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Nutrition International, EPHI partner to reduce incidences of NTDs

Nutrition International – a global nutrition organization and the Ethiopian Public Health Institute (EPHI) have jointly launched a project that will enable the sample production and market testing of table salt fortified with folic acid and iodine, and reduce the incidence of Neural Tube Defects (NTDs).
NTDs are a group of congenital anomalies (physical abnormality present from birth) including anencephaly (a baby is born without parts of the brain and skull) and spina bifida (birth defect of the spine) in a fetus.
NTDs are formed within the first 18 days of a pregnancy, often before a woman knows she is pregnant. While anencephaly always results in early death, lucky survivors of spina bifida may adjust to a life-long disability through rehabilitation and surgery.
Studies indicate that in Ethiopia, the live birth rate of babies affected by NTDs may reach up to 13.8 per 1,000 births significantly higher than the African average of 1 – 2.5 with resulted devastating individual, economic, and social costs.
For many populations, it is very difficult to get enough folic acid in a regular diet and prevent NTDs. To supply the required dose, fortifying foods consumed routinely by the great majority of the population such as staples (wheat, rice, oil, etc.) or condiments (sugar, salt, tomato paste, etc.) with folic acid is an alternative.
In many of the countries that have implemented large-scale and mandatory folic acid fortification programs – such as Canada, the United States, Costa Rica, South Africa, Oman and others – the incidence of NTDs consistently declined to 0.5-0.6 per 1,000 live births.
Accordingly, Nutrition International (NI) has designed a project that aims at fortifying Ethiopian produced table salt with folic acid and iodine, i.e. Double Fortified Salt with Iodine and Folic Acid (DSF-IoFA). The project is hoped to reach approximately 25,320,722 women of reproductive age and 11,653,102 adolescent girls. This is more than 35% of the 2022 total population of Ethiopia based on the population projection by the Ethiopian Statistics Agency.
Implemented from 2022-2025 with funding from the Bill and Melinda Gates Foundation, the Project shall conduct product development and market testing of a table salt fortified with iodine and folic acid.
Table salt is selected due to its relatively huge potential of being used in almost all foods, and mostly sourced from a single source in Ethiopia offering an opportunity to centralize the processing, thus at a potentially low cost. In this regard, EPHI shall produce a sample product through its laboratory, and conduct a study on a number of parameters: taste, market acceptability, safety, and economic viability.
The other partner of the Project University of California Davis (UC-Davis) will offer oversight in the scientific process of the research.
At the end of the three-year period, the findings of research and market testing are expected to be published, along with recommendations to the Government of Ethiopia to adopt legislative and policy measures, including development of a mandatory standard of an iodine-folic acid fortified table salt.
EPHI’s Director General, Dr. Mesay Hailu, said, “this workshop will enrich the proposed research plan and its implementation to make sure quality evidence and system-based findings will be produced and goes to policymakers and program developers that will allow them to use our limited resource appropriately and cost-effectively.”
“Today’s workshop will provide a platform for stakeholders to engage, discuss and offer their vital inputs for the successful implementation of the Double Fortification of Salt with Iodine and Folic Acid Research Project,” said NI’s Deputy Country Director, Girma Mamo.
“As a global leader in finding and scaling solutions to malnutrition, Nutrition International is committed to support the Government of Ethiopia’s effort in the prevention and control of all forms of malnutrition and in particular Neural Tube Defect,” Girma added.


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