Elements of a National Food- Fortification Program for Bangladesh

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SummarySummaryBackground, Objective, and MethodologyThis 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, which was conducted in April-May 2004, builds on a recent pilot wheat-flourfortification program in Bangladesh. Performed through MOST for USAID/Dhaka, the pilotprogram was a limited-term project to improve vitamin A and iron status and also to reduceanemia through consumption of fortified wheat flour with vitamin A, iron, zinc, B1, B2, niacin,and folic acid.This study’s primary objective is to identify major elements of a food-fortification strategy inBangladesh, including micronutrient formulation for the food vehicles identified as suitable forfortification.Data were collected from available documents with relevance to the oil, wheat, and sugarindustries, and from extensive interviews with officials of the Government of Bangladesh (GOB)and other key personnel in Dhaka during a two-week visit to Bangladesh.Current Efforts to Reduce Micronutrient Deficiency in BangladeshBangladesh has achieved considerable progress in reducing poverty, child mortality, andmalnutrition. Despite these improvements, however, poverty remains alarmingly high, andthe overall level of child malnutrition remains one of the highest in the world. Only 32 percentof the population meet calorie requirements, 46 percent meet protein requirements, and 25percent meet fat requirements. Intake is low for most micronutrients, vitamin A indicators forchildren and women indicate the presence of a serious public health problem, and anemia iswidespread among all population groups.Bangladesh regards improved nutrition as a top government priority. Ongoing programsto reduce micronutrient deficiency include dietary diversification and other food-basedinterventions such as development of home gardens, poultry, fisheries, and other small farmanimals at the community level; salt iodization; and universal vitamin A supplementation foryoung children and lactating women.Food fortification was initiated with the implementation of a pilot wheat-flour fortificationactivity. Building on that initiative, the GOB has launched an effort to examine the suitabilityof other food-fortification vehicles. As a result of these interventions, it is expected thatfood-fortification will soon become an important element of the country’s strategy to reducemicronutrient malnutrition.ivMOST The USAID Micronutrient Program
SummaryElements of a National Food-Fortification ProgramFood Vehicles and Fortification RegimeThis study considered three foodfortificationvehicles: oil, wheat flour,and sugar. The suitability of each is brieflysummarized below.OilOil is a most suitable food-fortification vehiclein Bangladesh. Mustard-seed oil, soybean oil,and palm oil are the country’s three majorsources of edible oil. Since mustard-seed oilis not suitable for fortification, however, thefortification program should concentrate onsoybean and palm oils. Right now, per capitaconsumption of both these oils is adequateand rapidly increasing. For example, percapita consumption increased from 10g/dayin 1999-2000, to 14g/day on average between2000-2001 and 2002-2003, and was as high as17g/day in 2000-2002. Fortified at a minimumvitamin A level of 20mg/kg, consumption of13g/day/person of oil would supply morethan 50 percent of the estimated averagerequirement (EAR).At Tk 223, or $3.85 per metric ton (MT),oil has the lowest fortification cost amongthe three commodities considered — about20 percent below wheat-flour fortificationcost and well below sugar-fortification cost.In addition, total fortification costs, includingvitamin A, are estimated at 0.46 percent ofretail price for oil (0.43 percent for soybean oiland 0.53 percent for palm oil) — suggestingthat oil fortification will not have anymeaningful impact on consumption.These cost estimates do not include the47 percent import duty currently imposedon micronutrients. Taking the importtax into consideration raises the costsof oil fortification to $5.62/MT, with acorresponding increase in retail prices. Thesame conclusion applies to wheat flour andoil, suggesting that elimination of the importduty on micronutrients should be considered.Soybean oil and palm oil are imported inan unrefined form. These imports are thenprocessed by a limited number of producers.Of the 15 active oil producers in Bangladesh,3 have an individual capacity of over 1,000MT/day and process 80-90 percent of allsoybean and palm oil imports. Both the sizeand limited number of producers suggest thatmandatory fortification for oil would be themost-effective strategy.Wheat FlourWheat flour is a suitable food-fortificationvehicle in Bangladesh. The structure of themilling industry suggests that the wheat-flourfortification program should rely on rollermills rather than on chakki mills (small stonemills). It should also be private-sector drivenand voluntary.Per capita wheat-flour consumption isestimated at 43g/day. Fortification of wheatflour would supply about 20 percent of EARfor vitamin A, iron, folate, B-12, B-1, B-2, B-6,niacin, and zinc.Fortification costs for wheat flour are aboutTk295, or $5 per MT, and represent about 1.6percent of retail prices, suggesting that theadditional cost of fortification does not appearprohibitive to consumers.SugarStrong evidence presented in this studysuggests that sugar fortification in Bangladeshis not recommended. Because the bulk ofsugar consumed is imported in an alreadyrefined form, it places severe limitations onthe amount of sugar available for fortification.Local production is only about 20-25 percentof total sugar consumption, equivalent toless than 2g/day/person. Per capita sugarconsumption in rural areas, where most ofthe vulnerable groups can be found, is evenlower.At about Tk630, or $10.8 per MT, the costof sugar fortification is over twice as high asthat for wheat flour and nearly three timesthat for oil. The additional cost associatedElements of a National Food-fortification Program for Bangladeshv
Page 1 and 2: Elements of a National Food-Fortifi
Page 3 and 4: Elements of a National Food-Fortifi
Page 5 and 6: Table of Contents and AcronymsTable
Page 7: Table of Contents and AcronymsAcron
Page 11 and 12: Section 1: IntroductionSection 1: I
Page 13 and 14: Section 2: Nature of the Micronutri
Page 15 and 16: Section 2: Nature of the Micronutri
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
Page 23 and 24: Section 4: Cost Analysis of Food Fo
Page 25 and 26: Section 5: Elements of a National F
Page 27 and 28: Section 5: Elements of a National F
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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