Ministry of Public healthGD of Preventive medicine

Public Nutrition Department

Dr.M.Hamayoun Ludin

Director, Public Nutrition Department

Kabul-Afghanistan

Food Fortification regional workshop

Outline

• Nutrition situation in Afghanistan

• Overview of main staple Food Fortification Programs - Salt Iodization

- Wheat flour fortification

- Oil fortification with Vit A & D

• Challenges and constraints

• Recommendations

Nutrition situation in Afghanistan(NNS 2013)

Nutrition status of all children 0-59 months

WHO cut offs for VERY HIGH LEVEL

GAM > 15%SAM > 4%

WHO cut offs for VERY HIGH LEVEL

Stunting >40%

WHO cut offs for VERY HIGH LEVEL

Underweight >30%

Micronutrient statues

Deficiency/ Condition

Women of Reproductive Age

(15-49 years)

Children (6-59 months of age)

Adolescent girls (10-19 years)

Anemia 40.4% 44.9% 30.9%

Iron Deficiency 24% 26.1% -

Vitamin A deficiency

11.3% 50.4% -

Zinc Deficiency 23.4% 15.1% -

Iodine Deficiency 40.7% 29.5% -

Vitamin D deficiency

94.8% 81.0% -

Comparison – 2004 vs 2013

60.5

34

9

40.9

25

9.5

0 20 40 60 80

Stunting (HAZ)

Underweight(WAZ)

Wasting (WHZ)

Chart Title

NNS 2013 NNS 2004

Indicator 2004 2013

Early Initiation of breastfeeding

35% 69%

Undernourished women (15-49)BMI<18.5

20.9% 9.2%

Iron Deficiency (women)

48% 24%

Iodine Deficiency (women)

75% 41%

Iodine Deficiency (children)

72% 30%

Minimum Acceptable Diet by province (6-23 months)

12

0 1 1 2 24 4 4 4 5 6 6 7 7 8

9 9111112121213131314

15161617

1921

27

38

0

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10

15

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30

35

40

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Knowledge of Mothers about Micronutrients

38.7

30.2

60.864.2

0

10

20

30

40

50

60

70

Vitamins Vitamin A Anaemia Iodized Salt

Knowledge of respondent about

Pe

rce

nta

ge

Responding of mothers on use of fortified food commodities

38.1

48.0

3.910.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Yes No Not reported Don't know

Usage of fortified commodities

Pe

rce

nta

ge

Overview of main staple Food Fortification Programs

According to national nutrition policies and strategies thefollowing national food fortification programs have thepriorities & existing

1. Salt Iodization

2. Oil fortification with Vit A & D

3. Wheat flour fortification

1. Salt Iodization program

The program is initiated in 2003, by establishing firstiodized salt in kabul city through public-privatepartnership

The supply of potassium iodate was provided to Iodizedsalt plants up to end of 2013 as free of charge byUNICEF,MI & GAIN,

Currently there are 31 registered iodized salt plants withthe capacity of 3-8 MT/h functioning in 14 provinces ofcountry

Since 2011 when the USI legislation approved by thegovernment , salt iodization become mandatory

Since Feb,2014 the free donation of potassium iodatesupply was changed to revolving fund system , which isrunning by Iodized Salt Factories Association

Iodized salt production trend (MT/year)

4200

59100

92000

110000

74100

100000

117800

100100114900

111000

105000

68000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

2. Oil fortification with Vit A & D

The edible oil fortification with Vit A & D is started recently , just few months ago

There are three local producers of edible oil functioning in three provinces (Kabul, Balkh& Hirat)

The premix, dozer machine and installation process in mentioned oil producing factories are completed.

The amount of Vit A & D will be added to processed and refined oil based on national standards

A legislation on oil and flour fortification is under process in MoPH

3. Wheat flour fortification

Large scale Flour fortification is started since 2006 by support of WFP

Currently there are more than 14 mills functioning in 5 provinces of the country

Since there is no proved legislation yet the program is not mandatory

The annual production of fortified wheat flour is covering almost less than 5% of the need of people in 5 big cities (Kabul,Hirat, Mazar-e-Sharif, Kundoz and Jalabad)

Cont---

National Standards has been developed by support ofANSA (based on new standard only four micronutrients ,VitB12, Folic Acid, Zinc & Iron should be in the premix)

MoPH/PND provide The micro-feeder and premix whichhas five micronutrients(Iron, Folic Acid, Vit A, Zinc & VitB12)

The legislation for wheat flour and edible oil is underprocess in MoPH

MoPH/PND conducted training on QC & QA to provincialnutrition officer and millers in five provinces

Communication campaign in five big cities are also underprocess

FF production trend (MT/year)

2200017000

30000

74000

63000

15391

2362728611

44614

2006 2007 2008 2009 2010 2011 2012 2013 2014

Wheat flour production in percentage

0

10

20

30

40

50

60

70

80

90

100

Country production Imported

Percentage of wheat flour

Percentage of wheatflour

Outline

Outline

Afghanistan flour fortification standards are based on WHO recommendation

Nutrient Flour extraction

rate

Compound Level of nutrient to be added in parts per million (ppm) by

estimated average per capita wheat flour availability (g/day)

<75g/day 75-149g/day 150-300g/day >300g/day

Iron Low NaFeEDTA 40 40 20 15

Ferrous

sulphate

60 60 30 20

Ferrous

fumarate

60 60 30 20

Electrolytic iron NR NR 60 40

High NaFeEDTA 40 40 20 15

Folic acid Low or high Folic acid 5.0 2.6 1.3 1.0

Vitamin B12 Low or high Cyanocobalami

n

0.04 0.02 0.01 0.008

Vitamin A Low or high Vit A palmitate 5.9 3 1.5 1

Zinc Low Zinc oxide 95 55 40 30

High Zinc oxide 100 100 80 70

NR – Not Recommended

Challenges and constraints

Wheat flour

Low quality and quantity of locally produced wheatflour

Weak support on importation of wheat instead of flour(which are not fortified)

No program to convinces the traders to being fortified instead of non fortified flour from neighboring countries

Recommendations

Supporting the in-country production of iodized salt,fortified wheat flour & edible oil

Regional coordination to support government ofAfghanistan to finalize policy on importation ofwheat instead of wheat flour

Support the importation of fortified wheat flour &edible oil until the local production capacityincreased (Na Iron EDTA to 15)

Strengthening coordination & collaboration amonggovernments to import fortified food (iodized salt,fortified wheat flour & edible oil)

Harmonize standards among countries of the region

Remember, Remember ……

“Use every letter you write

Every conversation you have

Every meeting you attend

to express your fundamental beliefs and dreams

Affirm to others the vision of the world you want”

(Robert Muller)Robert Muller (March 11, 1923 – September 20, 2010) was an international civil servant for 40 years, his ideas about world government, world peace and spirituality . He was known by some as "the philosopher 1]

Thanks , Better future and better coordination