FFI Newsletter December 2013
Where Were You on 25 October 2013?
Friday, 25 October 2013, was a memorable day in Belgrade, Serbia, as children with spina bifida and/or hydrocephalus and their families gathered for a live concert at the Delta City Mall. The event was organized by the Hydrocephalus and Spina Bifida Association of Serbia (HISBAS) to raise awareness about the two health conditions, support those affected and advocate for preventative measures.
"Here we are gathered for a noble cause. Our idea was to give children who are enduring long-lasting medical treatments the opportunity to enjoy music and to attract their attention to something different from hospitals and pain," said Ivana Trbojevic, HISBAS President.
"Seeing the children, many in wheelchairs because they were born with a devastating birth defect, and knowing that we can greatly reduce the risk of these, invigorates me to do all I can to accelerate our work,” added Scott Montgomery, FFI Director.
As part of the World Spina Bifida and Hydrocephalus Day event, the milling company Agroposlovi launched a line of flour and pasta fortified with iron and folic acid. The company distributed free samples at the event and began selling the products in November. The fortified flour and pasta will cost the same as the unfortified products.
Sandra Grbic, a food technologist at the company, attended a regional meeting of the International Association of Operative Millers and a related FFI European advocacy meeting in 2008 in Romania. She also took part in a regional FFI technical workshop in Macedonia in 2009.
Sandra was motivated by the presentations at the meetings and brought the information back to her company. The mill managers at the time were not interested in pursuing fortification. A few years later, new owners took over the mill. Sandra approached Jelena Jovanović, General Manager of Agroposlovi, who immediately recognized the positive health impact that flour fortification could have, especially for women of childbearing age. She quickly became a strong supporter for the initiative. After reviewing information provided by HISBAS, UNICEF Serbia and FFI, Agroposlovi started making plans for a fortified product line.
The day before the mall event, Scott and Becky Handforth, FFI Europe Associate, attended Serbia’s 18th Milling Day, the only conference in the country planned for millers. The organizers had requested information about fortification because some trade partners are requiring flour imports to be fortified.
Maja Kanazir, Vice President for HISBAS, spoke to the millers about folic acid, neural tube defects and the role of flour fortification in preventing these serious birth defects. Scott outlined the benefits of fortifying with iron, the potential economic savings, and technical requirements for flour fortification.
While in Serbia, Scott and Becky visited other millers and government leaders to discuss the feasibility of a national flour fortification program. They were told that choosing the right time to introduce the idea, especially to the public sector, would be critical and that other topics take precedence currently. In the meantime, the grassroots efforts by HISBAS and Agroposlovi are very positive, and FFI will continue to encourage the work of those national champions.
Liberia Adopts Food Fortification Strategy
Liberia is the most recent country to pass comprehensive food fortification legislation, including requirements to fortify wheat flour. The legislation became mandatory in August 2013, the National Fortification Alliance announced the fortification standards in October 2013, and implementation is expected to begin by February 2014.
The regulation calls for adding vitamin A to cooking oil and sugar and adding iodine to salt. All wheat flour produced in the country will be fortified with iron, folic acid (vitamin B9), zinc, thiamine (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3) and B12. Read more…
According to the Food and Agriculture Organization of the United Nations, rice is the most commonly consumed cereal grain in Liberia. National leaders are working with international partners such as Project Healthy Children, PATH, and the World Food Programme to determine whether rice fortification should also be part of the country’s strategy to reduce vitamin and mineral deficiencies.
Emory Students Complete 'Global Field Experiences' with Flour Fortification
Earlier this year four Emory University graduate students received funding from Emory’s competitive Global Field Experience (GFE) program to conduct projects related to wheat flour fortification. The six- to eight-week program allows students to apply the public health skills they have gained in the classroom to a real-world setting. The completed projects are highlighted below, along with links to summary reports.
Laila Luopa worked with the UNICEF staff to create a communications campaign to accelerate the agenda. “I truly enjoyed the professional and personal connections I made in Armenia. I had a fabulous time and learned a lot from my experience there,” Laila said. Read her communications strategy summary.
One project the Armenia UNICEF staff suggested was for selected Armenian leaders to visit a country where fortification is successful. Laila worked with Quentin Johnson, FFI Training and Technical Support Coordinator, to organize a study tour to Canada in October for the Armenian delegation.
The experience in Armenia will inform Laila’s master’s thesis project which is a communications toolkit for countries considering mandatory fortification of wheat flour, maize flour, and/or rice. The toolkit will be ready for your use by May 2014.
Four women from Armenia wear the
required protection to visit a flour mill in Canada as part of their study tour.
See more photos…
With support from the Nutrition Institute for Central America and Panama, Maya Rao interviewed stakeholders involved in all levels of flour fortification monitoring. This included representatives from ministries, regulatory agencies, flour millers associations, academic organizations and non-governmental organizations. She also observed monitoring practices during visits to flour mills, importation sites and the national food control laboratory.
She found that flour millers are using premixes that comply with the country’s specifications. However quantitative analysis of iron content in samples of fortified wheat flour, pasta and bread revealed inconsistent nutrient levels. Her report includes several recommendations to improve quality control measures.
“Developing and applying observation guides, interview guides and checklists for monitoring was a great learning experience,” Maya said. "With support from the Minister of Health inspector, I was able observe fortification practices in six local flour mills, using the monitoring tools to guide me through the process." Read more in English….
Espaňol: Esta presentación e informe resumen la situación actual con el monitoreo de la fortificación de harina de trigo que se efectúa en la República Dominicana. Muestran las fortalezas del seguimiento que se hace y oportunidades para mejorar algunos aspectos tanto a nivel de los molinos como del gobierno.
Maya Rao vistied Grupo Bocel in Santiago during her Global Field Experience in the Dominican Republic.
Katie accessed data from 6,488 non-pregnant women in the Indonesia Family Life Survey. This longitudinal study followed more than 30,000 Indonesians and included hemoglobin measurements as well as data on food purchases.
Looking at anemia status before and after fortification, Katie’s initial conclusion is that wheat flour fortification has not significantly contributed to the reduction in anemia prevalence among women of child-bearing age in Indonesia. This is most likely because electrolytic iron is used for fortification in Indonesia. Given the population’s wheat flour consumption levels, a more bioavailable form of iron is recommended. Read more….
Katie will continue to work on this project as her master’s thesis, which will be complete and available for your reference by May 2014.
Emory student Katie Kendrick, left, with new Indonesia friends Tanti, Gita, and Dewi.
Crystal Stafford studied the current food monitoring system, looking for gaps or compliance issues related to the mandatory regulations. She worked in partnership with the Uganda staff of Strengthening Partnerships, Results, and Innovations in Nutrition Globally Project (SPRING) as well as with Ronald Afidra, FFI Africa Network Coordinator.
Crystal found eight of the 10 wheat flour mills she visited were already fortifying. The other two planned to begin fortification within a month. Of five maize mills visited, three were already fortifying. The two that were not fortifying were exempt from the legislation due to their smaller capacity. Each of the five oil producers she visited was already fortifying cooking oil with vitamin A as required.
Yet she found discrepancy among practices for internal monitoring. Using globally recognized good manufacturing practices and regional manuals, she suggested a model for a modified monitoring system in Uganda. Read more…
The production manager at Unga Mills was one of the stakeholders interviewed.
Partnerships at Work in Southeast Asia
The fortification emphasis during this year’s International Association of Operative Millers (IAOM) Southeast Asia District Conference and Expo this year was a great example of partnerships at work. The meeting was 7-10 October in Viet Nam.
Before the conference opening session, 31 industry leaders in Viet Nam attended a special session to understand flour fortification progress there. Do Hong Phuong, Nutrition Policy Specialist with UNICEF Viet Nam, presented a policy paper that indicates that fortifying wheat flour would be a good economic investment for the country. Annoek van den Wijngaart, FFI’s Associate Executive Officer for Asia, discussed the global experience with flour fortification and explained what a mandatory flour fortification policy in Viet Nam would mean for millers.
During the IAOM conference, which 200 people attended, Lena Kampehl from Muehlenchemie gave a comprehensive presentation on technical concerns related to flour fortification in Southeast Asia. During coffee breaks, participants at the FFI booth were challenged with a taste test to see if they could determine whether a slice of a French baguette was made with fortified flour or not. These professional millers could not detect any difference in taste or appearance between the fortified and non-fortified baguette slices. The baguettes were provided by Interflour Vietnam.
“These flour fortification activities at the IOAM event would not have been possible without excellent collaboration between FFI’s partners,” Annoek said. See more photos and information here.
IAOM is one of FFI’s original partners. The first public meeting to discuss a global initiative to accelerate wheat flour fortification was held in conjunction with an IAOM district meeting in Mauritius in 2002.
Feedback Needed for Nutrition Survey Toolkit
The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) team of the US Centers for Disease Control and Prevention created a Nutrition Survey Toolkit in 2012. An updated version is being planned, and we would really appreciate your feedback. Please click this link and answer five brief questions about the toolkit. The survey will only take a few minutes. If you prefer, you can send suggestions for the toolkit to email@example.com.
And thanks to the Micronutrient Initiative for posting the toolkit on its website.