Journal Article

MONITORING OF THE NATIONAL OIL AND WHEAT FLOUR FORTIFICATION PROGRAMME IN CAMEROON: APPLICATION OF A PROGRAMME IMPACT PATHWAY FRAMEWORK

nankap, Martin, Assiene, Jules Guintang, Luo, Hanqi, Pattar, Amrita, Mark, Henry, Killilea, David, Engle-Stone, Reina

2017

Overview

Background and objectives: Since 2011 Cameroon has mandated the fortification of refined vegetable oil with vitamin A (target=40 IU/g, range=33-50 IU/g), and wheat flour with iron (60 mg/kg) and zinc (95 mg/kg). A 2012 interim impact assessment in Yaoundé and Douala indicated 76% of wheat flour samples were fortified and indicators of iron and zinc status in women and children were greater relative to prefortification values. However, only 44% of oil samples were fortified and indicators of vitamin A status were unchanged. We assessed Cameroon's food fortification programme using a programme impact pathway framework to identify barriers to optimal programme performance. Methods: Using semi-structured interviews, data on inputs and processes were collected from factories of all active domestic producers of refined vegetable oil (n=9) or wheat flour (n=10). Twelve sentinel sites were selected for market and household surveys, including assessment of frequency of fortified food consumption by women and children (600 households total). Food samples were collected from factories, markets, and households for measurement of vitamin A (iCheck) and iron and zinc (ICP-OES) content. Results: All factories had in-house methods (mostly qualitative) for testing the micronutrient content of fortified products, while 68% presented quality certificates for recent premix purchases. Industries cited premix import taxes and access to external laboratories as constraints. All but one factory oil sample had vitamin A content > 33 IU/g. Among the sentinel sites, 87% of n=393 market oil samples contained detectable vitamin A; 43% had levels > 33 IU/g. Among household oil samples, 86% contained detectable vitamin A; 46% contained > 33 IU/g. All factory flour samples appeared to be fortified, but only ~18% had mineral levels within 10% of the target. Among composite flour samples from markets and households the mean iron and zinc content was 25 mg/kg and 43 mg/kg, respectively, ~45% of target levels. Conclusions: The availability of fortified oil is encouraging and may partially reflect recent growth in the share of domestic oil production. The low levels of iron and zinc in wheat flour indicate the need for programme support, possibly through premix procurement and technical support for micronutrient analysis.

• Publisher: S. Karger AG
• Subject: Children / Data processing / Factories / Flour / Food / Food consumption / Food fortification / Fortified foods / Households / Indicators / Industrial plants / Iron / Nutrition / Oils & fats / Procurement / Public health / Taxes / Technical services / Vegetable oils / Vegetables / Vitamin A / Wheat / Zinc