2012年-世界发展银行全球_Action_Plan_for_the_Provision_of__Vitamins_and_Minerals_to_the_Tanzanian_Population_through_the_Enrichment_of_Staple_Foods_57页_1mb

Action Plan for Enrichment of Staple Foods in Tanzania

Core Content

This document outlines an Action Plan for the Provision of Vitamins and Minerals to the Tanzanian Population through the Enrichment of Staple Foods. It highlights the urgent need for addressing micronutrient deficiencies in Tanzania and proposes an integrated nutrition programme to mitigate their impact on public health and economic development.

Main Points and Key Information

1. Current Burden of Micronutrient Deficiencies

• Vitamin A Deficiency (VAD):

  • Leading cause of preventable blindness and visual impairment.
  • 24% of children and 69% of women have low serum retinol or breast milk retinol.
  • Only 52% of rural children and 61% of urban children consumed vitamin A-rich fruits and vegetables in the previous day (2005 DHS).
  • National VAS programme has reduced infant mortality, but it is not sufficient to address the broader population.

• Iron Deficiency:

  • Major contributor to maternal and perinatal mortality (20% of deaths).
  • Causes productivity loss in both heavy and light manual labor.
  • Leads to cognitive impairments in children, which can reduce future wages by 4%.
  • 73% of rural children, 66% of urban children, and 48% of women aged 15–49 are anemic.
  • 58% of pregnant women are anemic, and only 10% take supplements for the recommended 90+ days.

• Folic Acid Deficiency:

  • Critical for preventing neural tube defects (NTDs) and perinatal mortality.
  • 3.02 NTDs per 1000 live births in Dar es Salaam.
  • Antenatal folic acid supplementation is not effective due to low coverage and late initiation of care.

• Zinc and B-vitamins Deficiency:

  • Zinc deficiency increases risk of infectious diseases and impairs growth and development.
  • 37.5% of the Tanzanian population is at risk of inadequate zinc intake.
  • B-vitamin deficiencies are likely due to undiversified diets and anti-nutrient-rich plant-based foods.

• Iodine Deficiency:

  • Leading cause of preventable mental retardation and goiter.
  • 83.6% of households use iodized salt, but only 43% is within acceptable iodine levels.
  • National iodization programme has improved goiter rates from 25% in the 1980s to 7% in 2004.

2. Economic and Health Impact

• Annual economic loss due to deficiencies in iron, vitamin A, and folic acid exceeds $518 million (2.65% of GDP).
• 6,767 lives could be saved annually through food fortification.
• Net annual benefit of the enrichment programme is $113 million, with an economic return of $8.22 for every $1 invested.

3. Rationale for Integrated Nutrition Programme

• An integrated approach is necessary to address the root causes of micronutrient deficiencies.
• Food fortification is a key component but not the only one.
• The programme should include supplementation, crop productivity improvement, public health measures, nutrition education, dietary diversification, and food fortification.
• The action plan aims to ensure that all components are applied equally to achieve the desired impact.

4. Proposed Food Vehicles for Enrichment

Food Vehicle	Projected Coverage	Feasibility
Wheat Flour	14 million (mostly adults)	Immediately doable
Maize Flour	23 million (all ages)	Feasible with industrial and commercial hammer mills
Vegetable Oil	>30 million	Feasible with large processors, though small-scale processors need more analysis

5. Target Groups for Additional Enrichment

• Those consuming other staples (e.g., cassava, bananas, sorghum).
• Those processing maize at the household or rural mill level.
• People living with HIV/AIDS and their families.
• School children and children under 5 years old.

6. Programme Components

• Production and Distribution: Recruiting producers, certification, training, and establishing distribution channels for special groups.
• Quality Monitoring and Legislation: Developing national standards, legislation for enrichment, QA/QC protocols, and training for producers and food inspectors.
• Social Marketing and Behavior Change: Advocacy, public education, logo development, and campaigns to promote fortified products.
• Monitoring and Surveillance: M&E plan, NTD registration, and routine reporting.
• Programme Management: Strengthening the National Food Fortification Alliance (NFFA), establishing working groups, and appointing a programme manager.

7. Implementation and Timeline

• The plan was developed through a series of workshops and stakeholder meetings, including a High Level Forum (HLF) in September 2009.
• It was endorsed by the Prime Minister’s Office and includes multisectoral collaboration involving government, development partners, industry, and civil society.
• Key milestones include:
  • November 2008: International Food Fortification workshop in Arusha.
  • December 2009: World Bank approved $40 million for the Tanzania Health Sector Development Project, with $2 million allocated for fortification.
  • March 2010: Japan approved a $2.69 million grant for rural fortification.

8. Cost and Benefits

• Annual cost of the programme: $13.8 million (0.07% of GDP).
• Annual benefits: $126.8 million (0.65% of GDP).
• Net annual benefit: $113 million (0.58% of GDP).
• Estimated cost per person per year: Tsh. 1,025 for fortified maize, wheat, and oil.
• The programme requires equitable cost sharing among government, development partners, industry, and consumers.

Conclusion

The Action Plan emphasizes the importance of food fortification as a cost-effective and sustainable intervention to address micronutrient deficiencies in Tanzania. It outlines a comprehensive strategy involving production, quality control, social marketing, monitoring, and management. The plan is aligned with national and international nutrition policies and is supported by key stakeholders, including the World Bank and the World Food Programme. The ultimate goal is to improve the health and economic outcomes of Tanzanians, particularly children and women, by ensuring access to fortified staple foods.