ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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Nutrition : Shot in the Dark

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The government's recent announcement that it was about to embark on the sale of vitamin A fortified sugar must be viewed with some concern. While the scheme has been undergoing trials for some time, there have been no reports on the outcome – either of the efficacy of such fortification to reverse deficiency trends, the stability of the product, the distribution logistics or even the production process. All that we have is wild hope and the example of wholly USAID-supported projects in Bolivia, Guatemala and Brazil.

The idea originated in the fact that sugar consumption in these countries even among the poor is reasonable; so sugar could be used as a means of delivering vitamin A. The process design, another USAID initiative, has apparently been successfully operationalised in these countries. Research on sugar fortification with vitamin A has been going on since the 1960s at the Institute of Nutrition of Central America and Panama (INCAP). The technology was developed, with USAID support, over the following 10 years. In the 1970s several central American countries adopted the distribution of vitamin A fortified sugar as a primary strategy to combat the deficiency. However, the fortification programme was not as effective as expected because of the inability to put in place quality assurance systems. It was revived in the late 1980s. Guatemala's programme has been projected as a model. Guatemalan law now requires that all sugar that is processed and marketed be fortified with vitamin A at 15 mg of vitamin A per gram of sugar. Although impact studies of the programme over a five-year period indicated a 50 per cent reduction in vitamin A deficiency levels among pre-school children, there is little evidence that the large-scale distribution of fortified sugar has had an overall effect on deficiency levels. This could well be because the method is suitable for specific and small target populations with severe deficiency levels. In the mid-1990s a 12-month pilot programme wholly-supported financially and technically by USAID was launched. However, once again no conclusive reports are available.

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