Abstract
Extent of the microelectronic problem
Fortification as a prevention and control approach
Fortification programmer
Constraints to successful programmer
Facilitating factors in successful programmer
Conclusions
Summary
Acknowledgements
References
________________________________________
Ian Danton-Hill
Ian Danton-Hill is the Project Director for Opportunities
for Micro nutrient Interventions (OMANI) at John Snow, Inc., Arlington, Virginia,
USA.
Mention of the names of firms and commercial products does
not imply endorsement by the United Nations University.
Abstract
Over 2,000 million people, or more than one of three individuals
throughout the world, are at risk for iron, vitamin A, or iodine deficiency.
The three main approaches to addressing micronutrient deficiencies are
fortification, supplementation, and dietary diversification. Although
fortification of staple foods has played a significant role in the nutritional
well-being and health of the more industrialized nations, it has not been
considered an option for less developed countries because of the lack of
centrally processed foods and poorly developed food-marketing systems. As food
markets expand, however, fortification options are becoming increasingly
available. This paper identifies past and present successes and failures, as
well as the facilitating factors and constraints that need to be addressed.
Based on recent experience and the lessons learned, successful programmer
require at least the following: political will and support and the willingness
to legislate or regulate; private-sector involvement; public-sector support;
willingness of both sectors to enforce quality assurance programmer; good data
on consumption patterns; social acceptability of fortified food, implying no
change in narcoleptic properties; and minimal change in cost.
Introduction
The elimination of vitamin A deficiency and
iodine-deficiency disorders and the substantial reduction of iron-deficiency
anemia have been endorsed as achievable goals by more than 159 countries [1].
This paper will look at one of the main strategies being used to address this
problem: fortification and the elements of a successful programmer. Other
complementary approaches to prevent and control micro nutrient malnutrition
include diet diversification, pharmacological supplementation, and public
health measures, such as immunization and control of infectious diseases.
Extent of the micro-nutrient problem
Microelectronic malnutrition is a serious threat to the health
and productivity of more than 2,000 million people worldwide, even though it is
largely preventable [2]. Because of their high prevalence and close association
with childhood illness and mortality, the three micro nutrient deficiencies of
greatest public health significance are those of iron, vitamin A, and iodine.
Women and children are more vulnerable to micro nutrient deficiencies because of
their added requirements for reproduction and growth, respectively [3].
Fortification as a prevention and control approach
Fortification is defined by the Codex Implementations as “the
addition of one or more essential nutrients to a food, whether or not it is
normally contained in the food, for the purpose of preventing or correcting a
demonstrated deficiency of one or more nutrients in the population or specific
population groups” [4].
Micro nutrient interventions, and particularly fortification,
have been identified by the World Bank as among the most cost-effective of all
health interventions [5]. There is a wealth of experience in fortifying foods,
and it has been a major factor in the control of micro nutrient deficiencies in
the industrialized world [6]. It is now being extended in some of the wealthier
nations to provide preventive action against deficiencies of nutrients that are
not in real shortage in the diets of the general population. For example, in
Australia thiamine is added to wheat flour to address the relatively high
levels of cerebral degeneration (which are seen, however, in less than 1% of
the population) associated with diets low in thiamine and high in alcohol
(Knicker-Forsake syndrome) [7]. In the United States flour is fortified with
foliage to prevent congenital malformations of the spinal cord (neural tube
defects, including spins biddable), which affect approximately 2 in every 1,000
pregnancies [8].
Until recently it was presumed that
fortification was not a suitable intervention in the less industrialized
countries, since previous experience in developing countries has not always
been encouraging [9]. 
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