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The Unfinished Agenda for Food Fortification in Low- and Middle-Income Countries: Quantifying Progress, Gaps and Potential Opportunities

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Global Alliance for Improved Nutrition, Rue de Varembé 7, 1202 Geneva, Switzerland
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Food Fortification Initiative, 1518 Clifton Road, Atlanta, GA 30322, USA
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UNICEF, 3 UN Plaza, New York, NY 10017, USA
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Nutrition International 180 Elgin St., Suite 1000, Ottawa, ON K2P 2K3, Canada
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Helen Keller International, Regional Office for Africa, Dakar BP 29.898, Senegal
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World Food Programme, Via Cesare Giulio Viola, 68, 00148 Rome, Italy
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Iodine Global Network, Seattle, WA 98107, USA
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Authors to whom correspondence should be addressed.
Nutrients 2020, 12(2), 354; https://doi.org/10.3390/nu12020354
Received: 31 December 2019 / Revised: 23 January 2020 / Accepted: 27 January 2020 / Published: 29 January 2020
(This article belongs to the Special Issue Nutrient Fortification for Human Health)
Large-scale food fortification (LSFF) is a cost-effective intervention that is widely implemented, but there is scope to further increase its potential. To identify gaps and opportunities, we first accessed the Global Fortification Data Exchange (GFDx) to identify countries that could benefit from new fortification programs. Second, we aggregated Fortification Assessment Coverage Toolkit (FACT) survey data from 16 countries to ascertain LSFF coverage and gaps therein. Third, we extended our narrative review to assess current innovations. We identified 84 countries as good candidates for new LSFF programs. FACT data revealed that the potential of oil/ghee and salt fortification is not being met due mainly to low coverage of adequately fortified foods (quality). Wheat, rice and maize flour fortification have similar quality issues combined with lower coverage of the fortifiable food at population-level (<50%). A four-pronged strategy is needed to meet the unfinished agenda: first, establish new LSFF programs where warranted; second, systems innovations informed by implementation research to address coverage and quality gaps; third, advocacy to form new partnerships and resources, particularly with the private sector; and finally, exploration of new fortificants and vehicles (e.g. bouillon cubes; salt fortified with multiple nutrients) and other innovations that can address existing challenges. View Full-Text
Keywords: fortification; micronutrients; micronutrient deficiency; large- scale food fortification; low- and middle-income countries fortification; micronutrients; micronutrient deficiency; large- scale food fortification; low- and middle-income countries
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MDPI and ACS Style

Mkambula, P.; Mbuya, M.N.N.; Rowe, L.A.; Sablah, M.; Friesen, V.M.; Chadha, M.; Osei, A.K.; Ringholz, C.; Vasta, F.C.; Gorstein, J. The Unfinished Agenda for Food Fortification in Low- and Middle-Income Countries: Quantifying Progress, Gaps and Potential Opportunities. Nutrients 2020, 12, 354. https://doi.org/10.3390/nu12020354

AMA Style

Mkambula P, Mbuya MNN, Rowe LA, Sablah M, Friesen VM, Chadha M, Osei AK, Ringholz C, Vasta FC, Gorstein J. The Unfinished Agenda for Food Fortification in Low- and Middle-Income Countries: Quantifying Progress, Gaps and Potential Opportunities. Nutrients. 2020; 12(2):354. https://doi.org/10.3390/nu12020354

Chicago/Turabian Style

Mkambula, Penjani, Mduduzi N.N. Mbuya, Laura A. Rowe, Mawuli Sablah, Valerie M. Friesen, Manpreet Chadha, Akoto K. Osei, Corinne Ringholz, Florencia C. Vasta, and Jonathan Gorstein. 2020. "The Unfinished Agenda for Food Fortification in Low- and Middle-Income Countries: Quantifying Progress, Gaps and Potential Opportunities" Nutrients 12, no. 2: 354. https://doi.org/10.3390/nu12020354

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