USAID Micronutrient and Child Blindness Project Evolution
This content delves into the evolution of the USAID Micronutrient and Child Blindness Project, highlighting the exploration of fortification methods to combat nutritional deficiencies. It discusses the stability of vitamin A in fortified sugar and various food products, successful food fortification programs across different regions, assessing the need for micronutrients, and the potential impact of fortification in Uganda and Kampala. The journey from skepticism to advocacy, as portrayed by Omar Dary, is also depicted.
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A2Z: The USAID Micronutrient and Child Blindness Project A Personal Evolution: From an Unbeliever to an Advocator Omar Dary 7-January-2011 Conference on Micronutrient Fortification of Foods: Science, Applications & Management OD-2011-01-India 1
Stability of vitamin A in fortified sugar OD-2011-01-India 2
Stability of vitamin A in products PRODUCT SUGAR TYPE % RETENTION Candies Cookies Raw/white st. White st. 95 91 Jellies/Jams Direct white st. 90 Lemon/orange juice White st. Refined White st. 92 33 0 Soft-drink If nutrients are of good quality, they are highly stable during storage and during food preparation; only a few chemical processes are highly deleterious. OD-2011-01-India 3
Evolution of nutritional blindness Source: National Committee for Blind and Deaf of Guatemala 10 Affected children in hospitals of Guatemala and Quetzaltenango 8 6 4 Start of sugar fortification with vitamin A 2 0 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 Year OD-2011-01-India 4
Examples of successful food fort. programs % Price Product Food Place Nutrient % EAR1 Salt Worlwide Iodine 0.3 % 198 % (10 g day) Central America Sugar (80 g/day) Vitamin A 2.3 % 112 % Chile, RSA, USA, Canada 0.05% 0.6 %2 Wheat Flour (200 g/day) Folic Acid 88 % 1 EAR for women of reproductive age 2 Plus other micronutrients (Complete formula) OD-2011-01-India 5
Assessing the need and the solutions Need (assessment): Size of nutritional gap Percent of the people affected Solutions (science): Correction of inadequate intake (bioefficacy) Coverage: Percent of people who receive the benefit OD-2011-01-India 6
Potential impact of fortification with vit.A % Children (24-59 months) with intakes below the EAR values in Uganda - 2008 100 Kampala 80 60 South-West 40 20 0 North OD-2011-01-India 7
Potential impact of fortified w. flour in Kampala % Women (15-49 years) with intakes below the EAR values 100 80 Before 60 After 40 20 0 OD-2011-01-India 8
Estimated impact on intakes of fortified w. flour Palestinian women of Hebron and Gaza City - 2005 100 80 % below EAR value Before 60 After 40 20 0 Iron Zinc Vit. A Vit. B-12 Folate Formula also contains vitamin D, which appears to be the main nutritional clinical deficiency of women. OD-2011-01-India 9
Estimated impact on intakes of fortified w. flour Palestinian women of Hebron and Gaza City - 2005 100 80 % below EAR value Before 60 40 After 20 0 Calcium Vit. B-1 Vit. B-2 Niacin Vit. B-6 OD-2011-01-India 10
Folate and B12 in Palestinian communities Source: UNRWA, Juzoor, and Ministry of Education of the Palestinian Authority. West Bank 2009 school-age females Nutrient/ Indicator Folate >45.3 nmol/L (supra-physiological) Vit. B12 > 221 pg/mL (sufficiency) Bethlehem Ramallah Nablus 11 % 22 % 33 % 60 % 82 % 87 % Betlehem has lower access to fortified wheat flour. OD-2011-01-India 11
Success: Clear definition of responsibilities Safe, Efficacious and Sustainable MAIN PLAYERS Researchers, Economists, Statisticians Cost-Effectiveness Analysis Cost-Effectiveness Analysis Nutrition Researchers, Statisticians, Laboratories Impact Assessment Impact Assessment Food industry, Marketing, Government Guidance Social Marketing and Education Food Control from MoH, M.Economy, Food Labs Governmental Inspection and Auditing Food Industry QC/QA Department Quality Control & Assurance - Factories Food Industry/ Production Dept. Implementation and Production Implementation and Production of Micronutrient Premixes Premix manufacturers Bureau of Standards Standards and Regulations Central Government Policies and National Strategies Nutrition and Researchers A good product and a successful efficacy trial do not make a program Science (Efficacy trials) and Epidemiological Assessment Science (Efficacy trials) and Epidemiological Assessment OD-2011-01-India 12
