Let’s leverage food fortification for healthy outcomes

Today, nearly half of children born in urban and a quarter of those born in rural Kenya are likely to suffer brain and spinal cord defects due to folate (Vitamin B9) deficiency. Moreover, about a third of children are at risk of blindness due to Vitamin A deficiency while 22 per cent are predisposed to anaemia due to iron deficiency.

Zinc deficiency, which often results to compromised immunity, is predominantly high across the entire Kenyan population: over 80 per cent in children, 82 per cent in non-pregnant women, 68 per cent in pregnant women and 75 per cent in men (Kenya National Micronutrient Survey 2011).

Micronutrient deficiencies impedes one’s ability to live to their full potential, affecting economic productivity, health, social and cultural life. From the global perspective; each year, Vitamin A deficiency contributes to about 250,000 to 500,000 cases of childhood blindness. Every year, between 40 to 60 per cent infants in low and medium income countries are at risk of poor cognitive development due to iron deficiency. An estimated 300,000 children are born with birth defects due to maternal folate deficiency. Similarly, 20 per cent of maternal deaths are attributed to anemia during pregnancy.

Kenya, through the Ministry of Health has explored various interventions to address malnutrition. A key plank in the response strategy has been foodfortification. Fortification is the practice of deliberately adding micronutrients (vitamins and minerals) to foodto improve its nutritional quality.

Food fortification in Kenya dates back to 1970s with iodization of salt which led to decline in prevalence of goitre. Over time, fortification has evolved to include other food vehicles (maize flour, wheat flour, sugar, fats and oils). In 2006, the Kenya National FoodFortification Alliance was established.

This was followed in 2012, by an amendment of the Foods, Drugs and Chemical Substances Act of the Laws of Kenya CAP 254 that made it mandatory to fortify maize and wheat flour, fats and oils with specified vitamins and minerals.

The effectiveness of fortification programmes has been determined through various studies and experiences. In Kenya for instance, mandatory iodization of salt has led to almost complete elimination of goiter in the population. In Canada, mandatory fortification of cereals led to a reduction in brain and spinal cord defects by 46 per cent.

Likewise, the prevalence of beriberi in Southern US and Canada declined drastically following fortificationof flours and bread with high-vitamins. In Denmark, fortification of margarine with Vitamin A reduced cases of xerophthalmia (eye disease that can cause blindness) by more than 90 per cent.

Fortifying flour with folic acid was proven to reduce birth defects such as spina bifida by 40 to 50 per cent.

Failure to implement fortification can be costly to a country. In low and medium income countries, micronutrient deficiencies have been estimated to cause an annual GDP loss of 2 to 5 per cent, translating to an estimated annual cost of US$20 to US$30 billion.

Despite implementation of the national fortification programme in Kenya, there have been various challenges. A situation analysis conducted by Jomo Kenyatta University of Agriculture and Technology (JKUAT) and Ministry of Health at the production level, consumer level and regulatory level revealed a number of gaps. At the maize milling industry level, challenges noted include; inadequate technical know-how, insufficient equipment and technology, poor monitoring and evaluation structures and financial constraints, especially among low and medium scale millers. At the consumer level, low levels of knowledge and awareness on fortification was reported.

To strengthen the food fortification programme, JKUAT and the Ministry of Health, have been implementing the European Union funded project “Strengthening the Kenya National Food Fortification Program.”

The project aims at strengthening governance and the legal structures, scaling up fortification beyond large scale millers, to include medium and small scale millers, improving and introducing new fortification technologies, raising consumer awareness on benefits of consuming fortified food and improving monitoring and evaluation of Kenya food fortification programme.

- The writer is Assistant Project Manager, JKUAT FoodFortification Project