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Households consuming fortified flour (fortified flour coverage)
This indicator describes the coverage (or presence) of fortified flour in the household.
For fortified flour to improve nutrient intakes and improve micronutrient status, people need to consume foods made with fortified flour. Households where fortified flour is present are more likely to consume it. From a programme perspective, all eligible members of the target population should be exposed to the intervention package, and it is important to measure household coverage of fortified flour to assess the potential reach of the intervention and the likelihood that it will improve health and nutrition outcomes in the target population.
The percentage of households with flour confirmed to be fortified.
Numerator: number of households that provide a sample of flour that is confirmed to be fortified by application of a qualitative test.
Denominator: total number of households that provided a flour sample for testing.
• Divide the numerator by the denominator. Multiply the result by 100 to convert the number into a percentage.
Considerations for the calculations:
• If information on the brand and country of origin is collected, then the indicator should be reported by brand and country of origin.
access, coverage, fortified flour, fortified-flour products,presence
Food fortification
Output
Presence (coverage) in household or facility
School age children, 12-23 months, 24-35 months, 36-47 months, 48-59 months, 6-11 months, Adolescents, Men, Women of reproductive age
None,
All
Market-based
By law, not all types of flour may require fortification with vitamins and minerals. Therefore, household members should only be asked about the flour types that are supposed to be fortified.
When collecting this information, it may be useful to also consider collecting information on the brand and country of origin, as regulatory agencies can use this information to follow up with companies (domestic or international) that are not following fortification standards.
To assess if fortificants were added to flour, rapid qualitative tests, such as the iron spot test, are available.
High household coverage of fortified flour suggests that a nutritional benefit is probable among the target population.
Stratifying the household coverage by subgroups allows programme managers to examine whether key groups or vulnerable populations (e.g. rural or low income) are able to access the intervention, which can help to ensure equal access and coverage among target beneficiaries.
There may be contexts where flour is not typically used in the household, yet members eat fortified flour through flour-based foods such as bread. In those settings, this indicator will generate an artificially low estimate of fortified flour coverage.
Households that regularly use flour in the home may not have samples to provide for testing if it is fortified. Those households with flour available for sampling may not be representative of all households that use flour, potentially biasing the coverage estimate.
Presence of fortified flour in the household does not ensure all members in the household consume it.
This indicator does not take into account household size or fluctuations in their food buying patterns (e.g. the probability of having at least one food item is more likely the day that someone goes to the market or shops).
The qualitative iron spot test does not provide quantitative information regarding the iron level in the food. It is impossible to know if the iron content of foods collected from households are in line with the expected iron levels based on country legislation and standards.
In a survey of 200 households, enumerators asked the participants to provide a sample of wheat flour. One hundred twenty-eight households provided samples of sufficient quantity for testing. All samples were taken to a laboratory where the qualitative iron spot test was administered. Based on the test, 118 samples tested positive for added iron (fortification).
Numerator: 118
Denominator: 128
Calculation: 118/128 * 100 = 92% of households had iron fortified wheat flour.
1. Approved methods of analysis, 11th ed. Method 40-40.01. Iron-qualitative method. St Paul: AACC International; 2002 (http://methods.aaccnet.org/summaries/40-40-01.aspx, accessed 14 April 2021).