Three recently completed case studies have verified that industrial flourmills in Chile, Indonesia, and the Republic of South Africa (RSA) have rigorous internal controls to confirm that their products comply with country standards for fortification. While other types of monitoring varied considerably, the studies show that milling leaders have developed standard operating procedures to maintain and improve internal quality systems.

1. T
hree recently completed case studies
have verified that industrial flourmills
in Chile, Indonesia, and the Republic
of South Africa (RSA) have rigorous
internal controls to confirm that their
products comply with country standards
for fortification. While other types
of monitoring varied considerably,
the studies show that milling leaders
have developed standard operating procedures to maintain and
improve internal quality systems.
“We are pleased to see that these flour millers are at the
forefront of ensuring that their customers receive the health
benefits from fortification,” said Helena Pachón, Senior Nutrition
Scientist for the Food Fortification Initiative (FFI). The studies
are a collaborative effort between UNICEF, FFI, and the U.S.
Centers for Disease Control and Prevention.
Research for the case studies included interviewing government
personnel responsible for monitoring fortification and visiting
mills, bakeries, food retail outlets, inspection laboratories, and
companies that produce vitamin and mineral premix. The authors
found that the industry had instituted regular physical and visual
control points. Industry procedures used for internal monitoring
in the three countries included:
• Check weighing the premix feeder. This is when a miller
weighs the amount of premix discharged by the premix feeder
over one to two minutes then compares the amount to the
weight of premix expected to be discharged over that period.
• Ensuring that the feeder is working properly. This involves
confirming that the feeder has adequate amounts of premix and
that it is delivering the required quantity of premix.
• Recording results of fortification checks. This includes keeping
accurate records, such as the amount of premix used compared
to the amount of flour produced, so if a variation from the
norm is noted, it can be resolved.
Several resources are available to help plan monitoring
programs. For example, the FFI website has a page about internal
quality control at http://www.ffinetwork.org/monitor/internal.
html. The Flour Millers Toolkit at http://www.ffinetwork.org/
implement/toolkit.html, which offers a section on assuring quality
control at the mill. The World Health Organisation and the Food
and Agriculture Organisation of the United Nations discuss other
types of monitoring in detail in the book “Guidelines on Food
Fortification with Micronutrients”. See http://www.who.int/
nutrition/publications/micronutrients/9241594012/en/
Yet, the collaborating partners for these case studies determined
that very little information was available on how fortification
monitoring operates in real-world settings. The case studies
consequently looked at the strengths and challenges of actual
monitoring systems in three regions.
Rigorous internal monitoring was one of the few things the
countries had in common. Among the highlights from the other
types of monitoring are:
• Chile has the most comprehensive external monitoring plan in
which government regulators conduct a strategically planned
and financed program. The program focuses on the point of
production and on-site warehouses with some review of the
mill’s internal records of fortification monitoring. Warnings
and sanctions are issued if flour samples are non-compliant
in two or more micronutrients. Results of Chile’s monitoring
activities are published annually on the Ministry of Health
website.
• Indonesia has the most extensive commercial monitoring
program as it concentrates efforts on the retail sector.
Commercial monitoring assesses whether flour being sold at
retail establishments is properly fortified.
• Indonesia is the only country of the three studied with
significant amounts of imported flour. All premix shipments
require a Certificate of Analysis at Customs, but a lack of
laboratory resources and funding restrict regular monitoring of
imported flour.
• Chile is the only country of the three studied with a household
and individual monitoring aspect of the fortification program.
This determines whether fortified flour is available and being
used by specific population groups.
• All three countries have some health impact evaluation
component, which determines whether the nutritional goals of
the program are being met. Some of the impact evaluations are
Flour millers in three countries demonstrate
‘rigorous’ fortification monitoring
by Sarah Zimmerman, Food Fortification Initiative
FORTIFICATION
MONITORING
FLOUR
32 | Milling and Grain
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2. conducted through non-governmental special projects. This
information can be used to improve fortification to achieve the
maximum health benefits. For example, the Republic of South
Africa is using its impact evaluation to reconsider the levels
and type of iron used in fortification.
While the case studies reviewed all aspects of monitoring, not
all components are needed for every flour fortification program.
Commercial monitoring of packaged flour may not be needed, for
example, if most flour is distributed to bakeries rather than sold at
retail outlets. And import monitoring may not be needed if most
flour is domestically produced.
Ideally fortification monitoring programs are created by
Ramadan Deliu, Head of Laboratory at M & Sillosi
Milling Company in Kosovo, prepares flour for an iron
spot test. Photo credit: Kate Wheeler
February 2015 | 33
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3. multiple-sector stakeholders who consider the country’s capacity
to measure the program’s performance. The stakeholders can
evaluate the human, technical, and financial requirements for
effective monitoring then design a fortification program with the
resources needed to implement a monitoring program.
In most cases, however, it is logical for national fortification
programs to include at least internal and external monitoring,
Pachón said. Internal monitoring at the production site identifies
and resolves issues quickly before problems become widespread.
Since flour milling is typically a centralised industry, external
monitoring of a smaller number of mills is usually more
practical than commercial monitoring of thousands of retail
establishments.
As the next step, collaborating partners reviewed the case
studies to identify key components for successful monitoring
programs. This led to several questions that are being asked of all
countries that legislate fortification of wheat flour, maize, flour,
and/or rice. The questions include:
• Is there a national committee that oversees the flour
fortification program?
• Are rules and operating procedures by national authorities
for external monitoring, commercial monitoring and import
monitoring of flour fortification stipulated in a document?
• Has a national report on the status of wheat flour fortification
monitoring and compliance been compiled?
• Has an impact evaluation of the wheat flour fortification
program been completed?
This information will be added to FFI’s database on global
fortification progress and become a resource for countries
wanting to design or improve fortification monitoring programs.
A good example of a well-designed evaluation is an effectiveness
evaluation of the food fortification program in Costa Rica. The
study, published in the American Journal of Clinical Nutrition
in November 2014, indicates that fortification is the
plausible cause of improved iron status and reduced
anemia there.
Costa Rica had been using reduced iron in wheat
flour; however, it is not an effective iron compound for
fortification. In 2002, the fortification standard for wheat
flour was changed to include ferrous fumarate. Also,
ferrous bisglycinate was added to maize flour in 1999
and to liquid and powdered milk in 2001. The study used
national surveys and sentinel sites before and after those
years to gather baseline and follow up data. Authors
also gathered monitoring data and found that foods were
fortified as mandated.
The results showed that anemia declined in women
(from 18.4 percent to 10.2 percent) and children (from
19.3 percent to 4.0 percent). Fortification of milk and
wheat flour provided about half the estimated average
requirement for iron in children. In children, iron
deficiency declined from 26.9 percent to 6.8 percent,
and iron deficiency anemia, which was 6.2 percent at
baseline, could no longer be detected at the follow up
assessment.
FFI has traditionally tracked the number of countries
with legislation to fortify wheat flour. In 2004, 33
countries had documented national regulations for
adding essential vitamins and minerals to wheat flour. By
31 December 2014, 81 countries had such legislation, 12
countries included maize, and six countries required rice
fortification.
While the increase in legislation is progress,
fortification must be well implemented and monitored
for it to have the desired health impact. The industry’s
role in internal monitoring, as documented in these case
studies, is a positive step toward that goal.
CASE STUDIES
A number of case studies that support this article are
available online:
Chile: www.ffinetwork.org
/monitor/Documents/ChileCS.pdf
Indonesia: www.ffinetwork.org
/monitor/Documents/IndonesiaCS.pdf
South Africa: www.ffinetwork.org
/monitor/Documents/SouthAfricaCS.pdf
34 | Milling and Grain
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4. Mühlenchemie –
we never sleep.
As the international market leader in flour im­
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operates in over 100 countries worldwide. Our
branches in Germany, Singapore, Brazil, China,
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of which we have several around the globe.
So when the staff of our facility in Wujiang, near
Shanghai, make their way home at the end of
the day, work has already started in Mexico
City – and of course no­one turns the light off
before an individual solution has been found
for each of our customers.
German Quality made by Mühlenchemie.
• Flour improvement
• Flour standardization
• Fortification with vitamins
and minerals
• Flour analysis
• Applications services
• Metering equipment
for micro-ingredients
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