Fortification Of Maize Flour Research Articles

Prediction of Retinol in Fortified Maize Flour using Fourier Transform - Near Infrared Spectroscopy

Food fortification is one strategy for addressing micronutrient deficiencies among the population groups at risk. Non-compliance with fortification standards hinders the success of fortification programs. This is due to a lack of techniques to rapidly check the amounts of the added fortificants. Fourier transform - near-infrared (FT-NIR) spectroscopy is a fast and reliable technique that would be used to ensure adherence to requirements. This study aimed to investigate the potential of using FT-NIR spectroscopy to predict the amount of retinol in fortified maize flour. 150 fortified maize flour samples were used in this study. Partial least squares regression (PLS-R) was used to build calibration models based on the retinol reference values obtained by high-performance liquid chromatography (HPLC), and fortified maize flour NIR spectra acquired from the FT-NIR spectrophotometer. Two calibration models were developed to predict retinol above and below 1.0 mg/kg. The performance metrics of model one developed to predict retinol < 1.0 mg/kg were: R2c = 0.81, RMSEE = 0.08, RPD = 2.29 and R2v = 0.82, RMSEP = 0.09, RPD = 2.07 for the calibration and validation, respectively. The second model developed to predict retinol ≥ 1.0 mg/kg had the following performance metrics: R2c = 0.93, RMSEE = 0.16, RPD = 3.58 and R2v = 0.81, RMSEP = 0.22, RPD = 2.43 for the calibration and validation, respectively. Overall, the findings demonstrated that FT-NIR spectroscopy can be utilised to reliably predict retinol levels in fortified maize flour samples. FT-NIR spectroscopy, by replacing time-consuming and laborious wet chemistry laboratory procedures, has the potential to be used for rapid regulatory monitoring of fortification compliance for a large number of samples.

Compliance Level and Stability of Micronutrients in Fortified Maize Flour in Tanzania.

Maize flour fortification was introduced in Tanzania in 2011 to address the risk of micronutrient deficiency to children, adolescents, and women of childbearing age. Fortified maize flours are processed by small-scale processors who are exempted from mandatory fortification. The current study is aimed at assessing the compliance and stability of fortified processed maize flour with zinc, iron, and folic acid by small-scale processors in comparison to the recommended Tanzania national standards (TZS 328). A total of 69 samples of fortified maize flour were collected at the point of production and retail outlets in Dar es Salaam and Morogoro municipalities, Tanzania. Micronutrients (zinc and iron) were analysed using microwave plasma atomic emission spectrometry (MP-AES), and folic acid was analysed using high-performance liquid chromatography (HPLC). The mean concentrations of micronutrient were significantly (p < 0.05) higher at the production site compared to the retail outlet. The amount of iron, zinc, and folic acid in the samples at the production site was 27.17 ± 1.63 mg/kg, 30.56 ± 2.01 mg/kg, and 0.69 ± 0.02 mg/kg, respectively, while it was 19.34 ± 0.97 mg/kg, 21.71 ± 1.50 mg/kg, and 0.49 ± 0.02 mg/kg for iron, zinc, and folic acid, respectively, at the retail outlets. Only 31.6% of the assessed samples from production and 12.9% from retail outlets complied with the recommended national standard. The stability of iron, zinc, and folic acid for the fortified maize flour stored at room temperature (20-32°C) for six months was 95.8%, 96.9%, and 66.9%, respectively. Further investigation on the consistency performance of the dosifier and consistency training of working in the processing unit on the requirements of fortification standards should be done.

Effects of Ugali Maize Flour Fortification with Chia Seeds (Salvia hispanica L.) on Its Physico-Chemical Properties and Consumer Acceptability.

The study investigated the effect of incorporating whole chia seeds (WCS) and defatted chia seed flour (DCF) into whole maize meal for ugali preparation. Both were incorporated at substitution levels of 3%, 6%, and 9% separately, and the resulting treatments subjected to laboratory analysis. In addition, ugali samples were prepared from all the resulting flour formulations and subjected to consumer acceptability assessment. Incorporation of both DCF and WCS resulted in increased water absorption capacity (ranging from 0.78 to 0.98 g/mL), swelling index (ranging from 0.15 to 3.25 mL/g), and swelling capacity (ranging from 2.46 to 5.74 g/g). WCS decreased the bulk density and oil absorption capacity. DCF, however, resulted in an increase in bulk density and oil absorption capacity. Both DCF and WCS lowered the lightness (L*) of the products. Proximate composition ranged from 4.78 to 7.46% for crude fat, 7.22% to 9.16% for crude protein, and 1.74 to 4.27% for crude fiber. The obtained results show the potential of chia seeds as a good fortificant of maize flour since it resulted in nutritionally superior products (crude ash, crude protein, crude fat, and energy value) when compared to control. The freshly prepared ugali samples were generally acceptable to the panelists up to 9% WCS and 6% DCF substitution levels.

Firm-Level and Public-Sector Costs Make Small-Scale Maize Flour Fortification Challenging in Uganda.

Maize flour in Uganda is milled by hundreds of enterprises, mostly small- (5-20 metric tons [MT]/day) and micro-scale (<5 MT/day) mills or firms. A mandatory maize flour fortification program exists for medium-scale mills (>20 MT/day) and policymakers are considering including smaller-scale millers. We estimated the private and public costs of maize flour fortification at different scales and explored their implications for extending the mandatory fortification to include smaller-scale mills. We used secondary data on the structure of the maize flour market and primary data on milling and fortification costs to estimate mill and regulatory costs at 3 scales of flour production: micro, small, and medium. For micro-, small-, and medium-size operations, respectively, operational costs of fortification were US$13, US$9, and US$7 per metric ton (MT) of maize flour, which represented 20%, 16%, and 16% of annual operating costs, and the ratio of fortification equipment cost to mill equipment costs was higher for micro-scale mills (2.7) than for small- (0.38) and medium-scale (0.54) maize mills. Governmental regulatory costs rise if smaller-scale mills are included due to the increased number of facility inspections. Fortification and regulatory costs increase as production scale decreases. Up-front capital costs of fortification would be daunting for micro- and small-scale mills. Medium-scale mills, which supply social protection programs, might be able to manage fortification costs and other challenges. Decision-makers should consider all costs and cost burdens, and the realities of enforcement capabilities before expanding fortification programs to include smaller-scale operations.

Voluntary Maize Flour Fortification in Tanzania: Adequacy of Small-Scale Processors&amp;apos; Implementation of the Quality Assurance and Quality Control Programmes

Voluntary Maize Flour Fortification in Tanzania: Adequacy of Small-Scale Processors&amp;apos; Implementation of the Quality Assurance and Quality Control Programmes

Effect of Storage Condition on Retention of Vitamins in Selected Commercial Fortified Maize Flour in Kenya

Food fortification is one strategy that has been used to overcome micronutrient deficiencies among vulnerable populations. Maize, a common staple food in Kenya, has been used as a suitable fortification vehicle. However, several factors, including storage conditions, impact micronutrient stability in fortified maize flour.This study aimed to to assess the influence of storage condition on the retention of retinol and B-vitamins in selected commercial fortified maize flour. Fresh samples of fortified maize flours from two brands (coded XX1 and XY2) were sampled from the manufacturers at the point of production. The storage stability of retinol and B-vitamins in the two brands (XX1 and XY2) was monitored for 6 months at 25 °C/ 75 % relative humidity and 35 °C/ 83 % relative humidity. Retinol and thiamine were the least stable vitamins in both flour brands, while riboflavin and folate were relatively stable. Niacin was the most stable vitamin. Retinol was the least stable vitamin for brand XXI at both 25 °C/75% RH and 35 °C/83% RH, followed by thiamine, riboflavin, folate, and niacin. However, brand XY2 showed that under both storage conditions, thiamine was the least stable vitamin, followed by retinol, riboflavin, folate, and niacin. Vitamin retention was higher in samples stored at a lower temperature and relative humidity (25 °C/ 75 % RH) than in samples stored at higher temperature and relative humidity (35 °C/ 83 % RH) for both brands. In conclusion, thiamine and retinol were generally more susceptible to storage losses. Although the vitamin content in the flour samples decreased during storage, the changes in both storage conditions (except for riboflavin) and both brands were not significantly different.

Nutritional Anemia Reductions in Women of Childbearing Age Due to Food Fortification

ObjectivesReview literature and conduct a meta-analysis to quantify changes in hemoglobin (Hb) and anemia prevalence among women of childbearing age after fortification of wheat flour, maize flour, rice and oil (singly or combined). MethodsOnline databases were searched for English-language documents with no restrictions on location or publication date that included longitudinal, pre-post cross-sectional, efficacy and effectiveness studies. A Bayesian arm-based meta-analysis estimated mean change and probability of Hb and anemia improvement from 17 studies. Results were stratified by fortified food and nutrients added to food. ResultsThere was a > 95% probability that fortified wheat flour improved Hb and reduced anemia; mean Hb increased by 3.39 g/L (95% Credible Interval (CI) –0.63, 7.17) and anemia decreased by 12.8 percentage points (pp) (95% CI –23, 0.9). Likewise, fortified rice had a > 65% probability of improving Hb and reducing anemia; mean Hb increased by 2.71 g/L (95% CI –4.88, 10.64) and anemia decreased by 16.9 pp (95% CI –81, 37.8). Conversely, fortified maize flour had < 45% probability of improving Hb and reducing anemia; mean Hb decreased by 2.88 g/L (95% CI–12.85, 7.24) and anemia increased by 13.5 pp (95% CI –133,164). There was a > 90% probability that fortifying maize flour, oil, rice, and/or wheat flour with iron, folic acid or multiple micronutrients (MM) improved Hb. Mean Hb increase was highest for iron fortification (3.93 g/L, 95% CI 0.50, 7.56), followed by folic-acid fortification (3.42 g/L, 95% CI –2.08, 9.56), and lowest for MM fortification (2.11 g/L, 95% CI 0.75, 3.68). There was a > 45% probability that fortifying with any nutrients reduced anemia. Mean anemia decrease was highest for iron at 17.3 pp (95% CI –78.2, 35), followed by folic acid at 7.2 pp (95% CI –32.5, 19.7); however, fortification with MM increased anemia by 1.2 pp (95% CI –9.8, 14.9). ConclusionsThere was a high probability of fortification increasing hemoglobin concentration if wheat flour or rice are fortified independently, and if foods are fortified with iron alone, folic acid alone, or a combination of multiple micronutrients. Anemia reductions were greatest for fortified wheat flour and rice and for foods fortified with iron and folic acid. Funding SourcesGlobal Affairs Canada.

The Potential Contribution of Fortified Maize Flour, Oil, Rice, Salt, and Wheat Flour to Estimated Average Requirements and Tolerable Upper Intake Levels for 15 Nutrients in 153 Countries.

Food fortification is designed to improve the nutritional profile of diets. The purpose of this research was to estimate the potential nutrient contribution of fortified maize flour, oil, rice, salt, and wheat flour in 153 countries, using the national intake (or availability) of the food and the nutrient levels required for fortification. This was done under two scenarios—maximum, where 100% of the food is assumed to be industrially processed and fortified, and realistic, where the maximum value is adjusted based on the percent of the food that is industrially processed and fortified. Under the maximum scenario, the median Estimated Average Requirements (EARs) met ranged from 22–75% for 14 nutrients (vitamins A, B1, B2, B3, B6, B12, D, E, folic acid and calcium, fluoride, iron, selenium and zinc), and 338% for iodine. In the realistic scenario, the median EARs met were 181% for iodine and <35% for the other nutrients. In both scenarios, the median Tolerable Upper Intake Levels (ULs) met were <55% for all nutrients. Under the realistic scenario, no country exceeded 100% of the UL for any nutrient. Current fortification practices of the five foods of interest have the global potential to contribute up to 15 nutrients to the diets of people, with minimal risk of exceeding ULs.

Most national, mandatory flour fortification standards do not align with international recommendations for iron, zinc, and vitamin B12 levels

As national flour fortification standards are one of the policy documents developed to guide food fortification, the objective was to compare national, mandatory wheat and maize flour fortification standards to World Health Organization (WHO) fortification guidelines. For each nutrient in 72 countries’ standards, the type of compound was noted as ‘yes’ if it was included in international guidelines or ‘no’ if it was not. Nutrient levels in standards were classified as lower than, equal to, or higher than those suggested by WHO. If another food (i.e. rice, oil, milk) was mass fortified with a nutrient categorized as “lower than,” the classification was changed to “less than recommendation and included in other mass fortified food”. At least 61% of standards included one or more recommended compounds for all nutrients in standards for wheat flour alone (iron, folic acid, vitamin A, zinc, vitamin B12,), wheat and maize flour together (iron, folic acid, vitamin A, zinc, vitamin B12) and maize flour alone (thiamin, riboflavin, niacin, pyridoxine); no country included pantothenic acid in its maize flour standard. For folic acid, vitamin A, thiamin, riboflavin, niacin and pyridoxine, at least 50% of standards (1) met or exceeded WHO suggested levels, or (2) were lower than suggested levels and another food was mass fortified with the specific nutrient in the country. For iron, zinc and vitamin B12, less than 50% of standards met (1) or (2). In conclusion, iron, zinc and vitamin B12 may require the most attention in national fortification standards.

Compliance status and stability of vitamins and minerals in Fortified Maize Flour in Kenya

Fortification of staple foods is a cost-effective strategy that has been used to reduce the prevalence of micronutrient deficiency in the population. National mandatory maize flour fortification legislation was introduced in Kenya in 2012 to help address micronutrient deficiencies among the vulnerable groups of the population. This study aimed to quantify the amount of vitamin A, vitamin B2, B3, B9, iron and zinc in maize flour and premixes, relative to the national fortification standard, EAS 768 and determine the stability of micronutrients in fortified maize flour under normal storage conditions experienced in Kenya. A total of 27 maize flour brands and 2 brands of maize flour premixes were procured from the market and analyzed for compliance with the national standards for vitamin A, vitamin B2, vitamin B3, vitamin B9, iron, and zinc. Losses of micronutrients in fortified maize flour stored at 25°C/RH 60% and 35°C/RH 75% for six months were also quantified. Overall, the level of compliance of fortified maize flour to national standards was low with only 11.1% of the samples complying in the micronutrients analyzed. According to the Government of Kenya, compliance is accorded to brands that comply in at least three micronutrients. Only 48.1% of the samples had complied in three or more of the micronutrients analyzed. Compliance status for specific micronutrients to national standards varied greatly with minerals having higher compliance levels than vitamins. About a fifth (18%) of the samples from the market did not comply for any micronutrient analyzed. Some samples had folate and retinol levels below detectable limits. The retention of the vitamins analyzed was significantly affected by storage conditions (temperature and relative humidity). Low retention was observed for storage at 35°C/RH 75% compared to 25°C/RH 60%. In conclusion, fortification of maize flour is still low in Kenya and there is a need to strengthen efforts towards improved compliance.

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

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.

National Wheat and Maize Flour Fortification Standards and Their Comparison with International Guidelines in Countries with Mandatory Fortification (P22-001-19)

ObjectivesCompare national wheat and maize flour standards to World Health Organization (WHO) fortification guidelines in countries with mandatory fortification. MethodsSeventy-three countries’ grain availability, flour extraction rate, flour standards (with fortification compounds and nutrient levels) and mass fortification of other foods were obtained from databases and country contacts. For each nutrient, standards were compared with recommendations, specifically, presence of a compound that is in guidelines was noted (yes/no), and nutrient levels in standards were classified as lower than, equal to, or higher than those suggested by WHO. When a nutrient in flour was categorized as “lower than” in a particular standard and if another food (e.g., rice, oil, milk) was mass fortified with the same nutrient, the classification was changed to “less than recommendation and included in other mass fortified food”. ResultsAt least 63% of standards included one or more recommended compounds for all nutrients in standards for wheat flour alone (iron, folic acid, vitamin A, zinc, vitamin B12,), wheat and maize flour together (iron, folic acid, vitamin A, zinc, vitamin B12) and maize flour alone (thiamin, riboflavin, niacin, pyridoxine); no country included pantothenic acid in its maize flour standard. For folic acid, vitamin A, thiamin, riboflavin, niacin and pyridoxine, >50% of standards (1) met or exceeded WHO suggested levels, or (2) were lower than suggested levels and another food was mass fortified with the specific nutrient in the country. For iron, zinc and vitamin B12, <50% of standards met (1) or (2). ConclusionsIron, zinc and vitamin B12 may require the most attention in national wheat and maize flour fortification standards. Funding SourcesNo external funding received for conduct of this study.

English

Maize is the most widely consumed staple food by the Kenyan population. Its wide consumption and centralized processing make it an appropriate fortification vehicle to supply essential micronutrients to the population. The legislation was enacted in 2012 that makes it mandatory for all commercial maize mills in Kenya to fortify the maize flour with specified micronutrients as a public health effort to reduce the prevalence of micronutrient deficiencies. However, there is limited information on the current status of maize milling and implementation of the flour fortification programme by these mills. A cross-sectional study was therefore carried out to characterize the commercial maize mills and determine the status of flour fortification in Kenya. Questionnaires were used to collect data. Information was obtained from 22 large-scale, 25 medium-scale and 31 small-scale mills. These mills had an installed capacity of 6084 metric tons/day of flour using roller and hammer mills. While all the large-scale mills implemented the recommended statutory flour fortification programs, only 45.8% of the medium and 24.1% of small-scale mills did so. There was evidence of weak quality management systems for fortified maize flour and most companies did not have trained mill operators. Regulatory monitoring was mainly done by the Kenya Bureau of Standards and the Ministry of Health. There is a need to enhance industry capacity in food fortification practices and fortification compliance. Key words: Fortification, maize flour, maize mills, mill characteristics.

Fortification of maize flour with iron for controlling anaemia and iron deficiency in populations.

Fortification of maize flour with iron for controlling anaemia and iron deficiency in populations.

Coverage and Consumption of Micronutrient Powders, Fortified Staples, and Iodized Salt Among Children Aged 6 to 23 Months in Selected Neighborhoods of Nairobi County, Kenya.

Intake of micronutrient-rich foods among children aged 6 to 23 months in Nairobi is low. This study aimed to assess existing coverage and utilization of micronutrient powders (MNPs), fortified staples, and iodized salt among children aged 6 to 23 months prior to implementation of an MNP program. A cross-sectional survey among caregivers of children aged 6 to 23 months (n = 618) was implemented in 7 neighborhoods within Nairobi County, representing the implementation area of the new MNP program. Results for MNP coverage and utilization showed 28.5% of all caregivers were aware of MNP, 18.5% had ever received MNP for their child, and 10.8% had fed MNP to their child in the previous 7 days. Effective coverage (ie, the child had been given the MNP at least 3 times in the previous 7 days) was 5.8%. Effective coverage of infants and young children with poor feeding practices was significantly lower as compared to those with non-poor feeding practices (coverage ratio, 0.34; confidence interval, 0.12-0.70). Most households purchased iodized salt (96.9%), fortified oil (61.0%), and fortified maize flour (93.9%). An estimated 23.9% of vitamin A requirements of children (6-23 months) were provided from fortified oil and 50.7% of iron from fortified maize flour. Most households consumed processed milk (81%). Coverage of MNPs in the surveyed neighborhoods was low. Coverage of fortified salt, oil, and maize flour was high and provided significant amount of micronutrients to children. Processed milk has potential as a vehicle for food fortification.

Biofortification of maize flour with grain amaranth for improved nutrition

Food insecurity and malnutrition remain two major problems in Kenya that cause undernutrition (protein-energy malnutrition) and nutrient deficiencies. In a bid to combat the problem, the government has targeted increased production of the micronutrient (minerals, vitamins) fortified maize flour. This is mostly based on chemical fortificants, which is a short-term measure that targets reducing the level of malnutrition while creating better livelihoods. However, there is need to think about long- term and sustainable strategies. Among the causes that have led to food and nutrition insecurity in the country is the over reliance on maize as the staple food. Other staples in Kenya are sorghum, rice and millet. This study aimed at providing a better and more sustainable approach by fortifying maize based diets with grain amaranth. Maize was procured from National Cereals and Produce Board and processed to refined flour, while amaranth grain that had been toasted at 100oC for 5 minutes and milled into flour was obtained from Annicos Limited Company, Nairobi. Complementary formulations were then prepared by blending the flours. The refined maize flour was mixed with varying ratios of 0, 20, 30 and 40% of the grain amaranth flour. The proximate composition, mineral content and microbiological analysis of the raw materials and the blends were determined using recognized standard methods, while protein digestibility was determined after enzyme digestion. Nutritional composition of grain amaranth flour differed significantly (p≤0.05) as compared to refined maize flour; amaranth flour was found to be superior in proteins (15.82%), lipids (7.61%), ash (2.54%) and fibre (4.39%), as compared to proteins (6.29%), lipids (1.92%), ash (0.55%) and fibre (0.76%) in refined maize flour. Adding grain amaranth flour to refined maize flour at the different ratios increased the nutrient density significantly (p≤0.05), particularly protein, iron, calcium and zinc. However, it decreased the digestibility of protein significantly (p≤0.05). The results indicate that although adding 40% grain amaranth gave the best results, the most acceptable blend was the 20% grain amaranth addition. They also indicate that “food to food” fortification can be an approach that can be adapted towards meeting the nutrition requirements of the society. Keywords: Nutrition security, biofortification, amaranth flour, maize flour, optimal blend

Consumption and wastage of home-fortified maize flour products in northern Malawi

Objective: The objective of the study was to determine the amount of home-fortified maize flour products consumed and wasted by women aged 15–49 years, and children aged ≤ 5 years.Design: This was a descriptive cross-sectional study.Setting: The study took place in Ekwendeni, a home fortification project area in Mzimba District, Northern Region, Malawi.Subjects: The study subjects were members of a random sample of 205 households practising home fortification.Outcome measures: The study’s outcome measures included weighing fortified nsima, a thick maize flour-based porridge which was consumed, and its leftovers, using a kitchen scale. Using systematic random sampling, fortified maize flour and nsima samples were collected from households for energy, iron, zinc and vitamin A analysis. The data were analysed using descriptive statistics.Results: The food intake and plate waste of fortified food products pertaining to 94 children (49% male and 51% female) and 173 women was analysed. Predominantly, nsima (55%) was the main food product made from fortified maize flour. Other foods were porridge and chigumu, whole maize flour-based bread. Overall, the daily average consumption of fortified foods (nsima, porridge and chigumu) was 332 g/day for children, and 1011 g/day for women. Plate waste accounted for 25% of the food served to the children, and 12% served to the women. Discarding fortified nsima resulted in a 23% loss of energy and micronutrients in the children, and a 11.2% loss in the women.Conclusion: Commonly consumed home-fortified maize flour products were nsima, porridge and chigumu. The plate waste of the fortified foods, primarily nsima, resulted in considerable loss of energy and micronutrients, especially in the children. Home-fortification interventions should include nutrition messages on food budgeting to minimise food and nutrient losses in women and children in northern Malawi.

Technical considerations for maize flour and corn meal fortification in public health: consultation rationale and summary.

Fortification is the purposeful addition of vitamins and minerals to foods during their industrial processing, as a way to improve the nutrition and health of populations who consume these foods. Twelve countries have mandatory maize (Zea mays subsp. Mays) flour or meal fortification. The World Health Organization (WHO) is updating evidence-informed guidelines for the fortification of staple foods in public health, including the fortification of maize flour and corn meal with iron and other micronutrients. Although there is limited experience with fortification of maize, mass fortification of maize flour with at least iron has been practiced for many years in several countries in the Americas and Africa: Brazil, Costa Rica, El Salvador, Kenya, Mexico, Nigeria, Rwanda, South Africa, Tanzania, Uganda, the United States, and Venezuela. The WHO, in collaboration with the Sackler Institute for Nutrition Science and the Flour Fortification Initiative (FFI), convened a consultation on technical considerations for fortification of maize flour and corn meal in public health in New York, New York on April 8-9, 2013 to provide input into the guideline-development process and to discuss technical considerations of the fortification processes for maize flour and corn meal.

Equity in access to fortified maize flour and corn meal.

Mass fortification of maize flour and corn meal with a single or multiple micronutrients is a public health intervention that aims to improve vitamin and mineral intake, micronutrient nutritional status, health, and development of the general population. Micronutrient malnutrition is unevenly distributed among population groups and is importantly determined by social factors, such as living conditions, socioeconomic position, gender, cultural norms, health systems, and the socioeconomic and political context in which people access food. Efforts trying to make fortified foods accessible to the population groups that most need them require acknowledgment of the role of these determinants. Using a perspective of social determinants of health, this article presents a conceptual framework to approach equity in access to fortified maize flour and corn meal, and provides nonexhaustive examples that illustrate the different levels included in the framework. Key monitoring areas and issues to consider in order to expand and guarantee a more equitable access to maize flour and corn meal are described.

Maize flour fortification in Africa: markets, feasibility, coverage, and costs

The economic feasibility of maize flour and maize meal fortification in Kenya, Uganda, and Zambia is assessed using information about the maize milling industry, households' purchases and consumption levels of maize flour, and the incremental cost and estimated price impacts of fortification. Premix costs comprise the overwhelming share of incremental fortification costs and vary by 50% in Kenya and by more than 100% across the three countries. The estimated incremental cost of maize flour fortification per metric ton varies from $3.19 in Zambia to $4.41 in Uganda. Assuming all incremental costs are passed onto the consumer, fortification in Zambia would result in at most a 0.9% increase in the price of maize flour, and would increase annual outlays of the average maize flour-consuming household by 0.2%. The increases for Kenyans and Ugandans would be even less. Although the coverage of maize flour fortification is not likely to be as high as some advocates have predicted, fortification is economically feasible, and would reduce deficiencies of multiple micronutrients, which are significant public health problems in each of these countries.