Clinic-based Assessment of Folate Levels for Women of Reproductive Age, as an Impact Indicator for a National Food Fortification Program in Tanzania.

Objectives: To determine prevalence of folate deficiency and effectiveness of the National Food Fortification Program on folate levels among women of reproductive age in Tanzania. Methods: A Prospective cohort study comparing participants’ folate levels prior and gradually upon the roll-out and scale-up of the national food fortification program. A total of 636 women of reproductive age (18-49 years) enrolled and undergoing follow-up across 10 primary health facilities in Dar Es Salaam. Blood samples, food frequency, and fortified food consumption data collected at baseline (prior the program roll out), 6, 9 and 12 months. Serum folate assays performed using e411Cobas machine and results merged with food frequency and intake data. Results: We present baseline and follow-up data, estimating pre & fortification era folate levels for women of reproductive age in Tanzania. More than 25% of women have pre-fortification intake <80% their RDA for folate (mean 446, median 416, IQR ranging between 313-551micrograms). Wheat consumption is high with median portion intake of wheat-carbohydrates approximating 1 portion/day. demographics, complementing serum folate assays results will be presented. Conclusions: Low folate intake and high wheat consumption suggest potential for mandatory folate fortification of wheat in Tanzania.

Implementing Large-scale Food Fortification in Tanzania: Lessons Learned.

Objectives: The main objective is to identify achievements, challenges and lessons learned in implementing large scale food fortification in Tanzania for the benefit of other countries attempting to initiate national mandatory fortification of staple foods Methods: Lessons learned were drawn from fortification program documents and interviews with fortification stakeholders. The lessons learned cover the key components of fortification programs, including production, distribution, quality control and enforcement, standards setting, legislation, social marketing and communication, monitoring and evaluation. A food rapid assessment tool (FRAT) survey was conducted to determine appropriate staple food vehicles for fortification. Results: The FRAT survey identified wheat flour, maize meal, and vegetable oil as appropriate fortification vehicles. It was estimated that 23 million could be reached with both fortified vegetable oil and wheat flour. Political will and commitment especially at highest level of leadership was critical in engendering support for fortification from both the public and private sector. Furthermore, establishment of a local premix distribution hub in Tanzania has ensured regular availability of premix. Importantly, Tanzania exonerated the purchase of premix from taxes, a model for east Africa. Conclusions: Through mandatory legislation and enabling political environment Tanzania has successfully launched and scaled up fortification of vegetable oil and wheat flour.

Food Fortification Strategy to Control Micronutrient Deficiencies in Tanzania.

Objectives: Micronutrient deficiencies are widespread in Tanzania affecting people of all ages and socio-economic groups. The primary cause being insufficient intake of bioavailable minerals and vitamins from foods. Food fortification of some staple foods was made mandatory by the Government recently as the strategy to control micronutrient deficient. Methods: National Food Fortification Alliance was created to coordinate the programme. The operational approach was based on production, distribution, quality control and social marketing of fortified foods. Ssurvey was conducted to find the suitable vehicles and knowledge, attitude and practices on fortification aspects using structured questionnaire. The whole program was strengthened through capacity building for the stakeholders in the chain. Results: The national nutrition strategy identifies food fortification an important strategies to reduce the prevalence of micronutrient deficiencies. Wheat flour, maize flour and edible oil were identified as suitable food vehicles. The baseline status of micronutrients in targeted groups is known. These data will allow a long-term assessment of the effect of the program. Standards, regulations and guidelines on food fortification are available. The program was launched officially on 15th May 2013 by His Excellency President of the United Republic of Tanzania. Currently, industries are producing fortified edible oils and wheat flour. Social marketing campaigns, capacity building to implementers and sensitization sessions are going on. Conclusions: The program helped in setting important health indicators of the selected vulnerable groups and develop a good strategy to progressively eradicate micronutrient deficiencies. Challenges includes inspection, monitoring and evaluation systems of the production and distribution lines for sustainability.