title: Fortification of staple cereal flours with iron and other micronutrients: cost implications of following World Health Organization-endorsed recommendations.
abstract: BACKGROUND
  Wheat and maize flours are widely used delivery vehicles for mass fortification. In lower-income countries, most, if not all, national-level cereal flour fortification programs routinely fortify with iron; however, cofortification with other micronutrients is common. Little information is available on the cost implications programs face when considering current fortification practices versus what the World Health Organization (WHO) interim consensus statement recommends.
  
  
  OBJECTIVE
  The objectives of the present paper are to provide information on the costs of adding different chemical forms of iron and/or other micronutrients to premix formulations, and to discuss some of the issues that should be considered regarding which micronutrients to include in the premix.
  
  
  METHODS
  Nine countries in Latin America, Africa, and Asia (three countries per region) that currently cofortify with multiple micronutrients including iron were selected based on low (< 75 g/day), medium (75 to 149 g/day), and high (> or = 150 g/day) mean population flour consumption levels. Premix costs per metric ton of flour produced were estimated for improving iron formulations and for following WHO recommendations for other micronutrients.
  
  
  RESULTS
  For the selected programs to maintain current premix formulations and improve iron compounds, premix costs would increase by between 155% and 343% when the iron compound was switched from electrolytic iron to sodium iron ethylenediaminetetraacetate (NaFeEDTA), by 6% to 50% when it was switched from electrolytic iron to ferrous sulfate, and by 4% to 13 when iron addition rates were adjusted without switching the compound. To meet WHO recommendations for other micronutrients, premix costs would increase the most when the amounts of vitamins B12 and A were increased.
  
  
  CONCLUSIONS
  For programs that currently cofortify with iron and additional micronutrients, the quality of the iron fortificant should not be overlooked simply to be able to afford to add more micronutrients to the premix. Micronutrients should be selected according to population needs, costs, and potential beneficial synergistic reactions the added micronutrients may have.
authors: Global Alliance for Improved Nutrition (GAIN), P.O. Box 55, Geneva 1211, Switzerland. gjaaron@gainhealth.org
authors: Grant J
authors: GJ
authors: Aaron
authors: Arnaud
authors: A
authors: Laillou
authors: Julian
authors: J
authors: Wolfson
authors: Regina
authors: R
authors: Moench-Pfanner
mesh_terms: D000349:Africa; D001208:Asia; D004492:Edetic Acid / Q000191:economics; D002523:Edible Grain / Q000737:chemistry; D005290:Ferric Compounds / Q000191:economics; D005296:Ferrous Compounds / Q000191:economics; D005433:Flour / Q000191:economics*; D005527:Food, Fortified / Q000191:economics* / Q000592:standards; D006801:Humans; D019266:Iron, Dietary / Q000008:administration & dosage* / Q000191:economics; D007843:Latin America; D018977:Micronutrients / Q000008:administration & dosage* / Q000191:economics; D014908:Triticum / Q000737:chemistry; D014805:Vitamin B 12 / Q000008:administration & dosage / Q000191:economics; D014944:World Health Organization; D003313:Zea mays / Q000737:chemistry
chemical_list: D005290:Ferric Compounds; D005296:Ferrous Compounds; D019266:Iron, Dietary; D018977:Micronutrients; C020748:ferrous sulfate; D004492:Edetic Acid; C019179:Fe(III)-EDTA; D014805:Vitamin B 12