Coverage of Large-Scale Food Fortification of Edible Oil, Wheat Flour, and Maize Flour Varies Greatly by Vehicle and Country but Is Consistently Lower among the Most Vulnerable: Results from Coverage Surveys in 8 Countries
Coverage of Large-Scale Food Fortification of Edible Oil, Wheat Flour, and Maize Flour Varies Greatly by Vehicle and Country but Is Consistently Lower among the Most Vulnerable: Results from Coverage Surveys in 8 Countries
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DOI：
10.3945/jn.116.245753
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发表时间：
2017-05-01
影响因子：
4.2
通讯作者：
Myatt, Mark
中科院分区：
文献类型：
--
作者：
Aaron, Grant J.;Friesen, Valerie M.;Myatt, Mark
背景：在低收入和中等收入国家，普遍消费的食品载体的大规模食品强化（LSFF）得到广泛实施。许多项目存在监测信息缺口，大多数国家未能评估项目覆盖率。目的：本工作的目的是介绍LSFF覆盖率调查结果（总体和弱势群体）2013年至2015年期间在8个国家进行了7个小麦粉、4个玉米粉和7个食用油项目。为使评估标准化，开发了强化评估覆盖工具包。三个指标被用来评估覆盖率和脆弱性之间的关系：（1）贫困，（2）饮食多样性差，（3）农村居住。评估了三种覆盖措施：1）车辆消费，2）可强化车辆消费，3）强化车辆消费。根据以下内容评估个人计划绩效：1）实现总体覆盖率>= 50%，2）在>= 1个弱势群体中实现覆盖率>= 75%，3）在>= 1个弱势群体中实现公平覆盖率。在评估的18个LSFF项目中，只有2个项目符合所有3个项目绩效标准。两个主要的计划瓶颈是车辆选择不当和未能加强可加强车辆（即，结论：研究结果强调了合理的项目设计和常规监测与评估的重要性。有强有力的证据表明当地社会融资框架的影响和成本效益;然而，只有在方案设计和执行期间遵循必要的活动和程序，才能产生影响。FACT方法填补了标准化工具可用性方面的一个重要空白。这里评估的LSFF计划需要重新评估，以确定是否进一步投资于计划，其他工具是否合适，以及是否需要其他方法。
Background: Large-scale food fortification (LSFF) of commonly consumed food vehicles is widely implemented in low- and middle-income countries. Many programs have monitoring information gaps and most countries fail to assess program coverage.Objective: The aim of this work was to present LSFF coverage survey findings (overall and in vulnerable populations) from 18 programs (7 wheat flour, 4 maize flour, and 7 edible oil programs) conducted in 8 countries between 2013 and 2015.Methods: A Fortification Assessment Coverage Toolkit (FACT) was developed to standardize the assessments. Three indicators were used to assess the relations between coverage and vulnerability: 1) poverty, 2) poor dietary diversity, and 3) rural residence. Three measures of coverage were assessed: 1) consumption of the vehicle, 2) consumption of a fortifiable vehicle, and 3) consumption of a fortified vehicle. Individual program performance was assessed based on the following: 1) achieving overall coverage >= 50%, 2) achieving coverage of >= 75% in >= 1 vulnerable group, and 3) achieving equity in coverage for >= 1 vulnerable group.Results: Coverage varied widely by food vehicle and country. Only 2 of the 18 LSFF programs assessed met all 3 program performance criteria. The 2 main program bottlenecks were a poor choice of vehicle and failure to fortify a fortifiable vehicle (i.e., absence of fortification).Conclusions: The results highlight the importance of sound program design and routine monitoring and evaluation. There is strong evidence of the impact and cost-effectiveness of LSFF; however, impact can only be achieved when the necessary activities and processes during program design and implementation are followed. The FACT approach fills an important gap in the availability of standardized tools. The LSFF programs assessed here need to be re-evaluated to determine whether to further invest in the programs, whether other vehicles are appropriate, and whether other approaches are needed.