GAIN

Monitoring National Food Fortification Programs using FortifyMIS: A Web-Based Management Approach to Capture Program Compliance and Increase Impact on NTDs

Background

Today, food fortification is widely recognized as one of the most cost-effective approaches to reduce vitamin and mineral deficiencies and improve the health of populations and national economies. If implemented properly, fortification has proven to have a return on investment that is one of the highest development dividends that exist today.

As a result, 105 countries implement mandatory national universal salt iodization (USI) programs, 87 countries mandate at least one kind of cereal grain fortification, and 29 countries mandate the fortification of edible oils. Many other countries have also started to scale up fortification of condiments such as fish and soy sauces and bouillon cubes.

One of the areas where food fortification has seen the greatest impacts is in reducing neural tube defects (NTDs) through fortification of cereal grains (wheat and maize flours and rice) with folic acid. While all people need folic acid to produce and maintain healthy cells, folic acid is a critical micronutrient for pregnant women to reduce the risk of their children having birth defects of the brain and spine, including spina bifida and anencephaly (among other NTDs). Food fortification can increase folic acid consumption among women of reproductive age prior to conception to ensure the greatest chance of NTD prevention. Around 75% of NTD scan be prevented.

Despite the global momentum to engage in food fortification, many national programs are currently not achieving nutritional impact targets, in large part because of weak monitoring systems. Effectively verifying and enforcing the production of adequately fortified staple foods that meet national standards, a process known as regulatory or compliance monitoring (i.e. determining if added nutrient levels are too high or too low based on adopted food standards), remains an on-going challenge for many governments. Furthermore, many countries do not have routine data collection or reporting on the prevalence of birth defects. This is a major gap in understanding the magnitude of preventable morbidity and mortality due to NTDs and in designing appropriate interventions to mitigate the risk of NTDs forming during pregnancy. GAIN has worked alongside partners in several countries already to establish birth defects registries, which allow hospitals and birth centers to better track the prevalence of NTDs.

In our cooperation with Ineke Feitz, we propose to develop and utilize an innovative data collection and aggregation tool, FortifyMIS, to help food industry and government regulators monitor the quality and compliance of their fortified foods, especially those foods fortified with folic acid. In addition, we propose to establish a birth defects registry module within this tool to allow countries to integrate data from hospitals and birth centers to not only track the prevalence of NTDs, but to also seamlessly compare with ongoing fortification efforts. This will be a useful addition to advocacy efforts in low- and middle-income countries utilizing FortifyMIS as a monitoring and surveillance tool to encourage efforts to build, improve, and sustain fortification programs.

The FortifyMIS platform provides:

  • A practical online data aggregation solution for country-specific use in real time;

  • More efficient and effective tracking of product compliance in real time to better understand whether or not fortified foods actually 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.

Description of Proposed Activities

With support from the Ineke Feitz Foundation, GAIN intends to support a roll-out of FortifyMIS in Nigeria and work towards establishing a birth defects registry module within the FortifyMIS platform for use in this and other countries.