Authored by Felix Siwa, MAC Programme Graduate
Despite the concerted efforts to reduce hunger and malnutrition in the recent years, the undernourished global population grew from 785.4 million in 2015 to 821.6 million in 2018 (FAO et al., 2019) with the highest regional prevalence of undernourishment reported in Sub-Saharan Africa (SSA). The global approach to estimating and understanding burdens of micronutrient deficiency requires a combination of data types and, dietary data play an essential role in identifying interventions that could provide sufficient additional micronutrients to populations with the greatest needs (Tang et al., 2021).
Despite progress, micronutrient-deficiency-related malnutrition still remains a major concern in SSA. Among these, vitamin A deficiency that can lead to eye damage and xeropthalmia (leading to night blindness), weakened immunity, and general increase in the incidence and severity of infectious diseases and mortality (Schmitz et al. 2012; Low et al. 2017; Shikuku et al. 2019). VAD has also been linked to birth-related deaths among pregnant women. It is estimated that 190 million pre-school age children suffer from VAD (2005 estimates), with 56.4 million in Africa (WHO 2009). A recent effort determining dietary micronutrient supplies found that SSA, as of 2011, had the highest estimated prevalence of inadequate intake of vitamin A and the second highest for iron, calcium, vitamin C, vitamin B12, zinc and niacin among the regions of the world (Beal et al. 2017). Moreover, SSA was the only region where dietary micronutrient density declined between 1961 and 2011.
Kenya has made considerable progress towards achieving some of the World Health Assembly 2025 targets including reducing stunting and wasting and strengthening exclusive breastfeeding (Bunyasi, 2012). Despite this progress, micronutrient deficiencies remain a public health concern especially for Kenya’s women and children. The most common deficiencies among the Kenyan population are those of iron, folate, zinc, iodine and vitamin A. A bout one third of children aged 6-59 months and 42% of pregnant women are anemic, VAD and marginal VAD among preschool children is at 9.2% and 52.6% respectively, the prevalence of zinc deficiency is also high at 83.3% among preschool children and 68.3% for pregnant women (Nutrition International, 2020).
To overcome these challenges of micronutrient deficiencies, several studies have shown that food fortification is one of the best strategies that are safe and effective in preventing micronutrient deficiencies. In recognition that micronutrient deficiency remains an obstacle to the overall national development, the Government of Kenya (GoK) adopted and mandated fortification of certain staple foods in 2012, some of these foods include but not limited to salt, wheat flour, maize flour, porridge flour and vegetables oils and fats to specific standards.
Younger children may benefit from staple food fortification, however, due to high nutrient requirements during this age range, additional interventions are often necessary. Ensuring that infant and young child feeding practices are adequate is essential for healthy growth and development (Leyvraz et al., 2017). One intervention to improve the micronutrient content of infant and young child diets is home fortification with micronutrient powders (MNPs).
Micronutrient powders were first introduced in Kenya as part of an effectiveness trial that was conducted in a rural region of the Nyanza Province which is located in the western part of the country. This trial showed that the distribution of MNP through a community and market-based approach was effective in reducing the prevalence of iron and VAD as well as anaemia among the children aged between 6 and 35 months. Another trial with MNPs has also shown that MNPs improve iron status among children aged 6 to 23 months in Kenya. As a result of this evidence base, the Government of Kenya has included MNP as part of the National Nutrition Action Plan 2012 to 2017.
Designing an effective and successful national food fortification program requires valid and accurate national-level information on dietary intake. Nutritionists generally regard Observed-Weighed Food Record (OWFR) or 24-hour recall survey data from a representative national sample as the methods of choice. However, they are costly and difficult to adapt efficiently for large-scale use (Lividini et al., 2013). The external validity of these surveys is questionable, as their use for national policy formulation. Although nutritional policy makers are cognizant of the general risks of inappropriately using small-scale studies to design national-level programs, in the absence of more comprehensive data, policy makers often feel compelled to use the best available data this often means using data from 24-hour recall surveys based on small samples and assuming these risks (Lividini et al., 2013b).
Bunyasi, P. A. (2012). Kenya: Food Security Brief. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.1992451
FAO, UNICEF, IFAD, WFP, & WHO. (2019). The State of Food Security and Nutrition the World 2019. Safeguarding Against Economic Slowdowns and Downturns. https://doi.org/http://www.fao.org/3/ca5162en/ca5162en.pdf
Leyvraz, M., David-Kigaru, D. M., Macharia-Mutie, C., Aaron, G. J., Roefs, M., & Tumilowicz, A. (2017). Coverage and Consumption of Micronutrient Powders, Fortified Staples, and Iodized Salt Among Children Aged 6 to 23 Months in Selected Neighborhoods of Nairobi County, Kenya. Food and Nutrition Bulletin, 39(1), 107–115. https://doi.org/10.1177/0379572117737678
Lividini, K., Fiedler, J. L., & Bermudez, O. I. (2013). Policy Implications of Using a Household Consumption and Expenditures Survey versus an Observed-Weighed Food Record Survey to Design a Food Fortification Program. Food and Nutrition Bulletin, 34(4), 520–532. https://doi.org/10.1177/156482651303400414
Nutrition International. (2020, November 2). FOOD FORTIFICATION IN KENYA- Policy brief.
Tang, K., Adams, K. P., Ferguson, E. L., Woldt, M., Kalimbira, A. A., Likoswe, B., Yourkavitch, J., Chrisinger, B., Pedersen, S., Segovia De La Revilla, L., Dary, O., Ander, E. L., & Joy, E. J. M. (2021). Modeling food fortification contributions to micronutrient requirements in Malawi using Household Consumption and Expenditure Surveys. Annals of the New York Academy of Sciences, 1508(1), 105–122. https://doi.org/10.1111/nyas.14697