Household income and expenditure surveys: A tool for accelerating the development of evidence-based fortification programs

Background. One-third of the worlds population suffers from micronutrient deficiencies due primarily to inadequate dietary intake. Food fortification is often touted as the most promising short- to medium-term strategy for combating these deficiencies. Despite its appealing characteristics, progress in fortification has been slow. Objective. To assess the potential of household food purchase data to fill the food-consumption information gap, which has been an important factor contributing to the slow growth of fortification programs. Methods. Household income and expenditure survey (HIES) data about: (a) a population's distribution Of apparent household consumption, which are essential to setting safe fortification levels, (b) the proportion of households purchasing 'fortifiable food, and (c) the quantity of food being purchased were used to proxy food-consumption data and develop suggested fortification levels. Results. The usefulness of the approach in addressing several common fortification program design issues is demonstrated. HIES-based suggested fortification levels are juxtaposed with ones developed using the most common current approach, which relies upon Food and Agriculture Organization (FAO) Food Balance Sheets. Conclusions. Despite its limitations, the use of HIES data constitutes a generally unexploited opportunity to address the food-consumption information gap by using survey data that nearly every country of the world is already routinely collecting. HIES data enable the design of fortification programs to become more based on country-specific data and less on general rules of thumb. The more routine use of HIES data constitutes a first step in improving the precision of fortification feasibility analyses and improving estimates of the coverage, costs, and impact of fortification programs.