The Feasibility of Micronutrient (Iron) Food Fortification in Pacific Island Countries (A report of Mr Robert Hughes prepared for WHO Western Pacific Regional Office)
Summary
Objectives:
The main aim of the consultancy was to obtain information on food production and distribution, availability and consumption in the Pacific to determine the best vehicles for food fortification. Specific objects were:
1. Determination of the total volume of possible vehicles for fortification available for consumption in Pacific Island Countries (PIC) by source of origin.
2. Description of distribution and marketing structure (in bulk or labeled), as well as agreements among countries regarding importations and food control.
3. Investigate the availability of information from food consumption studies that can help determine the distribution of the above foods (potential vehicles for fortification) in each country in order to estimate nutritional implications for urban vs rural population, different age groups, males/females and socio-economic classes.
4. Draw conclusions on the most suitable vehicles for a fortification program for the Pacific countries and propose the steps needed to implement this.
Summary of activities, findings, conclusions and recommendations:
The prevalence of anaemia is high in the region and the most likely causes are diets insufficient in iron and/or parasite infections.
The prevalence of anaemia in women and children in PICs is high enough to warrant a public health intervention.
Fortifying the food supply with iron would be an effective way of increasing population iron intakes.
The most effective programs to reduce iron deficiency anaemia would involve the elimination of helminth and parasite infections and increasing dietary iron intakes of Pacific populations.
Food import volumes were determined for 10 PICs.
The principal sources of origin of flour and rice for most PICs were Fiji, Australia and the USA and imported rice and flour from these countries now provide the main staple foods.
Literature searches found only three recent Pacific food consumption studies.
Low proportions of rural populations consume flour and rice (14.7%) in Vanuatu and possibly most of rural/remote Melanesia.
On the basis of evidence food availability data and limited consumption studies, flour and rice appear to be the most suitable vehicles for fortification.
Results of 3 food consumption studies may not be sufficient on which to base a food fortification program.
Imported flour and rice is already enriched in many PICs.
Food production in Australia, NZ and the USA shows a general trend towards enriching foods for domestic consumption with additional nutrients, including iron.
The issue of fortifying multiple food vehicles becomes an alternative to fortification of a single food.
Food availability data collected and analysed by FAO remains the best source of food availability in the Pacific. Unfortunately, these data only provide information for 8 PICs and at best, are only rough estimates.
In many cases country import data were either, unreliable, inappropriate, or not available in a form that could be analysed, raising more issues than solely determining the nutrient quality of the food supply.
From the results of this consultancy, it is recommended that:
1. Wheat flour and rice are the most suitable vehicles for iron fortification in PICs.
Issues such as levels and safety of iron fortificants, policing of mandatory fortification, quality control, contamination and producer compliance are beyond the scope of this consultancy.
2. Fortification and helminth elimination programs be undertaken in unison.
There is enough evidence to suggest that a food fortification program should not be undertaken in isolation. Iron deficiency anaemia is an outcome of a range of influencing factors that include an iron deficient diet and helminth/parasite infections. Since fortified foods seem to be imported into many PICs, the question of whether a fortification program is necessary arises. More data should be collected to determine the exact proportions of fortified foods already entering PICs. Pacific governments should be alerted to this in order to make informed decisions about the development of national and/or regional food fortification programs. This also enables governments and regional bodies to determine whether a single or multiple food vehicle program will be the most effective.
3. Regular low-cost food and nutrition surveys be undertaken.
The searches undertaken during this consultancy showed that little is known about the dietary habits and food consumption patterns of Pacific populations. Very little is known about food distribution within countries and what proportion of anaemia prevalence is due to parasitic infection. Accurate information on food consumption is necessary for governments to make decisions about a range of food and health issues in order to develop policy and programs.
4. A uniform regional approach to food import and availability data collection and analysis be taken.
This consultancy found it difficult to access individual PIC food availability data and of data received, many were incomplete, difficult to interpret and/or inconsistent. This raises issues of national food security, disaster preparedness and emergency relief. Every country government should have easy access to up-to-date per capita food availability of nutrient rich foods in order to determine quantities of foods available to feed populations in times of emergency.