addressing micronutrient deficiency in food based safety nets
TRANSCRIPT
Addressing micronutrient deficiency in food based safety nets:
Is fortification the answer?
Patrick Webb
Dean for Academic AffairsFriedman School of Nutrition Science and Policy
Tufts University
Oct 2, 2008
The effects of Rising Food Prices on Poverty in MexicoJorge Valero-Gil and Magali Valero (Sept 2008)
After considering the positive effects of public policiesannounced in 2008, such as reduced taxes and tariffs on food products and greater subsidies to the extremely poor, the extreme poverty rate measured through consumptionincreases from 10.6% to 16%.
Policies oriented towards relieving the food price pressure on the Mexican poor should aim at lowering the prices of eggs, vegetable oil, milk, and chicken.
Disease Nutrient Location Year(s) Deficiency (Group affected)
Scurvy Vitamin C Sudan 1984, 1991 Kenya 1994/95Afghanistan 2000-2002
Beri Beri Thiamin Mauritania 1974Thailand 1985
X.Thalmia Vitamin A Sudan 1984-1987
Pellagra Niacin Malawi 1989-1995Angola 2002-2005
-.5-.2
50
.25
.5
Jan96 Jul96 Jan97 Jul97 crisis Jan98 Jul98 Jan99 Jul99 Jan00 Jul00 Jan01Date
Chan
ge in
Z-S
core
Rel
ativ
e to
Base
Per
iod
Conditional Time Path of Child WAZ
Conclusion: No rise in child malnutrition?
Source: Block, Kiess, Webb et. al. 2004
-1-.7
5-.5
-.25
0.2
5.5
Jul96 Jan97 Jul97 crisis Jan98 Jul98 Jan99 Jul99 Jan00 Jul00 Jan01Date
Cha
nge
Rel
ativ
e to
Bas
e Pe
riod
(g/d
L)
95% confidence intervals
Conditional Time Path of Child Hemoglobin Concentration
In fact: Mean child Hb fell from 11.0 to 10.45Iron-deficiency anemia rose from 52% to 70%
Source: Block, Kiess, Webb et. al. 2004
Impact of currency devaluation in Senegal and Congo. Fouéré et. al. 2000. Public Health Nutr.
Depletion of fat and vegetable content of meals; cutting one daily meal.
Impact of maize price hike in Zambia: Gitau et. al. 2005. Public Health Nutr.
Decreased maternal plasma vitamin A during pregnancy (P = 0.028)and vitamin E postpartum (P = 0.042); no significant effects on maternal weight or infant weight.
Top emergency Food/Fuelfood aid recipients priority lists*
2007 2008
Ethiopia LiberiaSudan BurundiN. Korea EthiopiaUganda HaitiOPT MozambiqueKenya NigerAfghanistan Sierra LeoneZimbabwe ZambiaSomalia TajikistanDR Congo Burkina Faso
*Sources: FFP; HLTF; WHO; UNICEF; FAP; IFAD; WFP
Food/Fuel Anemia Vit. A def. Iodine def.priority lists* (<5s %) (<6s %) (∑ goiter rate)
Liberia 69 38 18Burundi 82 44 42Ethiopia 85 30 23Haiti 66 32 12Mozambique 80 26 17Niger 57 41 20Sierra Leone 86 47 16Zambia 63 66 25Tajikistan 45 18 28Burkina Faso 83 46 29
*Sources: FFP; HLTF; WHO; UNICEF; FAP; IFAD; WFP
Retail processed
foods
Populationaffected bydeficiencies
Staple foodfortification
Supplementation
RUTFsHome
fortificants
Targeted supplementary
foodfortification??
FortifiedFood aid
More Severity of deficiencies Less
More
Less
Staple foodfortification
Nigeria has mandated the fortification of three staple foods with vitamin A: vegetable oil, wheat and maize flours.
South Africa has started fortifying flour and other foods.
Cote d’Ivoire, Morocco, Yemen and Bangladesh were among the first countries to start voluntary fortification of veg. oil with vitamin A
National oil fortification programs have now also started in Mali and Burkina Faso as well.
170 mg maxSodium
76 μg*Iodine
47 μg*Selenium
3 mg*Copper
20 mg*Zinc
0.35 mg maxIron
73 mg*Magnesium
1173 mg*Potassium
0.1 mgBiotin
10 mg*Niacin
RUTFs
Homefortificants
Fortified Flours 10%
Fortified Blended Foods 6%
Cereals 73%
Pulses 7%Misc 1% Fortified Oil 4% Fortified Misc 0.36%
FortifiedFood aid
0.018.325.7Wild Foods0.024.043.5Vegetables0.613.516.1Fruits
65.36.295.1Oil46.26.992.2Sugar
0.03.44.4Eggs0.016.737.5Milk0.360.268.2Meat
65.729.164.6Pulses78.698.999.7Cereals
Source was food aid?*(%)
At least 3 days?(%)
At all(%)Foods/Groups
Consumed
Darfur 2006(N=2,090)
Frequency and Source of Foods Consumed
Source: Coates et. al (June 2007)
Food aid
Afghanistan: Wheat flour fortification
Staple foodfortification
2004: 37% <5s and 25% mothers anaemic
16 small-scale chakki mills used for start-up
Manual mixer needed to ‘dilute’ premix
Afghanistan: Constraints
While 70% accepted, 30% did not.Preference for imported white flour. No commercial incentive for millers.Assessed output capacity never reached.
Staple foodfortification
Conclusions:
1. Small-scale fortification = intensive, sustained interaction with many producers.
2. Quality control limited, but key to acceptability3. Acceptability requires social marketing
Southern Africa 2002/03: Maize meal
Crisis affecting 15 millions peopleGMO ‘crisis’ (related to trade rather than health)HIV prevalence
Opportunity fortify, since milling alreadyAgreements with 5 large roller mills in regionc. 150,000 MT meal fortified and distributed
Staple food/food aid
fortification
Southern Africa: successes
Kept mills openMillers willing to take husk to sell (animal feed market)Costs subsidized (premix, bagging, spare parts)Reasons well-understood (HIV rationale; GMO)Situation desperate (no alternative sources)
Staple foodfortification
North Korea: Fortified Blended Foods
6 million people on food aid3 million children (6m to 16y)300,000 pregnant/lactating mothers
Targeted supplementary
foodfortification
1998 national nutrition survey showed:62% stunting16% wastingVitamin A deficiency and anemia levels serious
Targeted supplementary
foodfortification
Primary and Boarding schools, Kindergartens
Fortified Biscuits
Pregnant and nursing womenFortified Noodles
Nurseries, Baby Homes, Children Centres, Pregnant and nursing women
Corn Soy Milk Blend (CSM)
Nurseries, Baby homes, Children Centres, Pregnant and nursing women
Cereal Milk Blend (CMB)
Baby homes, Children Centres, Paediatric hospitals/wards
Rice Milk Blend (RMB)
BeneficiariesCommodity
North Korea:
Power supply!Poor maintenance of unfamiliar technology/partsLimited milling capacity (to supply key input to FBFs)Uneven supply of inputs (for blended products)Lack transportation for finished products
But HUGE success60,000 MT FBF output by 2004 Dramatic improvements in nutrition 1998-2004
ChallengesChallenges
No coherence among fortification activities (Aceh)Some household resistance (Kabul) Some national resistance (Lebanon) – laws, politicsField-friendly assessment tools lackingIndustrial capacity/technology often limited
Costs not insignificant:Cash required…not just foodUnrestricted resources (earmarking)Local purchases of food (contracts, quality)Millers’ profits not assured without demandCosts higher when problem not universal
Addressing micronutrient deficiency in food based safety nets: Is fortification the answer?
No, its not ‘the’ answer
But it can be a partial response of real value:
Engaging dialogue on nutrition (hidden, long-term effects)Demonstrating public-private engagementBuilds national capacity, not merely ‘consumption’ response
Yes, worth supporting in some countries, for some commodities, as basis for long-term strategy—typically as part of a package of interventions.