FFI Newsletter: September 2015
Photo: Julio Pantoja/World Bank
Burundi to Fortify Three Types of Flour Plus Edible Oil
Burundi is the 84th country to require fortification of cereal grain products. The mandate applies to imported and domestically produced wheat, maize and cassava flour as well as oil. Salt is already fortified with iodine based on a previous presidential decree.
The East African country of 10 million people has three industrial wheat flour producers and four maize flour producers. Though Burundi does not have an industrial cassava flour mill currently, including cassava flour in the fortification mandate was a strategic move for the future. Cassava is commonly consumed, and the country is seeking investors to build a large-scale cassava flour mill.
Burundi leaders declared that the blend of vitamins and minerals (called premix) used in fortification will be exempt from Value Added Tax. Since the premix will be imported, this tax relief will reduce the price of fortification for producers.
Wheat and maize flour - and eventually cassava flour - will be fortified with iron, zinc, vitamin A, and the following B vitamins: folic acid, thiamin, riboflavin, niacin, B6 and B12. Edible oils will be fortified with vitamin A. Nutrient levels are based on standards recommended by the East, Central and Southern African Health Community (ECSA), regional experts, and Project Healthy Children.
One advantage to adding these nutrients to staple foods is that people are not required to change their habits; foods they commonly eat will simply be more nutritious. When fully implemented, fortification will reduce consumers’ risk of debilitating anemia from nutritional deficiencies and disabling or fatal neural tube birth defects from insufficient folic acid. With the combination of nutrients Burundi is including, other health benefits will be improved immune function and cognitive development. Economic benefits include enhanced productivity and averted healthcare expenses.
The presidential decree was signed in March 2015, and producers have until March 2016 to comply with the regulation. Burundi will use a Fortification Monitoring Tool, developed in close collaboration with Project Healthy Children, to ensure compliance with the decree. This includes training food inspectors on sampling and testing procedures, reporting results to stakeholders, and making changes as needed based on the results.
Global maps on the FFI website have been updated to include Burundi and are available to download.
Help Us Give Nutritional Anemia a Face
Of all the consequences of vitamin and mineral deficiencies, nutritional anemia is perhaps the hardest to visualize. Neural tube birth defects from insufficient folic acid, cretinism from inadequate iodine intake, and childhood blindness from too little vitamin A are mostly obvious. On the other hand, anemia steals an individual’s strength with significant but less evident outcomes.
Getting stakeholders to take action about this generally invisible health problem can be difficult. Sometimes emergencies such as floods or a measles outbreak demand more attention than nutrition. Or, stakeholders who have never personally experienced anemia do not empathize with the debilitating fatigue it causes.
To help stakeholders understand what it is like to have anemia and inspire them to fortify grains as an intervention, we are in the midst of a “Faces of Anemia” project. With this project and additional recently published material, we offer the following resources to help you advocate for fortifying grains to prevent nutritional anemia.
A set of photos and quotes from people who have had anemia helps explain the consequences. These quotes compare anemia to being a zombie, walking in quicksand, and having jet lag. A short video in Spanish is a testimonial from Helena Pachón, our Senior Nutrition Scientist, who had to drop out of her high school cross country team due to anemia.
The word art at right reflects comments from people who have had anemia. Download the image to use in your print or online publications as well as your social media.
A study published in July showed that countries which fortify wheat flour alone or in combination with maize flour show a 2.4% decrease in anemia each year. Most of these countries followed World Health Organization recommendations for fortifying flour with iron. Download a PowerPoint slide about this study.
A peer-reviewed brief summary about iron-fortification programs and iron status revealed three conditions for success:
Programs are well implemented and monitored
Coverage and consumption are optimized
Iron compounds are added at recommended concentrations
Download a PowerPoint slide about this summary
The World Health Organization’s “Global Prevalence of Anemia in 2011” published earlier this year estimates that 42% of anemia in children, 49% of anemia in non-pregnant women of child-bearing age, and 50% of anemia in pregnant women ages 15-49 years is related to iron deficiency. That translates to:
114.7 million children
243.2 million non-pregnant women of child-bearing age and
16.2 million pregnant women with anemia.
To illustrate the magnitude of the problem, we looked at the 243,187,000 non-pregnant women of child-bearing age with anemia related to iron deficiency. Assume each woman is 1.65 meters tall (5.41 feet). If they stood head to toe, they would be 401,259 kilometers – enough to reach the moon and circle it. Download a PowerPoint slide with this illustration.
The above information is combined in a 2.5-minute video titled “Circling the Moon.”
The Faces of Anemia page of our website serves as a hub of information for this material. It includes a link to things you can do to prevent nutritional anemia.
The current project focuses on reduced productivity from anemia. Another significant consequence of iron deficiency in children is undeveloped cognitive ability. That loss is never regained and is associated with a 2.5% drop in wages in adulthood. See more in The Economics of Iron Deficiency.
In pregnancy, anemia contributes to 20% of all maternal deaths. In contrast, a new study from Kenya found that correcting maternal iron deficiency resulted in an increased birth weight of 239 grams (8.4 ounces) and no detectable increase in malaria. The study was published in the Journal of the American Medical Association earlier in September.
For more information on fortifying grains to prevent nutritional anemia, contact us at info@ffinetwork.org.
Six Critical Action Areas Identified at Global Summit
Six critical areas of action are needed to ensure that food fortification reaches its maximum potential, according to a statement from the first Global Summit on Food Fortification. The Summit was 9-11 September in Arusha, Tanzania. It drew 450 delegates from 57 countries, including 29 country delegations and fortification partner organizations.
The six critical action areas are:
Modest new investments to build, improve and sustain fortification programs
Major efforts to improve oversight and enforcement of food fortification standards and regulations
More evidence to guide fortification policy and program design
More transparent accountability and global reporting
Continual advocacy with all stakeholders
Continued work of the Summit’s Technical Advisory Group to consolidate recommendations for a way forward
The Summit featured case studies from country successes with fortifying wheat flour, maize flour, rice, edible oil, and salt. The economic benefits and future challenges were outlined. Panel discussions reflected multi-sector stakeholders. See more details about the Summit and the recommendations.
New Resources for Rice Fortification
Fortifying rice with essential vitamins and minerals to improve people’s health continues to evolve as a public health strategy. Through collaborating with partners, two new tools are available:
The Rice Fortification Toolkit is a technical manual from the Global Alliance for Improved Nutrition (GAIN) and PATH. The 58-page document includes an overview of the manufacturing process, information on sourcing fortified kernels, integrating the blender and feeder, choosing equipment, and ensuring quality.
Two rapid assays to detect the presence of fortified rice kernels have been developed. Our industry partners have such tests for laboratory settings, but regulatory and program staff needed a similar test to use in other settings. The modified test that uses the same reagents used for the wheat flour fortification iron spot test was demonstrated in the Solomon Islands in August and at the Global Summit for Food Fortification earlier in September. See documentation and standard operating procedures for these assays.
In addition, Kansas State University in the United States hosted a workshop in August with the long-term goal of building capacity for fortified rice production for USA exports. Fortified rice consumed in the USA is frequently dusted with vitamins and minerals, and the nutrients are removed if rice is washed before cooking. That is acceptable because many residents do not wash rice before cooking. Different technology is needed for the fortified rice exported by the USA however, since the custom in most countries is to wash rice before cooking.
The workshop was a collaborative dialogue between researchers, US government representatives, international agencies, non-profit organizations, and industry leaders. (See photo below.) Scott Montgomery, FFI Director and one of the workshop presenters, said the workshop reflected the multi-sector collaboration evident at the Scaling Up Rice Fortification in Asia workshop. Reports from the Asia workshop held in 2014 have been published by Sight and Life.
To keep up with the developments in rice fortification, join the rice fortification resource platform that is being developed. It will include a database on fortified rice studies, current rice fortification research, list of fortified rice kernel producers, and information on rice fortification activities.
Did You Know?
As childhood mortality from infections decreases, the burden from birth defects is higher. We can only meet global infant mortality targets by reducing birth defects.
Globally the current neural tube defect birth prevalence is 24 per 10,000. With all folic acid interventions, we should aim to reach a birth prevalence of about 6 neural tube defects per 10,000.
See more in a presentation on periconception care during the 7th International Conference on Birth Defects and Disabilities in the Developing World.
Three types of birth defects are classified as neural tube defects: spina bifida, anencephaly, and encephalocele. Most of these can be prevented if women have at least 400 micrograms of folic acid prior to conception and in the early weeks of pregnancy. See information on fortifying grains with folic acid to prevent these birth defects.