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Four countries led grain fortification progress in 2018
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by Sarah Lynn Zimmermann, Communications Coordinator, Food Fortification Initiative
state in India, plus Afghanistan and Pakistan, led global progress in wheat flour fortification in 2018, according to an annual survey by the Food Fortification Initiative (FFI). In addition, Solomon Islands led progress in rice fortification by passing standards to require fortification of its imported rice. India’s Haryana state began distributing fortified atta (stoneground, whole-wheat flour) to some of its Public Distribution System beneficiaries in March 2018. The program has expanded and is now benefitting 177,000 people. Haryana leaders plan to scale it up to eventually reach 12.6 million people across the entire state. Afghanistan and Pakistan fortified less than five percent of their industrially milled wheat flour in 2017, according to the FFI survey. But in 2018, the Global Alliance for Improved Nutrition (GAIN) reported that 73 percent of Afghanistan’s industrially milled wheat flour and 51 percent of Pakistan’s industrially milled flour was fortified. In Solomon Islands, all of the domestically produced wheat flour is fortified, but the population consumes more rice than flour-based foods. Consequently, national leaders approved a standard in 2018 to require rice to be fortified with iron, zinc, folic acid, thiamin, and niacin. Requiring fortification of both rice and wheat flour will significantly increase vitamin and mineral intake of the country’s nearly 600,000 residents. In each of these countries, the prevalence of anemia in at least one population group is a “severe public health problem” - the World Health Organisation (WHO) classification for anemia prevalence higher than 40 percent. Anemia is a grave concern because: Pregnant women with severe anemia are twice as likely to die during or shortly after pregnancy than non-anemic women Anemic women in low and middle-income countries have a significantly higher risk of having a low-birth-weight infant
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than non-anemic women. Low birth weight means less than 2500 grams at birth; infants that small are prone to death and diseases while they are young. If they survive, they are more at risk for poor mental development in childhood and chronic health problems such as diabetes and heart disease later in life In childhood, anemia from iron deficiency stunts cognitive development which hinders academic performance and future earnings potential Anemia reduces productivity which may in turn reduce wages. Anemia is frequently caused by nutritional deficiencies and is estimated to contribute to 17 percent lower productivity in heavy manual labor and five percent lower productivity in other manual labor-based jobs Deficiencies of iron, riboflavin, folic acid (vitamin B9), zinc, vitamin A, and vitamin B12 can each cause anemia. Fortifying commonly consumed grains with these nutrients can lower the anemia prevalence. Also, adding folic acid (vitamin B9) to grains has lowered the prevalence of brain and spine birth defects in countries that measure this component of the fortification program. Research published in 2018 credited fortification with preventing 50,270 brain and spine birth defects in one year for an average of 137 healthier babies a day. Yet this is likely only 18 percent of the brain and spine birth defects that could be prevented globally through grain fortification. Of the four countries that led progress in 2018, only India has reported birth defect prevalence. Research there shows that 41to-45 of every 10,000 live births are affected by a brain or spine birth defect; in Haryana that translates to at least 2,400 babies a year. Adequate folic acid intake could drop the prevalence to six per 10,000 births. About 75 percent of children with brain and spine birth defects die before their fifth birthday. Spina bifida, one of the birth defects that can be mostly prevented with folic acid, has varying degrees of severity. Children with spina bifida who survive past their fifth birthday often have life-long disabilities.