FFI Newsletter June 2013
Fortification Maps Now Include Three Cereal Grains
Wheat, maize, and rice all highlighted
FFI is expanding our focus beyond the historical emphasis on wheat flour fortification to include fortification of maize flour and whole kernel rice. One of our first steps is updating content on our website. These changes will cause the web pages to take a little longer to load the first time you view them, but it will get faster every time you use the site.
Please note changes to the world map on the Global Progress page and the individual country maps on the country profiles. Countries shaded blue formerly meant that the country had legislation to mandate wheat flour fortification. Now the countries shaded blue on that map have legislation to fortify one or more cereal grain products – wheat flour, maize flour, or whole kernel rice. Here are five ways to find which product(s) are fortified in each country:
- Move your mouse over the country on the world map on the Global Progress page. A box will pop up with more information.
- Below the world map on the Global Progress page, the countries with mandates are listed alphabetically. Click on the country name, and the country profile will provide details. Only the countries with mandates are listed there.
- All countries are listed on the main Country Profile page. Click the country name, and a table in the country profile notes the legislative status of each grain product.
- See the table at the bottom of each Regional Activity page. Click on the headings in the table to sort the information by wheat, maize, or rice. Click on the country name to see the complete country profile.
- Send an e-mail to firstname.lastname@example.org to request data in an Excel spreadsheet.
Also, three new maps are available as images to download on the Global Progress page. The map for maize is at right as an example. Each map shows the countries where at least 75 grams per capita per day of the specified grain are available for human consumption, according to the Food and Agriculture Organization of the United Nations. The map also indicates which countries have legal mandates to fortify that grain product; the legislation status does not reflect grain availability.
We used 75 grams per capita per day as a minimum level for grain availability in the maps due to a note in the World Health Organization Recommendations on Wheat and Maize Flour Fortification. Footnote two in the table says that “estimated per capita consumption of less than 75 grams per day does not allow for addition of sufficient level of fortificant to cover micronutrient needs for women of childbearing age.”
We rely on our partners to provide accurate information for these maps. If you have information to correct or complete the data on a country profile, please send it to email@example.com.
Country Updates: Pakistan, Macedonia, Tanzania
Pakistan: The Punjab province is going to make wheat flour fortification mandatory, according to a news story. The Global Alliance for Improved Nutrition (GAIN) is one of the partners working in Pakistan. See the country information.
Macedonia: In April, FFI and UNICEF collaborated on two events to facilitate multi-sector discussions about food quality and safety with an emphasis on flour and fortified flour. With the support of the Institute of Public Health (IPH), the Food and Veterinary Agency, and the Association of Mills in Macedonia, a 3-day training program targeting food inspectors was held. The event focused on best practices for monitoring quality and safety of flour and included a demonstration of flour fortification at Zito Vardar Mill in Veles. The practical portion of the training was a highlight for many participants. The assessment of critical control points and applying a revised comprehensive inspection manual were particularly useful. Afterward, a one-day advocacy seminar was held to engage stakeholders in conversations about flour fortification in terms of the public health need and potential impact. At the end of the event, participants took part in a taste test of fortified and unfortified baked goods such as bread, rolls and croissants. No participant could tell the difference between products made with fortified or unfortified flours.
Tanzania: The food fortification program was launched in Tanzania on 15-16 May. A local news article said that fortification there will help reduce “health hazards grossly affecting stable growth of the children and the entire population.” Also see photos on the GAIN website.
Key Fortification Messages for Advocacy Conversations
Several recent publications have drawn new attention to the critical role of vitamins and minerals in health status. Two examples are The Lancet series on maternal and child nutrition and the World Health Organization’s Essential Nutrition Actions: improving maternal, newborn, infant and young child health and nutrition. In addition, maternal health is a component in the on-going emphasis on the first 1,000 days of life because the 1,000-day window begins with conception when the mother’s health is critical for the infant’s well-being.
This global attention is an opportunity for fortification champions to discuss the value of fortifying cereal grains. Here are three points to make during these conversations:
- Nutritional anemia can be caused by deficiencies in one or more of these nutrients: iron, folic acid, vitamin B12, vitamin A, zinc, copper, vitamin B2 (riboflavin), vitamin B6 (pyridoxal), vitamin C, and vitamin E [Nutritional Anemia by Sight and Life Press, 2007].
- Fortifying cereal grains such as wheat flour, maize flour, and whole grain rice with any of these nutrients can be expected to increase the nutrient intake of the population.
- A meta-analysis of eight population-based studies showed an overall 46% reduction in the incidence of neural tube birth defects such as spina bifida due to foods being fortified with folic acid.
For additional information, see the Why Fortify section of the FFI website.
New Print, Video, and Graphic Resources Available
Several new print, video, and graphic resources provide information that may be helpful for your advocacy efforts.
Rice fortification: its potential for improving micronutrient intake and steps required for implementation at scale
These authors examined the untapped opportunity for rice fortification and concluded that starting rice fortification is easier in countries with a large, centralized rice milling industry. Experiences with salt iodization and wheat flour fortification support their additional conclusion that a coalition from the public and private sectors is needed to support the use of fortified rice and overcome barriers to its implementation.
Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data
Results show that children's and women's haemoglobin status improved in some regions, but further improvement is needed in some regions, particularly south Asia and central and west Africa. See the comment piece that discusses possible interventions to prevent anaemia, including fortification.
Two Decades of Food Fortification in Nigeria: A Situational Analysis
Emory University graduate student Adeniyi Kayode Busari reviewed food fortification practices in Nigeria in partial fulfillment for his master's degree in public health. His conclusion is that program challenges need to be addressed to enhance fortification's benefits and reduce micronutrient deficiencies in the country.
Folic acid fortification of wheat flour: A cost-effective public health intervention to prevent birth defects in Europe
Despite the well-documented benefits of fortification and new evidence that provides a better understanding of purported risks associated with folic acid, European countries have yet to embrace this public health initiative. Viable primary-prevention strategies are needed given that an estimated 4500 NTDs occur in the 27 countries of the European Union annually, of which 72% end in terminations.
Flour Fortification – a possible strategy for the prevention of neural tube defects in Germany?
For a master’s thesis, Verena Kolb, a student at the Management Center Innsbruck, explored possible reasons for the reluctance to mandate wheat flour fortification in Europe. The emphasis of her work was in Germany which has one of the highest prevalence rates of neural tube defects in Europe. After conducting both a literature review and expert interviews, her conclusion is that mandatory fortification in Germany is highly unlikely. Request a copy of the full thesis by sending an e-mail to firstname.lastname@example.org.
World Health Statistics 2013
The World Health Organization’s annual compilation of health-related data for its 194 Member States. This year it includes summaries on reducing the gaps between the world’s most-advantaged and least-advantaged countries and on current trends in official development assistance for health.
The State of the World’s Children 2013: Children with Disabilities
Annual UNICEF report features beautiful photos and videos, along with global statistics on children with disabilities and their communities. The report notes that nutrition plays a role in preventing specific conditions or preventing health conditions that lead to physical, sensory, or intellectual disabilities.
With the help of Emory University students and colleagues from partnering organizations, we have developed a set of brief documents to summarize fortification topics. They include:
- Guidelines for setting standards for nutrients to add to flour if the nutrients are not listed in global guidelines
- The benefits of fortifying flour with folic acid to prevent neural tube defects
- Effectiveness of fortifying flour with iron to prevent iron deficiency
- Food fortification and anemia
Flour Millers Tool Kit
The recently updated Flour Millers Tool Kit has been revised to include instructions on how to modify the iron spot test if sodium iron EDTA is being used as the iron compound in flour fortification. See section five on assuring quality control.
First 1000 Days
World Vision video is a clever twist on the story of Peter Pan.
Time for mandatory folic acid fortification to go truly global?
An interview with Klaus Kraemer, Sight and Life Director, about fortifying flour with folic acid to prevent neural tube birth defects.
The Global Hidden Hunger Indices and Maps: An Advocacy Tool for Action
This online tool offers several maps and charts for downloading to illustrate the global problem of hidden hunger. The indices and maps provide data on multiple vitamin and mineral deficiencies.
Platform for Worldwide Exchange of Knowledge About Hidden Hunger
Participants of the International Congress Hidden Hunger 2013 in Stuttgart, Germany, called for a better communication between scientists, policy makers, politicians, NGOs, and local field workers to improve knowledge about hidden hunger as well as to ensure better domestic and cross-border cooperation world-wide. As a result, a new website nutri-matrix.org offers a communication platform for exchange of study results, experiences, observations, reflections and ideas related to the subject of hidden hunger. It is designed to offer an overview of research projects, funding offers and requests as well as collaboration and research requests from all over the world.