Aaron Grant J, Friesen Valerie M, Jungjohann Svenja, Garrett Greg S, Neufeld Lynnette M, Myatt Mark
Global Alliance for Improved Nutrition, Geneva, Switzerland; and
Global Alliance for Improved Nutrition, Geneva, Switzerland; and.
J Nutr. 2017 May;147(5):984S-994S. doi: 10.3945/jn.116.245753. Epub 2017 Apr 12.
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. 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. A Fortification Assessment Coverage Toolkit (FACT) was developed to standardize the assessments. Three indicators were used to assess the relations between coverage and vulnerability: ) poverty, ) poor dietary diversity, and ) rural residence. Three measures of coverage were assessed: ) consumption of the vehicle, ) consumption of a fortifiable vehicle, and ) consumption of a fortified vehicle. Individual program performance was assessed based on the following: ) achieving overall coverage ≥50%, 2) achieving coverage of ≥75% in ≥1 vulnerable group, and ) achieving equity in coverage for ≥1 vulnerable group. 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). 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.
在低收入和中等收入国家，普遍食用的食品载体的大规模食品强化（LSFF）得到了广泛实施。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范围。这项工作的目的是展示2013年至2015年期间在8个国家开展的18个项目（7个小麦粉项目、4个玉米粉项目和7个食用油项目）的LSFF覆盖范围调查结果（总体情况和弱势群体情况）。开发了一个强化评估覆盖工具包（FACT）来规范评估。使用三个指标来评估覆盖范围与脆弱性之间的关系：（1）贫困，（2）饮食多样性差，（3）农村居住情况。评估了三种覆盖范围衡量指标：（1）载体的消费量，（2）可强化载体的消费量，（3）强化载体的消费量。根据以下标准评估单个项目的表现：（1）总体覆盖率≥50%，（2）在≥1个弱势群体中覆盖率≥75%，（3）在≥1个弱势群体中实现覆盖范围公平。不同食品载体和国家的覆盖范围差异很大。在评估的18个LSFF项目中，只有2个项目符合所有3项项目表现标准。两个主要的项目瓶颈是载体选择不当和未能强化可强化载体（即未进行强化）。结果突出了合理项目设计以及常规监测和评估的重要性。有充分证据表明LSFF具有影响和成本效益；然而，只有在项目设计和实施过程中遵循必要的活动和流程时才能实现影响。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项目需要重新评估，以确定是否进一步对这些项目投资、其他载体是否合适以及是否需要其他方法。
