Abt’s B-FACT Tool Helps Tailor Nutrition Interventions

Roughly 1.5 billion people worldwide don’t get enough vitamins or minerals. That creates a public health danger. The resulting micronutrient deficiencies increase the risk of many diseases, including anemia, eye disorders, rickets, scurvy and goiter. The deficiencies also contribute to weakened immune systems and greater risk of death.

Proven food-based and agricultural interventions can address micronutrient deficiencies. The difficulty is knowing which mix of interventions is the right one for a given context.  Abt developed a tool, the Biofortification-Fortification Assessment Coverage Tool (B-FACT), to help policymakers decide which approach to use based on local food habits. The tool also can help agriculture and nutrition experts work together to coordinate their approach instead of in isolation, as is commonly the case. 

Potential interventions include:

• Biofortification: breeding commonly consumed crops with micronutrients.
• Fortification: adding micronutrients during processing of products such as flour, oil and sugar.
• Supplements: vitamin tablets or adding micronutrient powder to food at home.
• Dietary diversification: persuading people to eat a greater variety of foods with different nutrients (e.g., green leafy vegetables, mangoes, papayas and animal proteins).

Existing data collection and assessment tools typically focus on one kind of intervention: biofortification (HarvestPlus’s Biofortification Prioritization Index) or fortification (Fortification Assessment Coverage Toolkit). These tools focus on a few key questions: Are people consuming a potentially fortifiable product? Are people growing and consuming crops that could be biofortified? If researchers assess only the reach of biofortifiable crops, they might not consider a widely consumed product producers could fortify. Or they might add micronutrients to a product that reaches consumers who get that micronutrient through other food sources.

That’s where B-FACT can help. It assesses the potential reach of both biofortification and fortification while considering potential for interventions that improve dietary diversity. In doing so, B-FACT provides a planning tool to determine the most efficient use of resources to reach vulnerable populations. It also uses current data, rather than projecting potential impacts using uncertain assumptions. 

B-FACT assesses current crop production and consumption patterns. It assesses access to fortified products, fortifiable products, biofortiable products, and micronutrient-rich foods. In doing so, it identifies the most at risk population for micronutrient deficiencies. It also identifies the micronutrient interventions with the greatest potential of success based on household consumption patterns. Households that have access to fortifiable products, for example, are best served through fortification interventions.

Consider an application in Eastern Utter Pradesh in India. We used B-FACT to analyze food consumption and micronutrient gaps. We found that 96 percent of rural households lack access to zinc-fortified products or zinc-rich foods. No viable zinc fortification products exist, which suggests that biofortification has high potential. The tool showed rice biofortified with zinc could reach 84 percent of households, and wheat biofortified with zinc could reach 20 percent of households. We also found that rice biofortified with iron could be more effective than double-fortified salt to address existing iron deficiencies because households don’t like the double-fortified salt. The bottom line: biofortification has high potential to address zinc and iron deficiency. And we know some other foods to target for interventions that improve the quality of diets: foods with vitamin A, which 80 percent of households have access to, but are likely not consumed in the ideal quantity.

In rural northern Nigeria, vitamin A, zinc and iron all are issues. Fortification may be a more promising solution for vitamin A deficiency, given the consumption of fortifiable products, even among rural households. For example, food seasoning is a widely consumed, fortifiable product but fortification of it is voluntary. Making fortification mandatory could have more impact than biofortified crops. Sugar fortified with vitamin A also has rural reach and has potential if fortification is more consistently implemented than it is now. On the other hand, biofortification could play a major role in addressing iron and zinc deficiency because iron and zinc fortification is not as efficacious as it is for vitamin A, and access to zinc and iron-rich foods is low.

Policymakers need to assess the potential of fortification, biofortification and other interventions to improve diet quality to determine the ideal mix of interventions. And they need to take into account whether socio-political contexts affect the feasibility of one approach over another.  

B-FACT thus can tell policymakers what their best bets are for an area and monitor progress over time. It doesn’t guarantee success. But the comparative data B-FACT can provide increases the odds that a solution will work.