Food Fortifi ficati tion regio ional w workshop Dr.M.Hamayoun - PowerPoint PPT Presentation

Ministry of Public health GD of Preventive medicine Public Nutrition Department Food Fortifi ficati tion regio ional w workshop Dr.M.Hamayoun Lu Dr Ludin Director, Public Di ic Nutrit ition Dep Department Kabul-Afghanistan

Outline • Nutrition situation in Afghanistan • Overview of main staple Food Fortification Programs - Salt Iodization - Wheat flour fortification - Oil fortification with Vit A & D • Challenges and constraints • Recommendations

Nutrition situation in Afghanistan(NNS 2013)

Nutrition status of all children 0-59 months WHO cut offs for WHO cut offs for WHO cut offs for VERY VERY HIGH LEVEL VERY HIGH LEVEL HIGH LEVEL Underweight >30% Stunting >40% GAM > 15% SAM > 4%

Micronutrient statues Deficiency/ Women of Children (6-59 Adolescent girls Condition Reproductive Age months of age) (10-19 years) (15-49 years) Anemia 40.4% 44.9% 30.9% Iron Deficiency 24% 26.1% - Vitamin A 11.3% 50.4% - deficiency Zinc Deficiency 23.4% 15.1% - Iodine Deficiency 40.7% 29.5% - Vitamin D 94.8% 81.0% - deficiency

Co Comparis ison – 2004 vs s 2013 Indicator 2004 2013 Chart Title 9.5 Wasting (WHZ) Early Initiation 35% 69% 9 of breastfeeding Undernourishe 20.9% 9.2% 25 Underweight d women (15- (WAZ) 49) 34 BMI<18.5 Iron Deficiency 48% 24% (women) 40.9 Stunting (HAZ) 60.5 Iodine 75% 41% Deficiency (women) 0 20 40 60 80 Iodine 72% 30% NNS 2013 NNS 2004 Deficiency (children)

10 15 20 25 30 35 40 0 5 Minimum Acceptable Diet by province (6-23 months) 12 Overall Nuristan 0 1 1 2 2 4 4 4 4 5 6 6 7 7 8 9 9 Ghazni Ghor Paktia Helmand Kandahar Samangan Baghlan Paktika Daykundi Wardak Urozgan Khost Balkh Zabul Kapisa Badghis 1111 1212 1213 1313 1415 16 1617 Bamyan Panjshir Nangarhar Badakhshan Jawzjan Farah Laghman Saripul Kunduz Nimroz Faryab Logar Kabul 19 Parwan 21 Herat 27 Kunar 38 Takhar

Knowledge of Mothers about Micronutrients 70 64.2 60.8 60 50 Percentage 38.7 40 30.2 30 20 10 0 Vitamins Vitamin A Anaemia Iodized Salt Knowledge of respondent about

Responding of mothers on use of fortified food commodities 100.0 90.0 80.0 70.0 60.0 Percentage 48.0 50.0 38.1 40.0 30.0 20.0 10.0 10.0 3.9 0.0 Yes No Not reported Don't know Usage of fortified commodities

Overview of main staple Food Fortification Programs According to national nutrition policies and strategies the following national food fortification programs have the priorities & existing 1. Salt Iodization 2. Oil fortification with Vit A & D 3. Wheat flour fortification

1. Salt Iodization program  The program is initiated in 2003, by establishing first iodized salt in kabul city through public-private partnership  The supply of potassium iodate was provided to Iodized salt plants up to end of 2013 as free of charge by UNICEF,MI & GAIN,  Currently there are 31 registered iodized salt plants with the capacity of 3-8 MT/h functioning in 14 provinces of country  Since 2011 when the USI legislation approved by the government , salt iodization become mandatory  Since Feb,2014 the free donation of potassium iodate supply was changed to revolving fund system , which is running by Iodized Salt Factories Association

Iodized salt production trend ( MT/year ) 117800 111000 114900 110000 105000 100000 100100 92000 74100 68000 59100 4200 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

2. Oil fortification with Vit A & D  The edible oil fortification with Vit A & D is started recently , just few months ago  There are three local producers of edible oil functioning in three provinces (Kabul, Balkh& Hirat)  The premix, dozer machine and installation process in mentioned oil producing factories are completed.  The amount of Vit A & D will be added to processed and refined oil based on national standards  A legislation on oil and flour fortification is under process in MoPH

3. . Wheat fl flour fortification  Large scale Flour fortification is started since 2006 by support of WFP  Currently there are more than 14 mills functioning in 5 provinces of the country  Since there is no proved legislation yet the program is not mandatory  The annual production of fortified wheat flour is covering almost less than 5% of the need of people in 5 big cities (Kabul,Hirat, Mazar-e-Sharif, Kundoz and Jalabad)

Cont---  National Standards has been developed by support of ANSA (based on new standard only four micronutrients ,Vit B12, Folic Acid, Zinc & Iron should be in the premix)  MoPH/PND provide The micro-feeder and premix which has five micronutrients(Iron, Folic Acid, Vit A, Zinc & Vit B12)  The legislation for wheat flour and edible oil is under process in MoPH  MoPH/PND conducted training on QC & QA to provincial nutrition officer and millers in five provinces  Communication campaign in five big cities are also under process

FF production trend ( MT/year ) 74000 63000 44614 30000 28611 23627 22000 17000 15391 2006 2007 2008 2009 2010 2011 2012 2013 2014

Wheat flour production in percentage Percentage of wheat flour 100 90 80 70 60 50 Percentage of wheat flour 40 30 20 10 0 Country production Imported

Outline

Outline

Afghanistan flour fortification standards are based on WHO recommendation Nutrient Flour extraction Compound Level of nutrient to be added in parts per million (ppm) by rate estimated average per capita wheat flour availability (g/day) <75g/day 75-149g/day 150-300g/day >300g/day Iron Low NaFeEDTA 40 40 20 15 Ferrous 60 60 30 20 sulphate Ferrous 60 60 30 20 fumarate Electrolytic iron NR NR 60 40 High NaFeEDTA 40 40 20 15 Folic acid Low or high Folic acid 5.0 2.6 1.3 1.0 Vitamin B12 Low or high Cyanocobalami 0.04 0.02 0.01 0.008 n Vitamin A Low or high Vit A palmitate 5.9 3 1.5 1 Zinc Low Zinc oxide 95 55 40 30 High Zinc oxide 100 100 80 70 NR – Not Recommended

Challenges and constraints Wheat flour  Low quality and quantity of locally produced wheat flour  Weak support on importation of wheat instead of flour(which are not fortified)  No program to convinces the traders to being fortified instead of non fortified flour from neighboring countries

Recommendations  Supporting the in-country production of iodized salt ,fortified wheat flour & edible oil  Regional coordination to support government of Afghanistan to finalize policy on importation of wheat instead of wheat flour  Support the importation of fortified wheat flour & edible oil until the local production capacity increased (Na Iron EDTA to 15)  Strengthening coordination & collaboration among governments to import fortified food (iodized salt ,fortified wheat flour & edible oil)  Harmonize standards among countries of the region

Remember, Remember …… “Use every letter you write Every conversation you have Every meeting you attend to express your fundamental beliefs and dreams Affirm to others the vision of the world you want” (Robert Muller) Robert Muller (March 11, 1923 – September 20, 2010) was an international civil servant for 40 years, his ideas about world government, world peace and spirituality . He was known by some as "the philosopher 1]

Thanks , , Better fu future and better coordination