Mark Henry E, Assiene Jules G, Luo Hanqi, Nankap Martin, Ndjebayi Alex, Ngnie-Teta Ismael, Tarini Ann, Pattar Amrita, Killilea David W, Brown Kenneth H, Engle-Stone Reina
Department of Nutrition, University of California, Davis, Davis, CA, USA.
Helen Keller International, Yaoundé, Cameroon.
Curr Dev Nutr. 2019 Jun 20;3(8):nzz076. doi: 10.1093/cdn/nzz076. eCollection 2019 Aug.
Since 2011 Cameroon has mandated the fortification of refined vegetable oil with vitamin A and wheat flour with iron, zinc, folic acid, and vitamin B-12. In 2012, measured fortification levels for flour, and particularly oil, were below target.
We assessed Cameroon's food fortification program using a program impact pathway (PIP) to identify barriers to optimal performance.
We developed a PIP through literature review and key informant interviews. We conducted interviews at domestic factories for refined vegetable oil ( = 9) and wheat flour ( = 10). In 12 sentinel sites distributed nationally, we assessed availability and storage conditions of fortified foods in markets and frequency of consumption of fortified foods among women and children ( = 613 households). Food samples were collected from factories, markets, and households for measurement of micronutrient content.
Two-thirds of factories presented quality certificates for recent premix purchases. All factories had in-house capacity for micronutrient analysis, but most used qualitative methods. Industries cited premix import taxes and access to external laboratories as constraints. Mean vitamin A levels were 141% (95% CI: 116%, 167%), 75% (95% CI: 62%, 89%), and 75% (95% CI: 60%, 90%) of target in individual samples from factories, markets, and households, respectively. Most industry flour samples appeared to be fortified, but micronutrient levels were low. Among composite flour samples from markets and households, the mean iron and zinc content was 25 mg/kg and 43 mg/kg, respectively, ∼45% of target levels; folic acid (36%) and vitamin B-12 (29%) levels were also low. In the previous week, the majority of respondents had consumed "fortifiable" oil (63% women and 52% children) and wheat flour (82% women and 86% children).
In Cameroon, oil fortification program performance appears to have improved since 2012, but fortification levels remain below target, particularly for wheat flour. Consistent regulatory monitoring and program support, possibly through premix procurement and micronutrient analysis, are needed.
自2011年以来，喀麦隆已规定对精炼植物油强化维生素A，对小麦粉强化铁、锌、叶酸和维生素B-12。2012年，面粉尤其是植物油的实测强化水平低于目标值。
我们使用项目影响路径（PIP）评估喀麦隆的食品强化计划，以确定实现最佳绩效的障碍。
我们通过文献综述和关键信息人访谈制定了一个PIP。我们对国内的9家精炼植物油厂和10家小麦粉厂进行了访谈。在全国分布的12个哨点，我们评估了市场上强化食品的可获得性和储存条件，以及妇女和儿童（613户家庭）食用强化食品的频率。从工厂、市场和家庭收集食品样本，以测量微量营养素含量。
三分之二的工厂出示了近期预混料采购的质量证书。所有工厂都具备内部微量营养素分析能力，但大多数使用定性方法。企业称预混料进口税和外部实验室的使用是制约因素。工厂、市场和家庭单个样本中的维生素A平均水平分别为目标值的141%（95%CI：116%，167%）、75%（95%CI：62%，89%）和75%（95%CI：60%，90%）。大多数企业的面粉样本似乎经过了强化，但微量营养素水平较低。在市场和家庭的复合面粉样本中，铁和锌的平均含量分别为25毫克/千克和43毫克/千克，约为目标水平的45%；叶酸（36%）和维生素B-12（29%）水平也较低。在前一周，大多数受访者食用了“可强化”油（63%的女性和52%的儿童）和小麦粉（82%的女性和86%的儿童）。
在喀麦隆，自2012年以来，植物油强化计划的绩效似乎有所改善，但强化水平仍低于目标，尤其是小麦粉。需要持续的监管监测和项目支持，可能通过预混料采购和微量营养素分析来实现。
