Rodas-Moya Santiago, Giudici Francesca M, Owolabi Adedotun, Samuel Folake, Kodish Stephen R, Lachat Carl, Abreu Taymara C, van Het Hof Karin H, Osendarp Saskia J M, Brouwer Inge D, Feskens Edith J M, Melse-Boonstra Alida
Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands.
Department of Human Nutrition and Dietetics, College of Medicine, Faculty of Public Health, University of Ibadan, Ibadan, Oyo State, Nigeria.
Front Nutr. 2023 Jun 22;10:1163273. doi: 10.3389/fnut.2023.1163273. eCollection 2023.
Large-scale food fortification (LSFF) programs are widely implemented in low- and middle-income countries (LMIC) to alleviate micronutrient deficiencies. However, these programs may not achieve the desired impact due to poor design or bottlenecks in program implementation. Monitoring and evaluation (M&E) frameworks and a set of agreed indicators can help to benchmark progress and to strengthen the evidence-base of effectiveness in a standardized way. We aimed to formulate recommendations towards core indicators for evaluating the effectiveness of LSFF programs with their associated metrics, methods, and tools (IMMT). For this, we used a multi-method iterative approach, including a mapping review of the literature, semi-structured interviews with international experts, compilation of a generic Theory of Change (ToC) framework for LSFF program delivery, and selection of IMMT for M&E of LSFF programs at key stages along the ToC delivery framework. Lastly, we conducted exploratory, qualitative interviews with key informants in Nigeria to explore experiences and perceptions related to the implementation of LSFF programs in Nigeria's context, and their opinion towards the proposed set of core IMMT. The literature search resulted in 14 published and 15 grey literature documents, from which we extracted a total of 41 indicators. Based on the available literature and interviews with international experts, we mapped a ToC delivery framework and selected nine core indicators at the output, outcome and impact level for M&E of the effectiveness of LSFF programs. Key informants in Nigeria revealed that the main bottlenecks for implementation of the proposed IMMT are related to the lack of technical capacity, equipment, laboratory infrastructure, and financial resources. In conclusion, we propose a set of nine core indicators for enabling comprehensive M&E of the effectiveness of LSFF programs in LMIC. This proposed set of core indicators can be used for further evaluation, harmonization and integration in national and international protocols for M&E of LSFF programs.
大规模食品强化（LSFF）项目在低收入和中等收入国家（LMIC）广泛实施，以缓解微量营养素缺乏问题。然而，由于设计不佳或项目实施中的瓶颈，这些项目可能无法达到预期效果。监测与评估（M&E）框架以及一套商定的指标有助于以标准化方式衡量进展情况，并加强有效性的证据基础。我们旨在针对评估LSFF项目有效性的核心指标及其相关的度量、方法和工具（IMMT）制定建议。为此，我们采用了多方法迭代方法，包括对文献进行映射综述、与国际专家进行半结构化访谈、编制LSFF项目实施的通用变革理论（ToC）框架，以及在ToC实施框架的关键阶段选择用于LSFF项目监测与评估的IMMT。最后，我们对尼日利亚的关键信息提供者进行了探索性定性访谈，以探讨在尼日利亚背景下实施LSFF项目的经验和看法，以及他们对提议的核心IMMT集的意见。文献检索产生了14篇已发表文献和15篇灰色文献，我们从中总共提取了41个指标。基于现有文献和对国际专家的访谈，我们绘制了一个ToC实施框架，并在产出、成果和影响层面选择了九个核心指标，用于评估LSFF项目的有效性。尼日利亚的关键信息提供者透露，实施提议的IMMT的主要瓶颈与缺乏技术能力、设备、实验室基础设施和财政资源有关。总之，我们提出了一套九个核心指标，以实现对低收入和中等收入国家LSFF项目有效性的全面监测与评估。这套提议的核心指标可用于在国家和国际LSFF项目监测与评估协议中进行进一步评估、协调和整合。
