Monitoring and evaluation in flour fortification programs: design and implementation considerations

Peña‐Rosas, Juan Pablo; Parvanta, Ibrahim; Haar, Frits van der; Chapel, Thomas J.

doi:10.1111/j.1753-4887.2008.00019.x

Cited by 15 publications

(18 citation statements)

References 16 publications

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“…In low-income countries, preventable nutritional deficiencies can prevent one in thirty-eight newborns from reaching 5 years of age (3) . Other important vitamin and mineral deficiencies preventing optimal maternal and child health and nutrition include those of calcium, folate, vitamin B 12 , iodine and vitamin D. Various vitamin and mineral interventions targeting women, children and the entire population have been proposed for integration into public health programmes (4,5) . The interventions include oral supplementation for women and children, point-of-use fortification of foods consumed by children, fortification of staple foods and bio-fortification of staple crops.…”

mentioning

confidence: 99%

Development and use of the generic WHO/CDC logic model for vitamin and mineral interventions in public health programmes

De-Regil

Peña-Rosas

Flores‐Ayala

et al. 2013

Public Health Nutr.

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Objective: Nutrition interventions are critical to achieve the Millennium Development Goals; among them, micronutrient interventions are considered cost-effective and programmatically feasible to scale up, but there are limited tools to communicate the programme components and their relationships. The WHO/CDC (Centers for Disease Control and Prevention) logic model for micronutrient interventions in public health programmes is a useful resource for planning, implementation, monitoring and evaluation of these interventions, which depicts the programme theory and expected relationships between inputs and expected Millennium Development Goals. Design: The model was developed by applying principles of programme evaluation, public health nutrition theory and programmatic expertise. The multifaceted and iterative structure validation included feedback from potential users and adaptation by national stakeholders involved in public health programmes' design and implementation. Results: In addition to the inputs, main activity domains identified as essential for programme development, implementation and performance include: (i) policy; (ii) products and supply; (iii) delivery systems; (iv) quality control; and (v) behaviour change communication. Outputs encompass the access to and coverage of interventions. Outcomes include knowledge and appropriate use of the intervention, as well as effects on micronutrient intake, nutritional status and health of target populations, for ultimate achievement of the Millennium Development Goals. Conclusions: The WHO/CDC logic model simplifies the process of developing a logic model by providing a tool that has identified high-priority areas and concepts that apply to virtually all public health micronutrient interventions. Countries can adapt it to their context in order to support programme design, implementation, monitoring and evaluation for the successful scale-up of nutrition interventions in public health.

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mentioning

confidence: 99%

Development and use of the generic WHO/CDC logic model for vitamin and mineral interventions in public health programmes

De-Regil

Peña-Rosas

Flores‐Ayala

et al. 2013

Public Health Nutr.

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“…Continued support for monitoring efficacy will also be critical for sustaining fortification programs [ 30 ], and public-private partnerships can be effective to measure fortification levels and fortified food intake levels. It is now time to collect more evidence on the impact of food fortification programs in Southeast Asia in regards to a reduction in morbidity and mortality, particularly in women of reproductive age and children.…”

Section: Discussionmentioning

confidence: 99%

Micronutrient Fortification of Food in Southeast Asia: Recommendations from an Expert Workshop

Gayer¹,

Smith²

2015

Nutrients

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Micronutrient deficiencies remain a significant public health issue in Southeast Asia, particularly in vulnerable populations, such as women of reproductive age and young children. An important nutrition-specific intervention to address micronutrient malnutrition is fortification of staple foods and condiments. In October 2013, the International Life Sciences Institute (ILSI) Southeast Asia Region held a workshop on micronutrient fortification of food in Bangkok, Thailand. The objective was to engage multiple stakeholders in a discussion on food fortification and its importance as a public health intervention in Southeast Asia, and to identify and address key challenges/gaps in and potential opportunities for fortification of foods in ASEAN countries. Key challenges that were identified include: “scaling up” and mobilizing sustainable support for fortification programs in the form of multi-stakeholder partnerships, effecting policy change to support mandatory fortification, long-term monitoring of the programs’ compliance and efficacy in light of limited resources, and increasing awareness and uptake of fortified products through social marketing campaigns. Future actions recommended include the development of terms of engagement and governance for multi-stakeholder partnerships, moving towards a sustainable business model and more extensive monitoring, both for effectiveness and efficacy and for enforcement of fortification legislation.

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“…Evaluation is the objective assessment of a program that covers its need, design, implementation, effectiveness, efficiency and sustainability. In evaluating a program the aims are to analyze why intended impacts were or not achieved, to explore unintended results and to inform practice, decisionmaking and policy [42] [43].…”

Section: Implementing Food Fortification Programsmentioning

confidence: 99%

Planning and Implementing Food Fortification Programs to Combat Micronutrient Malnutrition: Iron

Garcı́a-Casal¹

2014

FNS

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Iron deficiency anemia is the most prevalent nutritional deficiency in the world and food fortification is a cost-effective approach to combat it. This paper reviews the food fortification process with micronutrients, with special emphasis on iron and the most critical steps and common difficulties found when implementing a program. The first step is to measure the magnitude of the problem and the groups affected by iron deficiency and anemia, to determine if there is a need for fortification. Then the adequate iron compound and vehicle should be selected, to obtain a bioavailable form of iron in a frequently consumed food item without changing the taste, appearance or cooking characteristics of the final food item or complete meals containing it, to assure the acceptance by consumers. Before implementation, bioavailability studies are in order for the fortified food item and for complete meals especially typical or traditional meals, followed by field studies and pilot tests. Once implemented, the program should be monitored and evaluated continuously, and the impact on health assessed periodically to give the program the flexibility for continuation made changes or finalization when necessary. Other key elements for successful implementation of food fortification programs include the presence of a viable food industry; available channels for food marketing and distribution; a health care system to identify and monitor micronutrient malnutrition in the population; institutions for education, treatment and evaluation of the impact of the program; and continuous and effective input into the planning, implementation, monitoring and evaluation of the intervention to ensure sustainability of the intervention.

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Monitoring and evaluation in flour fortification programs: design and implementation considerations

Cited by 15 publications

References 16 publications

Development and use of the generic WHO/CDC logic model for vitamin and mineral interventions in public health programmes

Development and use of the generic WHO/CDC logic model for vitamin and mineral interventions in public health programmes

Micronutrient Fortification of Food in Southeast Asia: Recommendations from an Expert Workshop

Planning and Implementing Food Fortification Programs to Combat Micronutrient Malnutrition: Iron

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