Right Move Ethiopia’s Mandatory Food Fortfication Plan to Enhance Nutrition, Prevent Birth Defects

In a significant stride towards combating malnutrition and improving public health, the Ethiopian government has recently endorsed the mandatory fortification of essential food items, such as edible oil, wheat flour, and potassium iodide. This decision aims to prevent the high burden of neural tube defects (NTDs) and address widespread micronutrient deficiencies in the country. By fortifying these staple foods, Ethiopia is taking a proactive approach to improve the overall well-being of its population and pave the way for a healthier future, writes EBR’s Eden Teshome

Ethiopia has long grappled with the consequences of malnutrition, particularly anaemia and stunting. The prevalence of micronutrient deficiencies in the country is alarming, with significant numbers of children and women of reproductive age affected. According to a report from the Manufacturing Industry Development Institute, Food and Beverage Industry Research and Development Center (FBIRDC), the current malnutrition status in Ethiopia is as follows: 39 Pct of children are stunted, 22 Pct are underweight, 11 Pct are wasted, and 6 Pct are overweight.

The report further highlights that stunting rates are exceptionally high in regions such as Afar (42 Pct), Oromia (41 Pct), Amhara (40 Pct), and SNNP (40 Pct). Shockingly, over 5.8 million children under the age of five are stunted. By enriching food with life-saving nutrients, children can effectively combat diseases, grow up to be healthy and educated, and lead productive lives.

Micronutrient deficiencies have far-reaching consequences, impacting both individuals and the nation. They contribute to increased morbidity and mortality rates, hinder proper growth and development, and impair cognitive function and productivity. The economic implications are substantial, with undernutrition estimated to cost Ethiopia’s gross domestic product 16.5 Pct. It is worth noting that malnutrition imposes an annual loss of USD 4.5 billion on the country. Furthermore, inadequate intake of essential nutrients, particularly folic acid and zinc, has been strongly linked to the occurrence of neural tube defects and severe congenital disabilities affecting the brain and spine.

Recognising the urgency and potential for transformation, the Ethiopian government has taken a proactive stance by endorsing mandatory food fortification. Edible oil and wheat flour, widely consumed by the population, are being fortified with essential nutrients to ensure their availability to all segments of society. Potassium iodide addresses iodine deficiencies, which can lead to severe health issues, particularly affecting brain development and thyroid function.

“We don’t get adequate micronutrients from our staple food. Thus, there is the need to replace nutrients lost during food processing or increase the nutrient density of staple foods,” said Solomon Hassen, Multisectoral and Seqota Declaration Officer.

Edible oil is a crucial component of the Ethiopian diet, and fortifying it with essential nutrients holds tremendous promise for improving public health. By adding vitamins such as vitamins A and D, often deficient in the population, fortified edible oil can enhance overall nutritional intake and combat the prevalence of deficiencies. This measure will have a far-reaching impact, particularly on vulnerable groups such as pregnant women, lactating mothers, and young children, who require adequate nutrition for optimal growth and development.

According to Addise Gakebo, the head of the Ethiopian Edible Oil Association, there won’t be any price increase on fortified oils compared to the existing prices. “We are working with the Food and Drug Administration, Industry Minister, and Trade Minister so that these feared price increases won’t happen,” he told EBR. Addise further highlighted that the industry faces minimal challenges in fortifying edible oil. However, he acknowledged that a common issue manufacfturers face is the shortage of foreign currency. Regarding this, Addise mentioned, “The government has given a solution to the matter by giving licenses to private suppliers so that the factories can buy it directly from them without the need for foreign exchange.”

There are 32 edible oil industries with a refinery system. Out of these, 28 sectors are currently operational, indicating edible oil’s active production and processing. Additionally, four factories are currently in the project phase. Notably, four industries have already implemented the practice of edible oil fortification.

Wheat flour is another staple food widely consumed in Ethiopia. By fortifying wheat flour with essential nutrients such as folic acid and other B vitamins, the government aims to address the high prevalence of neural tube defects.

In the wheat milling industry, there are a total of 402 millers. Among these, 359 industries are operational, actively processing and producing wheat flour. Additionally, 5 out of the functional industries have conducted trial productions. One out of the 359 active industries has already implemented wheat flour fortification, which is very low compared to the 28 edible oil industries that have already begun the fortification process.

“Our factories haven’t yet started fortifying wheat flour as planned by the government a year ago,” Muluneh Lema told EBR, President of the Ethiopian Millers Association and Founding Member and General Manager of Mintu Investment Group. Muluneh highlighted the challenges faced in the fortification process, explaining, “When other countries in the rest of the world add iron, folic acid, and vitamins, our government decided to exclude iron due to the belief that our iron consumption is already higher than other countries.” This decision poses a challenge as the premix obtained from other countries contains iron, making it unsuitable for fortifying Ethiopian wheat flour. Customising a premix without iron has become challenging to get.

The impact of this decision extends to laboratory testing; as Muluneh pointed out, “In other countries, there’s a device called ‘I Check’ used to test iron levels for fortification. However, here in Ethiopia, a different testing machine is required since we are not using iron and instead opting for zinc.” Developing a new testing machine requires research and investment from producing companies, making the process complex. Muluneh shared that UNICEF offered assistance but faced challenges regarding the cost and custom design of machines specifically tailored for Ethiopia, which hindered progress.

During a recent workshop in Holland, where Muluneh participated as a panellist, confusion arose when Dutch doctors highlighted the insufficiency of iron obtained solely from teff, a local grain, and emphasised the importance of iron from animal products. Muluneh expressed his perplexity, stating, “They suggested that fortifying our wheat flour with iron, like the rest of the world, would have been beneficial.”

In the field of iodisation and refining facilities in Ethiopia, there are a total of 12 large-scale facilities dedicated to the refining and iodisation process. These facilities operate on a larger scale and likely can process significant quantities of iodised products. Additionally, there are 20 small-scale iodisation facilities, which may have a more limited production capacity but still contribute to the iodisation efforts. Furthermore, there are more than three facilities in the project phase.

Iodine deficiency is a pressing concern in Ethiopia, with profound health implications, especially for pregnant women and children. Introducing potassium iodide in the fortification efforts will help address this deficiency, promoting healthy thyroid function and preventing iodine-related disorders.

“Iodine is necessary for normal foetal brain development. Pregnant women living in iodine- deficient regions are more likely to give birth to mentally retarded children. Salt regulation makes it mandatory that all salt for human consumption is iodised, according to the country’s specifications prescribed by the appropriate authority.” Solomon explains.

The success of mandatory food fortification in Ethiopia relies on collaborative efforts between the government, non-governmental organisations, and international bodies. Partner organisations, such as Nutrition International, are working closely with the Ethiopian Standard Council and other stakeholders to support implementing and operationalising the fortification programs. These partnerships ensure the availability of technical expertise, resources, and monitoring mechanisms to guarantee the sustained impact and effectiveness of the fortification strategy.

Ethiopia’s endorsement of mandatory food fortification marks a significant milestone in the country’s fight against malnutrition and micronutrient deficiencies. By fortifying essential food items, such as edible oil and wheat flour, and introducing potassium iodide, the government is taking proactive steps to improve public health, reduce the burden of neural tube defects, and address widespread deficiencies. This transformative initiative holds the potential to uplift the lives of millions, ensuring a healthier and more prosperous future for Ethiopia.  EBR

12th Year • January 16 2024 – February 15 2024 • No. 125