ASSESSMENT OF IRON FORTIFICATION OF RICE AND IODIZATION OF SALT SOLD IN SOME CITIES IN PNG V J TEMPLE , N KYAKAS, S GRANT, J BAUTAU, H. KAI, D SIRI, Micronutrient Research Laboratory BMS SMHS UPNG JAMES TEIO & DIANA KAVE Environmental Health NDOH PNG PROJECT SPONSORED BY WHO via EH NDOH (July to October 2019) 1
BACKGROUND • Micronutrient deficiency “ Hidden Hunger ” is a major obstacle to sustainable development; • Hidden Hunger (HH) increases the risk factors for disease burden, economic and social deprivation, because of its long ranging negative effects on vulnerable groups in the population [Lindsay 2000; UNICEF/WHO 2012] ; • It affects Public Health policies and strategies for prevention and control of Malaria, TB, HIV/AIDS and other diseases [UNICEF/WHO 2012, Temple 2012]; 2
Background cont … • IRON & IODINE deficiencies are 2 examples of HH, • Elimination or significant reduction of HH among women and children is a public health priority , • Anaemia is world’s 2nd leading cause of disability among children, non-pregnant, pregnant and lactating women [WHO/UNICEF 2006, 2014] ; • About 50% of all cases of anaemia are due to Iron deficiency [Steiger et al 2014, FFI 2014]; • Iron fortification of staple foods is the recommended long-term cost-effective strategies for control and prevention of Iron deficiency among at-risk group; 3
Background cont … • 2005 PNG National Nutrition Survey indicated anaemia prevalence of 40.0% [PNG NNS 2005]; • Legislation for mandatory fortification of white rice was introduced in PNG in 2007 [NDON 2007 ]; • According to the policy: • 100g of white Rice must contain at least • 0.5mg of Vitamin B1, • 6.0mg of Vitamin B3, • 3.0mg of Iron 4
Background cont … • Iodine deficiency is the world’s greatest single cause of preventable mental retardation [IGN 2007] • Mild to moderate iodine deficiency in apparently healthy children can cause: • Stunted growth, • Impaired learning ability, • Underperformance in school, • Poor performance in psychometric tests, • Impaired physical and cognitive functions • Reduced capacity for critical thinking ; 5
Background cont … • Iodine deficiency in adults causes : • low work capacity, • reduced productivity, • dry scaly skin, • tingling and numbness in extremities, • forgetfulness, • depression, • personality changes, • anemia, 6
Background cont … • Universal Salt Iodization (USI) is the strategy for control of Iodine deficiency ; • USI strategy was implemented in PNG in June 1995 with enactment of PNG Salt Legislation that prohibits importation, production and sale of non- iodised salt [Barter 1995] • PNG Food Sanitation Regulation states that iodine content in salt should not be less than 30.0ppm (30mg of iodine per kilogram of salt) [NDOH 2007] ; 7
The Issues: • Current situation with Iron fortification of white rice and salt fortification with Iodine raises some major questions : • Are the different brands of white rice sold in PNG fortified with Iron? • Rice can be fortified either by Kernels or Dusting technologies; what type of technology is used for fortification of white rice with iron in PNG? • Are the different brands of salt sold in PNG adequately fortified according to PNG standard? 8
Objectives • Major objective of this project was to assess the extent of compliance with national fortification standards for rice and salt sold in some cities ; • Samples of all brands of rice and salt commonly sold in selected cities were collected, so as to determine the number of brands that are fortified according to the national standards; 9
METHODOLOGY in brief: • Qualitative assessment of Iron in white rice [FFI 2014]: • Two techniques are used for fortification of white rice with Iron; • Fortification with Kernels, • Fortification by Dusting , • Standard Operating Procedure (SOP) : • Qualitative spot test was used to detect presence of Iron in fortified white rice ( courtesy Food Fortification Initiative ) 10
METHODOLOGY in brief: • WYD protocol used to quantitatively assess Iodine content in salt; • It measures amount of iodine in salt iodized with Potassium Iodate or Potassium Iodide • Amount of iodine is expressed in parts per million (ppm): • 1.0 mg iodine per kilogram of salt (mg/kg) {1.0 mg/kg = 1.0 ppm}; 11
METHODOLOGY in brief: • Qualitative assessment of Iron in white rice • Standard Operating Procedure (SOP) : DIAGRAMS 12
Fortified rice before spraying with SOP 13
Rice fortified by Kernel after spraying with SOP 14
Rice fortified by Dusting after spraying with SOP 15
Rice fortified by Dusting and Kernel after spraying with SOP 16
FINDINGS AND COMMENTS • 149 rice samples were received, • They were sorted using the brand codes and names provided by the EHO NDOH; • There were 21 different brands of rice ; • Rice samples were from 11 cities • SOP was used to assess each rice sample for presence of Iron; • The 149 rice samples were sorted according to the method used for iron fortification; • Results obtained are presented in Table 1; 17
Table 1: Summary of rice fortification results for rice sold in 11 cities in PNG Percent of Rice samples fortified by Brands (N) Rice (N) DUSTING KERNEL MIXED NEGATIVE CITIES HELA 2 2 0 50% 50% 0 GOROKA 13 13 15.4% 61.5% 15.4% 7.7% POM 19 19 5.3% 68.4% 5.3% 21.0% ALOTAU 9 9 11.1% 77.8% 11.1% 0 LAE 12 12 8.3% 66.7% 16.7% 8.3% MADANG 14 15 13.3% 73.3% 6.7% 6.7% VANIMO 6 6 50% 50% 0 0 KIMBE 11 11 0 90.9% 0 9.1% BIALLA 9 9 22.2% 77.8% 0 0 RABAUL 15 35 22.9% 65.7% 2.8% 8.6% KERAVAT 13 18 27.8% 50% 22.2% 0 18
FINDINGS AND COMMENTS • In PNG, rice is commonly washed before cooking; the major reason is to remove dust and to ensure that the rice is clean; • Washing of the rice and discarding the water results in significant loss of the iron fortificant, especially if dusting method is used; • Show diagrams 19
Water from unfortified rice washed once Water from rice fortified with Kernel was sprayed with SOP washed once. Water sprayed with SOP Water from rice fortified with Kernel: After Water from rice fortified with kernel. 2 nd wash. Water sprayed with SOP After 3 rd wash. Water sprayed with SOP 20
Water from unfortified rice washed once Water from rice fortified by dusting was sprayed with SOP washed once. Water sprayed with SOP Water from rice fortified by dusting: After Water from rice fortified by dusting. After 2nd wash. Water sprayed with SOP 3rd wash. Water sprayed with SOP 21
Iron fortification cont….. • Our results underscore the urgent need to advocate for the inclusion of Iron fortification of wheat flour in the PNG Food Fortification policy; • In PNG, the use of wheat flour in food preparation does not include washing the flour before cooking; thus, Iron fortification of flour has a greater potential in improving the Iron status of the population, than that of rice (which is commonly washed before cooking); 22
Salt iodization • Total of 50 salt samples were received; • They were sorted using the brand codes and brand names provided by the EHO NDOH; • Salt samples were from 7 cities excluding POM, • Samples from POM were purchased by lab • There were 16 different brands of salt; 23
Salt iodization • Results for iodine content in salt from 7 cities were sorted according to cut-off points in PNG Salt Legislation: Cut-off points used: No Iodine: Iodine below 5.0mg/kg Inadequate iodine: Iodine: 5.0 to 29.9mg/kg Adequate iodine: Iodine: 30.0 to 50.0mg/kg; Excess iodine: Iodine above 50.0mg/kg ; Criteria for interpretation of results: For effective implementation: Over 90% of salt samples MUST be adequately iodized 24
Table 2: % Distribution of iodine content in salt from 7 cities + POM according to cut-off points in PNG salt legislation Percent of salt samples with iodine content: NO IODINE INADEQUATE ADEQUATE EXCESS <5.0mg/kg 5 – 29.9mg/kg 30 – 50mg/kg > 50mg/kg CITIES Salt Brands (N) (N) HELA 2 2 0 0 50% 50% GOROKA 8 7 0 25% 37.5% 37.5% ALOTAU 6 4 0 0 50% 50% LAE 8 6 0 12.5% 50% 37.5% MADANG 10 7 0 30% 50% 20% KIMBE 10 10 10% 40% 40% 10% RABAUL 6 3 16.7% 16.7% 33.3% 33.3% POM 11 10 27.5% 27.5% 27.5% 18.2% 25
Salt iodization • This criterion has not been fulfilled in any of the cities; • The adequately iodized salt coverage was 50% in four cities at the time of this project; • This indicates poor implementation of PNG Salt Legislation; 26
Salt iodization • One generally accepted concept is that it is better to consume salt containing more iodine that less iodine [UNICEF/WHO/ICCIDD 2007] • Table 3 shows recalculation of the results for availability of iodized salt in the 7 cities + POM; • This was done by combining salt samples with adequate and excess iodine; 27
Table 3: Combined % distribution of adequate and excess iodine content in salt from the 7 cities + POM based on the cut-off points in PNG salt legislation Percent of salt samples with iodine content: No iodine Inadequate Adequate Excess Combined CITIES Salt Brands <5.0mg/kg 5 – 29.9mg/kg 30 – 50mg/kg >50mg/kg (mg/kg) (N) (N) HELA 2 2 0 0 50% 50% 100% GOROKA 8 7 0 25% 37.5% 37.5% 75.0% ALOTAU 6 4 0 0 50% 50% 100% LAE 8 6 0 12.5% 50% 37.5% 87.5% MADANG 10 7 0 30% 50% 20% 70.0% KIMBE 10 10 10% 40% 40% 10% 50.0% RABAUL 6 3 16.7% 16.7% 33.3% 33.3% 66.6% POM 11 10 27.3% 27.3% 27.3% 18.2% 45.5% 28
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