Review finds fortification documents often lack key elements

Geneva, 3 July 2018 - 

A review of grain fortification monitoring documents from 68 countries indicates that key elements are generally missing from the material. To help countries revise their documentation or establish new programs, the review authors created a 44-point checklist with sample text for food fortification legislation, standards, and monitoring policies. The review and checklist are available in the June 2018 issue of Global Health: Science and Practice.

The authors sought fortification documentation from countries with mandatory wheat flour, maize flour, and/or rice fortification as of 31 January 2015. They reviewed 72 sets of documents.

The authors found that documentation is generally lacking in the following areas:

  • Roles and responsibilities for monitoring between governmental agencies
  • Protocols and systems for monitoring
  • Costs of fortification and fortification monitoring
  • Enforcement strategies
  • How government monitoring results are reported to stakeholders

While details in the monitoring records varied widely, the authors often found missing documentation in areas that influence product compliance to a national standard. These details need to be clearly established for fortification to be successfully monitored.

In contrast, the documents reviewed typically note technical specifications, such as which foods are to be fortified and which nutrients to include. Most documents also specify systems for internal, external, commercial, and import monitoring.

Girl eating bread in the street, Afghanistan

Little girl eating bread in the streets of Afghanistan. © GAIN

While this research used grain fortification documents, the checklist can be used for other food fortification programs as well. "Our checklist can be used to strengthen documentation in countries with existing fortification programs or to help countries which are just starting fortification to develop documentation for their programs", said Kristin Marks, lead author and doctoral student at Emory University in Atlanta, Georgia, USA.

Co-authors represent the Food Fortification Initiative, the Global Alliance for Improved Nutrition (GAIN), Granotec, Project Healthy Children, Nutrition International, and the US Centers for Disease Control and Prevention.

Before reviewing documents, the authors created the checklist based on best practices for fortification. The checklist includes sections for vitamins and minerals; costs; labeling; roles of laboratories; reporting results; and internal, external, commercial and import monitoring. Excellent examples for each item are included for countries to consider as they create or modify protocols for fortification program.

For the review, two co-authors independently used the checklist to assess the 72 sets of documents collected. The authors then reached a consensus on how to score each item for the 72 sets of documents. Country scores from the review are included in the online publication.

If your country documentation is missing from the reviewed items, please e-mail it to