To reduce iron-deficiency anemia [10]. However, it has been
useful in many countries and has been found to be cost-effective [6, 10]. Chile
has used animal blood as a convenient and cheap source of iron for
fortification programmed [10]. Venezuela has fortified per-cooked corn flour,
to which other micro-nutrients, including vitamin A, have been added. Wheat
flour (without vitamin A) has also been fortified with iron successfully on a
national basis [15]. The OMNI Project is currently working with the Sri Lankan
government to test the efficacy of the fortification of wheat flour with iron
for tea plantation workers, with the intention of scaling up to a larger
program me when its efficacy has been established. The private sector in
Indonesia and other Asian countries is developing instant noodles fortified
with iron and other nutrients, aiming initially at a middle-income more than a
low-income market.
Salt and other products
Fortification of salt with iron has been implemented on a
limited scale in India and Thailand, but although it appears to be technically
feasible, it has not, at this time, been adopted more widely [10].
Iron-fortified salt may have a greater role in double fortification (see
below). Other vehicles of fortification include rice flour (Argentina and
Chile), fish sauce (Thailand), curry powder (South Africa), and such products
as barley sprout flour, coffee, grain amaranth cereal, maize meal, potato
starch, and wheat flour noodles, all of which are currently being investigated
and developed; however, their future on a large and sustainable scale remains
uncertain [10]. In Brazil there is an experimental project in some day-care
centers to fortify water-filtration systems with iron.
Summary of iron-fortification programmer
Success with iron fortification has involved finding
appropriate iron fortification and food vehicles in terms of organoleptic
properties, getting government commitment (often by legislation as a political
act), and increasing awareness of the extent of the problem of iron deficiency
as well as the fact that other interventions have not been particularly
sustainable or successful. Fortification with iron has also been shown to be
effective, e.g., in Chile and Venezuela [15,19].
Iodine
Iodine has been most vigorously pursued as a fortification of
salt for a variety of reasons, especially those factors which lead to or
contribute to successful programmer: consumption in fairly consistent amounts
by all sectors of society, consumption at roughly consistent levels throughout
the year, and technological feasibility and cost-effectiveness. It has also had
the advantage of strong international and government commitment and an
international experience that has been freely shared. Countries with effective
iodized salt programmer have shown sustained reductions in the prevalence of
iodine-deficiency disorders [6,10,20]. However, sustainability has not always
been ensured, and the populations of countries like China, Germany, and
Switzerland showed increases in the prevalence of iodine deficiency where
commitment to the programmed was not maintained.
Another problem has been the assumption that fortification
could be imposed from the top without the involvement or commitment of
consumers and, sometimes, policy makers. This has led, in some cases, to
consumer groups suing governments for the right to consume non-iodized salt,
e.g., in India, and to both consumers and government not being aware of the
importance and significance of iodization in terms of national health and
economic productivity. It is essential that people know why their salt is
iodized and what the associated benefits are, so that the programmed ensures
sustainability through consumer demand. It has also been shown that all salt
(including salt intended for animals and industry) must be iodized to ensure
the success and sustainability of these programmes [10,20].
Other vehicles of iodization have included bread, sweets,
milk, flour, sugar, and condiments. Fortification of animal feeds can be useful
in increasing the iodine content of animal products [4]. Dietary intake of
iodine can be increased by adding iodine to drinking water (as in schools in
Thailand) or to the local water supply (as in China), or by using a commercial
attachment to water pumps with slow-release resins, which is currently under
trial.
In summary, the success with digitization has been due to its
relative technological straightforwardness, much international experience,
proven efficacy, and enormous support and advocacy from the international donor
community, such as UNICEF and the International Council for the Control of
Iodine-Deficiency Disorders (ACIDIC)[20].
Multiple fortification
Multiple fortification of foods is a possible way of
addressing deficiencies of two or more micro-nutrients at the same time in a
cost-effective manner, although some organizational, technical, and
micro nutrient-interaction constraints need to be addressed in developing
countries. Nevertheless, progress is being made, e.g., in double fortification
of salt with iodine and iron [21]. Multiple fortification has been successful
in the more developed countries, particularly in fortification of cereals and
infant-weaning foods [10]. In some cases, fortification with two micro nutrients
(e.g., iron and vitamin A or iron and vitamin C) would enhance the effects of
fortification on micro-nutrient status [6,22].
Nevertheless, it is important to remember that although
scientific and engineering advances have resulted in an increasing number of
options regarding the choice of mortification compound and processing procedures,
there is a limit to the possibilities of new technologies. For example,
multiple fortifications of certain food vehicles may result in substantially
increased cost and reduced bio availability [23]. Changes in the sensory or
narcoleptic characteristics of the food can also be a problem. For example,
encapsulation of micro nutrients may not be cost-effective in some countries,
even though the technology is theoretically available.
Other micro-nutrients
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