Elements of a National Food- Fortification Program for Bangladesh

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Summarywith fortification would increase the retailprice of sugar by over 2 percent. Assumingfortification costs are passed on to consumers,this increase may place fortified sugar ata disadvantage relative to the importedunfortified product.Fortification FormulationThe table below describes the fortificationformulation and micronutrient supply foroil and wheat flour in Bangladesh. Fortifiedat a minimum vitamin A level of 20mg/kg,oil would supply about 52 percent of EAR— an amount expected to have a significantbiological impact. Based on the formulationdescribed in the table, fortification of maida(refined flour) would supply about 20 percentof EAR for vitamin A, iron, folate, B-12, B-1,B-2, B-6, niacin, and zinc.National Capacity to ImplementFood FortificationThere is fervent commitment to foodfortification in Bangladesh at the highestlevel of government, and a strong publicand private-sector partnership is emerging.In December 2003, the Bangladesh FoodFortification Alliance (NFA) was formed,consisting of more than 30 members fromthe public and private sectors, civil society,and international development partners. ATechnical Committee was also selected toprovide specialized support to NFA and itsmembers. NFA’s first meeting took place inApril 2004.A rapid assessment conducted for thisstudy indicates that Bangladesh has thenecessary human and institutional capacityto implement food fortification on a nationalscale. However, available evidence suggeststhat while NFA partners are interested in foodfortification, they will be unable to put theprogram into action without some technicalsupport. An integrated package of keytechnical assistance interventions providedby USAID, the Global Alliance for ImprovedNutrition, and other donors would create theconditions for NFA partners to proceed.Fortification Formulation and Micronutrient Supply for Wheat Flour (Maida) and Oil in BangladeshNutrient Form Minimum Level ofAddition (mg/kg) *Wheat FlourOverage (%) **% EAR in UsualConsumption ***Vitamin A SD250 2 50 16Iron Ferrous fumerate 45 5 20Folate Folic acid 2 50 23B-12 B-12 — 0.01% 0.010 30 18B-1 Thiamin mononitrate 6 40 18B-2 Riboflavin 4 30 16B-6 Pyridoxin 5 20 19Niacin Niacinamide 40 10 16Zinc Zinc oxide 20 5 19OilVitamin A Vitamin A oily 1.7mIU/g 20 5 52Notes:* Selected (1) to provide at least 20 percent EAR from 50g/day/person of wheat flour consumption, (2) to be compatiblewith the sensorial properties of the product, and (3) to be safe for those who consume large amounts of the product.** The additional amount over the minimum level to compensate for losses in production, storage, and transportation.*** 40g/day for wheat flour and 13g/day for oil; values for families, adult male.viMOST The USAID Micronutrient Program
Section 1: IntroductionSection 1: IntroductionBackgroundThis study was prepared under MOST, the USAID Micronutrient Program. Funded by theOffice of Health and Nutrition of the United States Agency for International Development(USAID), MOST is USAID’s flagship project for the promotion of activities to improve themicronutrient status of at-risk populations throughout the world.The study builds on a recent pilot wheat-flour fortification program in Bangladesh. Performedthrough MOST for USAID/Dhaka, the pilot program was a limited-term project to improvevitamin A and iron status and also to reduce anemia through consumption of fortified wheatflour with vitamin A, iron, zinc, B1, B2, niacin, and folic acid.Vitamin A and iron deficiency has led to high rates of night blindness, anemia, reducedimmune response, and other health problems in Bangladesh, particularly among children andpregnant women. In 1995, the Government of Bangladesh (GOB) implemented a universalvitamin A capsule distribution program that achieved high coverage for children 6 monthsto 5 years of age. Although the program has lowered the incidence of night blindness andother health problems associated with vitamin A deficiency, significant constraints remain. Inparticular, women are not covered, and many other important micronutrients are not beingsupplied through capsule distribution.The GOB initiated the pilot trial wheat-flour fortification program in August 1999, incollaboration with USAID/Dhaka. The purpose of the program was to examine the feasibilityof reducing micronutrient deficiency through food-fortification and to verify the applicabilityof known fortification technologies to the local situation. Program activities were designed togenerate important information on the feasibility of wheat-flour fortification on a larger scale. Toachieve this objective, several activities were undertaken:An organoleptic study to evaluate the organoleptic qualities of the fortified wheat flour andits productsAn efficacy study to assess the health impact of the fortified wheat flour on the iron andvitamin A status of the recipient populationA utilization and acceptability study to ascertain beneficiaries’ use of the wheat flourA cost analysis and sustainability study to assess cost factors and sustainabilityrequirements for a nationwide programA promotional and educational campaign to inform recipients of the health benefits of thefortified wheat flourThe wheat-flour fortification program demonstrated that wheat-flour fortification on a nationalscale would be both feasible and desirable. Following the success of the wheat-flour fortificationexperience, the GOB requested USAID/Dhaka assistance to examine the feasibility of fortifyingother food vehicles such as edible oil and sugar. This study took place in response to thatrequest.Elements of a National Food-fortification Program for Bangladesh1
Page 1 and 2: Elements of a National Food-Fortifi
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Page 5 and 6: Table of Contents and AcronymsTable
Page 7 and 8: Table of Contents and AcronymsAcron
Page 9: SummaryElements of a National Food-
Page 13 and 14: Section 2: Nature of the Micronutri
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Page 17 and 18: Section 3: Potential Food-Fortifica
Page 19 and 20: Section 3: Potential Food-Fortifica
Page 21 and 22: Section 4: Cost Analysis of Food Fo
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Page 25 and 26: Section 5: Elements of a National F
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Page 29 and 30: ReferencesReferencesBangladesh Bure
Page 31 and 32: Annex TablesAnnex B: Estimated Cost
Page 34: Bangladesh has the necessary human

Elements of a National Food- Fortification Program for Bangladesh

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