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

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 354 ◽  
Author(s):  
Penjani Mkambula ◽  
Mduduzi N. N. Mbuya ◽  
Laura A. Rowe ◽  
Mawuli Sablah ◽  
Valerie M. Friesen ◽  
...  
Keyword(s):  
Data Exchange ◽  
Large Scale ◽  
Population Level ◽  
Cost Effective ◽  
Food Fortification ◽  
Maize Flour ◽  
Fortified Foods ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Coverage

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.

scholarly journals Large-Scale Food Fortification and Biofortification in Low- and Middle-Income Countries: A Review of Programs, Trends, Challenges, and Evidence Gaps

2018 ◽  
Vol 39 (2) ◽  
pp. 315-331 ◽  
Author(s):  
Saskia J. M. Osendarp ◽  
Homero Martinez ◽  
Greg S. Garrett ◽  
Lynnette M. Neufeld ◽  
Luz Maria De-Regil ◽  
...  
Keyword(s):  
Large Scale ◽  
Food System ◽  
Food Fortification ◽  
Micronutrient Deficiencies ◽  
Middle Income ◽  
Middle Income Countries ◽  
Essential Components ◽  
Quality Of Delivery ◽  
And Control ◽  
Low And Middle Income

Background: Food fortification and biofortification are well-established strategies to address micronutrient deficiencies in vulnerable populations. However, the effectiveness of fortification programs is not only determined by the biological efficacy of the fortified foods but also by effective and sustainable implementation, which requires continual monitoring, quality assurance and control, and corrective measures to ensure high compliance. Objective: To provide an overview of efficacy, effectiveness, economics of food fortification and biofortification, and status of and challenges faced by large-scale food fortification programs in low- and middle-income countries (LMIC). Methods: A literature review of PubMed publications in English from 2000 to 2017, as well as gray literature, targeting nongovernmental organizations whose work focuses on this topic, complemented by national reports and a “snowball” process of citation searching. The article describes remaining technical challenges, barriers, and evidence gap and prioritizes recommendations and next steps to further accelerate progress and potential of impact. Results: The review identifies and highlights essential components of successful programs. It also points out issues that determine poor program performance, including lack of adequate monitoring and enforcement and poor compliance with standards by industry. Conclusions: In the last 17 years, large-scale food fortification initiatives have been reaching increasingly larger segments of populations in LMIC. Large-scale food fortification and biofortification should be part of other nutrition-specific and nutrition-sensitive efforts to prevent and control micronutrient deficiencies. There are remaining technical and food system challenges, especially in relation to improving coverage and quality of delivery and measuring progress of national programs.

scholarly journals Examining Heterogeneity of Food Fortification and Biofortification Business Models: Emerging Evidence for a Typology

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1233
Author(s):  
Baqir Lalani ◽  
Rania Hassan ◽  
Ben Bennett
Keyword(s):  
Large Scale ◽  
Business Models ◽  
Food Fortification ◽  
Micronutrient Deficiencies ◽  
Middle Income ◽  
Middle Income Countries ◽  
Comprehensive Literature Review ◽  
Business Conditions ◽  
Staple Foods ◽  
Measurement Of Success

Efforts to address Micronutrient deficiencies (MNDs) in lower-and middle-income countries (LMICs) have been gaining pace in recent years. Commodities such as staple foods (e.g., cereals, roots, and tubers) and condiments (e.g., salt) have been targeted as ‘vehicles’ for fortification and biofortification through numerous projects and initiatives. To date, there have been mixed experiences with delivery and coverage with very little documented on the range of business models applied in different geographies, business conditions and polities and this makes classification and measurement of success and failure difficult. This research aims to address this gap in knowledge through proposing a typology that clarifies similarities (internal heterogeneity) and differences (external heterogeneity) between models and that can allow all types to be defined by the combination of attributes. Building on a comprehensive literature review; NVivo was used to code initiatives from 34 key references (955 cases in total) which have been grouped into 17 categories. Using non-metric multidimensional scaling (NMDS) we find evidence of four business model groupings that typify fortification initiatives: (1) Large-scale private, unregulated, (2) Mixed-Scale, private, unregulated (3) Large-scale, public-private, regulated; and (4) Large-scale, private, regulated. We characterise these four groups with country examples and suggest that this typology can help the discourse around viability of food fortification initiatives.

scholarly journals Enablers and Barriers of Zinc Fortification; Experience from 10 Low- and Middle-Income Countries with Mandatory Large-Scale Food Fortification

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 2051
Author(s):  
Ann Tarini ◽  
Mari S. Manger ◽  
Kenneth H. Brown ◽  
Mduduzi N. N. Mbuya ◽  
Laura A. Rowe ◽  
...  
Keyword(s):  
Zinc Deficiency ◽  
Large Scale ◽  
Public Health Problem ◽  
Child Growth ◽  
World Health ◽  
Food Fortification ◽  
Middle Income ◽  
Middle Income Countries ◽  
Zinc Fortification ◽  
Low And Middle Income

Adequate zinc nutrition is important for child growth, neurodevelopment, immune function, and normal pregnancy outcomes. Seventeen percent of the global population is estimated to be at risk for inadequate zinc intake. However, zinc is not included in the fortification standards of several low- and middle-income countries with mandatory fortification programs, despite data suggesting a zinc deficiency public health problem. To guide policy decisions, we investigated the factors enabling and impeding the inclusion of zinc as a fortificant by conducting in-depth interviews with 17 key informants from 10 countries. Findings revealed the decision to include zinc was influenced by guidance from international development partners and enabled by the assessment of zinc deficiency, mandatory regional food fortification standards which included zinc, the World Health Organization (WHO) guidelines for zinc fortification, and the low cost of zinc compound commonly used. Barriers included the absence of zinc from regional fortification standards, limited available data on the efficacy and effectiveness of zinc fortification, and the absence of national objectives related to the prevention of zinc deficiency. To promote zinc fortification there is a need to put the prevention of zinc deficiency higher on the international nutrition agenda and to promote large-scale food fortification as a key deficiency mitigation strategy.

scholarly journals The Fallacy of Using Administrative Data in Assessing the Effectiveness of Food Fortification. Comment on: “Folic Acid Fortification and Neural Tube Defect Risk: Analysis of the Food Fortification Initiative Dataset. Nutrients 2020, 12, 247”

Nutrients ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1352 ◽  
Author(s):  
Vijaya Kancherla ◽  
Helena Pachón ◽  
Hannah Blencowe ◽  
Homero Martinez ◽  
Godfrey P. Oakley ◽  
...  
Keyword(s):  
Folic Acid ◽  
Neural Tube ◽  
Large Scale ◽  
Population Level ◽  
Cost Effective ◽  
Food Fortification ◽  
Policy Makers ◽  
Folic Acid Fortification ◽  
Many Sources ◽  
Country Specific

Our objective in this comment is to highlight several limitations in an ecological research study that was published in Nutrients by Murphy and Westmark (2020) in January 2020. The study used data from the Food Fortification Initiative (FFI) website, and applying an ecological study design, made an error of “ecologic fallacy” in concluding that “national fortification with folic acid is not associated with a significant decrease in the prevalence of neural tube defects (NTDs) at the population level”. We list study limitations that led to their erroneous conclusions, stemming from incorrect considerations regarding NTD prevalence, the average grain availability for a country, the fortification coverage in a country, the population reach of fortified foods within a country, and the absence of the consideration of fortification type (voluntary vs. mandatory), country-specific policies on elective terminations for NTD-affected pregnancies, stillbirth proportions among those with NTDs, and fortification implementation. FFI data are derived from many sources and intended for fortification advocacy, not for hypothesis testing. The flawed study by Murphy & Westmark (2020) in Nutrients promotes a confusing and incorrect message to stakeholders, misguides policy makers, and hinders progress in global NTD prevention through a cost-effective, safe, and effective intervention: the mandatory large-scale folic acid fortification of staple foods.

scholarly journals Food Fortification: The Advantages, Disadvantages and Lessons from Sight and Life Programs

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1118
Author(s):  
Rebecca Olson ◽  
Breda Gavin-Smith ◽  
Chiara Ferraboschi ◽  
Klaus Kraemer
Keyword(s):  
Large Scale ◽  
Cost Effective ◽  
Economic Benefits ◽  
Cognitive Capacity ◽  
Nutritional Deficiencies ◽  
Food Fortification ◽  
Public And Private ◽  
Middle Income ◽  
Point Of Use ◽  
Public And Private Sector

Deficiencies in one or more micronutrients such as iron, zinc, and vitamin A are widespread in low- and middle-income countries and compromise the physical and cognitive capacity of millions of people. Food fortification is a cost-effective strategy with demonstrated health, economic and social benefits. Despite ongoing debates globally and in some countries regarding the performance and safety of food fortification, the practice offers significant benefits across each of the main vehicles for food fortification (large-scale food fortification, biofortification and point-of-use or home fortification) ranging from reducing the prevalence of nutritional deficiencies and economic benefits to societies and economies. Using Sight and Life’s global and national experiences in implementing food fortification efforts, we demonstrate how different programs in LMICs have successfully addressed challenges with food fortification and in doing so, find that these efforts are most successful when partnerships are formed that include the public and private sector as well as other parties that can provide support in key areas such as advocacy, management, capacity building, implementation and regulatory monitoring.

scholarly journals Achieving Viral Suppression in 90% of People Living With Human Immunodeficiency Virus on Antiretroviral Therapy in Low- and Middle-Income Countries: Progress, Challenges, and Opportunities

2018 ◽  
Vol 66 (10) ◽  
pp. 1487-1491 ◽  
Author(s):  
Jean B Nachega ◽  
Nadia A Sam-Agudu ◽  
Lynne M Mofenson ◽  
Mauro Schechter ◽  
John W Mellors
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Suppression ◽  
Cost Effective ◽  
Term Treatment ◽  
Middle Income ◽  
Middle Income Countries ◽  
Long Term Treatment ◽  
Wide Range ◽  
Immunodeficiency Virus ◽  
Low And Middle Income

Abstract Although significant progress has been made, the latest data from low- and middle-income countries show substantial gaps in reaching the third “90%” (viral suppression) of the UNAIDS 90-90-90 goals, especially among vulnerable and key populations. This article discusses critical gaps and promising, evidence-based solutions. There is no simple and/or single approach to achieve the last 90%. This will require multifaceted, scalable strategies that engage people living with human immunodeficiency virus, motivate long-term treatment adherence, and are community-entrenched and ‑supported, cost-effective, and tailored to a wide range of global communities.

scholarly journals Farming with Alternative Pollinators benefits pollinators, natural enemies, and yields, and offers transformative change to agriculture

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Stefanie Christmann ◽  
Youssef Bencharki ◽  
Soukaina Anougmar ◽  
Pierre Rasmont ◽  
Moulay Chrif Smaili ◽  
...  
Keyword(s):  
Large Scale ◽  
Transformative Change ◽  
Net Income ◽  
Land Sharing ◽  
Pollinator Decline ◽  
Middle Income ◽  
Land Sparing ◽  
Middle Income Countries ◽  
Small Grant ◽  
Wildflower Strips

AbstractLow- and middle-income countries cannot afford reward-based land sparing for wildflower strips to combat pollinator decline. Two small-grant projects assessed, if an opportunity-cost saving land-sharing approach, Farming with Alternative Pollinators, can provide a method-inherent incentive to motivate farmers to protect pollinators without external rewards. The first large-scale Farming-with-Alternative-Pollinators project used seven main field crops in 233 farmer fields of four agro-ecosystems (adequate rainfall, semi-arid, mountainous and oasis) in Morocco. Here we show results: higher diversity and abundance of wild pollinators and lower pest abundance in enhanced fields than in monocultural control fields; the average net-income increase per surface is 121%. The higher income is a performance-related incentive to enhance habitats. The income increase for farmers is significant and the increase in food production is substantial. Higher productivity per surface can reduce pressure on (semi)-natural landscapes which are increasingly used for agriculture. Land-use change additionally endangers biodiversity and pollinators, whereas this new pollinator-protection approach has potential for transformative change in agriculture.

scholarly journals School vision screening programmes in reducing uncorrected refractive error among children in Low and Middle-Income countries-LMIC (systematic review)

2020 ◽  
Vol 10 (4) ◽  
pp. 91-105
Author(s):  
Abraham Opare ◽  
Leila H Abdullahi ◽  
Deon Minnies ◽  
Colin Cook ◽  
Maylene Shung-King ◽  
...  
Keyword(s):  
Academic Performance ◽  
School Children ◽  
Refractive Error ◽  
Positive Impact ◽  
Cost Effective ◽  
Vision Screening ◽  
Middle Income ◽  
Middle Income Countries ◽  
School Vision ◽  
Uncorrected Refractive Error

ackground: The prevalence of uncorrected refractive error among school-age children is on the rise with detrimental effect on academic performance and socio-economic status of those affected. School vision screening programmes appear to be an effective way of identifying children with uncorrected refractive errors so early intervention can be made. Despite the increasing popularity of school vision screening programmes over the past few years, there is a lot of debate on its effectiveness in reducing the proportion of children with uncorrected refractive error in the long term, especially in settings where resources are limited. Some studies argue that school vision screening programmes are effective while other studies have reported otherwise. The purpose of this systematic review was to assess the effectiveness of school vision screening programmes in reducing uncorrected refractive error among children in low and middle income countries using evidence from published studies. Methods and findings: A comprehensive and systematic strategy was used to search various databases including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) which contains the Cochrane Eyes and vision Trial Register, the Cochrane Library, Medline (1980-2018), CINAHL, Academic Search Premier, Web of Science, the WHO’s Library Information System, Africa-Wide and Scopus. The search was restricted to articles published in English. Randomized control trials, cross-sectional studies, case-control studies and cohort studies were included in this review. Participants included school children with refractive error. Full-text review of search results, data extraction and risk of bias assessment was done by two independent reviewers. The certainty of the evidence was assessed using the GRADE approach and data were pooled using the random-effect model. Thirty studies met the inclusion criteria. This review found moderate certainty evidence indicating that school vision screenings may be effective in reducing uncorrected refractive error among school children by 81% (95% CI: 77%; 84%), 24% (95% CI: 13%; 35%) and 20% (95% CI: 18%; 22%) at two, six, and more than six months respectively after its introduction. Results: Results of this review also suggest that school vision screening may be effective in achieving 54% (95% CI: 25%; 100%), 57% (95% CI: 46%; 70%), 37% (95% CI: 26%; 52%), and 32% (95% CI: 14%; 72%) spectacle-wear compliance among school children at less than three months, at three months, at six months and at more than six months respectively after its introduction (low to moderate certainty evidence). This review further found moderate to high certainty evidence indicating that school vision screening, together with provision of spectacles, may be relatively cost effective, safe and has a positive impact on the academic performance of school children. Conclusion: The findings of this review show that school vision screening, together with provision of spectacles, may be a safe and cost-effective way of reducing the proportion of children with uncorrected refractive error, with long-term positive impact on academic performance of children. Most of the studies included in this review were, however, conducted in Asia. Research to investigate the effectiveness of school vision screening programmes in other parts of the world like Africa where few studies have been conducted is highly recommended

Sign in / Sign up

Export Citation Format

Share Document