Where the use of sprinkles is a targeted intervention, the fortification of staple foods with some of the key micronutrients is a blanket intervention designed to inject a very minimum load of certain micronutrients into the diet. South Africa introduced a compulsory fortification programme in 2003, where by law all white and brown bread flour and all maize meal had to be fortified with eight vitamins and minerals. Already, the rate of neural tube defects in newborns has dropped in recent years, suggesting that the addition of folic acid to staple foods is doing its work, but vitamin A and iron are not showing the desired result.
Any targeted interventions, such as introducing daily sprinkles into the diet or six-monthly vitamin A supplementation, has to be designed in such a way that it does not cause something like vitamin A toxicity, because you can never know how much of those vitamins a person is getting elsewhere in their diet, through eating a diverse range of fresh foods, for instance, as well as through fortification.
By Leonie Joubert