FFI Newsletter June 2016
Mozambique to Fortify Five Foods
Mozambique published legislation on 18 April 2016 to fortify five food vehicles as part of its multi-sector plan to reduce chronic undernutrition. The mandate calls for fortification of wheat flour, corn meal, cooking oil, sugar, and salt.
The law gives industries six months to meet the new requirements. When fully implemented, wheat flour and corn meal will be fortified with iron, zinc, folic acid, and vitamin B12. Fortifying flour with vitamin A, thiamine, riboflavin, niacin, and vitamin B6 is optional. Cooking oil and sugar will be fortified with vitamin A. Salt will be fortified with iodine.
Mozambique has 13 industrial roller maize mills with a capacity of at least 60 metric tons a day, 13 medium hammer mills with average daily production of 20 metric tons a day, and 10 industrial wheat mills. Small-scale mills which provide services for family consumption or do not package their products for the market are exempt from the fortification legislation.
During a workshop earlier in June, Mozambique leaders learned to use FORTIMAS (Fortification Monitoring and Surveillance) as a monitoring tool.
Nokuthula Lucas, Marla Amaro, and Eduarda Mungoi
FORTIMAS analyzes trends over time using existing data to determine if fortification is being implemented as expected. It can also identify whether health trends are improving as expected. FORTIMAS is available in English and French. (FORTIMAS: Une Approche pour le Suivi de
la Couverture et de l’Impact d’un Programme d’Enrichissement de la Farine).
The Mozambique legislation is a significant milestone after years of collaborative efforts by fortification advocates. A multi-sector National Committee for Food Fortification was established in March 2012. National leaders have included people from the Ministry of Industry and Commerce, Ministry of Finance, Ministry of Agriculture as well as the Ministry of Health. International partners have included the Global Alliance for Improved Nutrition (GAIN), Helen Keller International (HKI), Irish Aid, the United Nations Children’s Fund (UNICEF), the Food and Agriculture Organization of the United Nations (FAO), World Food Program, and Population Services International.
Representatives from Mozambique have attended multiple training events led by Smarter Futures, a public-private-civic partnership working to improve health in Africa through fortification of wheat and maize flour. Smarter Futures partners include HKI, the International Federation for Spina Bifida and Hydrocephalus, the Food Fortification Initiative, the Ministry of Foreign Affairs of the Netherlands, and AzkoNobel. The Smarter Futures partnership also developed FORTIMAS then provided the French translation.
With Mozambique, 86 countries have legislation to fortify at least one industrially milled cereal grain. The maps on our website are now color-coded to reflect the grains required in the legislation. For more details on the maps or any data in the country profiles, contact us at firstname.lastname@example.org.
What Nutrition Action Are You Taking This Decade?
In April the United Nations General Assembly declared 2016-2025 the “Decade of Action on Nutrition.” We asked you for actions that could be taken to improve nutrition through grain fortification. Here are some of your responses. Follow #NutritionDecade on Facebook and Twitter for more ideas.
- Urge policy makers in Egypt to restart the program to fortify flour. This program was considered successful several years ago, but it has since stopped. A recent World Grain article reported that the government of Egypt has received 4.7 million tons of wheat since the harvest began in mid April. Fortifying the flour made from this wheat has tremendous potential to improve the population's nutrition.
- Exempt premix from import fees. For example, Quentin Johnson, our technical coordinator, traveled to Kosovo earlier this year and found that the value added tax and import duties added 29% to the cost of premix. Eliminating these taxes would provide financial relief to millers who are already making a considerable investment in fortification.
- Use proven technologies in rice fortification. Colombia has achieved moderate population coverage with fortified rice, but the effectiveness of the technology being used is unknown. See this paper for lessons learned. See a presentation about the paper. Dinámicas de los sectores del arroz para lograr su fortificación: La experiencia de Colombia y sus lecciones.
- Measure red blood cell folate to determine the need to fortify with folic acid. The World Health Organization recommends a red blood folate cell concentration above 400 nanogram/millileter (ng/mL) in women of reproductive age to prevent neural tube birth defects (NTDs). At these levels, the NTD birth prevalence would be 0.5 to 0.6 per 1000. Several countries have NTD prevalence as high as 5 to 10 per 1000.
- Form multi-sector national alliances to advocate and plan for fortification or to oversee monitoring of existing programs. Pakistan has created four Provincial Fortification Alliances as chapters of its National Fortification Alliance.
Folic Acid Makes News
United States - The US Food and Drug Administration announced in April that it would allow folic acid to be added to corn masa flour. This type of flour is a specially treated maize product used in foods commonly consumed by Hispanics. It was not included in the 1996 US action which required most enriched grain products to contain folic acid.
Birth defect surveillance since 1996 showed that the prevalence of neural tube defects (NTDs) such as spina bifida was 21% higher among Hispanics than non-Hispanics in the US. Allowing folic acid to be added to corn masa flour is meant to lower the NTD birth prevalence among Hispanics which comprise 17% of the US population.
Europe - Not adding fortifying flour with folic acid is like having the polio vaccine and refusing to use it, Sir Nicholas Wald has written. He was the lead author of a randomized controlled trial that provided unquestionable evidence that folic acid would prevent NTDs. The study was published 25 years ago, and in this story Wald shares his thoughts on Europe’s resistance to fortify flour with folic acid.
Global –Spina bifida is “significantly more common” in regions without mandatory policies to add folic acid to the food supply, according to a systematic review and meta-analysis published in January. The authors noted that fortification practices lag behind the evidence, especially in Europe and Asia.
Another study of the number of spina bifida and anencephaly cases that could be prevented by fortifying flour with folic acid is scheduled to be published soon. A poster on this study will be presented at The Teratology Society Annual Meeting in the United States 25-29 June 2016. The author will address questions about the poster between 5:30 and 7:30 p.m. on Tuesday, 28 June 2016. It is abstract number P36, and it will be presented during poster session two. We’ll send more information about the study when it is published.
Regional QA/QC Workshop in Uganda
A regional Quality Assurance and Quality Control workshop for wheat and maize flour fortification was held 22-26 May in Kampala, Uganda. The event included 85 participants from eight countries (Uganda, Kenya, Tanzania, Mozambique, South Sudan, Ethiopia, Burundi, and Rwanda). Participants were from the industry and public sectors together with masters and doctorate students from seven universities.
Sponsors included Smarter Futures, Universiteit Gent, Makerere Univesity, VLIR-UOS, and the Global Alliance for Improved Nutrition (GAIN). A complete meeting report is being developed.