Can Food Fortification

Can Food Fortification Solve Malnutrition in Ethiopia?

Food fortification – the process of adding additional nutrients to certain food products to increase their health benefit – has been common in developed countries for decades. This practice, however, is relatively new to Ethiopia – and the government is taking measures to ensure that their food fortification programme succeeds. The country hopes to fortify key food items like flour, milk and edible oils. Advocates of fortification say that it has great potential for combatting malnutrition– a condition that affects nearly 3 million people throughout the country. Others, however, note that Ethiopia has a long way to go in terms of developing the necessary infrastructure to manage the lofty goals it has set for itself. EBR’s Fasika Tadesse spoke with industry insiders to learn more about the nuances of food fortification and the government’s plans to help bring its vision to fruition.

For decades, malnutrition and chronic food insecurity have been serious global health issues that are particularly threatening to developing countries. Malnutrition comes as a result of a person not receiving the adequate amount of nutrients, and its major factor is micronutrient deficiencies. As in many other developing nations, a large number of Ethiopians deal with malnutrition.
According to the United States Agency for International Development (USAID), malnutrition in Ethiopia affects 2.7 million people who are acutely food insecure. Malnutrition is caused by two main factors: First, when people do not have stable access to food due to either manmade or natural conditions like droughts. The second is a person not having their nutrient needs met through the food they consume.
Malnutrition and its effects can be especially problematic for children, who need nutrients for their development. Naomi Demisse is one such child who suffers from malnutrition in Ethiopia. She is 5 years old and was supposed to go school this year but has been unable to attend class because she’s been sick since April 2015. She is currently undergoing medical treatment at CURE Ethiopia Children’s Hospital.
Her mother says that Naomi’s malnutrition spurred other illnesses. “She was repeatedly susceptible to infections and very weak, so she could not attend school,” says her mother, Ayalneshe Alemu.
Naomi’s medical treatment involves visiting CURE on a monthly basis to receive hospital-based therapies. In addition to this, she also undergoes dietary treatment at home to alleviate the effects of malnutrition based on the recommendation of the doctor who is managing her care.
Naomi is one of millions of children dealing with malnutrition in Ethiopia. An estimated 40Pct of children in the country don’t receive adequate nutrition during their early years, according to the Mini-Demographic and Health Survey published by the Central Statistical Agency (CSA) in 2014.
Micronutrient deficiencies contribute significantly to morbidity and mortality among children. These deficiencies – particularly iron, iodine and Vitamin A – pose significant public health problems in Ethiopia, according to the National Nutrition Plan (NNP) that was released in June 2015 by the government.
“To combat malnutrition, a food-based approach, which involves working on food security to get sufficient nutrition, is the best option for Ethiopia,” says Abinet Tekle, senior programme officer at the Micronutrient Initiative, a Canadian NGO that works on eliminating malnutrition. “But until the country succeeds in a food-based approach, food fortification can be used as an interim solution to reduce the effects of malnutrition in Ethiopia.”
Food fortification is defined by the Food and Agricultural Organisation (FAO) as the addition of essential nutrients to a food, whether or not it is normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiency of nutrients in the population or specific population groups.
The annual costs associated with child malnutrition are estimated at ETB55.5 billion, which is equivalent to 16.5Pct of Ethiopia’s GDP, according to the Cost of Hunger in Africa Study, which is led by the African Union Commission and its partners.
Despite the fact that the country has a goal of ending child malnutrition by 2030, the concept of food fortification is relatively new in Ethiopia. A food fortification programme was incorporated under the Ministry of Industry’s (MoI) Food, Beverage and Pharmaceutical Industry Development Institute (FBPIDI) one-and-a-half years ago.
Prior to its implementation under the MoI, it was intermittently managed by the Ministry of Trade (MoT), the Ministry of Health (MoH) and the Food, Medicine and Health Care Administration and Control Authority (FMAHCA). Now, under the MoI, the government has shifted to the implementation of food fortification of flour, salt, and edible oils.
“For the solution of malnutrition we designed a National Nutrition Plan for the coming five years by enforcing food processing industries to fortify wheat flour, oil fortified with Vitamin A and iodizing salts,” says Bekele Mekuria, director of the Cereals Pulses Processing Directorate at FBPIDI.
But currently, with the exception of salt, fortification is not fully practiced in the country. Seven infant formula and enriched manufacturers fortify their products. These companies are Faffa Food, Tena Migib Producers, Abay International, Kidan Industrial Trading, Pecana, Norish, and Guts Agro Industry.
Yet, to date, no edible oil manufacturing plant is working on fortification, but one of the 300 flour milling factories and one milk powder factory are manufacturing fortified products. ASTCO Food Complex and New Zealand Milk Products are the first two companies that are fortifying flour and milk, respectively.
“We decided to launch our Anchor Fortified Milk Drink in Ethiopia because we see huge potential here, as Ethiopia has the second largest population in Africa,” says Zeco Kassim, general manager of New Zealand Milk Products. “At the same time, we know that there is a lack of access to affordable nutrition, especially when it comes to children.”
According to the company, Anchor Milk is fortified with more than 30 nutrients that are essential for a child’s growth and development, including protein, calcium, vitamins (A, D, C), iron, zinc, iodine and selenium. The company is a joint venture of Fonterra, a co-operative owned by more than 10,500 New Zealand dairy farmers and the local firm Faffa Foods.
The formula for the fortification was developed with the Food and Nutrition Society of Ethiopia to combat deficiencies in Ethiopian children’s’ diets and it is aligned with Ethiopia’s Food Fortification Strategy and supports the country’s goal to eliminate malnutrition by 2030, according to Zeco.
The other company, ASTCO Food Complex, is the first company in Ethiopia to fortify wheat flour. The company started the process of fortification in March 2015 through support from USAID.
Established in 2004, the company is a manufacturer of milled flour and two brands of macaroni and pasta products: Alta and Nouva. It uses vitamins, iron and iodine to enrich its flour. ASTCO has been fortifying its products on a trial basis until June 2015. However, it hasn’t been able to continue production, as it is experiencing difficulties accessing raw material for the fortification process.
“Now we halted production as we could not get [fortifiers/premix],” Gezahegne Abdu, general manager of the company, told EBR.
The company is selling a quintal of unfortified flour for ETB1,300 but it used to sell the fortified version for ETB1,150 because of low demand. “Our main challenge is a very passive response from the community, even the bakeries are not interested in buying our fortified flour,” Gezahegne says. “The government should encourage bulk purchasers such as universities, boarding schools, and military camps to buy from us.”
To overcome the market problem, the company is looking to international aid institutions such as the UNHCR, UNICEF and Save the Children to purchase its products, according to Gezahegne. The other problem mentioned by ASTCO is a dearth of laboratories to test their samples. “There are not many laboratories in the country; there is one state-owned laboratory and one private laboratory. The private one is expensive for us,” he says.
“To enforce the industries, we have to facilitate certain things first, such as creating awareness among the society about the merits of fortified products, securing a sustainable supply of raw materials for the process, and designing a nutritional profile should be finalised,” says Bekele.
In what seems to be a renewed commitment, the government began strict enforcement of the enrichment of food and infant formula by assigning an inspector to monitor manufacturers and follow their production processes as of October 23, 2015. These companies have been manufacturing 30,000 quintals of enriched fortified food after receiving an order from the government to aid the 8.2 million people affected by the drought.
To support these companies, the government is providing extensive trainings for the professionals of the factories, beyond designing the five-year strategic plan, according to Bekele. For the raw material supply shortage, the newly-established Ethiopian Industrial Inputs Development Enterprise (EIIDE) is in the process of importing premix for companies. Additionally, Bekele says the government is providing laboratory testing through the Ethiopian Conformity Assessment Enterprise.
“Bless Laboratory is also playing a significant role in the process of laboratory tests, as previously the [food] samples were sent to Uganda and France for testing,” according to Bekele.
Those close to the issue say that these efforts bode well for the prospects of growing Ethiopia’s fortification programme. “I can say Ethiopia is moving towards a wise approach when it is compared with other African countries,” says Abinet. “The government gives priority to research first, unlike many other African countries, before implementation because fortification is a complex programme.”
So far Ethiopia has prepared national nutrition plan a food consumption survey, micronutrient survey, and is currently working on standards for the fortification. The Ethiopian Pubic Health Institute (EPHI) is working on the preparation of nutrition profile for foods to be fortified.
Despite these efforts, Abniet says Ethiopia is late in implementing a deliberate food fortification programme. “We could have started fortifying edible oils long ago since it does not need complicated formula, as it only requires adding Vitamin A to fortify,” he says.
The main aim of the nutrition plan is to promote the use of fortified foods by supporting industries in the use of appropriate technologies; promoting the provision of credits, grants and microfinance services to support low-and medium-scale industries; raise awareness for the private sector (producers); and to build industry capacity to produce fortified food.
The Ethiopian National Food Fortification Steering Committee (NFFSC), established in 2012, is preparing national fortification standards and building various capacities to realise the goals. In addition to this, flour and edible oil fortification will start during the Growth and Transformation Plan II.
To realise these plans, the government is working with development partners. USAID currently works on the African Alliance for Food Processing (AAIFP) Project, in collaboration with the MoI through TechnoServe. The project is part of the U.S. Government’s USD250 million Feed the Future Initiative.
The Global Alliance for Improved Nutrition (GAIN), a well-known international organisation dedicated to supporting the use of food fortification worldwide, is also operating in Ethiopia.
With all the efforts to minimise the vulnerability of Ethiopian children such as Naomi, the private sector, government and the development partners, four companies are in the pipeline to fortify their flour products, while an additional two infant formula and enriched food manufacturers are set to start fortification in the coming two months, according to Bekele. EBR

4th Year • November 16 – December 15 2015 • No. 33


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