Abstract
Using a predetermined set of criteria, including burden of anemia and neural tube defects (NTDs) and an enabling environment for large-scale fortification, this paper identifies 18 low- and middle-income countries with the highest and most immediate potential for large-scale wheat flour and/or rice fortification in terms of health impact and economic benefit. Adequately fortified staples, delivered at estimated coverage rates in these countries, have the potential to avert 72.1 million cases of anemia among non-pregnant women of reproductive age; 51,636 live births associated with folic acid-preventable NTDs (i.e., spina bifida, anencephaly); and 46,378 child deaths associated with NTDs annually. This equates to a 34% reduction in the number of cases of anemia and 38% reduction in the number of NTDs in the 18 countries identified. An estimated 5.4 million disability-adjusted life years (DALYs) could be averted annually, and an economic value of 31.8 billion United States dollars (USD) generated from 1 year of fortification at scale in women and children beneficiaries. This paper presents a missed opportunity and warrants an urgent call to action for the countries identified to potentially avert a significant number of preventable birth defects, anemia, and under-five child mortality and move closer to achieving health equity by 2030 for the Sustainable Development Goals.
Highlights
More than two billion people are not getting the micronutrients they need to survive and thrive
Country-specific data and information on fortification program status were compiled, vetted, and analyzed by authors collaborating from Nutritional International (NI), the Food Fortification Initiative (FFI), Emory University’s Center for Spina Bifida
Eighteen low- and middle-income countries (LMICs) were identified with the greatest potential for preventing anemia, folic acid-preventable neural tube defects (NTDs), and associated under-five child deaths by implementing large-scale, mandatory fortification of wheat flour and/or rice with iron and folic acid
Summary
More than two billion people are not getting the micronutrients (vitamins and minerals) they need to survive and thrive. This includes two of the most critical micronutrients for human development—iron and folate (vitamin B9). Poor diet and limited access to nutrient-rich foods are common reasons for a person’s inadequate intake of micronutrients. Insufficient dietary intake of iron leads to iron-deficiency anemia (IDA)—. IDA impairs cognitive and motor development, causes fatigue, lowers productivity, and contributes to increased risk of death for a mother and her baby during pregnancy. Due to limited data at the country level on IDA, anemia was used to estimate potential impact of iron fortification under the assumption that, globally, 50% of anemia may be caused by IDA, evidence suggests that this global figure should be context-specific [1]
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