Wheat flour fortification considerations in Ethiopia consultation workshop

1. Food Fortification in Ethiopia
Adding value to ancient grain
Wheat flour and pasta International Conference
Addis Ababa, Ethiopia
Hilton Hotel
[December 6 – 7 , 2014]
Alem Hadera Abay
Country Manager, GAIN
Public Nutritionist, BA, MPH

2. 2
Why do we need to fortify?
- We don’t get adequate micronutrients from our staple
foods!
- Food (gain staples) loss its micronutrient content during
process- milling as high as 80% for wheat
- As food prices increase now, more than ever, we need to
add micronutrients to staple foods as our people move to
increasing reliance on those staples & most staples
such as do not meet our RDA for vitamins & minerals
• Folate – 28 slices of Bread (800g)
• Zinc – 4 to 5 cups Maize meal (450 to 600g)
• Iron – 800g to 1.2Kg red beef meat
• Vitamin A – 27 to 34 cans of sardines (2.5 to 3Kg)

3. 3
21st BOARD MEETING 3
Why fortify? Cereal-based Agricultural
Production & Consumption
2%
QTs(M)
0
Meher Season
2010/2011
69%
8%
300
7%
200
100
2%
5%
5%
3%
Sugar cane
Fruit crops
Oil crop
Vegetables
Root crop
Cereals
Pulses
Others
16%
28%
22%
20%
14%
Total
cereals
Sorghum
Maize
Wheat
Teff
Other
Chickpeas: 17%
Soybeans: 1%
3
% of average daily calory intake
100
80
60
40
20
0
Rural
6
2
2
5
2 1
7
73
Urban
7
3
3
4
5
7
6
65
National
7
3
3
5
2 2
7
72
Animal Products
Fruits/Veg
Root Crops
Oils/Fats
Pulses
Cereals
Source: FEWS 2011; Food Grain Consumption and Calorie Intake Patterns in Ethiopia, Working Paper 23, IFPRI 2011 based on CSA

4. 4
Indicators 2005 2011
Anaemia in Children 54% 44%
Anaemia in women 15-49 years 27% 17%
Anaemia in men 15-49 years --- 11%
Households consuming iodized salt 4% 15%
6-23 months children consuming Vit. A rich &
iron rich food
13%
Why fortify? Micronutrient Deficiencies,
EDHS

5. 5
Why fortify? Prevalence of anemia
among children in rural & urban areas
-26%
-17%
-39%
-36%
%
0
5
Rural
Urban
Rural
40
60
13
18
28
11
18
45
54
35
47
Rural
Urban
20
Urban
2005
2011
Children Women Men
WHO Cut offs:
Severe
Moderate
Mild

6. 6
Why Fortify? Projections on Impacts of
Several Deficiencies in Ethiopia
• Mortality: ~ 17% of Deaths in Children
• Vitamin A Deficiency
• > 38 thousand deaths/yr in children 6-
59 months
• Iron Deficiency Anemia
• > 8 thousand maternal and perinatal
deaths/yr
• Folic Acid Deficiency
• > 2 thousand deaths/yr
• Economic Impact: ~ USD ½ Billion/yr
• Depressed productivity in Adults
• Retarded cognitive development & lost
workforce
Source: WB
Standard Inception Workshop, FMHACA

7. 7
Effects of folate deficiency: Spinal Bifida

8. 8
a. Health
benefits
b. Improve
Productivity
c. Economic
benefit
Reduce global &
national burden of
disease, and deaths
Increased cognitive
capacity, physical
activity and work
performance
GDP Growth
USI- 1 : 26 (1.15 $/ton)
Iron (wheat): 1:8
(costs 3 $ per ton)
Vit.A (oil) 1:50
(costs 2$ per ton)
Benefits of Food Fortification:
Individuals
Society
National
Development
Impact
of
VMD
Standard Inception Workshop, FMHACA

9. 9
Opportunities for fortifying wheat:
Markets and Profitability
• Committed government to address malnutrition: NNP, FF
Steering committee & organized millers in association
• There is huge demand for wheat flour in-country,
regional and global levels.
• Ethiopia urbanization is growing at higher rate total
population that lives in urban area is estimated at 20%
• It is the only country in the region suitable for wheat
farming.
• Ethiopia has easy access to markets in the Middle east,
North Africa, and Europe. Ethiopian Airlines plays an
important role
• Many wheat millers fortify their products and they are all
still in business. The ever increasing demand for staple
food and strategic location of Ethiopia will make such
business ever profitable.

10. 10
Ethiopia’s Food Fortification plan
• FMoH led team participated in ECSA-HC 2009 & 2010
• 4th Regional FF & wheat & maize fortification workshops
• FMOH Commissioned Assessment in Oct, 2010
• Techno-feasibility & market landscape.
• The food consumption survey carried out by EHNRI in 2011
• Preliminary results shared today
• National Legislation for USI signed by late PM Meles , Feb 2011
• Legislation mandating all salt for edible consumption be iodized
• Multi-stakeholders initial planning of national FFP,Feb 7-8, 2012
• agreed on launching of national FF Program
• Fortification of wheat flour (9 micronutrients) & edible oil (vit A & D)
• Mandatory regulation
• FMoH Assess & provided 5 days training to public sectors at AAU, Feb,
2013.
• FMHACA prepared 1st draft and open for consultations and feedback with
partners, 29th -30th May, 2013.
• Draft NFCS shared by EPHI indicating high iron intake, September 2013
• Consensus reached in moving forward FFP & at the same time look for more
evidences of bioavialability of iron, July 2014
• Ethiopian standards national Technical Working Group on wheat flour
and edible oil convened in Adma from August 29th to September 1st, 2014 to
develop the standards

11. What Does it Require to Fortify?

12. What What it takes to fortify ?does it
take to fortify? Who Does
What?
Government
Enables the Market
Place
Industry
Fortifies
Consumer Pays
Regulation
Education
Monitoring Enforcement
Business Expertise
Capital Costs
Recurring Costs
Donors
Assist
Start-Up

13. 13
Cost & coverage for three potential
fortification Vehicles
Vehicle Nutrition
Protection
Feasibility industrial
coverage
Estimated cost Cost/
person
% WHO Standard % Share 000,000
Consumers
USD Million/Yr $/yr
Flour 26% EAR Iron; 64%
EAR Folic Acid
28% 22 $2.28 $0.10
Oil ~ 37% RNI Vitamin A 48% 38 $0.95 $0.02
Sugar ~ 36% RNI Vitamin A 20% 16 $5.98 $ 0.38
Standard Inception Workshop, FMHACA

14. 14
Standard Inception workshop , FMHACA

15. 15
What Can Flour Fortification with 8
Essential Vitamins & Minerals Achieve?
Nutrition Protection from Fortification Profile
at Mean Consumption 128 g/day (NFCS 2011)
Fortification
Level [mg/kg]
Source of
Recommendation
Added
WHO RNI [%]
Thiamin 9.8ECSA 80%
Riboflavin 6.6ECSA 54%
Niacin 50ECSA 44%
Folic Acid 2.6WHO 67%
Vitamin B6 6.5ECSA 45%
Vitamin B12 0.02WHO 80%
Iron (NaFeEDTA) 30WHO 34%
Zinc 55WHO 142%

16. 16
Conclusion and Way forward
• Fortification is the most cos-effective and safe way of
replacing and adding micronutrients to staples
• Build the capacity of the MoI, FMHACA and Industry.
• Strengthen the national steering committee on food
fortification spearheaded by MoI
• Finalize the mandatory standard development process
by FMHACA
• Active engagement of the milling industry
• Resource mobilization and fund raising for the national
FFP
• Establish robust cost recovery and procurement system

17. 17
ይቻላል!
እንዴታ!!!