South Africa’s food-fortification programme is generating interest throughout the continent, but it is too early to determine the effect on the health of South Africans, a World Health Organisation (WHO) affiliate said recently.
”The results of our analyses are not yet in. So, as scientists who are committed to making sure our statements are backed up by evidence, it is too soon for us to be able to make claims about reductions in vitamin and mineral deficiencies,” said Marc van Ameringen, executive director of the Global Alliance for Improved Nutrition (Gain).
In 2003 South Africa was one of four countries — the others are China, Morocco and Vietnam — that received a fortification grant from Gain, with South Africa’s largesse valued at $2,8-million.
The three-year project is worth about $70-million — with the government contributing $2,3-million, private industry $63-million and the difference coming from other sources.
”Nepad [the New Partnership for Africa’s Development] is working on an African strategy to address malnutrition, and food fortification will be an important part of that … Studies of fortification projects around the world have shown that for only a small amount, at most 25 cents per person per year, we can achieve significant improvements in health,” Van Ameringen said from Geneva.
The project, which looks at fortifying maize meal and wheat flour with eight vitamins and minerals, including folic acid, iron, vitamin A and B, as well as zinc, targets women and pre-school children and was expected to reach 30-million South Africans in the first year, 2004.
A 1994 study carried out among pre-school children showed that 33% of them were vitamin-A deficient, 21,4% were anaemic and 10% had an iron deficiency.
A 1999 national food-consumption survey conducted among children aged one to nine years found that one out of two children had an intake of approximately less than half of the required levels of energy, vitamins, iron and other micronutrients such as calcium, iron and zinc.
Vitamin-A deficiency is particularly worrisome. It can cause blindness in severe cases, and usually impairs the body’s ability to fight infections, making children more susceptible to respiratory diseases and diarrhoea. It also increases the risk of childhood death.
And, in a country where poverty and HIV/Aids are major developmental challenges, ensuring main staple foods are fortified with multiple multinutrients can play a positive role.
”What’s important about our programme is that it targeted foods that are consumed by the majority of the population — wheat flour, maize meal and bread flour. The bottom line is that fortification … is unlikely to be dangerous at the levels of fortification used, and is cost-effective,” said Dr Muhammad Ali Dhansay, director of the nutritional intervention research unit at the Medical Research Council (MRC).
Asked why it had taken so long to implement a baseline survey with which to compare the impact of the fortification programme, the chairperson of the survey, Prof Demetre Labadarios, said logistic and financial constraints hampered its finalisation.
”The implementation of any national survey is a complex process … There is no doubt, in my mind at least, that the survey will produce direction-giving data, not only on the current and future monitoring of the programme, but also on a number of other nutritional issues in the country,” said Labadarios, of the University of Stellenbosch, one of nine universities participating in the survey together with the MRC.
Labadarios said the national food-consumption survey: baseline one was completed and a report is currently being written for Minister of Health Manto Tshabalala-Msimang.
According to the 2006 Estimates of National Expenditure document tabled in Parliament, the responsibility for monitoring lies with environmental health practitioners employed by municipalities, and training for this will be fast-tracked.
Among the major challenges the fortification programme faces, Labadarios identified the collection of data supporting the effectiveness of the programme as one.
”The other major challenge is the fortification of the bread and maize products of people who mill their own grains or have it milled by the so-called small millers. Although a measure of progress has been achieved in this regard, it remains a challenge in the immediate to longer term,” he said.
However, Labadarios said industry has been forthcoming, supportive and mature in working with the government to implement the fortification programme. ”If you like, this is one example of what I would call a successful partnership in terms of a beneficial outcome for the population at large.” — Sapa