Modelling the Impact of Fortification on the Prevalence of Inadequate Micronutrient Intakes in Ethiopia: Results from the Ethiopian National Food Consumption Survey
Michelle Gibbs *
Global Alliance for Improved Nutrition, Geneva, Switzerland.
Aregash Samuel
Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia.
Sara Wuehler
Micronutrient Initiative, Ottawa, Canada.
Kiflu Tesfaye
Central Statistics Agency, Addis Ababa, Ethiopia.
Rosalind Gibson
University of Otago, Dunedin, New Zealand.
*Author to whom correspondence should be addressed.
Abstract
Objectives: To estimate the potential impact of national fortification of wheat flour and vegetable oil on inadequate intakes of vitamin A, zinc and iron in Ethiopian women of childbearing age.
Methods: Nationally representative 24-hour dietary recall data were collected from children (6-35 months), women (15-45 years), and males (19-45 years, urban only). Prevalence of inadequate and excessive intakes of vitamin A, zinc and iron were analysed using IMAPP after adjusting usual intake distributions with external within-person variance estimates. Modelling was based on fortification of oil with vitamin A (2000 μg / 100g), and wheat with vitamin A (380 μg / 100 g), zinc (9 mg / 100 g) and iron (6 mg / 100 g).
Results: Across 8267 households, 50% and 20% of women consumed oil and wheat, respectively. Vitamin A fortification of oil and wheat was estimated to reduce inadequacy from 59% to 36%. Zinc fortification of wheat could reduce inadequacy from 61% to 50%. For iron, <1% had inadequate current intakes. It was estimated that fortification would be more effective in urban areas, despite a similar initial prevalence of inadequacy, as higher proportions consumed fortifiable products (percentage change in vitamin A inadequacy: urban 65%, rural 24%; and zinc inadequacy: urban 51%, rural 12%). Fortification with vitamin A and zinc did not expose any population sub-group to >3% excessive intakes.
Conclusions: Fortification of oil and wheat with vitamin A, and wheat with zinc could reduce inadequacy in Ethiopian women, with greatest impact in urban areas. Iron fortification is not justified as intakes appear high and fortification could expose the population to excessive intakes.