Fortification interventions

Poor dietary intake, especially iron, results in deprived mental and physical health, frequent illness and unhealthy population. This type of malnutrition burdens the healthcare system and the economy. Iron-deficient people are less likely to be able to fully participate in economic activities to their fullest potential.

Investing in nutrition, especially in iron, is like investing in human capital and economic growth. In Pakistan, iron-deficiency anaemia remains among the main underlying causes of disability-adjusted life years lost among adolescents, causing respiratory infections and diarrhoea in 10–14 year olds; depressive and anxiety disorders and self-harm in 15–19 year olds.

Maternal conditions also get affected by iron deficiency. Very few programmes are in place to address micronutrient malnutrition among the Pakistani population. Nutrition-specific interventions, such as food fortification or iron folic acid (IFA) supplementation is targeted only for pregnant women, and not reaching out to other sects of a larger target population.

Globally, researchers and scientists are focusing on augmenting the nutritional value of food and food ingredients through fortification. It has been agreed globally that food fortification is the best and cheapest way to overcome malnourishment. Providing iron-fortified foods, specifically to nutritionally vulnerable groups, on a large scale can definitely change the productivity of the young population by increasing mental and emotional health along with their mind alertness.

Massey University in New Zealand has introduced a new and improved iron source known as Iron Plus which enhanced the absorption of the required micronutrient in the body as compared to the existing best available source of iron. The new source has facilitated addressing the issue of iron deficiency for over 1.6 billion people globally.

Fortification of staple foods such as wheat with iron or salt with iodine has shown promising impacts on the nutritional indicators of the various countries globally. For example, Mexico shows great improvement by adopting the practice of feeding fortified food to early development stages of infants and children and has accomplished good nutrition indicators. Developing countries like Zambia and Sudan are also showing improvement in their health indicators by mandating additions of micronutrients in their staple food.

According to the latest data from the Global Fortification Data Exchange (GFDx), food fortification interventions are promising and two-thirds of the world’s countries mandate the intervention. However, many developing countries are not adopting these policies for their healthy future. For example, in Pakistan, various misconceptions exist about fortified food like it might be genetically modified food or artificial food.

At the same time, the country shows a high burden of maternal and child malnutrition attributed to iron deficiency. Unfortunately, the recent National Nutrition survey (NNS) 2018 did not show any marked improvement in the indicators as compared to NNS 2011. The survey shows that children in Pakistan are malnourished with iron deficiency among the top deficiencies -- 49.1 percent as per the National Nutrition Survey 2018 for those under five years of age, showing the low level of effort and willingness by the government to address the malnutrition crisis.

There is a need to understand at a massive scale that fortification is just addition of micronutrients like iron, vitamins, calcium etc, and is the most cost effective way of feeding children with required micronutrients. Adding a cost in just a minimal amount per person can create a cost-to-benefit ratio unlike any other development investment. Like other countries, where it is mandated by the government for wheat millers to fortify flour and by providing subsidies on iron mix to the chakki and flour mill owners, iron deficiency among the population can easily be controlled.

The most relatable example is the success story of Universal Salt Iodization, where packaged salt was mandated to be supplemented by iodine, an important micronutrient to control thyroid issues, in the northern parts of Pakistan. Now, very few cases of thyroids can be seen in the area. Milk fortified with iron has been proved an effective measure to address anaemia and iron deficiency in countries like in Mexico.

The same way, with government support, legislation for mandatory wheat flour fortification with iron and folic acid for flour milling and flour grinding industry (Chakki) or milk with iron is required -- besides other interventions to avoid the iron deficient population in Pakistan.

The breakthrough technology of Iron Plus can be used in our staple foods to overcome the largest micronutrient deficiency and to build a productive generation that can contribute to their full potential in countries' development.

The writer is a public health consultant. She can be reached at:

fauziawaqar_28@hotmail.com