A knowledge-to-action approach to food fortification: Guiding principles for the design of fortification programs as a means of effectively addressing micronutrient malnutrition


The gap that exists between research and the dissemination and implementation of research findings has been well established. Food fortification, one of the most cost-effective means of addressing micronutrient malnutrition, is no exception. With decades of implementation experience, there is need to strengthen mechanisms that effectively broadcast proven strategies to promote the successful implementation of fortification programs in changing, challenging, and dynamic environments. This requires clear channels of communication, well-defined in-country leadership, and a streamlined and focused approach that can be adapted to country-specific contexts. Based on experience designing and implementing fortification programs throughout Africa and a broad understanding of past successes and failures, a model is proposed that articulates often over-looked program elements critical to design and implementation.

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Rowe, L. and Dodson, D. (2012) A knowledge-to-action approach to food fortification: Guiding principles for the design of fortification programs as a means of effectively addressing micronutrient malnutrition. Health, 4, 904-909. doi: 10.4236/health.2012.410138.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Haines, A., Kuruvilla, S. and Borchert, M. (2004) Bridging the implementation gap between knowledge and action for health. Bulletin of the World Health Organization, 82, 724-732.
[2] Melgaard, B. (2004) From research to action—A bridge to be crossed. Bulletin of the World Health Organization, 82, 723.
[3] Pfeffer, J. and Sutton, R.I. (2000) The knowing doing gap. Harvard Business School Press, Boston.
[4] Rogers, E.M., Singhal, A. and Quinlan, M.M. (2009) Diffusion of innovations. In: Stacks, D. and Salwen, M., Eds., An Integrated Approach to Communication Theory and Research, Lawrence Erlbaum Associates, Mahwah, 418-434.
[5] Pang, T., Pablos-Mendez, A. and IJsselmuiden, C. (2004) From Bangkok to Mexico: Towards a framework for turning knowledge into action to improve health systems. Bulletin of the World Health Organization, 82, 720-721.
[6] McCannon, C.J., Berwick, D.M. and Massoud, M.R. (2007) The science of large-scale change in global health. Journal of the American Medical Association, 298, 1934-1939. doi:10.1001/jama.298.16.1937
[7] Green, L.W., Ottoson, J.M., Garcia, C. and Hiatt, R.A. (2009) Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annual Review of Public Health, 30, 151-174. doi:10.1146/annurev.publhealth.031308.100049
[8] Committee on Micronutrient Deficiency (1998) Prevention of micronutrient deficiencies: Tools for policymakers and public health workers. National Academy Press, Washington DC.
[9] Rawe, K., Jayasinghe, D., Mason, F., Davis, A., Pizzini, M., Garde, M. and Crosby, L. (2012) A life free from hunger: Tacking child malnutrition. http://www.savethechildren.org.uk/sites/default/files/docs/A%20Life%20Free%20From%20Hunger%20UK%20low%20res.pdf.
[10] Micronutrient Initiative (2009) Investing in the future: A united call to action on vitamin and mineral deficiencies. Micronutrient Initiative, Ottawa.
[11] Solomons, N.W. (2011) Sight and life luncheon forum on contributions of micronutrients to achieve the MDGs. Sight and Life, 25, 76-80.
[12] Center for Disease Control (CDC) (2012) March of dimes. http://www.cdc.gov/immpact/micronutrients/index.html#Folate
[13] Victoria, C.G., Adair, L., Fall, C., Hallal, P.C., Martorell, R., Richter, L. and Sachdev, H.S. (2008) Maternal and child undernutrition: Consequences for adult health and human capital. The Lancet, 371, 340-357. doi:10.1016/S0140-6736(07)61692-4
[14] Barker, D.J.P. (1998) In utero programming of chronic disease. Clinical Science, 95, 115-128. doi:10.1042/CS19980019
[15] Mundial, B. (2006) Repositioning nutrition as central to development: A strategy for large-scale action. World Bank Publications, Washington DC.
[16] Horton, S. (1999) The economics of nutritional interventions. In: Semba, R.D. and Bloem, M.W., Eds., Nutrition and Health in Developing Countries. Humana Press, Inc., Totawa, 859-871.
[17] World Health Organization (2006) Guidelines on food fortification with micronutrients. World Health Organization, Geneva.
[18] (2008) Copenhagen consensus results. http://www.copenhagenconsensus.com/Files/Filer/CC08/Presse%20%20result/CC08_results_FINAL.pdf
[19] Horton, S. (2006) The economics of food fortification. Journal of Nutrition, 136, 1068-1071.
[20] Kim, S.S. (2009) Developing a national food fortification program in the dominican republic. In: Pinstrup-Anderson, P. and Cheng, F., Eds., Case Studies in Food Policy for Developing Countries, Cornell University Press, Ithaca, 57-68.
[21] Bishai, D. and Nalubola, R. (2002) The history of food fortification in the US: It’s relevance for current fortification efforts in developing countries. Economic Development and Cultural Change, 51, 37-53. doi:10.1086/345361
[22] Mora, J., Dary, O., Chinchilla, D. and Arroyave, G. (2009) Vitamin a sugar fortification in Central America: Experience and lessons learned. MOST/US Agency for International Development, Washington DC.
[23] Gottlieb, J. (2012) Center for global development. Case study #16: Prevention of neural-tube defects in Chile. http://www.cgdev.org/doc/millions/MS_case_16.pdf
[24] GAIN (2012) National food fortification program. http://wwws.gainhealth.org/programs/gain-national-food-fortification-program
[25] GAIN (2010) China soy sauce fortification project. http://www.gainhealth.org/project/china-soy-sauce-fortification-project
[26] De Wals, P., Tairou, F., Van Allen, M., Uh, S.H., Lowry, R.B., Sibbald, B., Evans, J.A., Van den, Hof, M.C., Zimmer, P., Crowley, M., Fernandez, B., Lee, N.S. and Niyonsenga, T. (2007) Reduction in Neural-tube defects after folic acid fortification in Canada. New England Journal of Medicine, 357, 135-142. doi:10.1056/NEJMoa067103
[27] Fiedler, J.L. and Macdonald, B. (2009) A strategic approach to the unfinished fortification agenda: Feasibility, costs, and cost-effectiveness analysis of fortification programs in 48 countries. Food and Nutrition Bulletin, 30, 283.
[28] Serdula, M., Pena-Rosas, J.P., Maberly, G.F. and Parvanta, I. (2010) Maximizing the impact of flour fortification to improve vitamin and mineral nutrition in populations. Food and Nutrition Bulletin, 31, S86-S93.
[29] Lotfi, M., Manar, M.G.V., Merx, R.J.H.M. and Naber-van den, Heuvel, P. (1999) Micronutrient fortification of foods: Developing a program. Journal of Food Technology in Africa, 4, 2-4.
[30] Spahn, K. (2009) How to effectively scale up interventions and actions that address malnutrition: Three cases from Helen Keller international. In: von Braun, J., Vargas Hill, R., and Pandya-Lorch, R. Eds., The Poorest and Hungry: Assessments, Analyses, and Actions 2020. IFPRI, Washington DC, 315-320.
[31] Haas, J.H. and Miller, D.D. (2006) Overview of experimental biology 2005 symposium: Food fortification in developing countries. The Journal of Nutrition, 136, 1053-1054.
[32] Mehansho, H. (2006) Iron fortification technology development: New approaches. The Journal of Nutrition, 136, 1059-1063.
[33] Allen, L. (2006) New approaches for designing and evaluating food fortification programs. The Journal of Nutrition, 136, 1055-1058.
[34] Mannar, V. and Gallego, E.B. (2002) Iron fortification: Country level experiences and lessons learned. The Journal of Nutrition, 132, 856S-858S.

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