The potential of food fortification to add micronutrients in young children and women of reproductive age - findings from a cross-sectional survey in Abidjan, Côte d'Ivoire

Poor micronutrient intakes are a major contributing factor to the high burden of micronutrient deficiencies in Côte d'Ivoire. Large-scale food fortification is considered a cost-effective approach to deliver micronutrients, and fortification of salt (iodine), wheat flour (iron and folic acid), and vegetable oil (vitamin A) is mandatory in Côte d'Ivoire. A cross-sectional survey on households with at least one child 6-23 months was conducted to update coverage figures with adequately fortified food vehicles in Abidjan, the capital of and largest urban community in Côte d'Ivoire, and to evaluate whether additional iron and vitamin A intake is sufficient to bear the potential to reduce micronutrient malnutrition. Information on demographics and food consumption was collected, along with samples of salt and oil. Wheat flour was sampled from bakeries and retailers residing in the selected clusters. In Abidjan, 86% and 97% of salt and vegetable oil samples, respectively, were adequately fortified, while only 32% of wheat flour samples were adequately fortified, but all samples contained some added iron. There were no major differences in additional vitamin A and iron intake between poor and non-poor households. For vitamin A in oil, the additional percentage of the recommended nutrient intake was 27% and 40% for children 6-23 months and women of reproductive age, respectively, while for iron from wheat flour, only 13% and 19% could be covered. Compared to previous estimates, coverage has remained stable for salt and wheat flour, but improved for vegetable oil. Fortification of vegetable oil clearly provides a meaningful additional amount of vitamin A. This is not currently the case for iron, due to the low fortification levels. Iron levels in wheat flour should be increased and monitored, and additional vehicles should be explored to add iron to the Ivorian diet

High awareness butlow coverage of a locally produced fortified complementary food in Abidjan, Côte d'Ivoire : findings from a cross-sectional survey

Poor complementary feeding practices among infants and young children in Côte d'Ivoire are major contributing factors to the country's high burden of malnutrition. As part of a broad effort to address this issue, an affordable, nutritious, and locally produced fortified complementary food product was launched in the Côte d'Ivoire in 2011. The objective of the current research was to assess various levels of coverage of the program and to identify coverage barriers. A cross-sectional household survey was conducted among caregivers of children less than 2-years of age living in Abidjan, Côte d'Ivoire. Four measures of coverage were assessed: "message coverage" (i.e., has the caregiver ever heard of the product?), "contact coverage" (i.e., has the caregiver ever fed the child the product?), "partial coverage" (i.e., has the caregiver fed the child the product in the previous month?), and "effective coverage" (i.e., has the caregiver fed the child the product in the previous 7 days?). A total of 1,113 caregivers with children between 0 and 23 months of age were interviewed. Results showed high message coverage (85.0%), moderate contact coverage (37.8%), and poor partial and effective coverages (8.8% and 4.6%, respectively). Product awareness was lower among caregivers from poorer households, but partial and effective coverages were comparable in both poor and non-poor groups. Infant and young child feeding (IYCF) practices were generally poor and did not appear to have improved since previous assessments. In conclusion, the results from the present study indicate that availability on the market and high awareness among the target population is not sufficient to achieve high and effective coverage. With market-based delivery models, significant efforts are needed to improve demand. Moreover, given the high prevalence of malnutrition and poor IYCF practices, additional modes of delivering IYCF interventions and improving IYCF practices should be considered

Legally mandated fortification levels in Côte d’Ivoire for wheat flour, vegetable oil and salt.

<p>Legally mandated fortification levels in Côte d’Ivoire for wheat flour, vegetable oil and salt.</p

Met Need and Coverage Ratios of PKL’s Fortified Complementary Instant Cereals by Coverage Measure and Risk Group ^a.

<p>Met Need and Coverage Ratios of PKL’s Fortified Complementary Instant Cereals by Coverage Measure and Risk Group <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0166295#t004fn001" target="_blank">^a</a>.</p

Additional Vitamin A and Iron Intake from Fortified Vegetable Oil and Wheat Flour for Children 6–23 Months of Age and Women of Reproductive Age, Disaggregated for Poor and Non-Poor Respondents, Abidjan, 2014.

<p>Additional Vitamin A and Iron Intake from Fortified Vegetable Oil and Wheat Flour for Children 6–23 Months of Age and Women of Reproductive Age, Disaggregated for Poor and Non-Poor Respondents, Abidjan, 2014.</p

Household Coverage with Unfortified and Inadequately and Adequately Fortified Wheat Flour, Salt, and Vegetable Oil, Abidjan, 2014.

<p>“Adequately fortified” is defined according to the most recent national regulations [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0158552#pone.0158552.ref015" target="_blank">15</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0158552#pone.0158552.ref016" target="_blank">16</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0158552#pone.0158552.ref018" target="_blank">18</a>]: > 30 mg iron/kg of flour as ferrous fumarate, > 30 mg iodine/kg salt as potassium iodate, and > 8 μg RE/g oil as retinyl palmitate.</p

Coverage and Consumption of PKL’s Fortified Complementary Instant Cereals among Children 6–23 Months.

<p>Coverage and Consumption of PKL’s Fortified Complementary Instant Cereals among Children 6–23 Months.</p

Daily Oil and Wheat Flour Consumption Stratified by Population Group and MPI Score, Abidjan, 2014^a.

<p>Daily Oil and Wheat Flour Consumption Stratified by Population Group and MPI Score, Abidjan, 2014<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0158552#t003fn001" target="_blank">^a</a>.</p

Vitamin A and Iron Contribution from Fortified Vegetable Oil and Wheat Flour, Expressed as % of RNI, Stratified by Population Group and MPI Score, Abidjan, 2014^a.

<p>Vitamin A and Iron Contribution from Fortified Vegetable Oil and Wheat Flour, Expressed as % of RNI, Stratified by Population Group and MPI Score, Abidjan, 2014<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0158552#t004fn001" target="_blank">^a</a>.</p