Abstract

Zinc-biofortified flour may be a cost-effective approach to improve zinc status of populations in low-resource settings. The success of biofortification programmes is subject to acceptability and uptake by consumers. This study explored community leaders’ and community members’ (n = 72) experiences and attitudes towards the flour provided during a cluster randomised controlled trial of zinc biofortified wheat in rural Pakistan (BiZiFED2). Focus group discussions (n = 12) were conducted and thematic analysis applied using an inductive, semantic, contextualist approach. Five themes were identified: (1) Contribution to food security; (2) Better sensory and baking properties than local flour; (3) Perceived health benefits; (4) Willingness to pay for the flour; and (5) Importance of trusted promoters/suppliers. Although the participants were blind to whether they had received control or biofortified flour, referred to collectively as “study flour”, the results indicated that the study flour performed well in terms of its taste and bread making qualities, with no adverse reports from participants in either arm of the BIZIFED2 RCT. Participants suggested that they would buy the biofortified wheat if this was available at a fair price due to perceived health benefits, reporting positive sensory characteristics and cooking attributes when compared to the flour available in the local markets. Overall, there was a positive reception of the programme and flour among the participants, and members of the community hoped for its continuation and expansion.

Highlights

  • Zinc deficiency is estimated to affect approximately 17% of the world’s population [1,2], with much higher prevalence in low- and middle-income countries [3]

  • In Pakistan, the recent National Nutrition Survey reported that the prevalence of zinc deficiency in children under 5 years of age and women of reproductive age was 18.6% and 22.1%, respectively [6]

  • BiZiFED2 included a cluster-randomised, double-blind, controlled trial designed to test the effectiveness of zinc biofortified wheat flour for improving zinc status of adolescent girls and children in rural Pakistan [8]

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Summary

Introduction

Zinc deficiency is estimated to affect approximately 17% of the world’s population [1,2], with much higher prevalence in low- and middle-income countries [3]. Children and women of reproductive age are groups at greater risk of suffering micronutrient deficiencies due to increased nutrient requirements [5]. In Pakistan, the recent National Nutrition Survey reported that the prevalence of zinc deficiency in children under 5 years of age and women of reproductive age was 18.6% and 22.1%, respectively [6]. Populations living in rural socio-economically deprived communities may be at higher risk of micronutrient deficiencies as they typically have low diet diversity and a high prevalence household food insecurity [7].

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