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FORTIFICATION MONITORING

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Flour millers in three countries demonstrate ‘rigorous’ fortification monitoring by Sarah Zimmerman, Food Fortification Initiative

hree recently completed case studies have verified that industrial flourmills in Chile, Indonesia, and the Republic of South Africa (RSA) have rigorous internal controls to confirm that their products comply with country standards for fortification. While other types of monitoring varied considerably, the studies show that milling leaders have developed standard operating procedures to maintain and improve internal quality systems. “We are pleased to see that these flour millers are at the forefront of ensuring that their customers receive the health benefits from fortification,” said Helena Pachón, Senior Nutrition Scientist for the Food Fortification Initiative (FFI). The studies are a collaborative effort between UNICEF, FFI, and the U.S. Centers for Disease Control and Prevention. Research for the case studies included interviewing government personnel responsible for monitoring fortification and visiting mills, bakeries, food retail outlets, inspection laboratories, and companies that produce vitamin and mineral premix. The authors found that the industry had instituted regular physical and visual control points. Industry procedures used for internal monitoring in the three countries included: • Check weighing the premix feeder. This is when a miller weighs the amount of premix discharged by the premix feeder over one to two minutes then compares the amount to the weight of premix expected to be discharged over that period. • Ensuring that the feeder is working properly. This involves confirming that the feeder has adequate amounts of premix and that it is delivering the required quantity of premix. • Recording results of fortification checks. This includes keeping accurate records, such as the amount of premix used compared to the amount of flour produced, so if a variation from the norm is noted, it can be resolved. Several resources are available to help plan monitoring programs. For example, the FFI website has a page about internal quality control at http://www.ffinetwork.org/monitor/internal. html. The Flour Millers Toolkit at http://www.ffinetwork.org/

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implement/toolkit.html, which offers a section on assuring quality control at the mill. The World Health Organisation and the Food and Agriculture Organisation of the United Nations discuss other types of monitoring in detail in the book “Guidelines on Food Fortification with Micronutrients”. See http://www.who.int/ nutrition/publications/micronutrients/9241594012/en/ Yet, the collaborating partners for these case studies determined that very little information was available on how fortification monitoring operates in real-world settings. The case studies consequently looked at the strengths and challenges of actual monitoring systems in three regions. Rigorous internal monitoring was one of the few things the countries had in common. Among the highlights from the other types of monitoring are: • Chile has the most comprehensive external monitoring plan in which government regulators conduct a strategically planned and financed program. The program focuses on the point of production and on-site warehouses with some review of the mill’s internal records of fortification monitoring. Warnings and sanctions are issued if flour samples are non-compliant in two or more micronutrients. Results of Chile’s monitoring activities are published annually on the Ministry of Health website. • Indonesia has the most extensive commercial monitoring program as it concentrates efforts on the retail sector. Commercial monitoring assesses whether flour being sold at retail establishments is properly fortified. • Indonesia is the only country of the three studied with significant amounts of imported flour. All premix shipments require a Certificate of Analysis at Customs, but a lack of laboratory resources and funding restrict regular monitoring of imported flour. • Chile is the only country of the three studied with a household and individual monitoring aspect of the fortification program. This determines whether fortified flour is available and being used by specific population groups. • All three countries have some health impact evaluation component, which determines whether the nutritional goals of the program are being met. Some of the impact evaluations are