eCatalogue of indicators for micronutrient programmes

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Household coverage of fortified wheat or maize flour or fortified wheat- or maize-flour products
This indicator describes the coverage (or presence) of fortified wheat or maize flour and/or wheat- or maize-flour products in the home.
For fortified wheat or maize flour to improve nutrient intakes and micronutrient status, people need to consume foods made with fortified flour. Households where fortified flour and fortified-flour products are present are more likely to consume them. 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 at least one package of fortified wheat or maize flour or flour products where the fortification is confirmed by the label or logo on the package Numerator: the number of households that present at least one package of fortified wheat or maize flour or food made from fortified wheat or maize flour, where the fortification is confirmed by review of the label or logo on the package Denominator: the total number of households surveyed • Divide the numerator by the denominator. Multiply the result by 100 to convert the number into a percentage. Considerations for the calculations: • For data collection and the calculation, it will be necessary to determine the appropriate criteria for confirming the presence of a fortified flour or food in the local context. For example, the criteria may be fulfilled if the packaging has a fortification logo, has a nutrition label showing nutrient levels consistent with fortification, and/or has a label with the fortification compounds (fortificants) listed. • If collecting information on foods made with fortified flour, it is important to predetermine which foods and/or food types will be collected and report the indicator for each type. • If information on the brand and country of origin is collected, then the indicator should be reported by brand and country of origin. • In contexts where fortified flour or fortified-flour products in the household are not labelled or do not have logos (for example bread purchased in unlabelled bags daily at bakeries), then observing the packaging for labels and logos will not be useful and it will be necessary to test food samples to determine whether they have been fortified. An alternative to relying on observation, even in a context where logos and labels are common, is to test food samples from the household and report the proportion fortified.
access, coverage, fortified flour, fortified-flour products
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, All, Men, Women of reproductive age
None,
Copper, Folate, Iron, Niacin, Selenium, Vitamin A, Thiamine (vitamin B1), Vitamin B12, Riboflavin (vitamin B2), Vitamin B6, Vitamin C, Vitamin D, Vitamin E, Vitamin K, Zinc
Market-based
By law, not all types of wheat or maize flour may require fortification with vitamins and minerals. Therefore, it is important to inquire only about those products that are made with the flour type that is 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 regulations. The presence of fortified flour or fortified-flour products can be determined according to labels or logos that indicate fortification, as well as nutrition labels showing nutrient levels consistent with fortification and/or with the fortification compounds listed. The use of logos and some aspects of labelling might be context specific, so it is important to define the appropriate criteria prior to data collection.
Observing food labels and logos in the household is easy and feasible. Methodologically, it is easy to add these observations into household surveys being planned for another purpose.
The presence of fortified flour or fortified-flour products in the household does not ensure all members in the household eat them. This indicator does not take into account household size or fluctuations in 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 presence of labelling does not guarantee that the flour or food is fortified or adequately fortified. Many food vehicles that are fortified are not sold in packaging that includes labels or logos (e.g. bread from a bakery).
In a household survey, the interviewers observed the packaging for wheat flour in the household and asked the participants to provide a sample. Among the 200 households interviewed, 143 had wheat flour in the house and 94 had the flour in the original packaging. Of those, 73 had the national fortification logo on the packaging. A sample of wheat flour was collected from households with sufficient quantity of wheat flour for testing (n = 128); all samples were taken to a laboratory where the qualitative iron spot test (1) was administered. Based on the test, 118 samples tested positive for added iron (fortification). Logo: Numerator: 73 with the national fortification logo on the packaging Denominator: 94 with original packaging Calculation: 73/94 *100 = 77.7% Qualitative iron spot test: Numerator: 118 tested positive for added iron Denominator: 128 tested Calculation: 118/128 * 100 = 92% These two methods show different ways to estimate household coverage of fortified wheat flour. In this example, a large proportion of the wheat flour available on the market is not purchased or stored in its original packaging, and by observing the logo the estimated household coverage of fortified wheat flour was 77.7%. The qualitative iron spot test showed a household coverage of any fortification of wheat flour as 92%.
1. Approved methods of analysis, 11th ed. Method 40-40.01. Iron-qualitative method. Reviewed 27 October 1982. St Paul: AACC International; 1982 (http://methods.aaccnet.org/summaries/40-40-01.aspx, accessed 6 October 2015).
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