Coverage and Utilization in Food Fortification Programs: Critical and Neglected Areas of Evaluation

Lynnette M Neufeld,Shawn Baker,Greg S Garrett,Lawrence Haddad

doi:10.3945/jn.116.246157

Lynnette M Neufeld, Shawn Baker + Show 2 more

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https://doi.org/10.3945/jn.116.246157

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Abstract

The need for evidence to inform nutrition program design and implementation has long been recognized, yet the generation and use of evidence for program decision making has lagged. The results of the coverage surveys reported in this supplement highlight some of the strengths and areas for improvement of current population-based (i.e., staple foods and condiments) and targeted (e.g., foods for infants and young children) fortification programs. Among other topics, the results identify a few striking successful fortification programs whereby the majority of the food vehicle used is fortifiable and fortified, and coverage is equitable among those classified as vulnerable and not. Other programs have great potential based on very high use of a fortifiable food vehicle, including in most cases among the vulnerable, but that potential is not currently reached because of low compliance with fortification requirements. Programs were also identified whereby the food vehicle has limited potential to make public health contributions to micronutrient intake, given the low proportions of the population who consume the food vehicle in general or who consume the fortifiable food vehicle. Four key lessons were learned: 1) the potential for impact of food fortification depends on the appropriate choice of food fortification vehicle but also on the proportion of the food vehicle consumed that is fortifiable; 2) the design of fortification programs should be informed by the magnitude and distribution of inadequate intake and deficiency and consumption of fortifiable foods, and part of micronutrient deficiency control strategies to ensure coordination with other programs; 3) effective quality control of fortification levels in foods urgently needs strengthening, including the many governance and other policy factors that influence the capacity, resources, and commitment to do this; 4) periodic review of the assumptions related to dietary patterns that underpin food fortification is needed to ensure continual safe and impactful programs.

Highlights

The need for evidence to inform program design and implementation has long been recognized for food fortification, as well as other nutrition interventions
Routine coverage data has been collected only for salt, and very few programs systematically report routine product quality data. It is precisely this paucity of information that prompted the development of the Fortification Assessment Coverage Toolkit (FACT) and the series of coverage surveys reported as part of this supplement
The results focused on 2 aspects of coverage, the first being the food vehicle itself, and the second being equity of coverage in the population

Summary

Introduction

The need for evidence to inform program design and implementation has long been recognized for food fortification, as well as other nutrition interventions. Routine coverage data has been collected only for salt, and very few programs systematically report routine product quality data It is precisely this paucity of information that prompted the development of the Fortification Assessment Coverage Toolkit (FACT) and the series of coverage surveys reported as part of this supplement. The FACT is a survey instrument that was designed to assess coverage and utilization of fortified foods in both population-based (i.e., staple foods and condiments) and targeted (e.g., complementary foods for infants and young children) fortification programs, independently of any routine monitoring systems that the program may have [7]. The FACT method was used to assess coverage of programs that included targeted fortified products, those intended for use in infants during the complementary feeding period (6–23 mo of age) [9]. In addition to providing insights into the quality of design and implementation, and the potential for impact of specific country programs, the series of studies reported here highlight a few considerations in fortification program design and implementation that merit further discussion

Vehicle Consumed that Is Fortifiable

Programs If Needed

Data for Program Decision Making Is Not a