Fortification Of Staple Foods Research Articles

MORINGA OLEIFERA, FUNCTIONAL INGREDIENT: NUTRITIONAL PROPERTIES AND HEALTH BENEFITS

Moringa oleifera is a tropical plant that provides various nutritional benefits in nutrition and medicine. It is a popular ingredient in fortified staple foods due to its antioxidant, anti-inflammatory, and anticarcinogenic properties. This study aims to assess the acceptability of the plant among students and its perceived properties. Thus, 44 subjects, divided into two groups (22 in each group) were included in this study. For ten days, each group consumed 5 or 10 grams of moringa per day. Throughout the study, the subjects completed two validated questionnaires: the first one was distributed before the consumption and the second questionnaire after the intended period. The results obtained at the end of the study showed that both groups of consumers noticed beneficial effects on physical well-being and intellectual activity. However, people who consumed 10 g of moringa experienced more noticeable effects due to its powerful effect on concentration, well-being and the elimination of factors that cause fatigue, compared to the consumption of 5 g of moringa, where the majority of respondents stated that they did not feel any effect due to the low dose ingested.

Closing the Fibre Gap-The Impact of Combination of Soluble and Insoluble Dietary Fibre on Bread Quality and Health Benefits.

Dietary fibre (DF) is important for overall health and disease prevention. However, the intake of DF in Westernised countries is below the recommended level, largely due to the excessive consumption of low-fibre foods. Fortifying staple foods, such as bread, with dietary fibre ingredients is one approach to closing the fibre gap in our diet. However, incorporating purified and chemically modified fibre ingredients into food is challenging. This study unveils interactions between soluble-fermentable (arabinoxylan), insoluble-fermentable (resistant starch type IV) and insoluble-unfermentable (cellulose) fibre ingredients and their impact on bread quality using Response Surface Methodology. This resulted in an optimised mixture of these fibre ingredients that can coexist within a bread matrix while maintaining quality characteristics comparable to white wheat bread. The partial replacement of flour with fibre ingredients led to an interference with the gluten network causing a reduction in gluten strength by 12.4% and prolonged gluten network development time by 24.4% compared to the control (no fibre addition). However, the CO2 retention coefficient during dough fermentation was not affected by fibre ingredient inclusion. The fibre content of the white bread was increased by 128%, with only a marginal negative impact on bread quality. Additionally, the fibre-fortified bread showed a lower release of reducing sugars during in vitro starch digestion. This study illustrates the synergy of different types of fibre ingredients in a bread system to advance in closing the fibre gap.

A global update on the status of prevention of folic acid-preventable spina bifida and anencephaly in year 2022.

Mandatory fortification of staple foods with folic acid is an effective public health strategy to prevent folic acid-preventable spina bifida and anencephaly (FAP SBA). We estimated the global proportion of FAP SBA prevented through mandatory folic acid fortification of cereal grains (i.e., wheat flour, maize flour, and rice). We used year 2022 data from the Food Fortification Initiative to identify countries (n = 69) with mandatory fortification of grains that includes folic acid. Sixty-eight countries were eligible for analysis with complete data. Proportion of FAP SBA prevention was modeled assuming >150 mcg/day of folic acid fortification protects against FAP SBA, reducing post-fortification prevalence to a lowest achievable level of 0.5 cases per 1000 births. Our analysis found that a total of 63,520 cases of FAP SBA were prevented in the year 2022 in 68 countries implementing mandatory folic acid fortification of grains with folic acid. This translated to a 23.7% prevention of all possible FAP SBA prevention globally. An excess of 204,430 cases of FAPSBA still occurred in over 100 countries where mandatory staple food fortification with folic acid is not implemented. Our study showed that only a quarter of all FAP SBA cases were averted through mandatory folic acid fortification in the year 2022; many countries are not implementing the policy, resulting in a large proportion of FAP SBA cases that can be prevented. Fortification will help countries with achieving 2030 Sustainable Development Goals on neonatal- and under-five mortality, disability, stillbirths, and elective terminations prevention, from FAP SBA.

Characterization of granular micronutrient premixes for food fortification

AbstractGranular micronutrient premixes have been used to fortify salt and proven to alleviate micronutrient deficiencies. Expansion of the micronutrient premix technology to other food vehicles requires characterization of the granules to establish a basic understanding of the material. The objective of this study is to determine the physical and chemical properties of micronutrient premixes, and examine these parameters in relation to the attrition of the granules. The physical properties examined were particle shape, density, and compressive strength; and chemical compositions of the granule surfaces and cross sections were mapped using x‐ray photoelectron spectroscopy, scanning electron microscopy, and time‐of‐flight secondary ion mass spectroscopy. Currently, premix granules coated with hydroxypropyl methylcellulose and fully hydrogenated soybean oil to a minimum coating thickness of 25 μm is sufficient for resisting attrition under the processing conditions of double‐fortified salt. Micronutrient premix granules can be made more resistant to attrition under harsher processing conditions through reduction in particle size, increase in sphericity, and increase in the coating thickness.Practical ApplicationsTwo billion people worldwide suffer from the deficiency at least one micronutrient, which burdens an individual's health and quality of life. Fortification of staple foods is a proven cost‐effective approach to mitigate micronutrient deficiencies. Micronutrient premix granules used to fortify salt have had great success in reducing iron‐deficient anemia. Premix granules must remain intact until they reach the consumer for the micronutrients to be absorbed by the body. Currently, existing formulations of premix can resist breakage under the processing and handling conditions of salt production. However, premix granules have not been tested under elevated temperatures and compression, so their integrity under such conditions remains to be shown. This study reports on the properties of micronutrient premix granules to establish a baseline understanding for the expansion of their use. Our results show that existing premix granules can be made smaller, rounder, and with a thicker coating to withstand harsher processing conditions.

A Landscape of Micronutrient Dietary Intake by 15- to 65-Years-Old Urban Population in 8 Latin American Countries: Results From the Latin American Study of Health and Nutrition.

Latin American countries have shifted from traditional diets rich in micronutrients to a Westernized diet rich in high energy-dense foods and low in micronutrients. This study aimed to determine the prevalence of adequate micronutrient intakes in urban populations of 8 Latin American countries. Micronutrient dietary intake data were collected from September 2014 to August 2015 from 9216 men and women aged 15.0 to 65.0 years living in urban populations of 8 Latin American countries. Dietary intake was collected using two 24-hour recalls on nonconsecutive days. Micronutrient adequacy of intake was calculated using the Estimated Average Requirement cut-off method. In general terms, the prevalence of inadequate intake of thiamine, riboflavin, niacin, folate, cobalamin, iron, phosphorus, copper, and selenium ranged from 0.4% to 9.9%. In contrast, the prevalence of inadequacy of pyridoxine, zinc, vitamin C, and vitamin A ranged from 15.7% to 51.5%. The nutrients with a critical prevalence of inadequacy were magnesium (80.5%), calcium (85.7%), and vitamin D (98.2%). The highest prevalence of inadequate intakes was observed in the low educational level, participants with overweight/obesity, in men, and varies according to socioeconomic status. There is an urgent need to define direct regional actions and strategies in Latin America aimed at improving micronutrient adequacy, either through staple food fortification programs, agronomic biofortification, or food policies that facilitate economic access to micronutrient-rich foods.

Micronutrient gaps during the complementary feeding period in seven countries in Southeast Asia: A Comprehensive Nutrient Gap Assessment

AbstractThe complementary feeding period is a critical stage of child development when micronutrient needs are high and challenging to meet. Understanding if specific micronutrient gaps exist during this period is critical for effective programming. A Comprehensive Nutrient Gap Assessment (CONGA) was conducted in seven countries in Southeast Asia to estimate gaps in micronutrients commonly lacking in the diets of children aged 6–23 months and to establish the certainty of available evidence for each identified gap. Sixty‐eight evidence sources were identified during this analysis, and 310 micronutrient‐specific data points were identified across all seven countries. Data points varied in recency, representativeness and evidence type. The CONGA methodology enabled the estimation of a gap burden rating for each micronutrient in each country, as well as a rating of their evidence certainty. Micronutrient gaps were identified in vitamin D, zinc and iron and a potential gap was identified in calcium during the complementary feeding period in the region. Evidence relevant to intake and deficiency of folate, vitamin B12, thiamine, niacin, vitamin C and vitamin B6 was limited across the region. Proven strategies to address these gaps include increasing the availability and consumption of nutrient‐dense foods, micronutrient supplementation, large‐scale fortification of staple foods and condiments and point‐of‐use fortification through multiple micronutrient powders and fortified speciality foods. More recent data on micronutrient availability, intake and deficiency is urgently needed in Southeast Asia.

Recent Advances in Dietary Sources, Health Benefits, Emerging Encapsulation Methods, Food Fortification, and New Sensor-Based Monitoring of Vitamin B12: A Critical Review.

In this overview, the latest achievements in dietary origins, absorption mechanism, bioavailability assay, health advantages, cutting-edge encapsulation techniques, fortification approaches, and innovative highly sensitive sensor-based detection methods of vitamin B12 (VB12) were addressed. The cobalt-centered vitamin B is mainly found in animal products, posing challenges for strict vegetarians and vegans. Its bioavailability is highly influenced by intrinsic factor, absorption in the ileum, and liver reabsorption. VB12 mainly contributes to blood cell synthesis, cognitive function, and cardiovascular health, and potentially reduces anemia and optic neuropathy. Microencapsulation techniques improve the stability and controlled release of VB12. Co-microencapsulation of VB12 with other vitamins and bioactive compounds enhances bioavailability and controlled release, providing versatile initiatives for improving bio-functionality. Nanotechnology, including nanovesicles, nanoemulsions, and nanoparticles can enhance the delivery, stability, and bioavailability of VB12 in diverse applications, ranging from antimicrobial agents to skincare and oral insulin delivery. Staple food fortification with encapsulated and free VB12 emerges as a prominent strategy to combat deficiency and promote nutritional value. Biosensing technologies, such as electrochemical and optical biosensors, offer rapid, portable, and sensitive VB12 assessment. Carbon dot-based fluorescent nanosensors, nanocluster-based fluorescent probes, and electrochemical sensors show promise for precise detection, especially in pharmaceutical and biomedical applications.

Birth prevalence and risk factors of neural tube defects in Ethiopia: a systematic review and meta-analysis

ObjectiveThis study aims to estimate the prevalence of neural tube defects (NTDs) and to identify potential risk factors in the Ethiopian context.Study designSystematic review and meta-analysis.Study participantsA total of 611...

Fortification of Staple Foods for Household Use with Vitamin D: An Overview of Systematic Reviews.

Vitamin D deficiency is a global public health concern with significant implications for bone health and chronic disease prevention. Our aim was to summarize the evidence from Cochrane and other systematic reviews evaluating the benefits or harms of vitamin D fortification of staple foods for household use. In April 2023, we systematically searched Ovid MEDLINE, Embase, Epistemonikos and the Cochrane Database of Systematic Reviews for systematic reviews investigating the effects of vitamin D fortification of food in general populations of any age. We used Cochrane methodology and assessed the methodological quality of included studies using AMSTAR (A MeaSurement Tool to Assess Systematic Reviews). We assessed the degree of overlap among reviews. All outcomes included in systematic reviews were assessed. The protocol is registered in PROSPERO (registration number: CRD42023420991). We included 27 systematic reviews out of 5028 records for analysis. Overall, 11 out of 12 systematic reviews calculating pooled estimates reported a significant increase in serum 25(OH)D concentrations. The mean change in serum 25(OH)D concentrations per additional 100 units of vitamin D ranged from 0.7 to 10.8 nmol/L. Fortification of food with vitamin D showed a reduction in the prevalence of vitamin D deficiency based on high-certainty evidence. Parathormone (PTH) levels were described to decrease, bone mineral density to increase, while the effects on other bone turnover markers were inconsistent. Fortification did not significantly impact most anthropometric parameters, but it seemed to positively influence lipid profiles. In summary, fortification of food with vitamin D results in a reduction of vitamin D deficiency and might increase serum 25(OH)D concentrations, to varying extents depending on the fortified vehicle and population characteristics. Additionally, fortification may have a positive impact on bone turnover and lipid metabolism but may only have a limited effect on anthropometric parameters.

Locally relevant food-based recommendations could increase iron and calcium intake for adolescent girls in Vietnam.

Unhealthy eating habits are common among adolescents in Vietnam, where transitioning food environments increasingly offer energy-dense micronutrient-poor foods. Successful behavior change approaches must be feasible and acceptable, promoting local foods that are available, accessible, and preferred. Yet, few studies have investigated the potential of food-based approaches for adolescents. We used linear programming to identify problem nutrients, local nutrient sources, and realistic food-based recommendations (FBRs) to improve nutrient intake among girls 16-22 years in Thai Nguyen, Vietnam. We then identified a reduced set of FBRs to prioritize the most critical micronutrient gaps. Calcium and iron targets could not be met in any realistic diet modeling scenario. The best set of FBRs included seven recommendations which could meet intake targets for 9 of 11 modeled micronutrients. The best reduced set of three FBRs targeting iron and calcium only-although more feasible for behavior change-was less effective at improving intake of these nutrients since fewer foods were recommended. Given the difficulty of meeting calcium and iron targets using local foods within acceptable dietary patterns, additional interventions, such as supplementation, staple food fortification, or increasing the availability of affordable calcium- and iron-rich foods, may be necessary to promote dietary adequacy for adolescent girls.

Iron Homeostasis During Pregnancy: Maternal, Placental, and Fetal Regulatory Mechanisms.

Pregnancy entails a large negative balance of iron, an essential micronutrient. During pregnancy, iron requirements increase substantially to support both maternal red blood cell expansion and the development of the placenta and fetus. As insufficient iron has long been linked to adverse pregnancy outcomes, universal iron supplementation is common practice before and during pregnancy. However, in high-resource countries with iron fortification of staple foods and increased red meat consumption, the effects of too much iron supplementation during pregnancy have become a concern because iron excess has also been linked to adverse pregnancy outcomes. In this review, we address physiologic iron homeostasis of the mother, placenta, and fetus and discuss perturbations in iron homeostasis that result in pathological pregnancy. As many mechanistic regulatory systems have been deduced from animal models, we also discuss the principles learned from these models and how these may apply to human pregnancy.

Zinc Tolerance of Special Yeasts and Lactic Acid Bacteria for Use in the Food Industry

In order to address human zinc deficiency, fortifying staple foods with zinc is a safe and cost-effective solution. To ensure the nutritional properties and quality of a final product, zinc tolerance of the microorganisms involved in the fermentation is necessary. Bread, which is widely consumed, occupies a substantial place in many people’s diets, and is often based on a sourdough making process; thus, it might be an important headlining product. This study investigated the zinc tolerance of yeasts and lactic acid bacteria that are specifically suited to produce sourdough bread made with cricket powder hydrolysate and wheat flour. Amongst the yeasts, Kazachstania servazzii KAZ2 and Kazachstania unispora FM2 were only slightly affected in regard to cell growth and colony-forming ability when cultured in YPD broth spiked with 0.5 or 1 mM ZnSO4, respectively. Yarrowia lipolytica RO25 showed a higher tolerance for up to 2.5 mM zinc (ZnSO4). All the yeast strains were capable of accumulating zinc in the range between 200 and 400 fg/cell. The heterofermentative lactic acid bacterium Fructilactobacillus sanfranciscensis DG1 appeared to have a moderate zinc requirement and was homeostatically balanced, even under a high 20 mM extracellular ZnSO4 load. A better understanding of zinc homeostasis in yeast and lactic acid bacteria for food industry applications may lead to improvements in zinc fortification, which might contribute to diminishing Zn deficiencies, especially in vulnerable population groups.

Barriers and facilitators to the implementation of mandatory folate fortification as an evidence-based policy to prevent neural tube defects

BackgroundNeural tube defects continue to be one of the main congenital malformations affecting the development of the nervous system and a significant cause of disability and disease burden to individuals living with these conditions. Mandatory food fortification with folic acid is, by far, one of the most efficacious, safe, and cost-effective interventions to prevent neural tube defects. However, most countries fail to effectively fortify staple foods with folic acid, impacting public health and healthcare systems and generating dismal disparities.AimThis article discusses the main barriers and facilitators for implementing mandatory food fortification as an evidence-based policy to prevent neural tube defects worldwide.MethodsA comprehensive review of the scientific literature allowed the identification of the determinant factors acting as barriers or facilitators for the reach, adoption, implementation, and scaling up of mandatory food fortification with folic acid as an evidence-based policy.ResultsWe identified eight barriers and seven facilitators as determinant factors for food fortification policies. The identified factors were classified as individual, contextual, and external, inspired by the Consolidated Framework for Implementation of Research (CFIR). We discuss mechanisms to overcome obstacles and seize the opportunities to approach this public health intervention safely and effectively.ConclusionsSeveral determinant factors acting as barriers or facilitators influence the implementation of mandatory food fortification as an evidence-based policy worldwide. Notoriously, policymakers in many countries may lack knowledge of the benefits of scaling up their policies to prevent folic acid-sensitive neural tube defects, improve the health status of their communities, and promote the protection of many children from these disabling but preventable conditions. Not addressing this problem negatively affects four levels: public health, society, family, and individuals. Science-driven advocacy and partnerships with essential stakeholders can help overcome the barriers and leverage the facilitators for safe and effective food fortification.

Pre and postnatal care characteristics and management features of children born with myelomeningocele in the post-folate fortification era of staple foods in Costa Rica (2004-2022).

To describe the clinical characteristics of pre- and postnatal care of children born with myelomeningocele in Costa Rica from 2004 to 2022 after the introduction of mandatory fortification of four major staple foods, describing the clinical features of this cohort including the size of the meningomyelocele, neurological level, presence of symptomatic Chiari II at birth, kyphosis, and the severity of hydrocephalus requiring cerebrospinal fluid (CSF) shunting. These results were compared against the pre-fortification historical data to determine favorable outcomes from this health policy. We performed a retrospective review of the clinical records of patients with myelomeningocele at the spina bifida clinic from the National Children's Hospital of Costa Rica who were born between 2004 and 2022, a period when staple food fortification was implemented in the country for four food staples (wheat and corn flour, rice, and dairy products). Pre and postnatal care data pertaining to the number of obstetric ultrasound studies, the trimester in which they were performed, the detection of myelomeningocele and associated hydrocephalus, gestational age and route of delivery, neurological level, myelomeningocele defect size, associated kyphosis and symptomatic Chiari II malformation at birth, time periods of myelomeningocele repair, and CSF shunting were examined. A descriptive comparative frequency analysis between myelomeningocele (MMC) defect size, CSF shunt insertion, symptomatic Chiari II, and kyphosis between the different functional levels was performed with the estimation of the Fisher's exact chi-square test by contingency tables, and 0.05 was set as significance level. Additionally, the postnatal features of this cohort were compared against pre-fortification historical data obtained from 100 live-born patients between 1995 and 1996. A total of 215 patients that were live born between 2004 and 2022 were eligible for analysis with a follow up ranging from 1 to 19years (median follow up: 7.9years). Among 99.1% of the mothers of patients who had prenatal consultations, 95.8% had an average of 3.8 obstetric ultrasound studies which led to a 59% prenatal detection rate of myelomeningocele. The pre and post fortification features showed a male/female ratio that changed from 0.92 to 1.25 respectively. Among these newborns, there was an increase from 54 to 64% cesarean sections as method for delivery. Only 26% of the pre fortification patients had the MMC defect repaired in the first 24h, 32% from 24 to 72h, 20% from 72h to 1week, and 22% later than 10days respectively which deeply contrasted with the post fortification cohort where 7.5% had the MMC defect repaired in less than 8h, 12.2% from 8 to 12h, 66.5% 12-24h, and 12.7% from 24 to 48h and 1% later than 48h, respectively (P < 0.01). Regarding the post fortification myelomeningocele anatomic and functional characteristics, defect size was measured as less than 3cm in 7% of cases, 3 to 5cm in 50% of cases, 5 to 7cm in 42% of cases, and greater than 7cm in 1% of cases. Thirteen percent of the cases had paraplegia due to a thoracic level, 10% had a high lumbar level, 58% had a middle lumbar level, 13% a lower lumbar level, and 6% only sacral compromise. When the data from the pre and post fortification cohorts were adjusted and compared, there was a reduction from thoracic/high lumbar cases from 26 to 23% (P < 0.56), with an increase of middle lumbar cases from 43 to 58% and a reduction from 25 to 13% of low lumbar cases (P < 0.01) while there was no change in the 6% percentage of sacral cases respectively. Lesions that were considered too extensive or larger than 7cm decreased from 7 to 1% while associated kyphotic deformities decreased from 6 to 1.4% (P < 0.01); symptomatic Chiari II malformation at birth also decreased from 7 to 2% in the pre- and post-fortification cohorts respectively with all these changes being statistically significant (P < 0.01). Seventy-nine percent and 80% of the pre and post FAF cohorts required CSF VP shunting with a mean time for insertion of 10days after spinal defect closure with no significant statistical change between the two groups. This study describes a four-staple folate fortified population of live-born patients with myelomeningocele lesions whose neurological level, defect size, and associated deformities such as spinal kyphosis and symptomatic Chiari II at birth suggest that folate fortification could have diminished the severity of this congenital disease.

Nutritional Strategies for Treating Iron Malnutrition: Implications on Nutrikinetic Approaches

Malnutrition remains a major global issue-affecting people of all ages. Iron deficiency is one of the existing malnutrition deficiencies limiting long-term human development. Food-based interventions play a vital role in the growth, development (physical and cognitive), and socioeconomic status of an individual. Several food-based approaches (viz., fortification and bio fortification of staple foods) have been employed for improving malnutrition in vulnerable populations. In underdeveloped countries, staple foods like rice, wheat, beans, and pearl millets etc. are being actively fortified and bio fortified to enhance the iron content intended to deliver the required nourishment with optimal consumption. However, translational iron levels from functional foods may not be proportional to iron absorbed into systems. Considering the effectiveness of bioavailability, additional emphasis is required in establishing the same for the functional foods which could serve as an effective alternative to existing methods in mitigating iron malnutrition. This review emphasizes the importance of iron, iron physio-pathological, and the current status of food strategies in dealing with iron malnutrition.

A case study of ReachAnother Foundation as a change champion for developing spina bifida neurosurgical care and advocating for primary prevention in Ethiopia.

Spina bifida is a serious birth defect affecting the central nervous system, characterized by incomplete closure of the neural tube. Ethiopia has a very high prevalence of spina bifida, affecting about 40 cases per 10,000 births. Babies born with spina bifida require early closure surgery, done within the first 2-3days after birth. Some babies need repeat surgeries to address complications, including hydrocephalus. Without medical care, babies have a high risk of death within the first 5years of their life. Neurosurgical capacity for spina bifida closure surgery at birth is a relatively new development in Ethiopia. ReachAnother Foundation, a not-for-profit organization based in OR, USA, started work in Ethiopia in 2009 and has been instrumental in training neurosurgeons and improving treatment for spina bifida and hydrocephalus. Along with the development of neurosurgical care, the Foundation has invested in training multi-disciplinary teams to conduct patient aftercare and has launched a platform for improved patient outcomes research. As of year 2022, they support six spina bifida "Centers of Excellence" nationwide and are continuously advocating for primary prevention of spina bifida through mandatory fortification of staple foods in Ethiopia. This paper describes ReachAnother's efforts in Ethiopia in a short interval of time, benefiting numerous patients and families with spina bifida and anencephaly. We document this as a case study for other countries to model where resources are limited and the prevalence of spina bifida and hydrocephalus is high, especially in Asia and Africa.

Failure to fortify staple foods with folic acid-still public health malpractice.

Failure to fortify staple foods with folic acid-still public health malpractice.

Neural tube defects: a review of global prevalence, causes, and primary prevention.

Neural tube defects (NTDs) are common birth defects and contribute to life-long disabilities, high medical care costs, and perinatal and child mortality. This review is a primer on prevalence, causes, and evidence-based prevention strategies for NTDs. The estimated average global prevalence of NTDs is two cases per 1000 births, amounting toapproximately 214,000-322,000 affected pregnancies worldwide annually. Prevalence and associated adverse outcomes are disproportionately high in developing countries. NTDs have multiple risk factors including genetic and non-genetic (i.e., maternal nutritional status, pre-pregnancy diabetes, early pregnancy exposure to valproic acid (anti-epileptic medication), and a previous pregnancy affected by aNTD) factors. Maternal folate insufficiency before and during early pregnancy is the most common risk factor and is preventable. Folic acid (vitamin B9) is required for formation of the neural tube early in pregnancy, around 28days after conception, when most women are unaware of their pregnancies. Current guidelines recommend that all women planning or capable of pregnancy take a daily supplement containing 400-800μg of folic acid. Mandatory folic acid fortification of staple foods (e.g., wheat flour, maize flour, rice) is safe, economical, and the effective intervention for primary prevention of NTDs. Currently, about 60 countries are implementing mandatory folic acid fortification of staple foods, preventing just a quarter of all preventable NTD cases worldwide. There is an urgent need for active champions, including neurosurgeons and other healthcare providers, to generate political will and promote effective mandatory food fortification with folic acid, and reach equitable primary prevention of NTDs in all countries.

Effect of Iron-fortified Wheat Flour on Hemoglobin Levels among Women of Reproductive Age Group in Mansehra, KPK, Pakistan.

Micronutrient deficiencies continue to affect approximately 25% of the World's population. Fortification of staple foods is recognized as one of the most effective interventions to combat micronutrient deficiencies such as iron deficiency. The objective of the current research was to elucidate the effect of iron-fortified wheat flour on the mean hemoglobin levels of women of the reproductive age group (15-49 years) in the Mansehra district, KPK, Pakistan. The study sample consisted of 280 women whose baseline hemoglobin levels were determined at the start of the study. They were fed with iron-fortified wheat flour for a period of 120 days after which their hemoglobin levels were measured again. A 24-hour dietary recall was also taken from the study participants to determine the amounts and frequencies of major foods consumed during the last 24 hours. The study results showed that the consumption of iron-fortified wheat flour had significantly increased the mean hemoglobin levels of women. The study concluded that the consumption of iron-fortified wheat flour could be an effective strategy to combat the problem of iron deficiency in Pakistan.

Knowledge of periconceptional folic acid supplementation and associated factors among pregnant women attending antenatal care at public health facilities in Hawassa, South Ethiopia.

Neural tube closure defect (NTD) such as spinal bifida and anencephaly are serious neurological disabilities that occur when the neural tube does not close completely within 28 days of conception. Even though Folic acid supplementation during and before pregnancy is proved to significantly reduces the risk of NTDs. Currently only 23% of folic acid preventable NTD achievedWorldwide; mainly due to lack of awareness about folic acid supplementation. This study was aimed to assess the knowledge of Folic acid supplementation among pregnant women attending antenatal care at public health facilities in Hawassa Ethiopia. Institution based cross-sectional study was employed among 358 pregnant women attending antenatal care. Data were collected using an interviewer-administered structured questionnaire and analyzed using SPSS version 22. The knowledge of Folic acid supplementation was assessed using six multiple-choice questions. The association between the dependent and independent variables were analyzed using Binary Logistic regression model and statistically significant predictors at p-value <.05 at 95% CI. This study indicated that only 7.5% (95% CI, 5.3-10.1) of pregnant women had good knowledge of Folic acid supplementation. The pregnant women who had a history of at least one previous pregnancy loss AOR=12.64 (95% CI: 4.98, 32.08) and those who had preconception consultation AOR = 11.77 (95% CI: 3.01, 46.07) were more likely to have good knowledge of periconceptional folic acid supplementation as compared to their counterpart. The knowledge of periconceptional folic acid supplementation among pregnant women was worryingly low in the study area. Alternative and more effective strategies are needed if the population of Ethiopia is to benefit fully from the folic acid prevention of NTDs. Thus, in Ethiopia the future strategies should focus on the possible way to reach the last group through fortification of staple foods with folic acid along with improving women's awareness on folic acid importance in reducing Neural tube defects.