Wheat flour fortification in Egypt: During a pandemic
by Jessie Genoway, Food Fortification Initiative, USA
During the COVID-19 pandemic, the uncertainty of supply chains, increased premix prices, and trade restrictions have led some countries to scale back efforts to fortify grains with vitamins and minerals that strengthen individual health and whole economies. Yet, the Egyptian government's commitment to the health of its citizens is clear: despite challenges posed by a pandemic, Egypt is pushing ahead with the Food Fortification Initiative's (FFI) support to restart the country's wheat flour fortification programme, save lives, and bolster the economy.
Food fortification, sometimes referred to as food enrichment, is when food producers add essential vitamins and minerals, also known as micronutrients, missing in a population's diet to food that people eat every day. Food is fortified to prevent micronutrient deficiencies that can limit a child's academic achievement, reduce adult productivity, and cause disabling or fatal birth defects.
Fortification: A weapon against COVID-19
Malnutrition from micronutrient deficiencies is a pressing public health issue in Egypt: 20-30 percent of women are anemic; birth defects are three times what they could be if women had adequate intake of folic acid and losses in gross domestic product due to vitamin and mineral deficiencies are over US $800 million annually.
But the potential for fortification to dramatically improve Egyptians' nutritional status is even greater: 90 percent of the population (90 million people) is reached by industrially processed wheat flour that can be easily fortified, providing a tremendous opportunity for Egypt to address persistent health and economic challenges.
More than ever, flour fortification with iron, folic acid, and other essential nutrients is a life-saving intervention vital to reducing the risk of malnutrition before, during, and after pandemics. The frontline of every country's health system is the immune systems of its people. Several micronutrients, including folic acid and iron, may influence the susceptibility of a person to infectious diseases and the course and outcome of such diseases. Good nutrition helps boost the immune system, lowers the risk of becoming critically ill with infectious diseases, and supports faster recovery when infected. While more data needs to become available on the role of nutrition to the severity of COVID-19, the role of micronutrients in the optimal function of immune systems is well established.
Furthermore, fortification is an adaptable intervention well-suited for the social distancing requirements demanded by the COVID-19 pandemic: large-scale fortification does not require direct person-to-person contact to deliver micronutrients to beneficiaries.
Bread builds life
Egypt's former national fortification programme provided fortified baladi bread, a staple food consumed by a majority of Egypt's low-income population, at a subsidised cost. In classical Arabic, baladi means 'life'. Through this programme, lifesaving amounts of folic acid and iron reached approximately 50 million Egyptians. However, due to the Arab Spring uprising in 2011, the country's fortification programme came to a halt.
In 2018, the Government of Egypt launched 100 Million Healthy Lives, an initiative that emphasised the critical role of nutrition in health and economic development. To help Egypt's 100 million citizens access essential micronutrients, the government decided to restart the national wheat flour fortification programme. In April 2019, the government requested FFI's technical support. Once a partner agreement was drafted, FFI completed a comprehensive situation assessment. The assessment mapped the opportunities and challenges for flour fortification that lay ahead and helped the government take its next step in planning a successful programme.
A stronger future
Building on the assessment and subsequent discussions with stakeholders including government, wheat millers, and consumers, FFI is working with the government develop a realistic plan for implementing fortification. Although Egypt had required the fortification of baladi bread through the national subsidy programme, this requirement did not include wheat flour produced for the open market. One of FFI's first recommendations is that the government enact mandatory fortification for wheat flour sold on the open market, an improvement that will ensure fortified wheat flour reaches at least 90 percent of the population.
From planning to implementation and monitoring, FFI and the Government of Egypt remain committed to the work of rebuilding a smarter, stronger, and healthier future for Egypt, one baladi bread at a time.
The Food Fortification Initiative champions effective grain fortification so people have the nutrition they need to be smarter, stronger, and healthier. FFI helps country leaders plan, implement, and monitor fortification of industrially milled wheat flour, maize flour, and rice. Established in 2002, FFI is the only global group that focuses exclusively on these commonly consumed grains through public, private, and civic partnerships.
World Health Organisation. The global prevalence of anemia in 2011. 2015.
Blencowe, H., et al. Estimates of global and regional prevalence of neural tube defects for 2015: a systematic analysis. Annals of the New York Academy of Sciences. 2018.
Egypt World Bank. Nutrition at a Glance. Accessed 12 February 2020.