Vitamin A could reduce child deaths by between a quarter and a third in many developing countries, saving between 1 and 3 million young lives a year. It could also save the eyesight of hundreds of thousands of children. Meanwhile, another micronutrient deficiency - the lack of iron - is affecting the development of half of those growing up in Africa and South Asia.
The problem is not restricted to children; about 40% of the developing world's women suffer from anaemia - a proportion that rises to over 50% in pregnancy (leading to increased risks of low birth weight and maternal death).
Iron and vitamin A are inexpensive and needed only in very small amounts. The challenge is one of getting them to the millions who lack these micronutrients.
Many countries are already distributing vitamin A supplements and iron folate tablets via national health services. As reported in The Progress of Nations 1995, 17 nations are moving towards the goal of adequate vitamin A for at least 80% of children under two. Large-scale programmes are now also under way in 24 more nations. In 35 countries, the problem is either not recognized or not being acted on.
But the success of salt iodization in controlling yet another micronutrient deficiency - iodine disorders (see Kenya and Nigeria iodize most salt) - is turning the attention of more and more countries to the possibilities for adding vitamin A and iron to foods that are regularly bought and consumed by the mass of the population. This kind of food fortification has long been common in industrialized nations, where the addition of iron to cereal flour, for example, has made a significant contribution to reducing anaemia in vulnerable groups.
Photo: Adding micronutrients to common foods is an inexpensive way to help protect millions.©
Food fortification is cost-effective. Tiny amounts of vitamin A and iron can be added to common foods such as wheat and maize flour, and sugar. The extra cost is so small that it can usually be borne by the consumer, once the initial investment has been made, so ensuring that supplementation programmes are sustained. Massive outreach can therefore be achieved without placing extra burdens on already overstretched health services.
In the case of salt iodization, success has come through partnership between government, food industry, and aid agencies. Following this lead, representatives of sugar refineries and government agencies from several African and Asian countries have travelled earlier this year (1996) to Guatemala to learn from the successful efforts there to fortify most of the nation's sugar with vitamin A. Similarly, several countries in eastern and southern Africa are considering following Venezuela's example and fortifying maize flour with both iron and vitamin A.
The following developing countries are currently fortifying basic foods widely consumed by populations at risk of vitamin A and/or iron
deficiency. Fortification cannot replace direct supplementation
programmes for those at greatest risk, but it can provide a foundation to help make those programmes more effective.
| Foods being fortified with | ||
|---|---|---|
| Vitamin A | Iron | |
| Bolivia* | Sugar | -- |
| Botswana | Tsabana** | -- |
| Brazil* | Sugar | -- |
| Chile | -- | Wheat flour |
| Egypt*** | -- | Wheat flour |
| El Salvador | Sugar | Wheat flour |
| Grenada | -- | Wheat flour |
| Guatemala | Sugar | Wheat flour |
| Honduras | Sugar | -- |
| India*** | Cow's milk | -- |
| Jamaica | -- | Wheat flour |
| Kyrgyzstan | -- | Wheat flour |
| Mexico*** | Chocolate drink mix | Chocolate drink mix |
| Pakistan | Cooking fat | -- |
| Philippines | Margarine | -- |
| St. Vincent/Grenadines | -- | Wheat flour |
| Sri Lanka | -- | Wheat flour |
| Venezuela | Maize flour | Maize flour Wheat flour |
* Pilot programme.
** Special food for young children.
*** Some areas.
Pilot programme means that fortified sugar is being consumed by many thousands of people in limited geographical areas: the programme will be extended if seen to be successful and affordable.
Only foods consumed by a substantial proportion of populations at risk of deficiency are listed here. Other foods may be fortified with micronutrients, including snack foods, milk products, and beverages, but they often are not consumed by those most at risk.
Developing countries currently investigating feasibility of fortifying foods with vitamin A or iron
| Bangladesh | Namibia |
| Brazil | Nigeria |
| Dominican Rep. | Oman |
| Ecuador | Papua New Guinea |
| Ethiopia | Peru |
| India | Philippines |
| Indonesia | South Africa |
| Iran | Tanzania |
| Kazakstan | Viet Nam |
| Kenya | Zambia |
| Malawi | Zimbabwe |
| Morocco |
Brazil, India, and the Philippines appear in both lists because they are investigating the possibility of fortifying foods other than the ones listed.
SOURCE Information supplied by UNICEF field offices and UNICEF Nutrition Section, February 1996.