards of 70% of calories are derived from
milled rice (FAO, 2012).
0
10
20
30
40
50
60
70
Zinc - rural Zinc -urban
Vitamin A -rural
Vitamin A -urban
Preschoolchildren
Women(NPNL)
Rice provides 70% of energy
Source: FAO. Food security country profile, 2012.
16%
6%
2%
3%
70%
3% Other
Soybean oil
Wheat flour
Refined sugar
Palm oil
Milled rice
Bangladesh: Zinc deficiency and rice intakes
1FANTA Bangladesh PROFILES, 20122 ICDDR,B et al. National Micronutrients Status Survey, 2011-2012; 2013.3 Arsenault et al. J Nutr 143: 197-203; 2013.
3
ADDITION AND MITIGATION OF LOSSESZinc
Farm inputs
Production
Soaking/
Parboiling
Milling
Cooking
Zinc-fertilizer enriched rice
Fortify parboil soaking water with zinc
Nutrition-sensitive parboiling
Reduced milling
Zinc biofortified rice germplasm
Use
optimal
cooking
water
volume
Extrusion fortification
www.gainhealth.org
Nutrition
evidence
NUTRITION EVIDENCE + MARKET
POTENTIAL
Objective: Test interventions along the agricultural value chain to improve
the nutritional density of rice in Bangladesh.
SCALE
Inputs into Food Production
Food Production
Food Storage
and Home Processing
Industrial Food
Processing
Distribution Transport & Trade
Food Retailing, Marketing
& Promotion
Food Preparation & Catering
Farm Input Post-Harvest
Market
potential
5
ESTIMATED INCREASE IN RICE GRAIN
CONTENT (MG ZINC/ KG RICE) UPDATED
Source: GAIN Bangladesh Nutritious Rice Technical Assessment, 2013; Dalberg analysis.
0.9 – 1.3
Zinc fertilizer (foliar)
Zinc fertilizer (soil) 0.1 - 6.0
Parboiling optimization
11.7 – 11.8
2.4 - 4.0Reduced milling
Fortificant soaking
1.4 - 4.6
Range of values
6
SUMMARY OF MARKET ASSESSMENT FOR EACH OF
THE INTERVENTIONS CONSIDERED
Soil
Foliar
(0.1 to 6.0 μg/g)5
(1.4 to 4.6+ μg/g)5
(+0 to + 0.6 Tk)
(+1 to +1.5 Tk)
Reduced milling
Zinc fertilizer
Fortification during parboiling
Increase in zinc content
(zinc µg/g)1
Evidence of demand(price impact)2 Supply chain capacity
Regulatoryenvironment
(2.4 to 4.0 μg/g)4 (-0.3 to -0.6 Tk)
(+1 .5 to +1.8 Tk)
(6.0 to 23.4 μg/g)3
Nutrition-sensitive parboiling (0.9 to 1.3 μg/g)6
1
2
3
4
(price increase)
Positive rating Negative rating
Notes: (1) Increase in zinc content of milled, washed and cooked rice; (2) Demand assessment relies on multiple factors, impact on price is not the only dimension used for rating; (3) This is across all concentrations. (4) This is ranked lower because increased phytate levels in reduced milled rice decrease the ultimate nutritional impact of the concept; (5) Fertilizer values are based on literature review; for soil-based fertilizer, +0.1 μg/g of zinc is in zinc adequate soils, and +6.0 μg/g is in zinc deficient soils; for foliar fertilizer, the range is given for zinc adequate soils only; data does not exist forimpact on zinc deficient soils, but is likely to be higher than soil-based ones; (6) This figure is not statistically significant and the rating is therefore lowerSource: GAIN Bangladesh Nutritious Rice Technical Assessment, 2013; HarvestPlus; Interview with World Food Programme; Dalberg analysis
7
PARBOIL FORTIFICATION: ADDITION OF
SOLUBLE NUTRIENTS TO SOAKING WATER
BEFORE PARBOILING
• 1950-1960’s: Approach first used in Japan to increase amino acid content of
rice (lysine and thiamin)
• Brown or milled rice soaked in an amino acid solution
• Thiamin enrichment used at industrial level
• 2000’s: Prom-u-thai et all studies this process in depth for iron and zinc:
• 1.4x increase adding zinc at 50 mg/kg paddy (9.7 to 13.2 mg zinc/kg
milled rice)
• 4.5x increase adding zinc at 400 mg/kg paddy (9.7 to 44.1 mg zinc/kg
milled rice)
• Use of low pH and hot temperature in soaking water to boost uptake (of
iron)
• Did not conduct industrial pilot tests in Thailand: parboiled rice is for
export therefore not of national interest
8
ZINC CONTENT IN PARBOIL FORTIFIED RICE
11.0 12.213.5
15.917.112.6 16.4
19.6
23.3
28.2
32.9
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
0 100 150 200 300 500 700 900 1100 1300
Zin
c c
on
ten
t (m
g/k
g p
ad
dy d
ry w
t
Mg zinc / L or kg paddy
Cooked rice - low
Cooked rice - high
1.6x ↑
9
ZINC CONTENT IN PARBOIL FORTIFIED RICE
11.0 12.213.5
15.917.112.6 16.4
19.6
23.3
28.2
32.9
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
0 100 150 200 300 500 700 900 1100 1300
Zin
c c
on
ten
t (m
g/k
g p
ad
dy d
ry w
t
Mg zinc / L or kg paddy
Cooked rice - low
Cooked rice - high
1.6x ↑
This amount of zinc in the milled rice represents
only 2.2% of the zinc added to the system
10
ZINC RETENTION IN PARBOIL FORTIFIED RICE
AFTER WASHING AND COOKING
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
0 100 150 200 300 500 700 900 1100 1300
Zin
c r
ete
nti
on
%
Mg zinc / L or kg paddy
Retention (%)
11
IMPACT OF ZINC PARBOIL FORTIFIED RICE ON
THE PREVALENCE OF INADEQUATE ZINC
INTAKES
0
10
20
30
40
50
60
70
80
90
100
Baseline 15% 50% 80% Baseline 15% 50% 80%
300 mg zinc L-1
1300 mg zinc L-1
Children 2-3 yrs Women
Hotz et al. J Sci Food Agric. 95:379-85; 2015
12
EARLY RESULTS INDICATE THERE IS DEMAND FOR
NUTRITIOUS RICE
(1) The consumers were provided brief awareness / education via the survey question, which was: “If you were told that this rice (a) provided you and your family with vitamins (b) would help prevent diarrhea/other diseases for your family, particularly children; (c) made the children stronger, what would be the fair price for this rice?”Source: GAIN technical tests in labs (November 2013); Interviews with experts; GAIN Bangladesh Consumer Survey, 2013; Dalberg analysis
Control, open parboilFortified with 1300mg,
open parboil
There are limited changes expected
to the organoleptic properties of rice
Initial results indicate that there are limited
changes in the smell, texture or taste of the
rice either
Consumers are willing to pay a ~2
taka premium for nutritious rice
38.63 39.28 41.07
0
50
+0.65
Current rice
Nutritious rice, pre-awareness
Nutritious rice, post awareness1
Urban
(n=752)
35.65 36.16 37.53
0
20
40
+0.51
Overall
Rural
(n=498)
+2.44
+1.88
13
FORTIFICANT SOAKED RICE IS EXPECTED TO
BE 1-1.5TK/KG (~3-5% INCREASE) FALLING
WITHIN CONSUMER WILLINGNESS TO PAY.
Source: GAIN Miller Survey 2013; Interviews with millers; Dalberg analysis.
www.gainhealth.org 14
Industrial Pilot Study
Small Scale (0.4 MT)
500 and 1100 mg zinc/kg
paddy
www.gainhealth.org
INDUSTRIAL PILOT - SMALL SCALE
ENGELBERG MILL VS LABORATORY STUDY
0
5
10
15
20
25
30
35
40
Control 500 mg Zn/kg paddy
1100 mgZn/kg paddy
Engelberg study - 2015
1.5x ↑
1.9x ↑
15
0
5
10
15
20
25
30
35
40
Control 500 mg Zn/kg paddy
1100 mgZn/kg paddy
Laboratory study 2013
1.5x ↑
2.2x% ↑
MILLED RICE - RAW
www.gainhealth.org 16
0
200
400
600
800
1000
1200
1400
Husk Bran Byproducts (mixed)
By-products
Control 500 mg Zn 1100 mg Zn
↑ 11 x
↑ 14 x
Estimates (non-representative samples)
RESULTS: ENGELBERG MILL STUDY
Combined
sample
www.gainhealth.org
COST IMPLICATIONS FOR MILLERS
$US DOLLARS
Cost $US – based on 565 MT
annual production
500 mg/kg 1100 mg/kg
Supplies / equipment 650 650
Zinc sulfate 6 498 14 145
Subtotal / year 7 148 14 145
Additional cost/kg milled rice $US 0.012 0.026
Additional cost/kg milled rice
Taka
0.9 2.0
17
Within range of willingness-to-pay for ‘nutritious rice’ with health information
Up to 2.0 Tk premium
www.gainhealth.org
ENGELBERG MILL STUDY: BYPRODUCTS
Potential Risks
• Improper handling of byproducts
could create zinc contamination in
the environment
• Closed management system would
be required
• Husks are an important source of
fuel for rice mill boilers – if burned
would need to collect ash waste
18
Potential Opportunities
• Zinc may be extracted for use as
fertilizer – a clean, reliable, local
source
• If the zinc byproducts have monetary
value as fertilizer, millers would be
incentivized to sell
• Determine if zinc husks can be
burned for fuel, and the ash
recovered for use in fertilizer
ZINC IS CONCENTRATED IN BYPRODUCTS & EFFLUENT
www.gainhealth.org
ZINC SULFATE VALUE CHAIN
19
Steel
production
Zinc dust
recovery
Zinc sulfate
Micronutrient
Fertilizer
Animal Feed
https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjjl6vTt53LAhXss4MKHZWEACEQjRwIBw&url=https://en.wikipedia.org/wiki/Zinc_sulfate&psig=AFQjCNH3cwYsMVGxWQoyVPQA4-VdK85q7A&ust=1456851164361661https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjjl6vTt53LAhXss4MKHZWEACEQjRwIBw&url=https://en.wikipedia.org/wiki/Zinc_sulfate&psig=AFQjCNH3cwYsMVGxWQoyVPQA4-VdK85q7A&ust=1456851164361661
www.gainhealth.org
ZINC FERTILIZER USE IN BANGLADESH
• Approximately half of arable land in Bangladesh is zinc deficient
• Use of zinc fertilizer for increased yield considered necessary by
government
• Usage of zinc fertilizer is low (~20% in 2012/13) compared to estimated
need
• No local manufacture of zinc fertilizer - imported (eg, China)
• Product adulteration is a problem – inadequate zinc, heavy metal
contamination
Increased use and quality of zinc fertilizers
20
www.gainhealth.org
SYSTEM REQUIREMENTS
Mills: Zinc fortification at
soaking
Zinc fortified milled rice
Zinc rich by-products &
effluent
Extraction / use in
fertilizer??
Rice production –
increase yield?
21
Food grade zinc sulfate
Consumers
$$
$$
$
X
www.gainhealth.org
CONCLUSIONS
• System was considered too
inefficient with too many
challenges/risks to invest further
• Other strategies - zinc biofortified
rice and extrusion technology
continue to be invested in
• These strategies are also
challenged by rice value chain
• Prevention of zinc deficiency –
need to look beyond rice as a
vehicle
22
Salt iodization: Successfully reaching billions
but suboptimal indicators
Omar Dary
USAID–Nutrition Division/HIDN/GH
USAID, Mini-University
March 4th, 2016
OD-2016-03
Fetus Abortion Stillborn Congenital abnormalities
Perinatal mortality
Infant mortality Neurologic cretinism: Mutism, mental retardation – deafness Endemic cretinism: dwarfism/ mental deficiency Psychomotor impairment
Infant Hypothyroidism / Irreversible mental retardation
Children and adolescent
IQ reduced / Goiter / Hypothyroidism / Impaired physical and mental development
Adult Goiter and complications Hypothyroidism
Consequences of iodine deficiency and excess
2424
Excesses
Temporal Permanent
Hyperthyroidism
(in population that were
iodine deficient)
Thyroid Cancer
(in adults from all sources of
iodine)
Brief history of iodized salt
YearAverage
[I] (mg/kg)Event
1915 SmallHunziker, in Switzerland, recommended adding small amount of iodine
to the diet of small children to prevent goiter.
1917 -Marine & Kimball (Akron, Ohio, USA) reduced goiter in girls using
supplements with iodine
1921 1.90 – 3.75 The salt iodization program started in Switzerland.
1924100.0
(average)
Michigan: Introduced, as prophylaxis against goiter, iodized salt; the
country (USA) has not accepted the practice as compulsory.
1962 7.5 Iodine content is increased in Switzerland.
1980 15.0 Nodular goiter raises temporally due to increment of iodine content.
1998 20.0 Another increment takes place based on epidemiological results.
2014 25.0 More recent increment in Switzerland to satisfy requirements for all.
Currently20-60
(range)Most countries, including USA; with common averages between 25
and 40 mg/kg.
25Source: Zimmermann oral communication and J Nutr 2008;138:2060.
26
Association between goiter and urinary iodine concentration*
Goiter %All Visible
UIC/E (µg/24 hours)*
Children 9-13 years in 9 localities
Nu
mb
er
of
cases
Source: Tobar E, Maisterrena JA, Chávez A. Iodine nutrition levels of school children in rural Mexico.
In: Stanbury JB, 1969. Endemic Goiter. PAHO, Sc. Publ. No. 193. pp 411- 415.
* The authors assumed that UIC was equivalent to 24-h UIE.
EAR = 73 µg/day
RNI (EAR) = 120µg/day
UL= 600 µg/day
27
Goiter prevalence vs urinary iodine in Central America – 1965-67
Source: Ascoli W, Arroyave G. Epidemiología del bocio endémico en Centro América. Arch Latinoamer Nutr 1970; 20:309-320.
* The authors estimated UIE based on UIC in causal urine samples adjusted by creatinine coefficient/ g creatinine x body weight
% g
oite
r p
reva
len
ce
UIE* (µg/day)
Design:
Around 30 localities per
country (186 in total);
3,181 urine samples
28
Goiter prevalence vs urinary iodine concentration for selecting indicator
Source: WHO Nutrition Unit. Indicators for Assessing for Control of Iodine Deficiency Disorders and their Control through Salt
Iodization, 1994, In: IOM, Academies of Science of the USA. Dietary Reference Intakes. Chapter of iodine. 2001.
% g
oite
r p
reva
len
ce
Median UIC (µg/dL)
Sources: USA-NHANES; UIC – 2007-2008, except non-pregnant and pregnant women 2005-2008, Caldwell et
al. Thyroid 2011; 21: 419; body weight 2003-2006, McDowell et al., Anthropometric reference data for children
and adults; National Health Statistics Report 2008; 10.
UIE (ug I/d) estimated by multiplying the reported UIC (ug I/L) for the calculated urinary volume
of each age- and gender group, based on body weight:
Urinary volume (L/d) = 0.009 L/h.kg x 24 h/d x wt (kg) – from IOM/ Academies of Sciences of
the USA: Dietary Reference Intakes for iodine and other nutrients. National Academy Press.
0
50
100
150
200
250
300
350
400
UIC(ug I/L)
Are we sure that we are interpreting well the UIC in pregnant women?
Years
0
50
100
150
200
250
300
350
400
UIC(ug I/L)
UIE(ug I/d)
Years
?
Reference figure: modified from DRI, IOM
of the Academies of Science of the USA.
95 150 1100 Iodine: µg/d
* Situation in Mexico: * females, ** men
345**
Assuming salt intakes: 7-16 g/d males, and 5-12 g/d*
females, and iodine content in salt of 30 mg I/kg
255*
30
Summary of the situation in Mexico -2013. Iodine intakes through salt.
*Based in: Correa et al. Mexico. Unpublished, 2014.
Minimum average: 95 µg I/5 g salt =
19 µg I /g salt =
19 mg I/kg
YearContent
[I] (mg/kg)Recommendation (WHO/UNICEF/ICC-IDD)
1996
20(average)
For providing 150 µg/day in 10 g salt/day = 150 µg/g , and 30% loss (150 x 1.3 = 19.5 µg/g) at the moment of production.
(40)(average)
Nothing is mentioned for salt intake of 5 g/day, but the range of ”averages” is stated 20-40 mg I/kg; a “range” was born.
15(average)
In households.
200015
(minimum)In posterior editions, the average became “minimum” and the concept of “adequate” iodized salt was born.
200720-40
(range)
“the percentage of food-grade salt with iodine content of between 20 and 40 ppm in a representative sample of households must be equal or greater than 90%”
31
How the concept of “adequate” iodized salt originated?
Parameter Coarse salt
n 32
Median (mg/kg) 23.8
Mean (mg I/kg) 39.9
S.D. (mg I/kg) 46.5
C.V. (%) 116.4%
% samples
< 20 mg I/kg33.4 %
% samples
< 15 mg I/kg29.6 %
32
Washed salt
42
29.7
30.9
10.0
32.4 %
13.8 %
5.6 %
Refined salt
20
33.7
33.9
2.9
7.6 %
0.0 %
0.0 %
Source: Unpublished results from Government Food Control (COFEPRIS), México, 2013.
Iodine content in different types of salt in México-2013 (Regulation: 30 ± 10 mg/kg)
33
Situation of the iodized salt in Mexico-2013;Regulation 30 ± 10 mg I/kg
10 40 60
0.15
0.30
0.45
0.60
Content (mg/kg)
Fre
quency
20 50 70 8030
Low variation
(refined salt)
Moderate variation
(washed salt)
Large variation
(coarse salt)
1. Nowadays, iodine is being supplied to most populations through iodized salt (discretionary –table and cooking- and salt used by food industries) or dairy products.
2. Almost all populations are receiving sufficient iodine, as the current iodine content in salt is between 25-45 mg I/kg, when only 15 mg I/kg in average would be sufficient for the current salt intakes.
3. The use of the “adequate” iodized salt (percent of samples below 15 mg I/kg) is causing confusion and it is an unfair parameter for qualifying the programmatic impact; many factors affect variation of the iodine content around the mean.
4. In general, a population median of iodine concentration in urine above 100 µg/L reflects good iodine intake in the whole population. The reference value for pregnant women is still pending.
5. Therefore, the 2 billion persons worldwide reported as at risk of suffering iodine deficiency is an exaggeration; iodized salt is one of the most successful programs of public health nutrition of the 20th Century.
Conclusions
34
19th BOARD MEETING 35
Assessing program performance and
potential for impact: the GAIN FACT tool
Lynnette Neufeld, PhD
Director, Monitoring, Learning and Research
36
Fortification has important impacts on
micronutrient status and on health outcomes –
but access to fortified foods and the conditions under which
they are stored, purchased, and used varies greatly within
and among countries
37
Fortified flour
is accessible
(available
and affordable)
in
communities
Households
use fortified
flour
appropriately
PO
LIC
IES
BE
HA
VIO
R C
HA
NG
E
CO
MM
UN
ICA
TIO
N
DE
LIV
ER
YQ
UA
LIT
YP
RO
DU
CT
ION
& S
UP
PL
Y
Households
increase
purchase of
fortified flour
/products
•Development &
implementation of:
nutrition policies,
fortification law,
regulations & standards
•Quality control &
assurance (mills &
commercial)
• Inspection and
auditing
Fortified flour
Imported,
produced &
distributed
meets quality
standards &
specifications
Providers/distributors
have knowledge
& motivation to
adequately
distribute, inform &
problem solve with
Women of
Reproductive Age
(WRA)
Households
know, demand,
accept, & have
ability to
appropriately use
fortified flour
Micronutrient
status of
individuals
improved
Micronutrient
Intake
increased
among those
at risk of low
micronutrient
intake
Other
interventions
Maternal
Morbidity
&
mortality
reduced
Child
morbidity
&
mortality
reduced
Cognition &
productivity
increased• Engagement of
stakeholders &
advocacy
• Development &
implementation of
intervention strategy
for consumer
information, education
& communication
• Flour industry
marketing
• Flour industry delivery
system
• Flour industry
management, training &
maintaining motivation
among providers &
distributors
Fortified flour
is available
in country
Anaemia &
neural tube
defects
decreased
•Production of fortified
flour by mills
•Importation of
fortified flour
•Micronutrient premix
Source: Flores 2013
Ma
na
gem
en
t, s
taff
, n
ati
on
al fo
rtif
ica
tio
n c
oa
liti
on
, fi
na
nc
ial
res
ou
rce
s, in
fra
str
uctu
re, o
the
r c
on
trib
uti
on
s f
rom
pa
rtn
ers
Knowledge &
Appropriate Use
Impact on Intake,
Status and FunctionAccess &
Coverage
Policies, Production, Delivery, Quality,
& Behavior Change Communication
38Coverge model from: Tanahashi Bull WHO 1978
To assess potential for impact we need to know
who consumes the food, how much, and how
much of the nutrient it actually contains
Contact coverage:
consume at least once per
week
Dietary contribution: %
Recommended Nutrient
Intakes (RNI)
Effective coverage:
requires some point of
comparison to how much is
needed
39
The Fortification Assessment Coverage Tool
(FACT)
• Proportion of the population that uses a
fortifiable food commodity, defined
appropriately for country, usually as
centrally produced (“contact coverage”)
• Intake of food from modified dietary recall
• Household
• Women of reproductive age; children
40
12 surveys in 10 countries:
~25,000 households representative of 1.5 billion people
41
Contact coverage of fortifiable* oil among
women of reproductive age (WRA)
0
10
20
30
40
50
60
70
80
90
100
Senegal Rajasthan, India Abidjan, Côted'Ivoire
% All
Poor
Non-poor
*Defined as commercially produced
42
Dietary contribution (% daily RNI) for vitamin A
met from consumption of fortified oil for WRA
0
10
20
30
40
50
60
70
80
90
100
Senegal Rajasthan, India Abidjan, Côted'Ivoire
% All
Poor
Non-poor
43
In Senegal, 51% of children 6 to 23 m of age
consume fortified oil at least once per week
% RNI estimated for all children who reported consuming oil at least once per week (51% of sample)
Consume fortifiable wheat flour at
least 1/week:
• 35% in rural South
• 51% in rural North
• 61% in peri-urban areas (exl. Dakar)
• 56% in Dakar
Mean (18.9%)
Median (13.3%)
44
Contact coverage of fortifiable* wheat flour
among WRA
0
10
20
30
40
50
60
70
80
90
100
Senegal Rajasthan, India Abidjan, Côted'Ivoire
% All
Poor
Non-poor
*Defined as commercially produced
45
Dietary contribution (% daily RNI) for iron met
by consumption of fortified wheat flour (WRA)
0
10
20
30
40
50
60
70
80
90
100
Senegal Rajasthan, India Abidjan, Côted'Ivoire
% All
Poor
Non-poor
Blue lines represented expected contribution following recommended fortification levels set by WHO
46
In Senegal, 57% of children 6 to 23 m of age
consume fortified wheat flour at least once
per week
% RNI estimated for all children who reported consuming wheat flour at least once per week (57% of sample)
Consume fortifiable wheat
flour at least 1/week:
• 51% of poor
• 67% of non-poor
Mean (21.6%)
Median (13.6%)
47
Contact coverage of iodized salt* by
households is moderate to high in all surveys
to date, but varies considerably by country
0
10
20
30
40
50
60
70
80
90
100
Rajasthan,India
Telangana,India
India(national)
Abidjan,Côte d'Ivoire
Bangladesh Ghana Senegal
%
All Poor Non-poor
*Reported as iodized
48
Utilization of salt that meets the standard*
however, is highly variable by country and
population group and very low in some contexts
0
10
20
30
40
50
60
70
80
90
100
Rajasthan,India
Telangana,India
India(national)
Abidjan,Côte d'Ivoire
Bangladesh Ghana Senegal
%
All Poor Non-poor
*Defined according to UNICEF/WHO standard of ≥ 15 ppm; except Abidjan data reported at country standard of ≥ 30 ppm
49
Hot off the press from Nigeria: Contact
coverage of fortifiable foods*
0
10
20
30
40
50
60
70
80
90
100
Oil Wheat flour Maize flour Salt Sugar
Kano State
Lagos State
*Preliminary results of recently completed survey. Fortifiable defined as commercially produced.
Includes all those mandated for fortification in Nigeria.
%
50
Hot off the press from Uganda: Contact
coverage of fortifiable foods*
0
10
20
30
40
50
60
70
80
90
100
Oil Wheat flour Maize flour Salt
Urban
Rural
National
*Preliminary results of recently completed survey. Fortifiable defined as commercially produced. Includes
all those mandated for fortification in Uganda.
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Limitations and areas of on-going work
A true measure of “effective coverage” requires an estimate of the
dietary gap in micronutrient intake that we wish to address with
fortification
– Our dietary intake method does not provide full dietary intake
estimate – exploring options to include this in future surveys
– E.g., Senegal – very high oil intakes are consistent with
previous surveys, but whether high vit A intake from oil is of
concern would depend on other sources in the diet
Our abbreviated dietary assessment estimate adapted from validated
methodologies, but as yet, not validated
– Recently completed survey in South Africa included 24-hr recall on
sub-set of population for comparison with our abbreviated tool
Results of these surveys contribute to evidence base, but ultimate
utility depends on their utilization for program improvement
– On-going (and planned) workshops and dissemination in country
to present and discuss and their implications for program
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Conclusions and implications
• Critical to know dietary patterns in the population to estimate
potential for impact, ensure fortification levels are set
appropriately and adjusted over time as dietary patterns change
• Investment in regular monitoring and surveillance and continual
feedback for program improvement, including enforcement to
standards is critical for impact and safety
• Substantial contribution to dietary intake of key
micronutrients from fortification programs:
• In some contexts, reaching rural, poor, children 6 to 23
mo of age, but considerable variation within and among
countries
• In all countries, quality control and enforcement requires
substantial improvement to identify and address under- and
over-fortification
Thank You
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