There are successful examples of fortified rice distribution in centralized and decentralized kitchens of the midday meal schemes in India.A successful example from Vizag’s centralised kitchen
In the central kitchen at Vizag, 61,000 children were fed fortified rice for more than a year in 2010-2011. The pilot was done to determine the technical and operational feasibility of integrating fortified rice in the midday meal scheme. The pilot was successful as the fortified kernels were able to withstand Indian conditions of transport, cooking, usage with no change in taste, color, odour, homogeneity and nutrient composition. Shelf life was studied. Fortified rice was well accepted by the children. The pilot concluded that distribution of fortified rice through centralized kitchens could be easily integrated thereby making it feasible for large scale adaptation.A successful example from Odisha’s decentralised kitchens
In the Gajapati district of Odisha, hot meals cooked using fortified rice were given to 97,790 school children in a decentralised model of the midday meal programme from December 2012. Endline evaluation in 2015 reported reduction of anaemia from 65 percent to 45 percent. Mean haemoglobin levels increased by 0.56 g/dl. It was also found that the acceptability of fortified rice was high as compared to the IFA tablets. The district has now taken up this initiative on its own.
The period between 1928 and 1932 and other beginning in 1939 witnessed a large, consistent decline in pellagra mortality. In the second phase (1939 onwards), fortification of grain products along with other factors and voluntary enrichment of bread with high-vitamin yeast by bakers contributed significantly towards a decline in pellagra deaths. Enrichment of bread alone increased per capita niacin intake by 2.9 to 5.7 mg/d which is about 4 to 8 times more than what would be attributable to the increase in the availability of animal-derived foods.
In 1992, Venezuelan health authorities began a programme to fortify precooked maize and wheat flour with iron and other vitamins. The authorities achieved success by selecting an effective and well-absorbed iron compound, choosing food vehicles that are consumed daily, and maintaining quality control over the process. The prevalence of anaemia in children aged 7, 11 and 15 years fell by 50 percent within 12 months of introduction of this programme, and average ferritin concentrations had almost doubled in the first 6 years since implementation (Gracia, 2002).
The first salt iodization programs began in the early 1920s in Switzerland and the United States in order to combat endemic goiter.
Iodine first began being added to salt commercially in the United States in 1924 by the Morton Salt Company at the request of the Government. This was done as a response to the fact that endemic iodine deficiency was prevalent in the Great Lakes, Appalachians, and Northwestern regions of the U.S., a geographic area known as the “goiter belt”, where 26%–70% of children had clinically apparent goiter.
David Marine, a U.S. physician in Ohio, and his colleagues initiated an iodine prophylaxis program in over 2100 schoolgirls in 1917. Over the next few years, he and colleagues published a series of papers reporting a significantly decreased frequency of goiter in children treated with iodine (0.2%), compared to children who did not receive iodine supplementation (>25%) . In 1922, David Cowie, chairman of the Pediatrics Department at the University of Michigan, proposed at a Michigan State Medical Society thyroid symposium that the U.S. adopt salt iodization to eliminate simple goiter . His work with the Society over the next few years, through the development of the Iodized Salt Committee, was instrumental in the history of the U.S. iodine supplementation effort
In 1991, the World Health Assembly resolved to eliminate iodine deficiency as a public health problem globally. Since then, many countries have introduced salt iodization programs. As of 2012, Iodine Global Network, formerly known as the International Council for the Control of Iodine Deficiency Disorders (ICCIDD), classified 23 countries in the world as mildly iodine deficient, 9 as moderately deficient and none as severely iodine deficient.
India was one of the first countries in the world to start a public health programme to address iodine deficiency disorders (IDD) through salt iodisation.
IDD was recognized as a public health problem and the National Goitre Control Programme (NGCP) was launched in 1962 by the Government of India. In 1983, the Central Health Council, Ministry of Health Family Welfare adopted Universal Salt Iodisation as the primary strategy to control IDD. In 1992, NGCP was reformulated as the National Iodine Deficiency Disorder Control Program (NIDDCP) in recognition of serious consequences of IDD on early brain development and cognition. All states were advised to ensure mandatory salt iodisation for direct human consumption by the Government of India.
In 2000, the ban on selling only iodised salt was lifted – drastically increasing consumption of non-iodized salt. Iodised salt consumption decreased within five years with approximately half of Indian households consuming non-iodized salt. As a result, the ban was reinstated in 2005.
The IDD control programme in India is a public health success story. Iodized salt production in the country was less than 2,00,000 metric tonnes (MT) per year in 1980s, which is now 6.4 million MT per year, well in excess of the national requirement of 5.2 million MT per year (Salt Department Annual Report, 2014-15).
There has been a significant increase in the coverage of iodized salt at the household level over the past 25 years. With increased availability and improvement in iodization practices and packaging, effective monitoring and heightened consumer awareness, according to the National Iodized Salt Intake Survey, 2015, currently 92% households consume iodised salt and 78% consume adequately iodised salt (Figure 1).
Fortification of vanaspati with vitamin A has been obligatory in India since 1953. There is a government notification stating that no oil will be sold loose in the market, which is an advantage for the sale of packaged fortified oil. Government of Gujarat has made oil fortification mandatory in the state since 2006. Successful models of fortification of cooking oil products with Vitamin A and D already exist and are operating in the Indian market. In 2008, Cargill Indiafunneled its efforts into fortifying two of its top edible oil brands. In addition to creating a new competitive advantage for Cargill in the Indian market, the initiative helped provide essential vitamins (A and D) to over 30 million people across the nation. Today, Cargill fortifies all of its consumer-pack oil brands in India with essential vitamins. Over time, the innovation motivated competing brands to fortify their oil offerings. Currently several medium and large industry players are fortifying edible oil. About 1.5 MMT tons of edible oil is fortified with vitamins A and D and is reaching about 200 M consumers.
During 1980s, the Department of Food, Government of India introduced a scheme of fortifying milk with vitamin A at 2000IU/L for toned/double toned milk to prevent nutrition blindness. The government reimbursed the cost of vitamin A premix to the dairies for fortifying milk for three years, after which the dairies were asked to reabsorb the cost. The total quantity of milk fortified with vitamin A during 1988-89 was 3.2 million litres per day. Even today, Mother Dairy continues to fortify its 9 lakh litres of bulk vended milk (BVM) every day. Rajasthan Cooperative Dairy Federation started fortifying milk in the year 2013 with vitamin A and D and has demonstrated a successful model of providing these essential vitamins to millions of people in Rajasthan.
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