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 Global Malnutrition

Sharing Industry Experience to Advance Fortification

Over the last decade, developing country governments and food industries have become increasingly aware that micronutrient fortification of staple foods can help improve nutrition and health on a broad scale. Adding essential vitamins and minerals to food staples consumed by micronutrient deficient populations can help mitigate the debilitating health effects and productive losses associated with poor and nutritionally incomplete daily diets. Food fortification can improve not only individual lives, but also the economy of nations.

The United States food sector has over fifty years' experience in food fortification, and has developed considerable expertise in fortification strategies and technologies. SUSTAIN has long recognized and proven the value of industry-to-industry assistance in food processing, quality control, storage and marketing. Now it is linking industry to industry to transfer state-of-the-art knowledge and technological expertise on the micronutrient fortification of food staples. With the support of the U.S. food industry, SUSTAIN has provided technical assistance in food fortification to individual industries in Central America, Brazil, Russia, Africa and Bangladesh.

Central America:

As part of a broad initiative to reduce the prevalence of micronutrient deficiencies in Central America, SUSTAIN offered technical training and assistance in iron fortification to regional wheat milling industries, and began to explore the potential for integrating iron fortification into the commercial production of corn masa flour, an increasingly popular product in the region.

In late 1996 and early 1997, a team from SUSTAIN visited flour mills in El Salvador, Guatemala, Honduras and Nicaragua to assess current iron fortification practices as well as the millers' capacity to produce fortified products according to the specifications in Central America. SUSTAIN identified no insurmountable obstacles to iron fortification of wheat flour in any of the four countries, although not all of the mills visited were consistent in their fortification practices. SUSTAIN recommended that governments in the region reach an agreement in coordination with industries to set uniform policy and specifications for the iron fortification of flours.

In the meantime, some smaller mills were found to be in need of technical assistance and training in quality assurance and control in milling and fortification technology. In 1998, SUSTAIN organized a workshop in collaboration with INCAP (Institution for Nutrition of Central America and Panama) for private sector millers on these topics. The objectives of the workshop were to promote learning, to interact with the private sector to facilitate activities related to food fortification and to identify areas where additional technical assistance might be needed. SUSTAIN also created an advisory panel of experts from industry, government and academia to provide recommendations for iron fortification of corn masa flour, given this product's rapidly growing popularity in the region.


Iron deficiency anemia affects between 20 and 80 percent of Brazil's children, and between 32 and 52 percent of pregnant women, depending on region. In May, 1999, the Brazilian government, millers, NGOs and consumer advocates signed a Social Pact, modeled after the government/industry agreement in Mexico, to address this problem, in part through voluntary fortification of wheat and corn flour with iron.

SUSTAIN was asked by the Brazilian government to assess the fortification capacity of Brazilian millers, and to provide technical support to encourage industry's participation in the fortification initiative. SUSTAIN sent a team to Brazil in March 2000 to perform the assessment, and in August shared information on fortification at a mobilization workshop for the millers, as well as disseminated the Iron Guidelines. The latter were highly useful in setting the recommendations in fortification manuals written for the corn and wheat milling industry. Finally, SUSTAIN arranged a tour of U.S. mills and baking facilities for two Brazilian government representatives in November 2000, during which they observed process and quality assurance methods that they could transfer home to assist their own industries in adopting fortification technologies.


SUSTAIN's involvement in micronutrient work in Russia began in 1997, when executive director Elizabeth Turner was invited to take part in a delegation visiting Russia under the auspices of the Gore-Chernomyrdin Commission. SUSTAIN invited representatives from the H.J. Heinz Company and American Ingredients to accompany Ms. Turner. The team learned of the dramatic decline in fortified foods in Russia subsequent to the 1991 transformation of the Soviet Union into independent republics and began discussing the situation with government and food industry representatives, setting the stage for future collaborations.

On a subsequent trip, SUSTAIN volunteer Bob Gies, in conjunction with a team from the U.S. Center for Disease Control, assessed the capabilities of several Russian milling companies interested in micronutrient fortification. Gies, a food-industry expert with American Ingredients, also hosted a delegation of Russian government officials and millers in a tour of U.S. facilities. The goal of these reciprocal visits was to determine what technologies were needed to meter out the vitamins and minerals Russian millers desired.

Gies has also worked closely with Mikhail Lazerev, a Russian entrepreneur who developed Fortamin, a vitamin and mineral premix designed to address chronic deficiencies of vitamins and minerals in children's diets. An initial pilot study was conducted in 1999/2000 in the Russian town of Dubna, whose population suffered from chronic deficiencies of micronutrients. Over 1600 preschoolers in kindergartens and an orphanage were provided with Fortamin-enriched bread over nine months. A dramatic 80% drop in anemia rates over this period convinced the town to incorporate the cost of fortification into its line-item budget. Doing so actually has saved the town money -- an estimated 10 rubles in medical costs associated with treating anemia for each ruble invested in the ongoing enrichment program.


In Africa, micronutrient deficiencies pose a chronic problem and unemployment is higher than anywhere in the world. SUSTAIN has worked in Ghana and Malawi to reduce micronutrient malnutrition and to strengthen small- and medium-sized food enterprises through the transfer of expertise in post-harvest processing of micronutrient-rich crops, food fortification, marketing, and distribution.

In Malawi, SUSTAIN brought volunteer expertise to bear on the dual goals of malnutrition reduction and the development of small and medium business enterprises. An initial assessment was conducted in 1998 to identify opportunities to assist Malawi businesses with the development and commercialization of fortified foods. SUSTAIN volunteers Neil Hammond (a food technologist) and Anthony Adams (a marketing specialist) visited Malawi along with Willem Wurdemann, a representative of Amsterdam's Royal Tropical Institute, which had been instrumental in helping set up four small Malawi producers of the low-cost weaning food "Likuni Phala".

The assessment team concluded that SUSTAIN could contribute to better nutrition and to entrepreneurship in Malawi by helping these businesses expand their sales base through more effective quality control, packaging and marketing. This was accomplished in part through direct technical assistance and in part through a series of workshops on marketing/retailing skills that brought together members of the National Association of Small and Medium Enterprises (NASME), the National Association of Business Women (NABM), the National Association of Hawkers and Informal Businessmen (NAHIBA) and managers and staff of the Likuni Phala production units.

The hoped for result was to help increase sales and widen the distribution of this nutritious food in Malawi and to reduce its producers' dependence on donor-support. Success was confirmed in a post-workshop survey conducted with Likuni Phala, in which over 50% of respondents reported a 20-40% increase in profits subsequent to the workshops.

SUSTAIN also offered a seminar in fortification technology and methodologies for Malawi bakers and for representatives of the Ministry of Health Nutrition Unit, and other government bureaus. The seminar received press and radio coverage and sparked a clear increase in interest in fortification in both the government and private sectors.

In Ghana, SUSTAIN assisted with post-harvest processing activities to generate a more reliable income for local tomato farmers and to address seasonal gluts of crops. SUSTAIN's technical support enabled ADRA to transfer a low-cost tomato processing technology to client farmers in the Brong Ahafo region and to build a pilot processing plant in Tuobodom, a small village in the region.

In addition to generating local income, this activity expanded the supply and year-round availability of a naturally vitamin-rich regional food product.


In response to a request from USAID/Dhaka, SUSTAIN participated in an assessment of the micronutrient fortification of atta wheat flour in Bangladesh and the possible introduction of fortified atta into the Bangladesh Government's Food for Education (FFE) program. Information gathered during the trip and a subsequent analysis of atta indicated that its fortification is technically feasible and that the use of fortified atta in the FFE program would effectively deliver deficit micronutrients to groups vulnerable to malnutrition in Bangladesh. The team recommended developing a pilot plan and proceeding with work to fortify donated wheat.