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Food Fortification THE 2008 UGANDA FOOD CONSUMPTION SURVEY Determining the Dietary Patterns of Ugandan Women and Children PHIL HARVEY ZO RAMBELOSON OMAR DARY MAY 2010 FOOD FORTIFICATION This study was made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Cooperative Agreement No. GHS-A-00-05-00012-00, and by support from the Global Alliance for Improved Nutrition (GAIN) and the World Food Programme (WFP). The contents are the responsibility of the Academy for Educational Development (AED) and do not necessarily represent the views of USAID, the United States Government, WFP, or GAIN. Recommended Citation: Harvey, Phil, Zo Rambeloson and Omar Dary. The 2008 Uganda Food Consumption Survey: Determining the Dietary Patterns of Ugandan Women and Children. A2Z: The USAID Micronutrient and Child Blindness Project, AED, Washington D.C., 2010. Copies of the Study can be obtained from: A2Z: The USAID Micronutrient and Child Blindness Project AED 1825 Connecticut Ave., NW Washington D.C., 20009-5721 Tel: 202-884-8000 Fax: 202-884-8432 E-mail: [email protected] Website: www.a2zproject.org Acknowledgments We thank the authors, Phil Harvey, independent consultant, and Zo Rambeloson and Omar Dary, A2Z-AED, for their valuable contributions in the drafting of this report. We also wish to acknowledge the important contributions of the study’s principle investigator, Associate Professor William Kyamuhangire, and co-investigators Professor Joyce Kikafunda and Dr. Archileo Kaaya, from Makerere University Department of Food Science and Technology. Their efforts went beyond the terms of their contract to organize and carry out the field work of this study. And as representatives of the institution responsible for the monitoring and evaluation component of the Ugandan National Food Fortification Program, they were able to provide valuable input regarding the fortification program, as well as realities and constraints on the ground in Uganda. We express our appreciation to the following individuals and institutions for their important contributions to the study: Abdelrahman Lubowa, collaborator nutrition, and Juliana Kalibbala, collaborator statistician from the Uganda Bureau of Statistics; Dr. Madraa Elizabeth, head, Department of Nutrition, Ministry of Health; Maureen Ndahura Uganda Ministry of Health program assistant/food fortification and other members of the National Working Group on Food Fortification; the staff of HarvestPlus/Uganda; Dr. Christine Holz, formerly of HarvestPlus; Martin Ahimbisibwe, nutritionist, World Food Program/Uganda; Louise Sserunjoji, Dr. Barbara Macdonald, and James Wirth, Global Alliance for Improved Nutrition (GAIN); Dr. Alfred Boyo, Ronald Afidra, Dr. Rolf Klemm, and other staff of A2Z-AED in Uganda and Washington DC; Jean Baker, AED, Dr. Ame Stormer, Veronica Lee, and Richard Semakula; Professor Rosalind Gibson, Department of Nutrition, University of Otago, New Zealand; Dr. Rafael Flores, program director, IMMPaCt- CDC, Dr. Anne Swindale, director, FANTA2-AED, and Dr. Alicia Carriquiry, Iowa State University. We also thank Joan Whelan, A2Z-AED, for her support with technical editing and 2 writing on the final drafts, as well as Uganda Chartered Healthnet for providing the PDAs used in data collection. 3 TABLE OF CONTENTS ACRONYMS AND ABBREVIATIONS ............................................................................................................ 6 PREFACE ................................................................................................................................................................. 7 EXECUTIVE SUMMARY ...................................................................................................................................... 8 I. INTRODUCTION AND METHODS ......................................................................................................... 11 Nutrition Situation in Uganda ........................................................................................................................................ 11 Food Fortification in Uganda .......................................................................................................................................... 11 Rationale for the study .................................................................................................................................................... 12 Objectives ........................................................................................................................................................................... 13 Institutional Partnerships ................................................................................................................................................. 13 II. METHODS ...................................................................................................................................................... 14 Study components ............................................................................................................................................................ 14 Study Sample ...................................................................................................................................................................... 14 Ethical Review .................................................................................................................................................................... 16 Data Collection ................................................................................................................................................................. 16 Data Analysis ...................................................................................................................................................................... 19 Strengths and limitations of the study .......................................................................................................................... 22 III. RESULTS .......................................................................................................................................................... 23 Socioeconomic Characteristics and Dietary Intakes ................................................................................... 23 Description of the Sample .............................................................................................................................................. 23 Food Group Intakes ......................................................................................................................................................... 25 Macronutrient Intakes ...................................................................................................................................................... 28 Micronutrient Intakes ....................................................................................................................................................... 30 Frequency of Consumption of Food Fortification Vehicles and the Amounts Consumed ............................. 31 Estimated Additional Intakes of Micronutrients through Mass Fortification ......................................... 33 Predicted Reduction in Inadequate Vitamin A Intake Due to Fortification ........................................................ 33 Predicted Reduction in Inadequate Intakes of Micronutrients in Kampala due to Flour Fortification ......... 35 Prevalence of Usual Intakes Exceeding the Tolerable Upper Intake Level (ULs) after Fortification with Folic acid and Vitamin A (Retinol) ................................................................................................................................. 38 IV. DISCUSSION ................................................................................................................................................. 39 Key Findings and Conclusions ........................................................................................................................................ 40 Policy and Program Implications ................................................................................................................................. 443 V. REFERENCES ................................................................................................................................................. 46 4 VI. ANNEXES ....................................................................................................................................................... 48 Annex 1: Districts of Uganda included in the survey, sampling size calculation, and sampling framework 48 Annex 2: Analyses that determine the risk of usual intakes being greater that the Upper Limits (ULs) of folic acid and retinol ......................................................................................................................................................... 52 Annex 3: DRI Values and Estimated Intakes of Micronutrients in Kampala (Kamp), and South-Western (S-W) and Northern (North) Regions of Uganda-2008 .......................................................................................... 60 Annex 4: Detailed results of the projected impact of fortification on prevalences of inadequate intake, with standard deviations .................................................................................................................................................. 62 Annex 5: Probability
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