Rice Fortification: Building an innovative model to address micronutrient malnutrition

Sergio Segall, Ph.D

Foundation for Social Innovation

sergiosegall@f4si.org

@f4si_lataml

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• Partners: F4SI and your Government

• Problem: Micronutrient Malnutrition

• Solution: Food Fortification

• Plan: Implementation Program in Peru

Who is F4SI

Real impact for a better future

How we can help grow your

business in Latin America

What you get

- Vision and objectives alignment at executive level

- Unify above statement with of all areas

- A Holistic view of Health and

- An impartial view of business processes with improvement areas

- Share regional and world wide best practices

- Results will be measured by citizens’ feedback (and votes)

Improve health and outcomes, today's challenges and how they can adapt to future needs,

the pressure of fulfilling the objectives and demands with fewer resources are critical issues.

Working together with leaders in health, FSI have the opportunity to help Healthcare

organizations and the communities around Latin America to have an impact for better

health.

FSI will focus on young people assisting them to cross the gap of opportunity helping them

to envision and achieve their full potential through a variety of innovative educational

programs. We partner with Governments, non-governmental organizations and educational

communities to offer models and scalable technologies, services and programs to allow a

quality education and opportunity for all young people.

It is the latest and most widely used today

It has received the approval of 183 countries and many UM/international

Organizations including: United Nations, FAO, WHO, WFP, WB and IFAD

“Global food security exists when all people, at all times,

have physical and economic access to sufficient, safe

and nutritious food to meet their dietary needs and food

preferences for healthy and active life”

• Source: Worldmapper, 2009

1Mason JB, Lotfi M, Dalmiya N, et al. The Micronutrient Report: Current Progress in the Control of Vitamin A, Iodine, and Iron Deficiencies. Micronutrient Initiative/International Development Research

Center, Ottawa, Canada, 2001.2Black et all. The Lancet Maternal and Child Undernutrition Series, 20083UNICEF Child Survival fact sheet, 2005.

Malnutrition

2,000,000,000Billion people

Global prevalence and health consequences:

Contribute

1/3 of death and disability

Iron deficiency

Every 2nd

pregnant woman

40% of preschool kid

Vitamin A and Zinc

1,000,000deaths

Lack of Folic acidcauses

200,000severe births defects

Deficit of Thiamin, Iron and other

nutrients

HIGHRates neonata

mortality

Economic Consequences:

The consequences of malnutrition

reduce the GDP of developing

countries by 2%

*Caulfield et al. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. AJCN. 2004;80:193-8

* *Black et all. The Lancet Maternal and Child Undernutrition Series, 2008

Malnutrition

underlies

35% of all

under-5

deaths**

PATH’s Ultra Rice® Technology

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©PATH/ Satvir Malhotra

Intervention:

Nutritional awareness & diet diversification Supplementation Food Fortification

Description:

Improve awareness of, access to and consumption of foods withvitamins & minerals in target population.

Supply target population with capsules, drops or syrups, which provide vitamins and minerals needed.

Add vitamins and minerals to staple foods and spices already well-established in the eating habits of target population.

Cost Medium High Low

Begin to see results Long-term Short-term Short-term

Compliance issues Medium High Low

Behavior change High High Low

Possible Solutions

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Copenhagen Consensus 2012

• World’s top economists (4 Nobel Laureates) convened to prioritize how

development dollars should be spent.

• Interventions to Reduce Chronic Under nutrition in Pre-Schoolers

(including micronutrient provision) ranked among the top international

development priorities

• Food fortification is viewed as highly cost-effective, with high return on

investment; benefit to cost ratio (BCR) at 9.5:1*

• Vernon Smith (Nobel Laureate) said: “One of the most compelling

investments is to get nutrients to the world’s undernourished. The benefits

from doing so – in terms of increased health, schooling, and productivity –

are tremendous.”

* Horton et al: Copenhagen consensus 2008, Malnutrition & Hunger- Executive Summary.

WHO + FAO

“The practice of

deliberately

increasing the content

of an essential

micronutrient, for

example vitamins and

minerals in a food so

as to improve the

nutritional quality of

the food supply and

to provide a public

health benefit.”

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Fortification History

• Developed countries began routinely

fortifying salt, wheat flour, sugar, margarine,

vegetable oils and dairy products in the early

20th century.

• Diseases such as goiter, rickets, beriberi,

pellagra and neural tube birth defects, which

were once common in these countries, are

rarely seen today.

• Developed countries fortify rice, but use a

dusting technology that is ineffective if the

rice is washed and soaked rice prior to

cooking – as it is in many developing

countries.

Decrease in iron deficiency:

Control : 77% to 53%Intervention: 69% to 25%

Decrease in anemia:

Control: 100% to 85.6%

Intervention: 100% to 62%

Studied proved :

• Ultra Rice is more effective than iron drops at improving the iron stores of young children

• Young children consume enough rice per day for fortified rice to make a difference

Source: Beinner M, et all. Iron-Fortified Rice Is As Efficacious As Supplemental Iron Drops in Infants and Young Children. Journal of Nutrition. 2009; 140;49–53.

Source: Arcanjo

P.N.F, et all. Use of

Iron-Fortified Rice

Reduces Anemia

in Infants. Journal

of Tropical

Pediatrics. 2012;

58 (2) ;01–06.

Source: Arcanjo P.N.F, et all. Use of Iron-Fortified Rice Reduces Anemia in Infants. Journal of Tropical

Pediatrics. 2012; 58 (2) ; 01–06.

Evaluate the impact

of iron-fortified rice

weekly on

hemoglobin and

anemia levels

Study deals with

infants (10–

23 months)

n = 216, in an 18

week intervention.

Group received

portions of fortified

rice (50 g) provided

56.4 mg

elemental/Fe.

Anemia prevalence

for intervention

center was 31.25% at

baseline, and 18.75%

at end of

study, p = 0.045

For control 43.50%

were anemic at

baseline, and 37.1%

at the end of

study, p = 0.22.

•Brazil’s recent experience in reducing poverty, capacity for

technical innovation

•Recent partnership: Agency for Brazilian Cooperation and

the Gates Foundation to leverage these models for Africa

•Additional models and further innovation needed to

address Brazil’s lingering poverty and malnutrition

Initiatives Name Scope

1 Clinical TrialsConduct clinical trials to evaluate the nutritional profile before (base line) and

after the intervention

2Public sector

engagement

Focus on school lunch and other public programs at the state and municipal

levels to increase access to fortified rice. Advocacy and policy efforts at all three

levels of government

3Private sector

engagement

Support to the supply chain and distribution channels from a commercial and

business perspective, including engagement of new millers and large retailers

and distributors, and their professional associations

4Supply and quality

management

Support to the entire supply chain from a technical perspective, including work

with fortified grain producers and millers and with UFV on standards and the

quality verification process

5 M&EDefinition of an appropriate metrics framework for the project, tracking of

indicators and reporting

6 Social marketing Demand generation and brand recognition through all media and channels

6 initiatives

18 months duration

Q1 Q2 Q3 Q4 Q5 Q6

Clinical Trial

PS engagement

Social Mktg

Supply & Quality

M&E

PS engagement

Private Sector Private Sector

M&E

480

1440

1440

380

1440Supply & Quality

380

Total

Supply & Quality

Strategic Themes

1. Expand & consolidate the gains achieved during the project

2. Build sustainability into project structures to enable long-term impact

3. Disseminate key learnings to the relevant LATAM community for replication

The structures and capacities resulting from the evolution and

institutionalization of food security and nutrition governance, and

continuing financial and political commitment are mandatory for the

success of the project

The political support to guarantee the engagement of all stakeholders

involved with the nutritional programs is extremely important to achieve

the goals.

The school lunch program if implemented adequately can significantly

reduce the estimated prevalence of undernourishment children in the

country.

Why

• Rice appealing to all social.

• No rice = no meal

• Easy to prepare

• Affordable price.

Benefits

• Considered perfect and it is not rejected.

• Recognized as a food that gives “substance”

• Consumption is allied to beans, known for having iron.

Observations

• Viewed mainly as food to

help “fill the belly”.

• Natural origin must be

stretched, too, since there

is rejection to artificial

composition.

Message

• Product should be as similar as possible of common

rice

• It is important that communication transmits it

• Valuing traditional rice characteristics and extending to

issues of rice processing.

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