Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Jan 29;12(2):354.
doi: 10.3390/nu12020354.

The Unfinished Agenda for Food Fortification in Low- and Middle-Income Countries: Quantifying Progress, Gaps and Potential Opportunities

Penjani Mkambula  1 , Mduduzi N N Mbuya  1 , Laura A Rowe  2 , Mawuli Sablah  3 , Valerie M Friesen  1 , Manpreet Chadha  4 , Akoto K Osei  5 , Corinne Ringholz  6 , Florencia C Vasta  1 , Jonathan Gorstein  7
Affiliations
Review

The Unfinished Agenda for Food Fortification in Low- and Middle-Income Countries: Quantifying Progress, Gaps and Potential Opportunities

Penjani Mkambula et al. Nutrients. .

Abstract

Large-scale food fortification (LSFF) is a cost-effective intervention that is widely implemented, but there is scope to further increase its potential. To identify gaps and opportunities, we first accessed the Global Fortification Data Exchange (GFDx) to identify countries that could benefit from new fortification programs. Second, we aggregated Fortification Assessment Coverage Toolkit (FACT) survey data from 16 countries to ascertain LSFF coverage and gaps therein. Third, we extended our narrative review to assess current innovations. We identified 84 countries as good candidates for new LSFF programs. FACT data revealed that the potential of oil/ghee and salt fortification is not being met due mainly to low coverage of adequately fortified foods (quality). Wheat, rice and maize flour fortification have similar quality issues combined with lower coverage of the fortifiable food at population-level (< 50%). A four-pronged strategy is needed to meet the unfinished agenda: first, establish new LSFF programs where warranted; second, systems innovations informed by implementation research to address coverage and quality gaps; third, advocacy to form new partnerships and resources, particularly with the private sector; and finally, exploration of new fortificants and vehicles (e.g. bouillon cubes; salt fortified with multiple nutrients) and other innovations that can address existing challenges.

Keywords: fortification; large- scale food fortification; low- and middle-income countries; micronutrient deficiency; micronutrients.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest. All authors are employed by organizations which receive funding from several donors to support food fortification programs in many countries. Mawuli Sablah is a UNICEF staff member and the opinions and statements in this article are those of the author and may not reflect official UNICEF policies.

Figures

Figure 1
Figure 1
Criteria the selection of Low- middle-, and upper-middle income countries that have potential to benefit from new LSFF programs or making voluntary programs mandatory.
Figure 2
Figure 2
Low-income, middle-income, and upper-middle income countries that do not have mandatory programs in place and have the potential to benefit from new LSFF programs or making voluntary programs mandatory.
Figure 3
Figure 3
Aggregated data on fortification coverage and corresponding bottlenecks/gaps across multiple surveys.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Pinstrup-Andersen P. Nutrition-sensitive food systems: From rhetoric to action. Lancet. 2013;382:375–376. doi: 10.1016/S0140-6736(13)61053-3. - DOI - PubMed
    1. Bailey R.L., West K.P., Jr., Black R.E. The epidemiology of global micronutrient deficiencies. Ann. Nutr. Metab. 2015;66(Suppl. 2):22–33. doi: 10.1159/000371618. - DOI - PubMed
    1. Bhutta Z.A., Das J.K., Rizvi A., Gaffey M.F., Walker N., Horton S., Webb P., Lartey A., Black R.E., The Lancet Nutrition Interventions Review Group et al. Evidence-based interventions for improvement of maternal and child nutrition: What can be done and at what cost? Lancet. 2013;382:452–477. doi: 10.1016/S0140-6736(13)60996-4. - DOI - PubMed
    1. Horton S. The economics of food fortification. J. Nutr. 2006;136:1068–1071. doi: 10.1093/jn/136.4.1068. - DOI - PubMed
    1. Beal T., Massiot E., Arsenault J.E., Smith M.R., Hijmans R.J. Global trends in dietary micronutrient supplies and estimated prevalence of inadequate intakes. PLoS ONE. 2017;12:e0175554. doi: 10.1371/journal.pone.0175554. - DOI - PMC - PubMed

LinkOut - more resources