An important part of monitoring is determining whether fortified flour is being used. Fortification can only have a health impact if foods made with fortified flour are consumed.
For this monitoring component, questions related to consumption of fortified flour products can be included in household surveys which countries conduct for other purposes. Existing data collection tools that could be used include:
- Cross-sectional community surveys
- Cross-sectional household surveys
- School surveys or censuses
- Cluster surveys
- Sentinel site monitoring (see FORTIMAS in English and Française and Português)
- Lot quality assurance sampling (LQAS)
- Market surveys
For example, the South African National Health and Nutrition Examination Survey (SANHANES-1) identified improvement in iron and vitamin A status in women of reproductive age as well as children. This improvement may reflect the impact of food fortification, and progress can be followed in future surveys.
Such surveys identify whether the population being assessed has access to fortified flour and foods made with fortified flour. Household surveys that collect information on food consumption or expenditures also indicate whether people consume enough of the fortified product to meet the program’s nutritional goals.
If fortified foods are not available in a large proportion of households and non-fortified foods are frequently consumed, survey questions can help determine why fortified foods are not being purchased. Results of household monitoring can be used to revise a fortification program and improve its effectiveness.
FORTIMAS (Fortification Monitoring and Surveillance) is an approach for tracking the population coverage and impact of a flour fortification program. It is available English and Française and Português.