A closer look at Kenya's food fortification programmes

While numerous regions in Kenya produce sufficient food to sustain local populations, the challenge persists in ensuring that the accessible food is rich in essential nutrients for promoting healthy growth, especially among children and adolescents.

For instance, the central-eastern counties of Tharaka Nithi, Meru and Embu are located in an agriculturally productive region that enjoys abundant rainfall throughout most of the year. But despite these favourable conditions, the government admits to the persistence of undernutrition in the region.

Research conducted in Kenya and parts of Eastern Africa by the International Center for Tropical Agriculture (CIAT) in 2016 linked low dietary diversity with high incidences of malnutrition in many parts of the region.

Furthermore, statistics from 2015 showed that up to 1.82 million children below the age of five in Kenya were suffering from chronic malnutrition. 

UNICEF reports that stunting rates soar as high as 46 per cent in certain parts of the country, particularly in arid and semi-arid areas, with poor diets cited as one of the contributing factors. According to government records as of February 2021, over 600,000 children and pregnant and lactating women (PLW) were identified as needing treatment for acute malnutrition in the country.

Food fortification has been proposed as one of the methods to advance food quality by boosting its nutritional value.

Various initiatives have been launched to provide fortified foods, particularly for food-insecure communities and populations without access to critical nutrients. 

Paving the way for food fortification, the Kenyan government initiated a programme in the early 1970s, fortifying regular salt with iodine. The Ministry of Health highlights that salt iodisation has since become a routine process in salt manufacturing.

In 1978, Kenya mandated the iodisation of all edible salt, establishing a standard of 100 mg iodine per kg. Beyond salt, Kenya has extended mandatory fortification to staple foods such as maize flour, wheat flour, and vegetable oils.

Kenya's constitution also emphasises the imperative of sufficient and high-quality food, mentioning the right of every individual to be free from hunger and to access food of acceptable quality.

Notable health benefits

Food fortification is a process involving the deliberate addition of vitamins and minerals to foods or condiments in order to enhance their nutritional content. Fortification is also achieved through biofortification, which is the process of selecting cultivated plant varieties to increase their nutritional value.

Food fortification is noted by scientists to have considerable advantages. One significant benefit is that this method can effectively reach broad populations without imposing changes on ordinary consumption patterns.

The handbook on food fortification, produced by the Kenyan Ministry of Health and its partners, addresses the market considerations associated with fortified foods. It states that, among these considerations, any fortified food product should not compromise consumer acceptability.

"If possible, there should be no detectable difference in the appearance or sensory properties of the fortified product, and the price should only be marginally higher," the handbook explains.

Jonah Kamau’s decision to feed his 83-year-old mother with fortified porridge was informed by the growing popularity of enriched porridge flour over maize flour, which many in his community had been using for years. 

"More and more people in this neighbourhood were switching to fortified porridge flour, which has become available in recent years in local milling houses," Kamau told FairPlanet at his home in Nakuru County.

"My mother has worked hard on the farm all her life, which had begun taking a toll in her old age," he shared. "Two years ago, we started feeding her this porridge for breakfast instead of tea and saw improvements in her health. Her weight increased from 56 to 65 after about five months, and she looks stronger and healthier now."

Kamau’s nephews, aged six and eight, who are part of his household, are also fed the porridge regularly for breakfast.

Kamau sources the fortified flour from local millers, a blend of maize, millet, sorghum, soy, black beans, beetroot, cassava and sardines. To enhance flavor and provide additional protein, the family adds milk into the porridge.

High nutritional value, high costs

Observers point to high costs and patchy accessibility associated with fortified flour as challenges hindering the proliferation of the product, particularly among poor and vulnerable households.

"Unfortunately, some of the products are very expensive," Dr Elizabeth Kamau, a nutrition expert with the Kenya-based Connar Consultants, told FairPlanet. "They are out of reach for those who may not afford them. When you think of fortified cooking oil and flour, think of the people in the slums who may not afford these items."

She cited the quality of components used in fortification as another limitation. 

"Some of the components may not have adequate fortificants in them. Some fortificants are not of good quality, [which] could translate to inadequate nutrient intakes."

To counter this, Dr Kamau said, there is a need for strict regulation to ensure that set standards for food fortification are adhered to.

She further argued that some imported food items may provide misleading information about their levels of fortification.

"Some imported products might not be fortified to the level that is recommended in Kenya. Some may not even be fortified at all, because fortification may not be a requirement in their countries of origin."

Dr Mbuthia, who served for more than three decades as a lecturer at the department of human nutrition at Kenya's Egerton University, stressed that fortification has numerous benefits, especially for vulnerable groups. 

"One of its foremost merits is that fortification alleviates micronutrient deficiencies - in populations that can afford," Dr Mbuthia said.

"In some school feeding programmes that have used fortified products, they can ensure that children get micronutrients that children might be missing in their meals at home."

In addition, she cited fortification as a viable means of restoring nutrients lost post-harvest.  

"Fortification ensures that any nutrients lost through inappropriate post-harvest practices are returned to the food. Some nutrients are lost in food due to poor post-harvest handling."

According to Dr Mbuthia, salt iodisation is a remarkable success story of food fortification, part of which she attributes to the low cost of salt.

"Salt iodisation has worked very well because the product is cheaply available to everybody," she said. "Almost everybody is using iodised salt, and so you find that the problems of lack of iodine have almost gone. Iodisation is a classic example of a successful food fortification."

The next steps 

Dr Mbuthia highlighted that, in addition to iodisation, fortification of flour and oil has shown some success and could achieve even greater impact if these products were more easily affordable.

"The fortified flours and cooking oils are working, but only where people can afford them [...] if they are not affordable, that limits access by the wider public."

As part of one initiative, several partners in Kenya have joined forces to create a liquid ready-to-drink "Super Porridge" for school children in arid areas. These regions, facing heightened food insecurity due to harsh climatic conditions that impede food production, stand to benefit from this nutritional intervention.

The product is produced using locally-sourced crops fortified with 15 micronutrients including vitamins A, C, E, calcium, zinc and iron.

"The Super Porridge has provided us with a platform to deliver a quality product to the school children in the Arid and semi-arid areas of Kenya through the National Council for Nomadic Education in Kenya (NACONEK), which is part of the Ministry of Education," Jackline Kittony Arao, marketing director for East Africa at Tetra Pak Limited, told FairPlanet. 

"The super porridge came as a result of a private- public partnership, where stakeholders such as Ingredion, DSM, Unibrain, Jetlak and ourselves came together to develop the product," she added. "The goal is to collectively shape more sustainable, resilient and equitable global food systems for generations to come."

The programme was launched in 2022 with 5,000 pupils targeted in its pilot stage. It was scaled in 2023 to reach 50,000 pupils. 

"We’ve been issuing the porridge to our school's pupils in grades one, two and three, from 7 July 2023," said Mr Abdirizak Ali, headteacher of the Mwangaza Primary School in Isiolo County, Kenya and a beneficiary of the programme.

"The programme has assisted my school very well. In terms of attendance, pupils come to school very early and drink the porridge," he said. "What I have realised is that there is retention of the child in the school."

Several countries across Africa have embraced food fortification as a strategy to enhance the consumption of essential nutrients domestically. Malnutrition remains prevalent in many parts of the continent, with estimates from the World Food Programme indicating that 60 per cent of consumers in Sub-Saharan Africa alone are unable to afford a nutritious diet containing vital fruits, vegetables and animal-source foods.

Countries such as South Africa, Uganda, Tanzania, Zimbabwe, Burundi, Nigeria, Malawi and Mozambique have implemented mandatory maize flour fortification legislation.

Rwanda, for example, has launched a programme that fortifies whole grains in school meals. Cote d'Ivoire has enforced a mandatory iron fortification policy on wheat flour since 2007 as part of its initiatives to address iron deficiency anemia (IDA).

Research published in 2012 by the Grain Alliance on the impact of iron-fortified flour revealed a positive effect on hemoglobin levels in all pre-school children included in the study. The findings indicated that each additional part per million (ppm) of iron in the flour correlated with a hemoglobin increase of 0.24 g/L.

Consequently, the researchers recommended the continuation of existing oil and iron fortification programmes, emphasising their significant benefits, particularly for children aged 6-59 months.

Image by Joseph Maina.