Household income and expenditure surveys: a tool for accelerating the development of evidence-based fortification programs.
BACKGROUND
One-third of the world's population suffers from micronutrient deficiencies due primarily to inadequate dietary intake. Food fortification is often touted as the most promising short- to medium-term strategy for combating these deficiencies. Despite its appealing characteristics, progress in fortification has been slow.


OBJECTIVE
To assess the potential of household food-purchase data to fill the food-consumption information gap, which has been an important factor contributing to the slow growth of fortification programs.


METHODS
Household income and expenditure survey (HIES) data about: (a) a population's distribution of apparent household consumption, which are essential to setting safe fortification levels, (b) the proportion of households purchasing "fortifiable" food, and (c) the quantity of food being purchased were used to proxy food-consumption data and develop suggested fortification levels.


RESULTS
The usefulness of the approach in addressing several common fortification program design issues is demonstrated. HIES-based suggested fortification levels are juxtaposed with ones developed using the most common current approach, which relies upon Food and Agriculture Organization (FAO) Food Balance Sheets.


CONCLUSIONS
Despite its limitations, the use of HIES data constitutes a generally unexploited opportunity to address the food-consumption information gap by using survey data that nearly every country of the world is already routinely collecting. HIES data enable the design of fortification programs to become more based on country-specific data and less on general rules of thumb. The more routine use of HIES data constitutes a first step in improving the precision of fortification feasibility analyses and improving estimates of the coverage, costs, and impact of fortification programs.
Fiedler
John L
JL
Social Sectors Development Strategies, 6442 Lily Dhu Lane, Falls Church, VA 22044-1409, USA. fiedler.jack@gmail.com
Smitz
Marc-Francois
MF
Dupriez
Olivier
O
Friedman
Jed
J
D002017:Budgets; D003365:Costs and Cost Analysis; D019317:Evidence-Based Medicine; D005191:Family Characteristics; D005523:Food Supply / Q000191:economics / Q000706:statistics & numerical data; D005527:Food, Fortified / Q000191:economics; D006801:Humans; D007182:Income; D018977:Micronutrients / Q000008:administration & dosage* / Q000191:economics*; D018673:Nutrition Policy / Q000191:economics; D011203:Poverty; D012959:Socioeconomic Factors
D018977:Micronutrients