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Wheat Flour FortificationMalik Tariq Sarwar Awan, Food Technologist,Chairman Research Wing to Pakistan Flour Mills Association,Editor, Wheat Milling News, PFMA .Member Pakistan Society of Food Scientists and Technologists &Munawar HussainProgram Manager Food FortificationGlobal Alliance for Improved Nutrition (GAIN)

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What is Food Security?

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 an active and healthy life.Source: according to World Food Summit

FOOD SECURITY

Avai

labi

lity

of

nutr

itiou

s fo

od

Food

Acc

ess

Stab

ility

Food

Util

izatio

n

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Food Security in Pakistan

Pakistan Urban Rural0

10

20

30

40

50

60

70

28.4 26.5 29.2

19.817.7

20.7

9.88.2

10.5Food Insecure with hunger (Sever)

Food Insecure with hunger (moderate)

Food Insecure without hunger

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Food Insecurity

• Food Insecurity principally connected to o Low productiono Low socio-economic statuso Increasing prices of foodo Geographic hurdles and distribution

• The main determinant of food insecurity is malnutrition

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Malnutrition and Food Insecurity

food secure food insecure without hunger

food insecure with moderate to severe

hunger

05

1015202530354045

25

32

42

% o

f you

ng c

hild

ren

stun

ted

The worse the food insecurity, the higher the child malnutrition

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Pakistan’s Progress on Malnutrition

Indicator NNS 2001-02

NNS 2011

1. Wasting % (Low Weight for Height) 12% 15%

2. Stunting% (Low Height for Age) 31% 44%

3. Under Weight% (Low Weight for Age) 42% 32%

4. Anemia (Children) 51% 62%

5. Anemia (Pregnant women) 29% 51%

6. Iodine Deficiency (Children) 63% 36%

7. Iodine Deficiency (Women) 76% 36%

8. Vitamin A Def (Children) 13% 54%

9. Vitamin A Def (Non-pregnant women) 6% 42%

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Why Malnutrition Matters?

Pneumonia 15%

Injuries, 3%

Other, 19%

Neonatal 42%

HIV/AIDS 1%

Diarrhoea 19%

Measles 1%

Malaria1%

45% attributable to

Under

nutrition

Globally 45% of under-five deaths are attributable to under nutrition

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Why Malnutrition Matters?

Costly inefficiencies (e.g. illness, deaths)

Direct links: Decreased physical

productivity

Indirect links: impaired cognitive

development, schooling and productivity

Overall loss to the

economy of 3% of GDP

annually

Bigger than energy crises (2% of GDP)

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Micronutrient Deficiencies

Affect mainly women and childrendue to poor quality of diet or depletion due to losses (e.g. infections)Main deficiencies:

IodineVitamin AIronFolic acidZinc

Also called HIDDEN HUNGER – often invisible

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Consequences of Iron and Folic Acid Deficiency

Iron deficiency anemia Poor cognitive development Reduced body immunity and resistance

against diseases Neural tube defects Increased child and mother mortality

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“Hidden Hunger”

Iron Deficiency Folic Acid Deficiency

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Maternal Anemia

Source: NNS 2011Pakist

anUrb

anRural

PunjabSin

dhKPK

Baluchist

anAJK GB

0

10

20

30

40

50

60

70

No Pregnant Women

Pregnant Women

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Anemia - Children Under Five Years of Age

Source: NNS 2011

Pakistan Urban Rural Punjab Sindh KPK Baluchistan AJK GB0

10

20

30

40

50

60

70

80

61.9 62.9 61.4 60.3

72.5

47.3

56.8

4641

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AddressingMicronutrient Malnutrition

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Addressing Micronutrient Malnutrition

Food FortificationDietary DiversificationSupplementation

Food fortification is safe and cost-effective intervention for the prevention of micronutrient deficiencies and has been widely practiced in developed countries for well over a century

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Why Fortification?

Could target population at largeTechnology - simple and well establishedGlobal success history of addressing

deficiencies of micronutrientsEconomical - very cost-effectiveNo need to change dietary habits of targeted

populationFortification vehicles are easily accessible

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Top 10 Investments for advancing global welfare

1 Micronutrient supplements - Malnutrition2 The Doha development agenda - Trade3 Micronutrient fortification - Malnutrition4 Expanded immunization coverage for children - Diseases5 Agricultural R&D on micronutrients - Malnutrition6 Deworming and nutrition programs at school - Malnutrition7 Lowering the price of schooling - Education8 Increase and improve girls’ schooling - Women9 Community-based nutrition promotion - Malnutrition10 Provide support for women’s reproductive role - Women

Copenhagen Consensus

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Fortification - Key Success Factors

Political commitment and supportIndustry supportAdequate legislationConsumer acceptanceNo cultural or other objectionAvailability of micronutrients and

fortification equipment/ dossifiers Economically sustainable interventions

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Wheat Flour Fortification

National Wheat Flour Fortification Program started in 2007 with the support of GAIN

Over 200 flour mills started producing fortified wheat flour

More than 12.7 M people got access to fortified wheat flour

Program suspended in 2011 after 18th constitutional amendment.

GAIN agreed to support Punjab Government toward end of 2013 to restart the program.

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GAIN’s Support to Project

Training and capacity building of industry and regulatory bodies

Laboratory strengthening and provision of spot testing kits Set up supply chain mechanism for market based

availability of micronutrients in Pakistan BCC to increase the demand of fortified wheat flour Support government and industry for legislative and legal

framework Support in setting up monitoring and evaluation

mechanism Assist government and industry for mechanism to pass

through the fortification cost to consumer

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PFMA’s Support to Project

Secure commitment from industry Production and distribution of fortified wheat flour Set up fortification equipment at mills Demand generation of fortified wheat flour Design and use the bags for fortified flour in line with

BCC campaign

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Government Support to Project

Political commitment and patronage of the program

Legislation for mandatory fortification and legal framework

Allow industry to pass through the minor cost of fortification to consumer

Coordination and collaboration among stakeholders

Awareness raising through public services messages

Regulatory monitoring and enforcement of legislation

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Thank you