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Home » DHS-8 Questionnaire Review - Archived » Core questionnaire: Nutrition » Food Fortification: Household Coverage of Fortifiable Foods
Food Fortification: Household Coverage of Fortifiable Foods [message #16780] Fri, 01 March 2019 14:25 Go to next message
DataDENT is currently offline  DataDENT
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Many low- and middle-income countries have staple food fortification programs to combat micronutrient deficiencies, but lack information on household level reach. We propose six new household fortification coverage indicators for the core household questionnaire that would accompany existing HHQ 145 (coverage of fortified salt). We have also included two generic coverage indicators that can be adapted for additional foods on a per country basis.

Household fortification coverage indicators:
1. Coverage of edible oil
Definition: Proportion of households that report consuming edible oil in the household (in any form)

2. Coverage of fortifiable edible oil
Definition: Proportion of households that report consuming edible oil in the household that is industrially processed (i.e. by large-scale factories, not home-produced)

3. Coverage of wheat flour
Definition: Proportion of households that report consuming wheat flour in the household (in any form) or purchasing foods made from wheat flour

4. Coverage of fortifiable wheat flour
Definition: Proportion of households that report consuming wheat flour in the household that is industrially processed (i.e. by large-scale factories, not home-produced) or purchasing foods made from wheat flour

5. Coverage of salt
Definition: Proportion of households that report consuming salt in the household (in any form)

6. Coverage of fortifiable salt
Definition: Proportion of households that report consuming salt in the household that is industrially processed (i.e. by large-scale factories, not home-produced)

Generic coverage indicators (to be adapted for additional foods on a per country basis):
- Coverage of the food vehicle
Definition: Proportion of households that report consuming a food vehicle in the household (in any form)

- Coverage of the fortifiable food vehicle
Definition: Proportion of households that report consuming a food vehicle in the household that is industrially processed (i.e. by large-scale factories, not home-produced)

Attached to this post is a completed submission form with full justification for the recommendation.

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This recommendation originated in the September 2018 Technical Consultation on Measuring Nutrition in Population-Based Household Surveys and Associated Facility Assessments--a 2-day working meeting convened by the Bill & Melinda Gates Foundation (BMGF) and United States Agency for International Development in collaboration with the World Health Organization (WHO) and United Nations Children's Fund (UNICEF), and coordinated by Data for Decisions to Expand Nutrition Transformation (DataDENT). The consultation included more than 60 technical experts, survey program representatives from DHS, MICS, LSMS and SMART, country data stakeholders, and donors from the nutrition measurement community.

This recommendation was authored by Mduduzi Mbuya (Global Alliance for Improved Nutrition (GAIN)) and Valerie Friesen (GAIN) and reviewed by Maria Jefferds (Center for Disease Control (CDC)), Reina Engle-Stone (UC Davis), and Laura Rowe (Food Fortification Initiative).

This recommendation is endorsed by the WHO-UNICEF Technical Expert Advisory Group on Nutrition Monitoring (TEAM). Out of the ten sets of recommendations endorsed by TEAM, this recommendation was prioritized as Tier 3 of 3 (important but appropriate for a module).

This recommendation is also endorsed by Countdown to 2030, Alive & Thrive, Global Alliance for Improved Nutrition (GAIN), the nutrition team at the Bill & Melinda Gates Foundation, and the Department of International Health at the Johns Hopkins Bloomberg School of Public Health.
Re: Food Fortification: Household Coverage of Fortifiable Foods [message #16818 is a reply to message #16780] Wed, 06 March 2019 12:32 Go to previous messageGo to next message
Bernice is currently offline  Bernice
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Have we considered households' awareness of what nutrients are used to fortify the products they use? In the region where I work, most people would normally not consider fortification as a factor in selecting food products simply because they have no idea about it. I will suggest that we also look at the proportion of households with knowledge of available fortified food products in their locality. A key person, such as the main person who shops for the household can answer this question.

Thank you
Re: Food Fortification: Household Coverage of Fortifiable Foods [message #16889 is a reply to message #16780] Wed, 13 March 2019 09:08 Go to previous messageGo to next message
Gwao Omari Gwao is currently offline  Gwao Omari Gwao
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Hi, my name is Gwao Omari Gwao. I am a Professional Nutritionist from Tanzania who has built my career as an Officer in the Public Health Sector with Central and Local Government and now as the Food Fortification Program Manager with Helen Keller International (HKI). I possess solid experience in project and program management and development which includes writing quality concept notes, proposals, reports and management of donor funded projects. On the evaluation side, I have participated in several policy and program evaluation using data from various sources including both surveys and routine. I have led several studies within Tanzania and supported work outside the country which cemented my ability in report writing, development of data collection tools, data analysis and giving feedback both to donors, staff and community including putting together monitoring and evaluation frameworks. I have solid experience on food fortification in Tanzania for both larger and small scale fortification. My current role includes coordination of country evaluation efforts in small scale fortification, staff capacity building, program management, monitor project compliance and strategic engagement with partners. Regarding proposed indicators for upcoming DHS I agree with all the indicators, however I suggest if possible to add coverage indicators for fortified and fortifiable maize flour specifically for Tanzania. In Tanzania 90% of Tanzanians consume maize flour as the main source of energy. Although the big proportional of maize flour is produced by medium and small scale producers but the country achieved a lot in supporting maize flour fortification across the country. So by having some indicators of fortified maize flour will help a lot in informing government and other stakeholders on status and hence help in policy making, strategies and programming as well.
Re: Food Fortification: Household Coverage of Fortifiable Foods [message #16903 is a reply to message #16780] Wed, 13 March 2019 21:39 Go to previous messageGo to next message
SUN Movement MEAL Team
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The SUN Movement MEAL Results Framework seeks to track country progress in increasing population consumption of fortified foods. The inclusion of these indicators in the DHS questionnaire would provide useful data at both the national and sub-national level to country-level decision makers on the priority food vehicles for fortification in each country context.
Re: Food Fortification: Household Coverage of Fortifiable Foods [message #16926 is a reply to message #16780] Thu, 14 March 2019 05:19 Go to previous messageGo to next message
Mauro Brero is currently offline  Mauro Brero
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UNICEF Tanzania Nutrition team proposes that all indicators should have a time frame.

Furthermore, for indicator 2, 4, and 6, there is an inherent assumption that industrially produced oil, wheat flour, and salt is fortified, which might not be the case. To properly measure coverage of fortified foods it is better to test edible oil, wheat flour and salt samples.

These indicators are important and in Tanzania will be used to track progress on coverage of fortified food and use this information to further strengthen relevant interventions.

UNICEF Tanzania Nutrition team
Re: Food Fortification: Household Coverage of Fortifiable Foods [message #16935 is a reply to message #16780] Thu, 14 March 2019 06:21 Go to previous messageGo to next message
DrSupreet is currently offline  DrSupreet
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Under fortified salt: As in India, double fortified salt with Iodine and Iron is available. Although it is not mandatory for iron to be included in fortified salt, but it is available for people to consume. In my suggestion, separate question for Iodine and Iodine+Iron to be included
Re: Food Fortification: Household Coverage of Fortifiable Foods [message #16960 is a reply to message #16780] Thu, 14 March 2019 11:54 Go to previous messageGo to next message
Nancy Johnson is currently offline  Nancy Johnson
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For countries where biofortified crops are widespread, the crop should be added to the list of fortified foods. As with other fortified foods, samples should be taken to confirm that they are indeed biofortfied and to measure micronutrient levels.
Re: Food Fortification: Household Coverage of Fortifiable Foods [message #16971 is a reply to message #16780] Thu, 14 March 2019 15:03 Go to previous messageGo to next message
jruelbergeron is currently offline  jruelbergeron
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The Global Financing Facility (GFF) Secretariat endorses the recommendations made in this document (DataDENT).

[Updated on: Thu, 14 March 2019 15:04]

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Re: Food Fortification: Household Coverage of Fortifiable Foods [message #17027 is a reply to message #16889] Fri, 15 March 2019 07:11 Go to previous messageGo to next message
Paula Kawiche is currently offline  Paula Kawiche
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I support Gwao's comment of "adding coverage indicators for fortified and fortifiable maize flour specifically for Tanzania. In Tanzania 90% of Tanzanians consume maize flour as the main source of energy. Although the big proportional of maize flour is produced by medium and small scale producers but the country achieved a lot in supporting maize flour fortification across the country. So by having some indicators of fortified maize flour will help a lot in informing government and other stakeholders on status and hence help in policy making, strategies and programming as well."
Re: Food Fortification: Household Coverage of Fortifiable Foods [message #17052 is a reply to message #16780] Fri, 15 March 2019 08:55 Go to previous messageGo to next message
Marie Ruel is currently offline  Marie Ruel
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I endorse the proposed questions related to document coverage of food fortification.
Re: Food Fortification: Household Coverage of Fortifiable Foods [message #17096 is a reply to message #16780] Fri, 15 March 2019 13:12 Go to previous messageGo to next message
Rolf Klemm is currently offline  Rolf Klemm
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Helen Keller International (HKI) recognizes and endorses the importance of tracking coverage and consumption of fortified staple foods such as cereal flours, edible oils and other vehicles (e.g. salt and other condiments). A major challenge is assessing household use of these fortified vehicles when they are repackaged into smaller quantities or used to make products that are not branded as fortified (e.g. use of fortified wheat flour for baked breads and other baked products). It will be important that methods and questions assessing indicators of household use of fortified staples and other food vehicles find ways to overcome this challenge to insure valid coverage estimates.
Re: Food Fortification: Household Coverage of Fortifiable Foods [message #17160 is a reply to message #16780] Fri, 15 March 2019 15:20 Go to previous messageGo to next message
PATH is currently offline  PATH
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Thanks to DataDENT for compiling these recommendations.

Suggest making these indicators country-specific, for instance for countries with food fortification policies about specific fortifiable staples.

Additionally, please note that the current suggestions ask about fortifiability and not whether these products are actively fortified.
Re: Food Fortification: Household Coverage of Fortifiable Foods [message #17176 is a reply to message #16780] Fri, 15 March 2019 15:28 Go to previous messageGo to next message
1000 Days is currently offline  1000 Days
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1,000 Days is the leading non-profit organization working in the U.S. and around the world to improve nutrition and ensure women and children have the healthiest first 1,000 days and we support this recommendation.
Re: Food Fortification: Household Coverage of Fortifiable Foods [message #17331 is a reply to message #17176] Fri, 15 March 2019 17:45 Go to previous messageGo to next message
ktripp is currently offline  ktripp
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Abt Associates endorses the inclusion of these indicators. We would specifically suggest prioritizing 2,4 and 6 , although 1, 3, 5 are useful questions to get a sense of whether people eat the foods at all. These questions are considered vital in efforts to understand globally what proportion of vehicles available in the household are fortifiable. Including a time frame would also be important when asking these questions.
Re: Food Fortification: Household Coverage of Fortifiable Foods [message #17359 is a reply to message #16780] Fri, 15 March 2019 18:47 Go to previous messageGo to next message
Olutayo
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This is another very important indicator proposed by DataDENT. Nigeria has mandated the fortification of oil, sugar, wheat and maize flours since 2002, and there are continuous efforts to enforce compliance. Yet there is no representative data about the percentage of the population that is even covered by fortifiable forms of these vehicles and the potential to benefit from fortification. Including the indicator and associated questions will contribute to rectifying the paucity of food-related nutrition coverage indicators in the DHS and increase DHS utility for understanding determinants of malnutrition and designing interventions.
Re: Food Fortification: Household Coverage of Fortifiable Foods [message #17418 is a reply to message #16780] Fri, 15 March 2019 23:29 Go to previous message
Judy Canahuati is currently offline  Judy Canahuati
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La Leche League International supports this recommendation
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