title: Flour fortification in South Africa: post-implementation survey of micronutrient levels at point of retail.
abstract: BACKGROUND
  Fortification of staple foods is an effective strategy to deliver and increase the intake of micronutrients in the diet and can reduce micronutrient deficiencies. It is important to ensure that the food vehicle consistently contains adequate amounts of nutrients at the point of consumption for effective impact.
  
  
  OBJECTIVE
  This survey aimed to gauge the level of fortification of maize and wheat flour at the retail level compared with staple food fortification regulations in South Africa to better understand the current obstacles to effective delivery of micronutrients through flour fortification and consider approaches to strengthening the program.
  
  
  METHODS
  White bread flour and maize meal samples were collected from retail points across all provinces and analyzed for vitamin A, iron, and nicotinamide, and a database capturing the origins of the sample was populated. Nicotinamide and vitamin A results were compared against each other and evaluated against food regulations.
  
  
  RESULTS
  The level of compliance with statutory fortification requirements was low, both for bread flour and for maize meal. There is evidence of insufficient addition of premix as opposed to losses due to vitamin A stability as seen from the strong correlation between vitamin A and nicotinamide in maize meal.
  
  
  CONCLUSIONS
  The current levels of micronutrients added to maize meal and bread flour are unsatisfactory. This is likely to be because of insufficient addition of premix at the mills. This affects the availability and intake by consumers of fortified product and potentially prevents the desired reduction in vitamin and mineral deficiencies expected from the flour fortification program.
authors: Global Alliance for Improved Nutrition (GAIN), P.O. Box 1234, Midrand, Halfway House 1685, Geneva. ryusufali@gmail.com
authors: Rizwan
authors: R
authors: Yusufali
authors: Nigel
authors: N
authors: Sunley
authors: Maude
authors: M
authors: de Hoop
authors: Dora
authors: D
authors: Panagides
mesh_terms: D001939:Bread / Q000032:analysis; D004032:Diet; D005433:Flour / Q000032:analysis*; D005527:Food, Fortified / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D019266:Iron, Dietary / Q000008:administration & dosage*; D044342:Malnutrition / Q000517:prevention & control*; D062407:Meals; D018977:Micronutrients / Q000008:administration & dosage / Q000172:deficiency; D009536:Niacinamide / Q000032:analysis; D018673:Nutrition Policy; D013019:South Africa; D014908:Triticum / Q000737:chemistry; D014801:Vitamin A / Q000008:administration & dosage*; D014802:Vitamin A Deficiency / Q000517:prevention & control; D003313:Zea mays / Q000737:chemistry
chemical_list: D019266:Iron, Dietary; D018977:Micronutrients; D014801:Vitamin A; D009536:Niacinamide