| Sumario: | Background
Large-scale food fortification (LSFF) is a cost-effective approach used in most countries to address widespread micronutrient deficiencies. Understanding who consumes fortified foods is challenging as these foods are often undetectable by design. The objective of this work was to refine survey items used to measure LSFF coverage for their potential use in routine multitopic household surveys.
Methods
In Bangladesh and Ethiopia, we interviewed shop vendors (n=108), program officers (n=28), and women beneficiaries of safety net programs (n=67). Shop observations assessed availability, type, brand, and fortification labeling for food vehicles (oil, wheat flour, salt, and rice). Key informant interviews were used to understand practices related to food acquisition/use and fortification knowledge. Cognitive interviewing techniques were used to refine questions from the Fortification Assessment Coverage Toolkit (FACT), with follow-up prompts to identify comprehension, retrieval, judgment, and response errors.
Results
Market observations revealed many types and brands of food vehicles, especially of rice in Bangladesh (35 types, 220 brands). Nearly all oil and salt, but not wheat flour in both countries or rice in Bangladesh were labeled as fortified. Program officers and women had limited knowledge about fortified foods. The concept of brand was not well understood, and women often could not remember the brand they last purchased. Modifications to the FACT survey items reduced cognitive errors. A set of four questions can capture household coverage of food vehicle and fortifiable food vehicle use.
Conclusions
Correct phrasing of key concepts as understood by respondents is essential to producing reliable estimates of LSFF coverage. In the absence of cheap, field-friendly technologies to test food samples, and given limited identifiable features of fortified foods, estimating coverage of fortification programs in household surveys remains challenging but worthy of further investigation.
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