Topical Area: Global Nutrition
Micronutrient deficiencies adversely affect women and children, especially from low-income populations. The human costs are astronomical in terms of loss of energy, illness, reduced cognition and IQ, and loss in productivity. The objective was to assess whether table salt double fortified with iodine and iron (DFS), provided through a food security program, would increase intake of those nutrients in the target population.
Methods : Subsidized DFS was supplied through the Public Distribution System (PDS) to address widely prevalent iron deficiency (51% in women, 64% in children) in Uttar Pradesh, India. Salt fortification levels were as per the Food Safety and Standards Authority of India (Iodine minimum 15 mg/kg, Iron 850 – 1100 mg/kg) to provide 100% DRI of Iodine and 30% DRI of iron for women in reproductive age group. Fortification regulations for labeling the salt packets were followed. The intervention reached 15 million people, with ~4000 Tons of DFS every month for a whole year, without interruption, ensuring the full household table salt requirements. We assessed coverage and utilization of DFS through monthly exit survey at distribution shops selected by random sampling, followed by household visits in the shops catchment area. Between August to December 2018, data was collected from 2000 households every month.
Results : High purchase rate of DFS from the PDS shops ( >90%) resulted from the ‘bundling’ of subsidized DFS with other food commodities. However, more than 80% of beneficiaries surveyed were unaware of the health benefits of DFS. Among those who purchased DFS, 51% reported regular use in daily cooking at the end of one year. Major reasons for non-regular use were: DFS giving a slightly dark appearance to cooked food (no difference in taste reported), pre-mix (coated iron) particles visible in the salt (perceived as impurities), and community preference for a specific popular brand.
Food security programs provide a readily available platform to accelerate the scale-up of fortified food products among vulnerable and low-income populations. However, awareness of micronutrient deficiencies and a favorable attitude are prerequisites for uptake and compliance.
Funding Sources : 1.Tata Trusts - The India Nutrition Initiative 2.Global Alliance for Improved Nutrition, Geneva (with support from the Bill and Melinda Gates Foundation)