Region making headway on food fortification

Basic nutrients people need to survive have been added to food around the world for almost a century, but West Africa is only now leading the way for the same life-saving technique to be rolled out in Africa, although experts warn it is just one small component in combating under-nutrition.

“West Africa has made more progress in food fortification than anywhere else on the continent except possibly South Africa,” said Shawn Baker, West Africa regional director of the non-governmental organisation Helen Keller International (HKI).

However “it is important not to oversell it,” he emphasised. “Large-scale food fortification is not going to solve all the region’s problems, but the levels of deficiency in West Africa are huge and I think the large-scale programs like this do nonetheless help in making an overall reduction.”

Huge deficiencies

Deficiencies in vitamin A, iron, iodine and zinc result in increased deaths among children and mothers, impaired growth, irreversible mental impairment, and greatly reduced economic development.

Fortification of common food staples and condiments with micronutrients is one of the key strategies to control micronutrient malnutrition. Unlike other strategies, such as supplementation, prioritising dietary diversification and public health interventions, food fortification is driven by private sector food industries.

“By bringing in private sector resources to help address a public sector problem, public sector resources can be targeted to the people who need it most,” Baker said.

Slow start

The West African Health Organization (WAHO), the official health agency of the Economic Community of West African States (ECOWAS), has been working with the Micronutrient Initiative and the UN’s Children’s Fund (UNICEF) in the sub-region for several years to promote food fortification.

The regional body ECOWAS has prioritised the fortification of salt with iodine. WAHO, which is composed of ECOWAS health ministers, last year recommended that all cooking oil produced and consumed in the region be fortified with vitamin A, and all flour flour with folic acid and other nutrients. ECOWAS is expected to endorse the recommendation.

“It was slow at first as there was a need for sensitisation, to get industry on board, improve the legal framework and where necessary to find funding,” HKI’s Baker explained. “It took a long time to overcome the overall disconnect between the speeds at which the public and private sectors wanted to move.”

In May 2007 cooking oil producing companies in the eight Monetary and Economic Union of West Africa (UEMOA) countries – Benin, Burkina Faso, Cote d’Ivoire, Guinea Bissau, Mali, Niger, Senegal and Togo – formed a partnership to produce vitamin A-fortified oil. Baker has estimated this project alone could save 100,000 children’s lives.

By October, wheat flour fortified with folic acid will start being produced by all flour mills in Ghana, as part of a collaboration between the private sector and the Ghanaian ministry of health. Likewise in Guinea, flour is fortified already.

Nigeria

Nigeria, which has a population of over 130 million and alone accounts for almost half the population of the ECOWAS area, is also “in the process of finalising” arrangements for widespread fortification.

Nigeria has already been fortifying some of the flour, maize, and sugar produced and processed there. In June this year UNICEF announced that 98 percent of people in Nigeria now have access to fortified salt, up from 40 percent in the 1980s.

“Basically, we’re excited about the developments in West Africa so far,” said Larry Umunna, Africa director of the Global Alliance for Improved Nutrition (GAIN), an organisation which focuses on food fortification. “There is still a lot of work to be done but at this point in time we are happy with developments in the various countries.”

Skeptical

David Sahn, an economist specialising in the link between poverty and malnutrition at Cornell University, is nonetheless skeptical about the prospects for a major improvement in nutrition in West Africa, despite the fortification advances.

“There are certain nutrient deficiencies that can be dealt with like iodine and iron, and certainly if the delivery mechanisms are economically and institutionally viable they should be put in place,” he said.

“But [fortification] leaves intact the fundamental features of under-nutrition in Africa which is shortages of good quality food, and varied proteins and the whole range of nutrients. Until the underlying issues of poverty and deprivation are addressed, fortification is at best working at the margins of addressing important problems, but not addressing the fundamental causes of the hunger and deprivation that we are talking about.”

HKI’s Baker also cautioned about the need for continued focus on broader nutritional problems in the region, especially the most marginalised and often vulnerable people in cities and the countryside who are so poor they eat only products they produce themselves and so will not be affected by commercially improved foodstuffs.

nr/np