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

Dr Dr.M.Hamayoun Lu Ludin Di Director, Public ic Nutrit ition Dep Department Kabul-Afghanistan

Food Fortifi ficati tion regio ional w workshop

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 VERY HIGH LEVEL GAM > 15% SAM > 4% WHO cut offs for VERY HIGH LEVEL Stunting >40% WHO cut offs for VERY HIGH LEVEL Underweight >30%

Micronutrient statues

Deficiency/ Condition Women of Reproductive Age (15-49 years) Children (6-59 months of age) Adolescent girls (10-19 years) Anemia 40.4% 44.9% 30.9% Iron Deficiency 24% 26.1%

• Vitamin A

deficiency 11.3% 50.4%

• Zinc Deficiency

23.4% 15.1%

• Iodine Deficiency

40.7% 29.5%

• Vitamin D

deficiency 94.8% 81.0%

Co Comparis ison – 2004 vs s 2013

60.5 34 9

40.9 25 9.5

20 40 60 80

Stunting (HAZ) Underweight (WAZ) Wasting (WHZ)

Chart Title

NNS 2013 NNS 2004

Indicator

2004 2013

Early Initiation

• f

breastfeeding

35% 69%

Undernourishe d women (15- 49) BMI<18.5

20.9% 9.2%

Iron Deficiency (women)

48% 24%

Iodine Deficiency (women)

75% 41%

Iodine Deficiency (children)

72% 30%

Minimum Acceptable Diet by province (6-23 months)

12 0 1 1 2 2 4 4 4 4 5 6 6 7 7 8 9 9 11111212121313131415161617 19 21 27 38

5 10 15 20 25 30 35 40

Overall Nuristan Ghazni Ghor Paktia Helmand Kandahar Samangan Baghlan Paktika Daykundi Wardak Urozgan Khost Balkh Zabul Kapisa Badghis Bamyan Panjshir Nangarhar Badakhshan Jawzjan Farah Laghman Saripul Kunduz Nimroz Faryab Logar Kabul Parwan Herat Kunar Takhar

Knowledge of Mothers about Micronutrients

38.7 30.2 60.8 64.2 10 20 30 40 50 60 70

Vitamins Vitamin A Anaemia Iodized Salt Knowledge of respondent about

Percentage

Responding of mothers on use of fortified food commodities

38.1 48.0 3.9 10.0

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0

Yes No Not reported Don't know Usage of fortified commodities

Percentage

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)

4200

59100 92000 110000 74100 100000 117800 100100 114900 111000 105000 68000 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)

22000 17000 30000 74000 63000 15391 23627 28611 44614 2006 2007 2008 2009 2010 2011 2012 2013 2014

Wheat flour production in percentage

10 20 30 40 50 60 70 80 90 100 Country production Imported

Percentage of wheat flour

Percentage of wheat flour

Outline

Outline

Afghanistan flour fortification standards are based

• n WHO recommendation

Nutrient Flour extraction rate Compound Level of nutrient to be added in parts per million (ppm) by 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 sulphate 60 60 30 20 Ferrous fumarate 60 60 30 20 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 n 0.04 0.02 0.01 0.008 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

• il

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