The Potential of Food Fortification to Add Micronutrients in Young Children and Women of Reproductive Age - Findings from a Cross-Sectional Survey in Abidjan, Côte d'Ivoire.

Fabian Rohner,James P Wirth,Grant J Aaron,Augusto Norte,Adiko F Adiko,Lasme J C E Esso,Amoin G Konan,Magali Leyvraz,Bassirou Bonfoh,Rachel A Nugent

doi:10.1371/journal.pone.0158552

Abstract

Poor micronutrient intakes are a major contributing factor to the high burden of micronutrient deficiencies in Côte d’Ivoire. Large-scale food fortification is considered a cost-effective approach to deliver micronutrients, and fortification of salt (iodine), wheat flour (iron and folic acid), and vegetable oil (vitamin A) is mandatory in Côte d’Ivoire. A cross-sectional survey on households with at least one child 6–23 months was conducted to update coverage figures with adequately fortified food vehicles in Abidjan, the capital of and largest urban community in Côte d’Ivoire, and to evaluate whether additional iron and vitamin A intake is sufficient to bear the potential to reduce micronutrient malnutrition. Information on demographics and food consumption was collected, along with samples of salt and oil. Wheat flour was sampled from bakeries and retailers residing in the selected clusters. In Abidjan, 86% and 97% of salt and vegetable oil samples, respectively, were adequately fortified, while only 32% of wheat flour samples were adequately fortified, but all samples contained some added iron. There were no major differences in additional vitamin A and iron intake between poor and non-poor households. For vitamin A in oil, the additional percentage of the recommended nutrient intake was 27% and 40% for children 6–23 months and women of reproductive age, respectively, while for iron from wheat flour, only 13% and 19% could be covered. Compared to previous estimates, coverage has remained stable for salt and wheat flour, but improved for vegetable oil. Fortification of vegetable oil clearly provides a meaningful additional amount of vitamin A. This is not currently the case for iron, due to the low fortification levels. Iron levels in wheat flour should be increased and monitored, and additional vehicles should be explored to add iron to the Ivorian diet.

Highlights

The burden of malnutrition in Côte d’Ivoire is among the highest in the world
In the first stage of sampling, nine primary sampling units (PSUs), which consisted of the smallest census unit and contained about 200 households, were randomly selected in each of the 10 communes in Abidjan, with the probability of selection for each PSU being proportional to the number of households in that PSU
A slightly larger household size than that reported by the most recent Demographic and Health Survey (DHS) of 5.3 members [2] was found in this survey (6.1 members), but this may be explained by the selection of households with at least one child under 2 years old, which leaves out households without children

Summary

Introduction

The burden of malnutrition in Côte d’Ivoire is among the highest in the world. According to recent estimates, almost one-third of preschool-aged children (PSC) are stunted, and suboptimal intrauterine growth, as expressed for small-for-gestational age newborns, affects over a quarter of newborns [1, 2]; anemia affects three-quarters of Ivorian PSC and more than half of women of reproductive age (WRA) [2].At the national level, vitamin A deficiency (VAD) in WRA (0.8%) was surprisingly low, as was iron deficiency prevalence (defined as low serum ferritin concentrations) among PSC (16%) and WRA (17%) in 2007. Interventions addressing undernutrition, in particular among PSC, have repeatedly scored high in the Copenhagen consensus for cost-effective strategies to address the world’s biggest challenges [4]. Large-scale food fortification is considered a highly cost-effective approach to deliver micronutrients, in particular if a wide range of the population is in need of additional micronutrient intakes [5]. For some micronutrients with a very narrow window of opportunity, it is difficult to reach the target population through a targeted approach, e.g., folic acid effectively reduces the risk of neural tube defects if provided to future pregnant women prior to conception, but not when given later on during pregnancy [6]

Methods

Results

Conclusion