The Fortification Assessment Coverage Toolkit (FACT)

Friesen, Valerie M; Nutrition, Global Alliance for Improved; Mbuya, Mduduzi N N; Neufeld, Lynnette M.

doi:10.36072/bp.1

Cited by 13 publications

(17 citation statements)

References 5 publications

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“…We also collected a sample of each fortifiable food assessed from the household if available. All survey questionnaires and modules were taken from FACT templates ( 7 ) and adapted to the local context according to the scope of the fortification program (i.e., number and type of foods) and other country-specific requirements (e.g., culturally appropriate wording of questions and response options). All survey instruments were translated into the common languages spoken in the survey areas and back-translated into English to ensure content validity.…”

Section: Methodsmentioning

confidence: 99%

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Fortified Foods Are Major Contributors to Apparent Intakes of Vitamin A and Iodine, but Not Iron, in Diets of Women of Reproductive Age in 4 African Countries

Friesen

Mbuya

Aaron

et al. 2020

The Journal of Nutrition

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Background Food fortification is implemented to increase intakes of specific nutrients in the diet, but contributions of fortified foods to nutrient intakes are rarely quantified. Objectives We quantified iron, vitamin A, and iodine intakes from fortified staple foods and condiments among women of reproductive age (WRA). Methods In subnational (Nigeria, South Africa) and national (Tanzania, Uganda) cross-sectional, clustered household surveys, we assessed fortifiable food consumption. We estimated daily nutrient intakes from fortified foods among WRA by multiplying the daily apparent fortifiable food consumption (by adult male equivalent method) by a fortification content for the food. Two fortification contents were used: measured, based on the median amount quantified from individual food samples collected from households; and potential, based on the targeted amount in national fortification standards. Results for both approaches are reported as percentages of the estimated average requirement (EAR) and recommended nutrient intake (RNI). Results Fortified foods made modest contributions to measured iron intakes (0%–13% RNI); potential intakes if standards are met were generally higher (0%–65% RNI). Fortified foods contributed substantially to measured vitamin A and iodine intakes (20%–125% and 88%–253% EAR, respectively); potential intakes were higher (53%–655% and 115%–377% EAR, respectively) and would exceed the tolerable upper intake level among 18%–56% of WRA for vitamin A in Nigeria and 1%–8% of WRA for iodine in Nigeria, Tanzania, and Uganda. Conclusions Fortified foods are major contributors to apparent intakes of vitamin A and iodine, but not iron, among WRA. Contributions to vitamin A and iodine are observed despite fortification standards not consistently being met and, if constraints to meeting standards are addressed, there is risk of excessive intakes in some countries. For all programs assessed, nutrient intakes from all dietary sources and fortification standards should be reviewed to inform adjustments where needed to avoid risk of low or excessive intakes.

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Section: Methodsmentioning

confidence: 99%

“…This information can be used to understand a program's performance and potential for biological impact and inform specific needs for program improvement related to design or delivery. It is for this purpose that the Fortification Assessment Coverage Toolkit (FACT) method was developed ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Fortified Foods Are Major Contributors to Apparent Intakes of Vitamin A and Iodine, but Not Iron, in Diets of Women of Reproductive Age in 4 African Countries

Friesen

Mbuya

Aaron

et al. 2020

The Journal of Nutrition

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“…In addition, 2 focus group discussions (FGDs) were conducted with 20 women (10 in each FGD) to collect information on local terminologies for biofortified foods, availability and consumption of the biofortified foods of interest, as well as preparation practices and storage conditions. A household questionnaire was developed using the Fortification Assessment Coverage Toolkit (FACT) household questionnaire ( 14 ) as a template, and modifications to this questionnaire were made based on the information collected through the formative research activities. Questionnaire modules were designed to streamline the interview process and to calculate population-level proportions of the newly developed indicators.…”

Section: Methodsmentioning

confidence: 99%

“…In contrast, data estimating the proportion of nonfarm households consuming biofortified foods are limited. Whereas standardized methods and indicators exist to assess the coverage and consumption of industrially fortified foods at the household level ( 13 , 14 ), similar methods for biofortified foods have not yet been developed or tested for application in household or market surveys. As the number and scale of programs that deliver biofortified seeds increase, it is critical to monitor the coverage of biofortified foods among both farm and nonfarm households to understand their potential for impact ( 4 , 15 ), and potential complementarity or overlap with other micronutrient and food system interventions.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Coverage of Biofortified Foods: Development and Testing of Methods and Indicators in Musanze, Rwanda

Petry¹,

Wirth²,

Friesen

et al. 2020

Current Developments in Nutrition

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Background Biofortification of staple crops has the potential to increase nutrient intakes and improve health outcomes. Despite program data on the number of farming households reached with and growing biofortified crops, information on the coverage of biofortified foods in the general population is often lacking. Such information is needed to ascertain potential for impact and identify bottlenecks to parts of the impact pathway. Objective To develop and test methods and indicators for assessing household coverage of biofortified foods. Methods To assess biofortification programs, 5 indicators of population-wide household coverage were developed, building on approaches previously used to assess large-scale food fortification programs. These were: 1) consumption of the food; 2) awareness of the biofortified food; 3) availability of the biofortified food; 4) consumption of the biofortified food (ever); and 5) consumption of the biofortified food (current). To ensure that the indicators are applicable to different settings they were tested in a cross-sectional household-based cluster survey in rural and peri-urban areas in Musanze District, Rwanda where planting material for iron-biofortified beans (IB) and orange fleshed sweet potatoes (OFSP) were delivered. Results Among the 242 households surveyed, consumption of beans and sweet potatoes was 99.2% and 96.3%, respectively. Awareness of IB or OFSP was 65.7% and 48.8%, and availability was 23.6% and 10.7%, respectively. Overall, 15.3% and 10.7% of households reported ever consuming IB and OFSP, and 10.4% and 2.1% of households were currently consuming these foods, respectively. The major bottlenecks to coverage of biofortified foods were awareness and availability. Conclusions These methods and indicators fill a gap in the availability of tools to assess coverage of biofortified foods, and the results of the survey highlight their utility for identifying bottlenecks. Further testing is warranted to confirm the generalizability of the coverage indicators and inform their operationalization when deployed in different settings.

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“…Also, GAIN developed the FACT toolkit with standardized methods for the collection, analysis, and synthesis of data on quality, coverage, and consumption of fortified foods across countries. 89,95 These tools are available at www.gainhealth.org.…”

Section: Role Of Government In Monitoring and Evaluationmentioning

confidence: 99%

Calcium‐fortified foods in public health programs: considerations for implementation

Palacios

Cormick

Hofmeyr

et al. 2020

Annals of the New York Academy of Sciences

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Low calcium intake is common worldwide and can result in nutritional rickets in children and osteomalacia in adults. Calcium-fortified foods could improve calcium intake. However, there is limited calcium fortification experience, with technical and practical issues that may hamper its adoption. The objective of this landscape review is to summarize these issues to help policymakers guide the planning and design of calcium fortification as a public health strategy. One challenge is the low bioavailability of calcium salts (∼20-40%); thus, large amounts need to be added to food to have a meaningful impact. Solubility is important when fortifying liquids and acidic foods. Calcium salts could change the flavor, color, and appearance of the food and may account for 70-90% of the total fortification cost. Safety is key to avoid exceeding the recommended intake; so the amount of added calcium should be based on the target calcium intake and the gap between inadequate and adequate levels. Monitoring includes the quality of the fortified food and population calcium intake using dietary assessment methods. Calcium fortification should follow regulations, implemented in an intersectorial way, and be informed by the right to health and equity. This information may help guide and plan this public health strategy.

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The Fortification Assessment Coverage Toolkit (FACT)

Cited by 13 publications

References 5 publications

Fortified Foods Are Major Contributors to Apparent Intakes of Vitamin A and Iodine, but Not Iron, in Diets of Women of Reproductive Age in 4 African Countries

Fortified Foods Are Major Contributors to Apparent Intakes of Vitamin A and Iodine, but Not Iron, in Diets of Women of Reproductive Age in 4 African Countries

Assessing the Coverage of Biofortified Foods: Development and Testing of Methods and Indicators in Musanze, Rwanda

Calcium‐fortified foods in public health programs: considerations for implementation

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