Main conclusion Nutrient-rich neglected and underutilized plant species could help transform food systems, provided science and policy are better connected, and greater coordination exists among the diverse stakeholders working with these species.

Objective: Simulating the probable impact of grain amaranth and highly absorbable, low-Fe micronutrient powder (MNP) on Fe status in a potential target population is an essential step in choosing and developing an appropriate actual intervention. Design: We simulated the potential effect of fortifying maize porridge with grain amaranth or MNP on the prevalence of inadequate Fe intake and Fe deficiency using data from two cross-sectional surveys. In the first survey (2008), dietary intake data were collected by two 24 h recalls (n 197). Biochemical data (n 70) were collected in the second survey (2010). A simulation with daily consumption for 80 d of non-fortified maize porridge (60 g of maize flour), amaranth-enriched porridge (80 g of grain amaranth-maize flour, 70:30 ratio) or maize porridge fortified with MNP (2?5 mg Fe as NaFeEDTA) was done. Setting: Mwingi District, Kenya. Subjects: Pre-school children aged 12-23 months. Results: Prevalence of anaemia, Fe deficiency and Fe-deficiency anaemia was 49 %, 46 % and 24 %, respectively. Consumption of non-fortified, amaranth-enriched and MNP-fortified maize porridge was estimated to provide a median daily Fe intake of 8?6 mg, 17?5 mg and 11?1 mg, respectively. The prevalence of inadequate Fe intake was reduced to 35 % in the amaranth-enriched porridge group and 45 % in the MNP-fortified porridge group, while ferritin concentration was increased in both (by 1?82 (95 % CI 1?42, 2?34) mg/l and 1?80 (95 % CI 1?40, 2?31) mg/l, respectively; P , 0?005) compared with the non-fortified maize porridge group, resulting in a decreased prevalence of Fe deficiency (27 %) in the two fortification groups. Conclusions: Addition of grain amaranth or low-Fe MNP to maize-based porridge has potential to improve Fe intake and status in pre-school children.

Maize is the most widely consumed staple food by the Kenyan population. Its wide consumption and centralized processing make it an appropriate fortification vehicle to supply essential micronutrients to the population. The legislation was enacted in 2012 that makes it mandatory for all commercial maize mills in Kenya to fortify the maize flour with specified micronutrients as a public health effort to reduce the prevalence of micronutrient deficiencies. However, there is limited information on the current status of maize milling and implementation of the flour fortification programme by these mills. A crosssectional study was therefore carried out to characterize the commercial maize mills and determine the status of flour fortification in Kenya. Questionnaires were used to collect data. Information was obtained from 22 large-scale, 25 medium-scale and 31 small-scale mills. These mills had an installed capacity of 6084 metric tons/day of flour using roller and hammer mills. While all the large-scale mills implemented the recommended statutory flour fortification programs, only 45.8% of the medium and 24.1% of small-scale mills did so. There was evidence of weak quality management systems for fortified maize flour and most companies did not have trained mill operators. Regulatory monitoring was mainly done by the Kenya Bureau of Standards and the Ministry of Health. There is a need to enhance industry capacity in food fortification practices and fortification compliance.

Progress of national Universal Salt Iodization (USI) strategies is typically assessed by household coverage of adequately iodized salt and median urinary iodine concentration (UIC) in spot urine collections. However, household coverage does not inform on the iodized salt used in preparation of processed foods outside homes, nor does the total UIC reflect the portion of population iodine intake attributable to the USI strategy. This study used data from three population-representative surveys of women of reproductive age (WRA) in Kenya, Senegal and India to develop and illustrate a new approach to apportion the population UIC levels by the principal dietary sources of iodine intake, namely native iodine, iodine in processed food salt and iodine in household salt. The technique requires measurement of urinary sodium concentrations (UNaC) in the same spot urine samples collected for iodine status assessment. Taking into account the different complex survey designs of each survey, generalized linear regression (GLR) analyses were performed in which the UIC data of WRA was set as the outcome variable that depends on their UNaC and household salt iodine (SI) data as explanatory variables. Estimates of the UIC portions that correspond to iodine intake sources were calculated with use of the intercept and regression coefficients for the UNaC and SI variables in each country’s regression equation. GLR coefficients for UNaC and SI were significant in all country-specific models. Rural location did not show a significant association in any country when controlled for other explanatory variables. The estimated UIC portion from native dietary iodine intake in each country fell below the minimum threshold for iodine sufficiency. The UIC portion arising from processed food salt in Kenya was substantially higher than in Senegal and India, while the UIC portions from household salt use varied in accordance with the mean level of household SI content in the country surveys. The UIC portions and all-salt-derived iodine intakes found in this study were illustrative of existing differences in national USI legislative frameworks and national salt supply situations between countries. The approach of apportioning the population UIC from spot urine collections may be useful for future monitoring of change in iodine nutrition from reduced salt use in processed foods and in households.

More than half of the morbidity and mortality cases among children in Kenya are as a result of micronutrient deficiencies (MNDs). Food fortification is considered by the Government of Kenya as a feasible strategy for addressing MNDs. Worldwide, fortification has been proven to be effective since it does not require any change in dietary habits. Success of large-scale food fortification however may depend on consumer awareness of the fortification benefits. A cross-sectional study was conducted in 13 counties to collect information on fortification awareness using structured questionnaires. 1435 respondents were selected using the Lot Quality Assurance Sampling method. Data were analyzed using Stata version 14.0 and statistical significance p<0.05. The study participants were described using descriptive statistics. The association of sociodemographic characteristics and awareness of fortification was performed using binary logistic regression analysis. The median age of the study participants was 35 years. Only 28% of the respondents were aware of the term “fortification.” Of the respondents, about 27% heard of food fortification through radio. Vernacular radio emerged as the most preferred channel for communicating fortification information among 24.9% of the respondents. Although awareness of vitamins (32%) and minerals (1.5%) was limited, most (76%) respondents reported of existence of health risks for lacking micronutrients. Awareness of food fortification was significantly associated with respondents’ occupation (p< 0.001), household size (p=0.012), education levels (p<0.001), and age (p=0.025). There is need for a wider use of broadcast media sources to modify information and education materials to promote fortification awareness among Kenyan consumers.