Fortification of Vegetable oil and Sugar with Vitamin A in Uganda

The cost comparison of providing 100 percent EAR yearly for each individual through oil and
sugar fortification is US$0.050/year for oil, and US$0.265 for sugar; i.e. a five time difference.
The higher fortification cost of sugar is from a more expensive type encapsulated powder form
of vitamin A. Thus, the fortificant compound of vitamin A for oil (1.7 million UI/g) is
equivalent to 510 g/kg vitamin A (1 mg vitamin A = 3333 IU); the price of this compound is
US$66.7/kg, so the cost is US$130 per kilogram of vitamin A (66.7/0.51). Likewise, the
fortificant compound of vitamin A for sugar (250,000 IU/g) is equivalent to 75 g/kg vitamin A;
the price of this compound is US$48 per kilogram, so the cost is US$640 per kilogram of vitamin
A (48/0.075). Thus the cost of the vitamin A compounds explains why sugar fortification is
more expensive. Sugar fortification will require a larger, yet necessary, investment, because
fortified oil will not reach some vulnerable groups.
In summary, a higher vitamin A level in oil combined with a lower sugar fortification level is an
adequate policy to follow. Now, Uganda must adjust downwards the vitamin A content of sugar,
following ECSA guidelines. Using both fortification programs, it would require a combined
annual investment of US$ 0.120 per person (US$2 million yearly for the whole country),
Uganda will provide almost the total needed amount of vitamin A to almost half the population
(46% or 13.3 million persons), who consume both oil and sugar; 60 percent EAR to about 11
percent of the population (3.2 million persons), who consume oil but not sugar; and 34 percent
EAR to a fifth of the population (19% or 5.5 million persons), who consume sugar but not oil. In
any case, 76 percent of the population (21.7 million persons) will have improved vitamin A
status. Although accurate additional amounts must be estimated by nutritional surveys, these
figures are a good first approximation.
The largest cost in oil and sugar fortification with vitamin A is the fortificant itself, 89 percent
and 93-95 percent, respectively. This important ingredient is considered an essential drug in
Uganda, and therefore is exempt from the 18 percent value-added tax. However, the National
Drug Authority must still audit and certify the manufacturing industries wherever they are, and
confirm compliance at importation sites. These processes cost approximately US$30,000/year,
which means 1.5 percent of the fortificant cost. Therefore, strategies to reduce these costs,
mainly for premix providers, may provide important savings for the whole program.
The proportion of the cost for purchasing equipment is very low for oil fortification (around 6%
of the total expenditures for the first year of operations, and 0.7% of the yearly cost when capital
costs are distributed over a 10-year period). For sugar fortification, the initial investment per
factory is about US$120,000, (24% of the annual expenditures of the first year if using the ECSA
food fortification formula, or 16% if using the current Uganda formula). The proportions are
reduced to 2.4 percent and 1.6 percent of the yearly costs, respectively, when considering the 10-
year useful life of the equipment.
The estimated cost associated to internal quality control and assurance, including sending
periodic samples to external reference laboratories, is within expected figures. An estimated
annual cost was US$45,000 for the oil and for the sugar fortification processes. This amount
means 8 percent of the oil fortification recurrent cost, and 2-3 percent of the sugar fortification
recurrent cost.
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