An assessment of the feasibility, coverage and cost of fortifying maize meal and sugar with vitamin A in South Africa
Hendricks, M.K.; Saitowitz, R.; Fiedler, J.L.; Sanghvi, T.; Roux, I. le; Makan, B.; Hussey, G.; Maglagang, H.; Dary, O.
SAJCN South African Journal of Clinical Nutrition 14(2): 46-52
2001
Document Number: 264898
A study was conducted to investigate the feasibility, coverage and cost of a national vitamin A fortification programme using maize meal and sugar in South Africa. Key components of a national fortification programme using maize meal and sugar were identified. Only added sugar and not sugar earmarked for industrial use was considered for fortification. The proportion of households consuming maize meal and sugar was determined from the Household Expenditure Survey (1994) of the South African Labour Development Research Unit (SALDRU). Consumption patterns of children aged under 6 years were obtained from 2 previous surveys done in Northern Province and Western Cape, and a food consumption survey done in 2 rural magisterial districts in the Northern Province. Different levels of fortification were selected to simulate the impact of vitamin A fortification using the raw data from these 3 surveys. Maximum safe intake of vitamin A was determined from data on the consumption of maize meal and sugar in the Risk Factor Study (BRISK) conducted among black peri-urban women. Key industry representatives were interviewed to determine the technological requirements needed in a fortification programme. Cost estimates were determined for the various inputs of the programme. Results revealed that the proportion of households consuming maize meal and sugar were 78% (range 57-93%) and 91% (range 78-97%), respectively. The maximum safe intake of vitamin A was 4 micro g retinol equivalents per gram (RE/g) and 44 micro g RE/g for fortified dry maize meal and added sugar, respectively. A higher level of vitamin A adequacy was achieved in rural children when fortified maize meal compared with fortified sugar was consumed (84% vs. 48%). Conversely, a higher level of vitamin A adequacy was achieved in peri-urban children with consumption of fortified sugar compared with fortified maize meal (79% vs. 56%). There are 7 sugar-refining mills: 6 in Kwazulu-Natal, where 90% of the sugar is produced, and one in Mpumalanga, where 10% of the sugar is produced. Six main maize millers process 70% of the maize meal, whereas 100-150 small mills process at least 20% of the maize meal. Based on 100% of the RDA, the cost of fortifying sugar would be greater than that of maize meal (R23.2 million vs. R59.1 million). This study shows that fortifying maize meal or sugar with vitamin A would be technically feasible and could achieve wide coverage. The costs would be lower for fortifying maize meal and could result in higher levels of vitamin A adequacy in rural children who are at greatest risk of vitamin A deficiency. However, the impact would be less in peri-urban children, and in reaching the latter group another food vehicle such as wheat flour, in addition to maize meal, would probably need to be fortified. Fortifying sugar will result in higher levels of vitamin A adequacy in peri-urban children but may have less impact on rural children. The centralized nature of the sugar industry compared with the maize meal industry will facilitate monitoring of the fortified product. The final choice of food vehicles for fortification, however, would need to be guided by the results of the national food consumption survey that was conducted by the National Food Consumption Survey Group.