The economic feasibility of maize flour and maize meal fortification in Kenya, Uganda, and Zambia is assessed using information about the maize milling industry, households' purchases and consumption levels of maize flour, and the incremental cost and estimated price impacts of fortification. Premix costs comprise the overwhelming share of incremental fortification costs and vary by 50% in Kenya and by more than 100% across the three countries. The estimated incremental cost of maize flour fortification per metric ton varies from $3.19 in Zambia to $4.41 in Uganda. Assuming all incremental costs are passed onto the consumer, fortification in Zambia would result in at most a 0.9% increase in the price of maize flour, and would increase annual outlays of the average maize flour-consuming household by 0.2%. The increases for Kenyans and Ugandans would be even less. Although the coverage of maize flour fortification is not likely to be as high as some advocates have predicted, fortification is economically feasible, and would reduce deficiencies of multiple micronutrients, which are significant public health problems in each of these countries.

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Corn flour and maize meal fortification can benefit the consumer when the added nutrient contents are in amounts appropriate to address nutrient gaps. Legislative instruments (standards and regulations) are needed to provide guidance to the producers and food control authorities. We reviewed a number of national standards and regulations of fortified corn flour and maize meal and identified constraints; contrary to current belief, the practice of using minimum contents or ranges of nutrients has caused confusion, misinterpretation, and conflict, and should therefore be abandoned. On the basis of the findings, a model of fortification legislation is proposed, in which the additional content and the expected average nutrient content in a final product are recommended as the main parameters for quality control and enforcement. For labeling, the average content, or one adjusted to the expected content of the product at the market, can be applied. Variation in micronutrient contents should still be checked to ensure homogeneity but with adherence to clear procedures of sampling and testing, which should be part of the standards and regulations.Keywords: food fortification; corn flour; maize meal; micronutrients; fortification contents IntroductionFortification of corn flour and maize meal is one potential nutrition intervention for managing micronutrient inadequacies in countries where maize is a staple food produced industrially.1 These conditions are fulfilled in many sub-Saharan African and South American countries, where the fortification of this staple has either already started or is being considered.A program of food fortification should be guided by technical specifications that respond to epidemiological need 2 and to industry context of each country. Those specifications are gathered in standards and regulations, which are the most common legislative instruments applied to fortified foods.3 A few countries have also enacted laws for food fortification, although this practice is increasingly abandoned because of its rigidity in making timely modifications in response to changes in nutrition epidemiology or industry technological advances.The objective of this paper is to gather existent legislative instruments applicable to the fortification of corn flour and maize meal, to compare them, identify common limitations and constraints, and to propose a generic model that could improve the preparation of these technical and legal instruments. For the latter, this paper uses the estimations done for the case of Kampala, Uganda, in Guamuch et al., 4 in which details about how to use food and nutrient intakes to define nutrient contents in fortified foods are described. We explain in this paper how to calculate the values of several parameters that should appear in the legislative frameworks of fortified foods. These parameters are: the additional micronutrient contents that should be incorporated into the foods during the fortification process; the final average content and the allowable variation of contents at pr...

The objective of this work was to present a generic model for estimating fortification contents when several food vehicles are being considered simultaneously. It is based on approximating the magnitude of the nutritional inadequacy of the population (nutrient gap), the optimal use of the combination of food vehicles (fortifiable food energy, FFE), and the upper intake level to decrease the possibility that individuals with the highest combined intake of all food vehicles will exceed it. The model is intended to be used when only per capita food and micronutrient intake information, not detailed food intake data, are available. Food consumption survey data from Mexico and Kampala (Uganda) were analyzed for adult women, assuming that their intake may be similar to general per capita values. General adjustment factors for estimating the lowest and highest FFE and micronutrient intake for satisfying the requirements of other family members were calculated. These factors were used to estimate the additional effective content and the maximum allowable content, and then the recommended nutrient contents at the consumers' level were chosen on the basis of technological compatibility and cost. The method should be used in other contexts to test its validity as well as its application to nonstaple foods.

Objectives To develop a global action plan for the control of folate deficiency and folic acid responsive neural tube defects (anencephaly and spina bifida) Methods • Establish a multi- and inter-disciplinary group to develop a global action plan for folate-sensitive NTD prevention • Ensure regional lab capacity exists to assess folate status applying a harmonized microbiologic assay (MBA) to measure red blood cell (RBC) folate, establishing a global network of regional laboratories coordinated by an umbrella organization • Promote improvements of folate status in women of reproductive age (WRA) in LMIC, engaging a wide variety of national and global stakeholders • Address key knowledge gaps related to the prevention of folate sensitive NTDs • Improve knowledge availability and sharing amongst global stakeholders in NTD prevention • Communicate and share the work of the Folate Task Team Results • A standing Folate Task Team comprised of a 2-member Secretariat, a 10-member Expert Advisory Group, 4 Ex-Officio members, and 4 “As Needed” advisors (see Fig. 1) • Identification of an initial list of 12 global stakeholders and partner organizations • Five resource laboratories have been trained at the Division of Laboratory Sciences - CDC, including labs in Vietnam, Sri Lanka, Philippines, Tanzania, and Pakistan • A training video supported by a manual and mini posters to illustrate specific activities of the assay has been produced by CDC. • A landscaping analysis has identified countries that have mandatory/voluntary food fortification practices, information on folate status in the population, burden of NTDs, and consumption patterns of fortified foods • Identification of alternative foods/food vehicles likely to be fortified to reach at-risk segments of WRA • Dissemination activities are shared at https://www.nutritionintl.org/what-we-do/nteam/folate-task-team/ Conclusions • The estimated global prevalence of NTD-affected pregnancies is estimated to be 260,100 in 2015 and has a significant emotional and economic impact on families and society, while contributing to the loss of human potential for countries • The global action provides a clear path forward to help direct and prioritize investments, advance resource mobilization, and garner the political will to accelerate NTD prevention in LMIC Funding Sources The Bill & Melinda Gates Foundation. Supporting Tables, Images and/or Graphs