The recent increase in overweight prevalence among both urban poor and rural women, along with high prevalence of CED, indicates the emergence of a double burden of malnutrition in Bangladesh.

This paper assesses the additional benefits of a homestead gardening program designed to control vitamin A deficiency in Bangladesh. In February and March 2002, data were collected on the food security and social status of women from 2,160 households of active and former participants in the gardening program and from control groups in order to assess the impact and sustainability of the program. The proportions of active and former-participant households that gardened year-round were fivefold and threefold, respectively, higher than that of the control group (78% and 50% vs. 15%). In a three-month period, the households of active participants produced a median of 135 kg and consumed a median of 85 kg of vegetables, while the control households produced a median of 46 kg and consumed a median of 38 kg (p and consumed a median of 38 kg (p and consumed a median of 38 kg (< .001). About 64% of the active-participant households generated a median garden income of 347 taka (US$1 = 51 taka), which was spent mainly on food, and 25% of the control households generated 200 taka in the same period (p generated 200 taka in the same period (p generated 200 taka in the same period (< .001). The garden production and income levels of formerly participating households three years after withdrawal of program support were much higher than those of the control households, illustrating the sustainability of the program and its ability to increase household food security. Significantly more women in active-and former-participant households than in control households perceived that they had increased their economic contribution to their households since the time the program was launched in their subdistricts (> 85% vs. 52%). Similar results were found for the level of influence gained by women on household decision-making. These results highlight the multiple benefits that homestead gardening programs can bring and demonstrate that these benefits should be considered when selecting nutritional and development approaches targeting poor households.

Challenges to access to premix experienced by small producers can be overcome with a central procurement model in which the distributor leverages the overall volume by tendering for a consolidated order. The SBC model has the potential to be expanded and to considerably increase the coverage of the population consuming iodized salt in Ghana. Successful implementation of the cost-effective iCheck CHROMA rapid test device should be replicated in other countries where quality control of fortified vegetable oil is a challenge, and extended to additional food vehicles, such as wheat flour and salt. Only a reduced impact on iron deficiency in Ghana can be expected, given the low level of fortificant added to the wheat flour. An integrated approach, with complementary programs including additional iron-fortified food vehicles, should be explored to maximize health impact.

Targeted fortification programs for infants and young children are an effective strategy to prevent micronutrient deficiencies in developing countries, but the role of large-scale fortification of staple foods and condiments is less clear. Dietary modeling in children aged 6–60 months was undertaken, based on food consumption patterns described in the 2009 national food consumption survey, using a 24-h recall method. Consumption data showed that the median intake of a child for iron, vitamin A and zinc, as a proportion of the Vietnamese Recommended Dietary Allowance (VRDA), is respectively 16%–48%, 14%–49% and 36%–46%, (depending on the age group). Potential fortification vehicles, such as rice, fish/soy sauces and vegetable oil are consumed daily in significant amounts (median: 170 g/capita/day, 4 g/capita/day and 6 g/capita/day, respectively) by over 40% of the children. Vegetable oil fortification could contribute to an additional vitamin A intake of 21%–24% of VRDA recommended nutrient intake, while fortified rice could support the intakes of all the other micronutrients (14%–61% for iron, 4%–11% for zinc and 33%–49% of folate requirements). Other food vehicles, such as wheat flour, which is consumed by 16% of children, could also contribute to efforts to increase micronutrient intakes, although little impact on the prevalence of micronutrient deficiencies can be expected if used alone. The modeling suggests that fortification of vegetable oil, rice and sauces would be an effective strategy to address micronutrient gaps and deficiencies in young children.

The current levels of micronutrients added to maize meal and bread flour are unsatisfactory. This is likely to be because of insufficient addition of premix at the mills. This affects the availability and intake by consumers of fortified product and potentially prevents the desired reduction in vitamin and mineral deficiencies expected from the flour fortification program.