Regional Adviser in Nutrition, World Health Organization (WHO), Regional Office for Eastern Mediterranean Region (Egypt)
24 October 2017
FFI: What inspired you to become involved with food fortification?
Al-Jawaldeh: Micronutrient malnutrition is widespread globally, especially in developing countries where I come from. It affects all age groups, especially young children and women of reproductive age. In the Eastern Mediterranean Region, 45% of the total population has iron deficiency anemia, 54% has insufficient iodine intake, and 22% of preschool children have vitamin A deficiency. These statistics pose a big challenge to find sustainable solutions, especially for the most vulnerable groups. However, increased dietary diversity is important, but it is a longer-run solution especially in low and middle income countries. Fortification is the medium-term solution. Using evidence-based and best practices in food system, food fortification is considered cost effective intervention to address micronutrients deficiencies.
During my previous work with WFP (World Food Programme) and current work with WHO, we tried to help guide countries to fortify food in order to improve the micronutrient status of the population. Wheat flour, a common staple in most countries of the region, becomes a vehicle for fortification with iron, folic acid and others. Salt is a successful vehicle for iodine fortification. Since then, I have been working very closely with colleagues to support and advocate for food fortification. We believe that food fortification generates more benefits to the public, especially the poor.
FFI: What are the main components to a successful fortification program where you live?
Al-Jawaldeh: Private/public partnerships from industry, government, academia, and civil society might be the key for sustainability. To achieve impact, program managers are using fortification vehicles that are consumed by the nutritionally vulnerable and add bioavailable fortificants. Fortifying at adequate levels will reduce dietary gaps and micronutrient deficiencies. Institutional research and champions of fortification are important features of successful programs in the region, especially in Oman, Bahrain, Kuwait, Iran, Palestine, Saudi Arabia and Morocco. Mandatory food fortification regulation is crucial to ensure sustainability of the program.
FFI: What can we do, as a society, to continue raising the fortification efforts?
Al-Jawaldeh: The lack of concrete policies and legislation at country level is preventing people from benefiting from food fortification. There is immense potential in scaling up fortification programs in countries with a high burden of micronutrient deficiencies. We each need to raise awareness so that the public will support government efforts to fortify food, and encourage donors to support these projects.
We also need to make sure that legislation is developed and followed through with adequate monitoring and compliance. Even where we have legislation, we’re often seeing a systemic problem with compliance. Generating evidence and impact is essential for countries to invest in food fortification and encourage other countries to follow.
FFI: Would you like to share anything else?
Al-Jawaldeh: Adequate monitoring and quality control are essential. We recommend that the evaluation be specified up-front, including a pre and post data collection to make improvements and to strengthen causal inferences. With the increased number of fortification projects globally, there is a need to share the common lessons learned relating to their implementation and responses to project-related and external challenges. National fortification projects are dynamic and must be continually modified in response to specific performance issues and broader shifts in market structure and consumption patterns.