Tools

"Flour Fortification in the Islamic Republic of Iran: Sustainable Route to Improved Health" provides detailed information on the country's wheat flour fortification program development.

The flour fortification monitoring systems, challenges and successes from three countries are highlighted in the following case studies:

• Chile

• Indonesia

• South Africa

A case study from New Zealand details the country’s long journey to mandate fortification of wheat flour with folic acid to prevent neural tube defects.

The Flour Millers Toolkit offers basic information for wheat and maize flour fortification. The toolkit is a set of PowerPoint slides that include speaker notes for more information.

Among the technical topics covered are:

• The most common way to fortify flour is using a micro feeder. This adds premix to flour at pre-determined rates in the process of flour production.

• Three types of feeders are available: screw, revolving disk and drum or roller. Screw feeders are the most common. They dispense a set volume of premix at a constant rate. The size of the screw determines the feed rate capacity, and this allows a wide range of delivery rates.

• Mills generally need one feeder per type of flour or meal line to be fortified. The size and number of feeders needed depends on the amount of flour produced per hour.

• Magnets are used in flour production to remove unwanted substances like staples or other metal pieces. Most iron compounds used in fortification (ferrous sulfate, ferrous fumarate, and sodium iron EDTA) are not attracted to magnets. Elemental iron, which is sometimes used for fortification, may be attracted to the magnets, but only rare magnets are strong enough to pull this iron from flour.

The most current version of the toolkit is only available in English. Older versions are available in Arabic, Chinese, French, and Russian.

For more information, contact Wilson Enzama, FFI Training and Technical Support Advisor: wenzama@gmail.com.

FortifyMIS is an online data collection and aggregation approach for fortification monitoring. The Management Information System (MIS) provides an improved means for food producers and government inspectors to monitor the quality of fortified products while providing decision makers with timely information to improve program performance.

FortifyMIS aims to:

1. Simplify the process of compliance data collection for national-level food inspectors and food producers

2. Improve how food control agencies are informed of implementation challenges

Developed by Project Healthy Children (PHC) and the Global Alliance for Improved Nutrition (GAIN), FortifyMIS can be used on computers, tablets, and handheld mobile devices. It allows for automatic tracking of fortified food quality and safety data using customizable digital forms, real-time dashboards, and tailored data reporting methods.

The platform aims to reduce the time and cost of monitoring and improve overall program performance by quickly tracking the quality of foods and identifying where improvements are needed. By using FortifyMIS, national governments and fortification stakeholders can better capture critical data needed to improve data-driven program outcomes.

The FortifyMIS platform provides:

• A practical data aggregation solution for country-specific use;

• More efficient and effective tracking of product compliance in real time to better understand whether fortified foods contain the amounts of vitamins and minerals per national standards; and

• Data needed for countries to identify and act upon gaps to improve program outcomes in a timely, cost-effective, and sustainable manner.

By ensuring the delivery of adequate nutrients to target populations, FortifyMIS will be an integral component of global and national efforts to improve the nutritional benefits that fortification programs can offer to millions of consumers.

Users need their own login and permissions to view country data.

To see how the system works in training mode, contact Laura Rowe: laura.rowe@ffinetwork.org.

The Rice Fortification Toolkit describes in detail the process to blend fortified kernels with milled, non-fortified rice to produce fortified rice. It describes the equipment required, its integration with a typical rice milling facility, and important quality control (QC) aspects.

The Global Alliance for Improved Nutrition (GAIN) and PATH developed the toolkit to build capacity of rice millers to upgrade their facilities for fortified rice production and ensuring quality. The toolkit serves as a consolidated manual to help any fortified rice manufacturing facility to carry out effective production of high-quality fortified rice. It also serves as a guidebook for training new employees on the fortified rice production process.

For more information, contact Becky Tsang, FFI Technical Officer for Asia: becky.tsang@ffinetwork.org.

Standards

• WHO guideline for fortifying wheat flour with vitamins and minerals.

• WHO guidance on fortifying maize flour with iron, vitamin A, zinc and the following B vitamins: folic acid, niacin, pantothenic acid, pyridoxine riboflavin,  thiamine, and vitamin B12.

• WHO guidance for fortifying rice includes recommendations to fortify rice with iron, vitamin A, and folic acid  as a public health strategy in settings where rice is a staple food.

• Proposed nutrient and nutrient levels for rice fortification based on the per capita availability of rice. Nutrients included are folic acid, iron, vitamin B12, vitamin A, and zinc.

• The Food Fortification Formulator is a series of spreadsheets that include dietary parameters for different gender and age groups, the price of commonly used fortificants, and the usual stability of vitamins and minerals during production, distribution, and marketing of fortified foods. The Formulator can be adjusted to different consumption patterns and tailored to each country’s specific conditions to generate suggested levels of addition for each fortificant. It is designed to assist in determining the potential additional intakes of vitamins and minerals for populations following efficacious and safety comparisons; the costs associated with food fortification programs; the fortification levels that can be used as technical specifications in the factories, national standards and regulations; and the amount of fortificant to be added in the micronutrient premixes. Directions for using it being on page 19 of this document.

Monitoring

• WHO Monitoring Manual for Millers, Regulators, and Programme Managers (2021)

• FFI Monitoring Framework Shell (2021). This tool takes recommendations from FFI and partners' 2018 Regulatory Monitoring Guidance and puts it into a fillable form. The template allows countries to add unique context with the general recommendations and processes already filled in. This is one of two tools that can be used as a complement to the WHO Monitoring Manual (2021).

• Regulatory Monitoring of National Food Fortification Programs: A Policy Guidance Document (2018). The document proposes a standardized, feasible approach to determining fortification compliance and offers country-specific examples for addressing common, ongoing challenges faced by public and private sectors. This is one of two tools that can be used as a complement to the WHO Monitoring Manual (2021). The document is available in English, Español, Français, and Russian.

For more information, contact info@ffinetwork.org.

The Micronutrient Survey Toolkit includes resources to help assess and monitor vitamin and mineral deficiencies. It will keep you from having to create new tools for every survey. Sample topics include a laboratory overview, data and sample collection procedures, supplies needed, and guidance for hiring personnel. Each module includes tools that can be used as needed and examples of the tools used in different contexts.

The Micronutrient Survey Toolkit was developed by the US Centers for Disease Control and Prevention (CDC) International Micronutrient Malnutrition Prevention and Control Program (IMMPaCt). The toolkit provides resources collected from many sources and new tools that were created to fill gaps.

The toolkit can either be used by itself or in conjunction with the manual, Indicators and Methods for Cross Sectional Surveys of Vitamin and Mineral Status of Populations, which is also included in the manual module of the toolkit.

For more information contact info@ffinetwork.org.

The comprehensive Introduction to Micronutrients and Food Fortification Training is a remote training program that provides an in-depth analysis of key micronutrients (vitamins and minerals) and staple food fortification processes.

The course objective is to ensure that participants have a strong working knowledge of:

• Basic nutrition concepts, micronutrient interventions, and how key micronutrients used in fortification programs function in the body;

• The process of food fortification as it relates to commonly fortified food vehicles and the components required to establish an effective fortification program.

Trainings include summary documents and slides, relevant readings, and topic-specific self-evaluations. Every week (or a selected time frame agreed upon by the student(s) and facilitator), a different topic accompanied by a topic-specific evaluation is presented to students. Evaluations are reviewed by the facilitator and returned to the student for further learning.

The four modules, which participants move through at their own pace, are:

Basics of (Mal)nutrition

Section I

• Under-nutrition and how it is measured

• What are micronutrients and why are they important

• An introduction to fat soluble and water-soluble vitamins

• Demystifying recommended daily allowances (RDA), reference nutrient intake (RNI), dietary reference intake (DRI), estimated average requirement (EAR), and upper level (UL)

• Micronutrient deficiency definitions

Section II

• Interventions to address micronutrient malnutrition

• Brief overview of Ready-to-Use Therapeutic Foods (RUTF), corn-soy blend (CSB), and complementary feeding

• Elements required to build an effective fortification program

• An introduction to key players in the field of fortification

Overview of key micronutrients (vitamin A, iron, folic acid, zinc, and iodine)

• Review of micronutrient from a historical perspective

• Food sources, forms, and functions

• Variability of requirements across populations

• Signs and symptoms of deficiencies and toxicities

• Deficiency measurements (clinical, functional, and biochemical)

• Recommended dosage / requirements

• Nutrient-nutrient interactions

• Absorption inhibitors

• Stability

• Interconnectedness of micronutrient deficiencies and their impact (e.g. the idea that multiple micronutrients impact single outcomes such as anemia)

Industry-specific fortification processes and recommendations

• Outline of the fortification process for each major staple food vehicle including cooking oil, sugar, maize and wheat flour, salt, and rice

• Recommended fortification compounds

• Overview of quality assurance and quality control measures

Relevant fortification program design tools

• Regulatory monitoring

• Introduction to the Food Fortification Formulator

• Costing models

The course was created by Project Healthy Children (PHC). The intended audience includes representatives of government ministries and partner organizations, food producers, food inspectors, and program managers. The course could be used to train staff working on fortification programs or to facilitate a baseline level of knowledge among individuals preparing to work in the area of fortification. Students who successfully complete the course will receive a certificate of completion.

For information contact info@ffinetwork.org.