Use Nutrition Data to Plan Fortification Strategy

Nutritional anemia and neural tube defects are the two most common health concerns addressed by fortification. Data from your country on these two issues will help determine if fortification could be a helpful strategy.

Nutritional Anemia

Anemia can be caused by many factors, including deficiencies in iron, folic acid, zinc, riboflavin, vitamin A, and vitamin B12. Fortifying grains with these vitamins and minerals can help prevent anemia caused by nutritional deficiencies.

If available, compare anemia data for men and women in your country. Women in their childbearing years are more prone to anemia than men. If anemia among women ages 15 to 49 is higher than anemia among men in the same age group, then the anemia is most likely a result of iron deficiency. In that case, fortifying with iron will most likely make people less prone to iron deficiency anemia.

If men and women in the 15-49 age group have similar anemia statistics, then other factors such as other nutritional deficiencies or malaria or parasitic infections are probably causing the anemia. Other interventions will be necessary to reduce anemia in these populations.

Young children are especially vulnerable to iron deficiency between the ages of 6 and 24 months. Other health interventions may be needed for this age group.

For more information:

Look for anemia results on Demographic and Health Surveys.

See the World Health Organization (WHO) Vitamin and Mineral Nutrition Information System (VMNIS) Database on Anemia.

Select your country from our country profiles for selected anemia data.

When reviewing anemia data, refer to this classification of anemia as a public health problem from WHO:

≤4.9% No problem
5.0-19.9 Mild problem
20.0-39.9 Moderate problem

Severe problem

Neural Tube Defects

All people need folic acid (vitamin B9) to produce and maintain healthy cells and avoid a certain type of anemia. Women who may become pregnant are encouraged to consume 400 micrograms of folic acid daily to help prevent birth defects of the brain and spine, also called neural tube defects (NTDs).

Countries that fortify flour with folic acid generally reduce the NTD prevalence to less than 10 per 10,000 births. When looking for NTD data, consider whether the results include loss of pregnancy or termination of pregnancy. NTD prevalence for only live births will misrepresent the NTD prevalence in all pregnancies.

Three types of birth defects are NTDs: spina bifida, anencephaly, and cephalocele. The International Classification of Diseases (ICD)  codes for those are:

  • Anencephaly - ICD11 LA00.0-LA00.Z
  • Cephalocele - ICD11 LA01
  • Spina bifida - ICD11 LA02.0-LA02.Z

Hospital systems may be able to provide data on birth defects based on those codes.

For more information:

Some countries have entries in the Annual Report from the International Clearinghouse for Birth Defects Surveillance and Research.

For 21 countries in Europe, see the EUROCAT European Surveillance of Congenital Anomalies.

Country profiles on our website list NTDs per 10,000 births based on the above resources where available or estimates from other research.

Vitamin A Deficiency

Vitamin A deficiency diminishes the ability to fight infections, and it is the leading cause of childhood blindness. Vitamin A deficiency may also lead to anemia. Vitamin A can be added to wheat or maize flour, but it shortens the flour’s shelf life and increases the cost of flour fortification. Consequently vitamin A is more frequently added to rice, oils, margarine, or sugar.

For data on vitamin A deficiency, see WHO's Global Prevalence of Vitamin A Deficiency in Populations at Risk 1995-2005

Zinc Deficiency

Zinc deficiency is one cause of childhood stunting, and zinc deficiency is also linked with diarrhoeal diseases, pneumonia, malaria.

WHO estimates that zinc deficiency affects about one-third of the world's population, with estimates ranging from 4% to 73% across subregions. Worldwide, zinc deficiency is responsible for approximately 16% of lower respiratory tract infections, 18% of malaria and 10% of diarrhoeal disease. About 1.4% of deaths worldwide were attributable to zinc deficiency.

See your country profile for the percent of the populaton at risk of inadequate zinc intake.


For guidance on determining a country's nutritional needs, contact Helena Pachon, FFI Senior Nutrition Scientist, at

Micronutrient Survey Toolkit

Resources to help assess and monitor vitamin and mineral deficiencies are available in a Micronutrient Survey Toolkit. Sample topics covered include a laboratory overview, data and sample collection procedures, supplies needed, and hiring personnel. Each module includes tools that can be used as needed and examples of the tools used in different contexts.