Meeting on "Community-Based Fortification of Cereals"
June 1–2, 1998
Ottawa, Canada

Goal
The goal of the meeting was to assist in the development of ideas and strategies for the field testing of community-based food fortification of cereals and the identification of related needs and support activities.
 

Objectives

• to share information about community-based fortification-related activities being planned or undertaken by the agencies represented at the meeting;

 
• to provide information about the technical aspects of milling and fortification of cereals (e.g., mill operations, blending systems for making and adding premix, establishing levels and forms of micronutrients to be added);

 
• to identify and discuss key considerations to be addressed when field testing the feasibility of community-based fortification of cereals (e.g., social, economic, logistic, training, community education and involvement, monitoring and evaluation); and

• to identify steps to be taken and needs to be addressed in order to work in a systematic, effective way to further advance and support efforts to develop and field test small-scale community-based fortification of cereals.

 

• to gain a better understanding of the technical options available for fortification at small-scale milling operations;

 
• to identify specific technical questions that need to be answered in order to proceed with field studies, and to identify areas where a knowledge base exists and the gaps;

• to outline specific plans for field testing fortification at small-scale milling operations;

 
• to outline commonalities that could be addressed by groups involved in the field testing (should we strive for a common protocol?);

• to make recommendations on improving networking and communications between those interested/involved in fortification at small scale milling operations; and

 
• to outline a work plan (i.e., at least an outline of key activities) over the next 12–24 months aimed at advancing efforts to test/introduce fortification at small-scale milling operations.
 

Oxfam
Jim MacKinnon spoke about how OXFAM is starting a pilot program in Zimbabwe and Mozambique. They are targeting 16 communities in 5 districts, all border towns. The main activities of this project will be:

1) community gardens;

2) promotion and re-introduction of small grains (Zimbabwe is dependent on maize);

3) fortification of small grains;

4) a health component (malaria) – related to the baseline survey; and

5) capacity building among 4 NGOs.

The management of this project will be by OXFAM in collaboration with 4 NGOs. Through this collaboration they will try to establish a set of "lessons learned", as different NGOs bring to the project different expertise.

The baseline study for this project was done in July, 1997, and they looked at (i) for the 5 districts – what information existed. For this they used UNICEF data; and (ii) the results of a community-level questionnaire on health-nutrition at the household level. To carry out this household-level study, they did not use any biochemical indicators (reason: the prevalence of HIV/AIDS in the areas of study is 30–50%, and OXFAM is reluctant to take any actions that involve drawing blood). This questionnaire addressed diet, income (its source, and how it gets spent), incidence of malaria, and HIV/AIDS.

The participant from OXFAM looked to the group for feedback on what they thought the sustainability of this kind of activity would be.

CIDA
The representative from CIDA, Barbara MacDonald, expressed to the group that NGOs play a special role in these kinds of programs as they can have access to areas government cannot, and they have a unique ability to monitor activities. CIDA wants to be supportive, especially since fortification is very important and suggests that the Canadian experience be used as a guide.

CARE Canada
Jaqueline Wood from CARE Canada described how CARE is beginning a community-level fortification project in Zimbabwe. This is a new area for CARE, and they are looking for guidance from others' experiences. The Zimbabwe project will address 3 components:

1) women's groups-agro processing, small scale processors, millers;

2) technical issues of fortification, appropriateness of technology, and compliance; and

3) social marketing at the village level, cost recovery, and sustainability.

CARE is also extensively involved in programming with Canadian food commodities in emergency distribution and development projects. These are potential avenues for further fortification work.

World Vision Canada
World Vision Canada, as explained by Janet-Marie Huddle, is planning community-based fortification programs in Malawi, Tanzania, and Guatemala.

In Malawi the project focus is on weaning foods, producing a maize and soya blend with premix added. WFP in Malawi agreed to provide the premix for the World Vision mill operating within the MICAH program at Domasi. The issues they will address are: product marketing, sustainability, and seasonal demand of the product (if people are producing their own they don't need to purchase it). The buildings are finished, the mill is constructed, and production is ready to start. There is to be a workshop in Malawi in September 1998 regarding fortification.

The Tanzania project is still in the preparation stage, but the baseline studies are done. World Vision is looking for input on this activity.

In Guatemala, the project is in the conceptual stage. They plan to look at maize products in the existing community bakery and to implement fortification at the bakery level. The target population will be young children. The representative from World Vision asked the group if they think this will be possible. The group conceded that you can fortify at the community bakery as well as at the household level. It was suggested that in principle, people may grind maize at home and add a sachet of premix.

Aga Khan Foundation
The representative, Tony Breuer, explained that Aga Khan Foundation is primarily involved in emergency response activities. He chose two examples to illustrate the work they are doing:

1) Kyrgyzstan: In this country, the population has both a high nutrition and education level. The crisis now experienced resulted because 80% of the food consumed was brought in through the Soviet system, and agricultural productivity is very low. Aga Khan bought wheat from Central Asia to import to Kyrgyzstan. The project also includes teaching the population to do sustenance farming, needed due to the break up of State farms. The program has moved very quickly due to the pre-crisis high standard of living.

2) Afghanistan: The nutritional status of the population is very low, and access to markets is very limited. Narcotics trafficking is very high, and there is substantial political instability. Aga Khan Foundation has started to distribute wheat, but still has to determine health and nutritional status of the population (the intent is to use biochemical indicators) and will need to do an agricultural and income survey. A site visit to the mills has revealed that the general consensus is that local millers are shortchanging the farmers because the millers take up to 10% of the grain as their fee. The Aga Khan Foundation wants to move away from bringing the product in, instead they want to develop this at community level.

OMNI/USAID
Penny Nestel told the group that most of OMNI/USAID's work has been done on the large scale, at the national level. Their perspective is that food fortification is part of dietary diversification interventions. Over the last 20 years, OMNI/USAID's involvements have been:

1) national level sugar fortification with vitamin A in Central America, and Zambia;

2) wheat fortification with iron in Sri Lanka;

3) developing and testing sprinkles to add zinc, vitamin A and iron to complementary food. The target population of this intervention is young children. Dr. Zlotkin from University of Toronto is conducting efficacy trials in Nicaragua, Ghana and possibly India;

4) quality assurance, iron and vitamin A content of foods;

5) quality assurance of wheat flour fortification at the bakery level, but would like to move to the milling level.

Micronutrient Initiative
Jenny Cervinskas presented an overview of MI's work in this field, and summarized it according to MI's thematic areas as follows.

Advocacy and Alliance Building: In the area of advocacy and alliance building, MI is active on both a national and regional scale. In Latin America, MI has been working with ALIM (Association Latin American Millers) to prepare a declaration on the fortification of flour with micronutrients; in the Middle East MI is working to initiate a dialogue between national governments and millers; in Asia, food fortification advocacy efforts are focused on Bangladesh, India, Nepal and Pakistan; in Africa MI has been working with the World Food Program in Malawi, Zambia; Zimbabwe; and on a global level MI held both the Ottawa Forum and the IUNS-Food Fortification Workshop (both of which were meetings to promote public-private sector dialogue), as well as being actively involved in the production of advocacy and information materials.

Development and Application of Technologies: In terms of the development and application of technologies activities relevant to this meeting, MI is currently involved in the development of a blending system to evenly distribute premix in milled cereal.

Capacity Building: MI's capacity building efforts include the training of millers in Latin America, and the production of various technical documents/information texts (e.g., flour fortification booklets; directory of premix suppliers; standards for premix and sample tender forms).

Operational Issues: Some of the operational issues MI is addressing on this topic are evident in MI's field testing of small scale milling (Zambia), and the exploration of opportunities for fortifying cereals used in refugee feeding in sub-Saharan Africa (with Refugee Policy Group).

Discussion

Issues to be Addressed
Following the presentations by participants, the group did a brainstorming exercise and generated a list of issues that need to be addressed in any attempt to fortify cereals at the small scale. This is presented below.

• The purpose of fortification should be explicit. Is it to treat disease or to improve nutrition?

• Which micronutrients are to be added?

• What is the relationship between existing and newly-introduced interventions?

• What is the target group?

• What is necessary to start an intervention? What essential information is needed to start? Time available will need to be balanced with desire or ability to achieve accuracy.

• Will one strive to demonstrate efficacy or effectiveness? It is likely that it will be easier to demonstrate efficacy than effectiveness.

• Do strategies differ depending on the type of cereal or small grain to be fortified?

• Who controls the interventions, and how?

• Does the term small scale also include household level milling and/or fortification?

Definitions
Since the discussion at times moved to addressing food fortification at large scales of operation, it was urged that the group focus on small scale operations. This led to a questioning of definitions. What is meant by small-scale? By community? For the purposes of this meeting it was agreed that small scale is defined as those milling operations with a capacity of producing 3 tons of milled cereal per day, or less.

Time Frame
The expectations about the time frame for small scale fortification were questioned. It was asked "Do the participants view small scale fortification as a long term goal or an effort to be pursued just until one gets the macro scale up and running?". Some participants from the NGO sector said they viewed small scale efforts as being a long term goal, requiring a long term process – one needing a process of refinement over time. The view was that we will monitor as we go along, and will start to be able to answer questions as a result of the experience gained.

One participant said that this viewpoint makes it a food-based solution versus a technology-based one. In pursuing food fortification at the small scale mills one is not aiming to change entire dietary practices but instead, seeking to complement and improve the existing diet.

It was suggested that the discussion be limited to small scale, possible emergency level since that is where we will be starting, but keep the assumption that this is to be increased coverage.

Food aid was briefly discussed, with one participant noting that feasibility studies could be done; for example, in emergency situations where cereal food aid is being distributed. Often, this food aid is imported cereals that are milled locally. Another pointed out that cereal flours can even be fortified to Canadian standards prior to export. The possibility of using micronutrients for disease control in refugee settings was suggested.

Parameters for discussion in this meeting were therefore set as:

• Food-based strategies;
• Small-scale milling operations, defined as less than 3 tons per day;
• Small scale to include community level;
• Fortification of (Canadian) food aid is to be the topic of another workshop.

Sustainability
Concerns were expressed about the sustainability due to the small scale of the operations. Small scale will mean that milling operations could be very crude, that there is limited access to the milled product. The limitations were acknowledged, with the point made that if it is found that the milling system itself is not appropriate, then alternatives will need to be explored. The resourcefulness of millers who do currently fortify their products was mentioned. It was noted that cement mixers are being used to fortify some blended foods being produced in Africa (and there is nothing wrong with this practice). The need to ensure that monitoring is done was mentioned.

Household Level Food Fortification
It was stated that it will be important to define the composition of the premix according to use/ target group, and that toxicity of household level fortification is a serious issue. One participant said that household level efforts should be directed at preschool children, and viewed as a targeted intervention. Thus, the objectives of household level fortification are different from food fortification at the small-scale level. If efforts do take place to fortify foods at the household level, we need to think about what we are telling parents, what we are saying about nutrition. This can help put mothers back in control of what their child eats. This can be more empowering than to encourage mothers to "go get your iron drops every 2 months." Besides micronutrients, there are other important factors.

It was mentioned that preliminary work is being carried out in Bangladesh to develop a multiple-fortified sprinkle. It was stated that this concept can work in Bangladesh because of existing infrastructure of community health workers, whereas it would not be feasible in a refugee camp setting that does not have much infrastructure.

The importance of educating people before any new technology or product was introduced into their households was stressed. "Don't jump the gun; the buy-in is needed," stated one participant.

Point of Intervention
Regarding the possible points where fortification could take place, it was pointed out that one needs to examine the distribution levels and ask "where can we intervene?". The preferred choice is likely to be at the national level or central milling, with the second one being to fortify cereals post-milling, before distribution, and the household level as the last resort.

The same question of "where can we intervene" can be applied to cereal food aid. Since supplies generally come from outside, the need is to think of an intervention point. Where does the grain get milled? Does it even get milled? We know that some people eat whole grains, cooked and mashed. In any case, besides asking where one can intervene, one needs to ask "how can this be done?".

Acceptability
Acceptability and use of the cereal needs to be considered. It was mentioned that blended foods are more acceptable since it is like porridge, a familiar food, and that distributed grains can have a market value, therefore are sometimes sold to buy more familiar foods.

It was pointed out that it might be possible to envisage a situation where a number of products are fortified, for example, that cereals are fortified at a large or smaller scale of production, and that household level products (e.g. sprinkles) would also be available, specifically for use by mothers in complementary feeding.

The question was raised "How does the education/community awareness and training needs differ when speaking of household level food fortification efforts versus small-scale efforts at a community level?".

There is a need to establish who the target is for any effort to fortify food. One cannot design a food for the target and use it "across the board." Micronutrients are not target-specific; micronutrient deficiencies are not a problem limited to children. A general fortification program will not address the needs of the vulnerable group aged 6 months to 3 years.

Can a general fortification program deal with the problems of the young child? Safety is an issue and is affected by the concentration of the premix. Premixes need to be tailored according to their use.

Techinical Presentations
The day continued with two technical presentations: the first on blending systems, and the second on premixes.

I: Blending Systems
Presented by Mr. Ravi Philar

From Mr. Philar's experience, specific criteria and conditions are necessary for successful fortification at the small scale mill. These are:

• The blender (i.e., the vessel in which the maize meal would be blended with the fortificants) needs to be rugged, inexpensive, portable, and have few moving parts (this would decrease the chances of breakdown). It should be easy to repair locally. It should be manually operated: fuel or electrically driven operations would be prone to shortages or shutdown, respectively.

• Effective blending should occur in less than 5 minutes. It was noted that this timing was based on an assumption about how long a period would be acceptable to the person doing the blending. The premix (fortificant) would need to be uniformly distributed in the milled maize, therefore the consistency of the premix must match that of the milled maize.

 
• Consumer acceptability of the blending concept and the actual practice would need to be secured. It is assumed that it will be the customer him/herself who will control and/or do the blending and that a simpler design is more desirable.

 
• The cost of both the blender and the premix must be affordable, as the costs will likely eventually be passed on to the consumer.

• identify the technical requirements for fortification (how big, how does it work);
  
  
• make use of existing, available, and appropriate technology;
  
  
• test the ability of each blending system to evenly distribute the fortificant;
  
  
• estimate capital cost, personnel and training needs, and infrastructure needs (e.g., water wheel needed?) associated with each blending system;
  
  
• assess community acceptance of these systems, and identify possible barriers; and
  
  
• propose an action plan.

The capital cost of equipment for a typical mill is approximately CAD$1,700, and the milling cost to the consumer for an average batch (20 kg) is approximately $0.20–$0.33.

Mr. Philar then explained how MI went about designing and testing various blenders that were meant to be suitable for the Zambian conditions described above. First (with the aid of a video and the actual presence of some of the blenders) he described and demonstrated the various blending systems that were designed. Five in all were developed. The blenders range in cost and sophistication from a US$950 hand-operated stainless steel ribbon blender originally developed for iodizing salt, to small plastic pails (with or without baffle inserts) that cost U$ 1-3 each, and that can be rolled to and fro on the mill floor. Also in a lower price range (approximately US$15) was a plastic pail with an integral baffle that would allow for movement up and down, as well as along the circumference, while being rolled along the floor (this pail, called the ODJOB, is commonly used to mix cement), and a blender with a paddle to be placed directly into the pail and manually stirred (cost about CAD$15–20).

From March–May 1998 blending trials took place in Ottawa, Canada in which the five types of blenders were tested to determine the efficacy of each method for blending the premix with the maize meal. Maize meal that was milled to an 80-mesh particle size in a hammer mill at an Ottawa feed facility was used. A premix powder containing iron (as ferrous fumerate), vitamin A, thiamine, riboflavin and niacin was supplied by a US-based firm. The premix (developed specially for use in fortifying maize meal in South America) was added at the rate of 25 g per 100 kg maize meal. Using a sampling protocol developed by a scientist at Agriculture Canada, different batch sizes (i.e, 10, 15 and 20 kg) of maize were tested, with samples of blended maize taken at intervals of 1, 3, 5 and 10 minutes. One sample per quadrant and two samples at full depth were taken. The samples were then sent to an independent laboratory to determine the concentration of iron in the feed and the fortified maize. While the analysis of the data is still not completed, Mr Philar presented the early results emerging from the blending trials.

The preliminary analysis suggests that satisfactory blending can be achieved in 3 to 5 minutes by three of the blenders. The hand-operated stainless steel blender gave the best results. Good results were also obtained from two other blenders but they had the disadvantage of a larger variability in the efficacy of mixing.

Ms. Cervinskas said that after further analysis is done to determine which blending system is most efficient and the costing of the different methods done, MI would be able to share the results with interested parties and also share the equipment design and fabrication specifications. It is expected that field testing of the recommended blending systems will be started in Zambia soon.

II: Premixes
Presented by Mr. Quentin Johnson.

Mr. Johnson explained that there are two types of premixes: (i) those that are related to cereals such as wheat and maize; and (ii) those that are related to unimix.

Those related to cereals are added in low levels to the cereals (i.e., 0.18 mg of premix added to 100 mg of wheat), and are composed of nutrients such as iron, B vitamin group, and folic acid, whereas those related to unimix contain a large range of nutrients. Issues to consider with unimix, therefore, are the interactions between micronutrients (e.g., vitamin A reacts with vitamin C).

Using the example of iron, he talked about the how the micronutrients are added and in what form in order to address the issue of micronutrient interaction and the stability of the micronutrient-fortified product. When trying to determine which iron source should be used (e.g., reduced iron vs ferrous fumerate) there is a debate between nutritionists who know that ferrous fumerate is more bioavailable than reduced iron, and food technologists who know that reduced iron is more stable. His solution is to use both sources, but increase the amount of elemental iron to compensate for low bioavailability. In addition to the form of the micronutrient chosen, it should be noted that stability/discoloration of the product can be affected by the cooking method as well.

Therefore, in order to purchase an appropriate premix for your project, Mr. Johnson explained that the premix supplier will need to know what nutrient composition is desired, what cooking method will be used, and what will it be added to (e.g., wheat, sorghum).

Accessibility of the premix itself can affect field level success of the fortification efforts. Using the example of the large-scale production of fortified cereals in the WFP program in Zambia and Malawi, where 1 kilo of premix is added to 1 metric ton of flour at the mill level, the delivery time of the premix is approximately 6 months from the supplier, which is in South Africa. In addition, in some cases the mills may have to pay for the premix up front.

Quality assurance and monitoring is necessary to avoid toxicity, therefore you need to know the composition/concentration of the premix as it leaves the factory. Quality can be controlled by having the premix in dilute form, then added accordingly to obtain the levels desired. The question can be "how do you monitor the fortificant levels when stability of the premix varies in the field?". Mr. Johnson stated that semi-quantitative spot tests can be conducted, i.e., elemental iron will show up; however vitamin A testing requires the use of hydrochloric acid (a very strong acid), which is not "field-friendly."

When developing Action Steps, the group wanted to establish some premix standards to serve as a basic guideline, or possibly a premix designed for universal use. Mr. Johnson feels that would be extremely difficult to do so globally, but might be possible for specific geographical areas due

to similarities in diet and cooking methods.

MORE ON PREMIXES...
Can a premix be designed for universal use, or, perhaps, be designed for a general pattern of food consumption? This question, raised at the end of day 1, generated a lot of interest, the answer being highly relevant to those ready to embark on feasibility trials, or indeed, anyone procuring premix for fortification efforts.

Given this interest Dr. Beaton was asked by the workshop organizers to provide his views about this, and comment on what needs to be considered when selecting types, levels and forms of micronutrients for a premix. A summary of Dr Beaton's "mini presentation" is provided below.

The following key factors need to be considered when selecting types, level and form of micronutrient to add to a premix:

• Recommended dietary intake (RDI);
• Estimated consumption of the grain (i.e., need to know what the diet consists of; what the food practices are) and the variability within the population;
• Estimated loss of micronutrients;
• Other ongoing interventions.

Dr. Beaton urged that one must first establish some ground rules, such as the following:

Start with energy supply and try to ensure an adequate intake of food, then worry about nutritional quality. Realize that energy intake and nutrient intake are not necessarily correlated. That is, adequate energy intake is a necessary, but insufficient, prerequisite to an adequate nutritional situation.

Conceptually, the concern is in meeting the nutritional needs of the general population; so, the target group is the members of a household. It is usual in a household that members share the same food supply.

Do not expect fortification to treat an existing nutritional problem; it is a means to prevent nutritional deficiency.

The assumption is that there are no widely divergent diet types in the population and that the level of fortication added will meet the needs of those who eat the fortified product.

This approach can only be used when fortifying staple foods. Conversely, there are settings in which a general premix should not be approached.

Dr. Beaton stressed that the goal in terms of nutriture must be known in advance. Is it to prevent classical deficiency diseases, or is it to meet all know functional needs, or is it to build and maintain normative stores? These imply different nutrient requirements and different additions to

foods. Dr. Beaton urged that one not set the goal at simply preventing clinical malnutrition. The diet should be at least adequate to cover functional needs. The cost of adding sufficient additional nutrient to aim for normative stores may be marginal.

It is critically important that one recognize that nutrient needs vary among classes of individuals (men, women, children) and, within classes, between individuals. Total food intake and hence expected nutrient intake also varies among individuals and classes. The design problem must be considered under a probability approach –the design of a "diet" that, when consumed by various members of the household, is likely to be adequate for all of them. That translates to the need to think in terms of nutrient densities of the diet available to the household. In turn it requires as a very early step, the establishment of a reference nutrient density profile – a target to be achieved with the aid of fortification. We now have the tools to do this. Recognize that the nutrient density profile will have to reflect the highest nutrient density need among the classes of individuals expected to be in the population. This might most often be the pregnant adolescent girl. It may not be possible to meet all of her estimated requirements through a fortified diet and selective direct supplementation is likely to be needed.

This can be approached by system modeling.

In the discussion that followed this brief presentation the point was made that these issues have implications for how programs are measured. For example, a false conclusion could be made since an inadequate energy intake can negatively influence the ability to improve micronutrient status.

It is accepted that information about the diet needs to be known; but, what degree of accuracy is needed? There are some countries where quite a lot of information is known about dietary patterns and food intake. For example, in Malawi, over 70% of energy intake is derived from maize.

The importance of product acceptability to the consumer was stressed. Once this is known, then other measures, like intake of fortified food and its distribution, can be done.

SMALL GROUP EXERCISE
Following Dr. Beaton's presentation, the rest of the morning of day 2 was dedicated to a small group exercise aimed at bringing out design issues and factors related to the social, economic and technical issues faced when field testing the community-based fortification of cereals in settings where grain is brought to small scale commercial mills to be milled in small batches (e.g., less than 25 kg).

The participants were divided into two groups. A summary of each of these discussions is presented below.

Group 1: Janice Johnston, Mahshid Lotfi, Jim MacKinnon, Penny Nestel, Alison Greig, Ravi Philar, Janet-Marie Huddle.

Group 1 focused their exercise by first establishing the objectives of a field trial, and then setting the group task as being that of developing the action plan of steps to be taken when conducting a trial.

Objectives

• to develop safe, acceptable, sustainable and affordable methods of fortifying milled grains (maize, millet) processed as a service to farmers by local millers;
• to improve public health and nutrition status; and
• to test the technology. This will involve considerations such as: Is the technology acceptable? Are the nutrients met? Levels of dosage?

2) Collect information on the following:

• Ongoing supplementation programs
• Dietary data. This could be done through a short (eg., four week) survey by consultant
• Quantitative data on food intake
• Nutrient intake
• Consumption of the staple to be fortified by age group
• Energy intake. Is it meeting requirements?
• Information needs? (Sources: HKI/IVACG)
• Toxicity issues. A decision needs to be made about the safe levels of intake. This could be a non-issue if dietary intake data is available
• Nutrient level. The amount to be added needs to be determined.
• Organoleptic changes that may result from the fortification. These may be more significant than adequacy of intake
• Preparation of the staple. It is important to know if it is, for example, sifted or fermented. What method is used to cook the food?
• Estimation of nutrient losses due to cooking. This might be done by a desk estimate
• Estimation of any overage that might be needed to compensate for the nutrient losses during preparation and cooking
• Impact monitoring
• Cost effectiveness. Specify the cost implications of meeting normative requirements for nutrients. The intervention must be cost effective.

3) Information needs related to milling.(This activity could be done in parallel with others).

• How is grain being milled?
• Is it dry milled or wet milled?
• What is the quality of the milled grain product? Its moisture content?
• What is the quantity of grain milled?
• Storage conditions. Is there infestation by bugs (i.e., iron dependent bugs)?
• Shelf life – 1–3 weeks shelf life has been reported. There can be mold and mycotoxins
• Losses (overage)
• Organoleptic qualities of preferred product: meal, flour
• Current regulatory and health inspection environment. May need the involvement of the ministry of health, and ministry of agriculture
• Buy-in of millers, community level associations
• Limiting factors could be identified by focus groups with women, and millers

5) Cost and marketing – what are people willing to pay for fortification and/or the fortified product?

6) Testing the system (in parallel with step 7, below):

• How will the micronutrients be added? Where? Using what equipment?
• Premix manufacturer. Parameters to consider include colour and taste

• This must be done in-country.

Group 2 focused the exercise on establishing the main objective for a field test and outlining the main activities to be completed to meet the objectives. Their work is summarized below.

Objectives

• to (develop and) field test methods of fortifying grains (maize, millet) at small-scale commercial mills in a setting where farmers bring small amounts (i.e., 25 kg) to be milled;
• to identify the costs of such fortification – to the miller, and to the farmer. Costs will be in time, money, work, and family resources;
• to examine the acceptability of the fortified product in terms of organoleptic qualities (such as color and taste) and use of the product;
• to determine the perceived benefits/costs/harm; and
• to provide information to millers, farmers, and relevant ministries about the study.

A number of assumption are held, such as: the project bears the cost of fortification (i.e., the milling cost will not be increased), and the majority of staples are commercially milled.

Critical issues

• Technology – how to field test it
• What are the target nutrient levels?
• How can the fortified flour be produced with nutrients wanted, at the levels desired, and be acceptable?

• To provide information about the feasibility study to millers, farmers, Ministry of Health
• To determine target nutrients and levels

-describe likely intake and usage of milled cereal

-describe patterns of food intake and nutrient intakes

• Determine perceived benefits/ costs/ harm
• Identify the costs (in terms of time, money, work, family resources) to the farmer and miller
• Test the acceptability of the fortified flour in terms of: organoleptic qualities and use
• Design an education/training component (why? what kind of education? when?)

• What are the community priorities? Often, nutrition is not one of them, so the issue becomes how to make fortification and nutrition a community priority.

 
• A variety of dimensions will need to be examined – social, cultural, economic, logistical, etc.

 
• Specialized technical assistance, often from more than one discipline, is likely to be needed to fully conduct any trial. It was pointed out that external technical expertise might be needed to collect some of the above information. For example, an expert could be hired to help conduct the dietary surveys, or to determine the level of micronutrients to add.

• The trials as a whole are complex, and will likely generally consist of a variety of activities, with fairly extensive information needs. These information needs will be determined in part by how much existing data exists. For example, if extensive information is available about the food consumption patterns and dietary intake it will not be necessary to collect this data; if this is not available, then it may be necessary to carry out dietary intake surveys.

• It is likely that the use of qualitative methods will be highly relevant in the field trials.

• Who should pay for the premix? It was agreed that this could change over time. Initially the cost could be borne by the project. This could allow for "buy-in" from the millers and the community members.

• Regarding the timing of activities it was recognized that some activities could probably be done in parallel, while others would need to be sequential.

• It was recognized that there could be an interest not only to fortify maize but also millet or other small grains. Does this make a difference for the blending? Are there any implications that need to be considered if different grains are fortified?

• The extraction rates for the grains may be important to know, since these can affect the level of nutrient inhibitors such as phytates and tannins in the milled product.

 
• Regarding indicators and measuring the results of the feasibility trials, it was noted that the time frame and resources (human and financial) that are available to any feasibility study will set limitations on the indicators to be selected. Measurements cost money; funds are often limited. Also, it was emphasized that value judgements are made when deciding on indicators, especially biological ones. For example, one participant noted that the NGO in which he works does not want to adopt what it judges to be invasive methods to measure project impact (e.g., drawing blood) and that taking blood samples itself represents a risk in communities where the prevalence of HIV/AIDS is very high.

Next Steps
As the closing session of the workshop, a plenary discussion was held to brainstorm what steps could be taken to accelerate efforts to test the feasibility of fortifying cereals in small scale milling operations. Specific action points were identified and these are summarized in the table below.
 

Activities	By whom and when?
Develop a practical guide (step by step) to small-scale community-based fortification of cereals	MI  12–18 mos.
For the above, identify the target audience, table of contents, timetable, organization of work, and budget	MI/OMNI  end of September
Establish an information network (a hub) – electronic discussion group	MI
Mapping exercise of existing small-scale community fortification efforts	OMNI  end of August
Field testing and refinement of mixing technology	MI, NGOs, technical experts
Stability trials and sensory trials	Technical expert
Determine level and premix of micronutrients and fortificant, with case studies - Provide minimum info needs (WVC)	Technical expert
Follow up workshop in a year's time	TBD

Summary
The group confirmed their interest in testing the feasibility of fortifying cereals at a small-scale milling operation, and see this as a means to contribute to alleviating micronutrient deficiencies in at-risk populations. Such field testing will depend on the development of a technology for effectively blending the premix into a batch of milled grain to be fortified. MI has taken a number of steps toward meeting this need, and these were described in Mr. Philar's presentation about the design and testing of the efficacy of different blending technologies. These technologies are now ready to be field tested.

For any intervention or field trial, it was stressed that clear objectives are essential. The purpose of the fortification effort should be clear (i.e., is it for the treatment of disease or to improve nutrition), and specialized training is likely to be needed. Issues to be addressed when designing and carrying out trials to test the feasibility of fortifying grains at small scale milling operations were identified. These included: acceptability by the millers and consumers, selection of fortificants and their form, who controls what is added, what technology is required, what training is required, what is the target population, and how to demonstrate efficacy of the intervention.

There is interest on the part of Canadian NGOs to be part of this field testing initiative. Some work is to be done in the North, some in developing countries. It was agreed that it would be advantageous to continue to exchange information and establish a network of groups involved in field testing.
 

George Beaton
9 Silverview Drive
Willowdale, ON
Canada M2M 2B2
TEL: (416) 221-7409; FAX: (416) 221-8563
EMAIL: g.beaton@utoronto.ca

Tony Breuer
Aga Khan Foundation
350 Albert Street, Suite 1800
Ottawa, ON
Canada
TEL: (613) 237-2532; FAX: (613) 567-2532
EMAIL: akfc@compuserve.com

Jenny Cervinskas
Micronutrient Initiative
250 Albert Street
Ottawa, ON
Canada K1G 3H9
TEL: (613) 236-6163, ext. 2262; FAX: (613) 236-9579
EMAIL: jcervinskas@idrc.ca

Janet-Marie Huddle
World Vision
6630 Turner Valley Road
Mississauga, ON
Canada L5N 2S4
TEL: (905) 821-3033, ext. 396; FAX: (905) 821-1825
EMAIL: janet-marie_huddle@worldvision.ca

Quentin Johnson
RR#4 Rockwood, ON
Canada N0B 2K0
TEL: (519) 856-2364
FAX: (519) 856-1101
EMAIL: quentin@quican.com

Janice Johnston
Micronutrient Initiative
250 Albert Street
Ottawa, ON
Canada K1G 3H9
TEL: (613) 236-6163; FAX: (613) 236-9579

Mahshid Lotfi
Micronutrient Initiative
250 Albert Street
Ottawa, ON
Canada K1G 3H9
TEL: (613) 236-6163, ext. 2482; FAX: (613) 236-9579
EMAIL: mlotfi@idrc.ca

Barbara MacDonald
CIDA
200 Promenade du Portage
Food Aid Centre, 9th Floor
Hull, Quebec
Canada K1A 0G4
TEL: (819) 994-3920; FAX: (819) 953-5348
EMAIL: barb_macdonald@acdi-cida.gc.ca

Jim MacKinnon
OXFAM
300-294 Albert Street
Ottawa, ON
Canada K1P 6E6
TEL: (613) 237-5236; FAX: (613) 237-0524
EMAIL: jimmac@oxfam.ca

M.G. Venkatesh Mannar
Micronutrient Initiative
250 Albert Street
Ottawa, ON
Canada K1G 3H9
TEL: (613) 236-6163, ext. 2210; FAX: (613) 236-9579
EMAIL: vmannar@idrc.ca

Penny Nestel
OMNI
1616 N. Fort Myer Drive, 11^th Floor
Arlington, VA 22209
USA
TEL: (703) 528-7474; FAX: (703) 528-7480
EMAIL: penny_nestel@jsi.com

Ravi Philar
ProMarket International
1226A Wellington Street
Ottawa, ON
Canada K1Y 3A1
TEL: (613) 729-6030; FAX: (613) 729-3752
EMAIL: rphilar@pro-market.com

Jacqueline Wood
CARE Canada
P.O. Box 9000
Ottawa, ON
Canada K2P 0M2
TEL: (613) 228-5608
FAX: (613) 226-5777
EMAIL: jackie@care.ca

Monday, June 1

Co-chairs: Jenny Cervinskas (JC) and Jim MacKinnon (JM)

Rapporteur: Alison Greig

10:00 Coffee and Muffins

10:30 Welcome (Venkatesh Mannar)

Introduction of participants (JM)

Objectives and expected outputs; Review of agenda (JC)

11:00 Presentations from organizations

• OXFAM
• CIDA
• MI
• Care Canada
• World Vision
• Aga Khan
• OMNI/USAID
 

14:00 Technical aspects of small scale milling and fortification (Ravi Philar/ Quentin Johnson)

• Small scale mills: their operations
• Fortification at small scale milling operations: blending systems
• Premixes: sharing of technical information and discussion of issues of interest

17:00 Close of Day 1

DAY 2

Tuesday, June 2

Co-chairs (TBA)

Rapporteur (TBA)

9:00-10:00 Field testing small scale community-based fortification of cereals: A small group exercise to bring out field trial design issues, and factors related to the social, economic and technical issues.

10:30 Coffee Break

10:45-12:00 Feedback from small groups and plenary discussion

12:00-13:00 Lunch (served on 14^th Floor)

13:00 Next Steps

14:00 Close of Workshop

1. The report of the blending trails is expected to be available by December 1998 and will be available to interested parties who request it through MI.