The fight against hidden hunger

IN THE 1980s and 1990s, there was a rampant condition called goitre. It was prevalent among children and adults from both rural and urban Zimbabwean communities. But it is almost rare to come across someone with a goitre today. Goitre is a manifestation of iodine deficiency.

So how did Zimbabwe efficiently reduce and control iodine deficiency?

It was through the mandatory salt iodisation that was introduced, a food fortification strategy similar to what has recently been adopted with maizemeal, wheat flour, sugar and cooking oil to fight deficiencies of Vitamin A, Iron, Vitamin D, Zinc, and Folate among other micronutrients.

Hidden hunger

Known as “hidden hunger,” micronutrient deficiencies are an insidious form of malnutrition that affects over two billion people worldwide.

It is the cause of stunted growth of an estimated 195 million children under five years in the world, weakened immune systems, poor cognitive and learning capacity.

This hidden hunger contributes to more than a third of deaths in children under five years per year and is also the main cause of productivity and earning potential losses.

Micronutrient deficiency is a problem of public health significance in Zimbabwe.

The latest Zimbabwe Demographic and Health Surveys and the Micronutrient Survey shows that many Zimbabweans, especially children and women suffer from micronutrient deficiencies especially Iron and Vitamin A as outlined below:

◆ Vitamin A deficiency affects about a fifth (19 percent) of children below the age of five;

◆ 62 percent of women of child bearing age (15-49) suffer from iron deficiency while 26 percent have anaemia; and

◆ 72 percent of children below the age of five are iron deficient and 31 percent suffer from anaemia;

As a consequence of these and other micronutrient deficiencies, more than five million Zimbabweans are prevented from realising their full potential as students, workers, parents and citizens.

Food Fortification Strategy

Responding to this serious micronutrient deficiency burden Zimbabwe, led by the Health and Child Care Ministry, has developed a Food Fortification Strategy as an immediate measure to address micronutrient deficiencies.

The strategy provides a comprehensive initiative in which several staple food products — maize flour, wheat flour, cooking oil, and sugar — are fortified with key micronutrients necessary for adequate health and proper growth.

The National Food Fortification Strategy is one of the key instruments in the fight against malnutrition and was developed in line with the comprehensive National Food and Nutrition Security Policy.

How it works

Food fortification is the process of adding small amounts of micronutrients — for example vitamin A, iron, and iodine — to food during processing.

The taste, appearance, colour and texture do not change. All food compositions do not change except the increased levels of the micronutrient added.

This can be done both by large-scale industries and small-scale producers.

For instance a large milling company like National Foods or Victoria Foods can produce fortified maize-meal similar to fortified maize-meal that can be produced by a small-scale hammer-mill in Nembudziya.

So now in addition to the fortified salt being sold as iodised salt in supermarkets and shops in Zimbabwe, four additional foods that include sugar, cooking oil, maize-meal and wheat flour are now being fortified.

Monitoring and regulation

Government has developed regulations and legislation as we move from voluntary to mandatory food fortification.

Mandatory food fortification, which started during in July, is guided by the Food Standards (Fortification) Regulations Statutory Instrument 120 of 2016.

Every producer or importer of cooking oil, wheat flour, sugar and maize meal is required to fortify these products found on the commercial market.

Health inspectors will continue working closely with food producers to ensure food producers will fortify these food products.

The concentration on food fortification was born out of the realisation that it is one of the most effective and sustainable ways to eliminate dietary micronutrient deficiencies using multiple micronutrients (eg vitamin A, vitamin D, vitamin B1, vitamin B2, vitamin B6, vitamin B12, niacin, folate, iron and zinc).

Also, food fortification is socially acceptable, does not change the food’s characteristics, does not require change in dietary habits, has quick and visible benefits, relatively easy to monitor while being cost effective for government with greater sustainability.

For instance, it costs less than US$1 per year to protect an individual against deficiencies of the stated micronutrients. To be specific, it costs US$0,67 to fortify all the four foods mentioned above per person per year based on average consumption levels.

If you compare this with the cost of US$9,87 you require to manage a single vitamin or mineral deficiency disorder per treatment cycle, you realise that food fortification is cheaper and necessary.

It should also be noted that introducing food fortification does not reverse nutrition recommendations from the Health and Child Care Ministry.

For instance, intake of sugar and salt should be controlled to prevent non-communicable diseases such as hypertension, diabetes mellitus type 2 and heart diseases.

Eating a diet consisting of a variety of foods is strongly encouraged to promote good health and optimal nutritional status.

The Health and Child Care Ministry will continue providing micronutrient supplements to children and women.

This shows that food fortification is only coming to complement other strategies that Government is implementing to ensure we eradicate these deficiencies.

Issues clarified

It should clarified to everyone that food fortification will not result in price hikes.

The Health Ministry established a Food Fortification Taskforce that has been working on this since 2012 following the Micronutrient Survey that showed the serious micronutrient burden Zimbabwe is facing.

Through various engagements with industry associations and those representing industry in the National Food Fortification Taskforce, a mechanism has been put in place to ensure prices will not go up because of food fortification.

These include facilitation by the Health Ministry to ensure industries are exempted from paying duty when importing fortificants and equipment. This means for a 2kg packet of sugar, the price will be affected by USc1 — if it really has to change at all.

Government is not forcing industries to fortify without a choice.

Those facing challenges can apply for a waiver to the Secretary of Health and Child Care so that they get support as they prepare to start fortifying.

The ministry is very considerate of small-scale companies that could be facing challenges and has put mechanisms to ensure they receive support from various partners supporting the Food Fortification Programme.

What companies simply have to do is to apply to the Secretary of Health and Child Care and get assistance just as other large-scale industries who have already started to fortify.

The Health and Child Care Ministry remains committed to the fight against micronutrient deficiencies in Zimbabwe and strongly appeals to all stakeholders to unite and support the Food Fortification Strategy to achieve a more significant and sustainable change in the health of our people and bring development to our communities.

As general advice, we recommend the public to consume fortified foods and they can recognise them by the logo on every food product as indicated below.