Empowering Health: Rice Fortification’s Role in Eradicating Vitamin and Mineral Deficiencies in Women and Children

Empowering Health: Rice Fortification's Role in Eradicating Vitamin and Mineral Deficiencies in Women and Children
Empowering Health: Rice Fortification's Role in Eradicating Vitamin and Mineral Deficiencies in Women and Children

Abstract:

This blog explores the potential of rice fortification as a strategy to combat vitamin and mineral deficiency, particularly among women and children. With alarming rates of anaemia and birth defects reported in national surveys, the need for effective interventions is evident. Government initiatives to distribute fortified rice through various welfare schemes are discussed, along with the phased implementation plan.

The benefits and limitations of fortified rice are evaluated, emphasizing the importance of awareness campaigns and targeted interventions. Through a review of national and international studies, the efficacy of fortified rice in improving health outcomes is demonstrated, highlighting its role in reducing anaemia prevalence and enhancing cognitive and physical performance. The research concludes with recommendations for further research and the importance of scaling up rice fortification efforts to address global nutrition challenges.

Key words: Anaemia, Fortified rice, Hidden hunger, Rice fortification, FRK, Vitamin and mineral deficiency.

Introduction:

Vitamin and mineral deficiency pose significant public health challenges, particularly among vulnerable populations such as women and children. According to the National Family Health Survey (NFHS 5), anaemia affects a substantial proportion of children and women in India, with anaemia prevalence rates reaching alarming levels. Moreover, deficiencies in key nutrients like folic acid contribute to preventable birth defects, underscoring the urgent need for effective interventions.

Government Initiatives in Distribution of Fortified Rice:

The Government of India has recognized the potential of rice fortification in addressing nutritional deficiencies and has initiated various schemes to facilitate its distribution. Through programs such as the Targeted Public Distribution System (TPDS) and the Integrated Child Development Service Scheme (ICDS), fortified rice is being made available to beneficiaries across states and union territories. The phased implementation plan aims to ensure nationwide coverage by 2024, with an emphasis on districts with high exposure to stunting.

Need for Rice Fortification:

In a world where proper nutrition is crucial for overall health, the need for rice fortification emerges as a critical solution to combat widespread deficiencies.

The latest data from the National Family Health Survey (NFHS 5) serves as a stark reminder of the challenges ahead. According to the survey, a staggering 67.1% of children under the age of 5 years are anaemic, pointing towards a concerning trend in early childhood health. Furthermore, the statistics reveal that 57.2% of women in the reproductive age group and 52.2% of pregnant women suffer from anaemia, highlighting the pervasive nature of this issue across different demographics.

Table: 1 Few select NFHS- 5 indicators depicting nutrition status among Indians

Cohort characteristicsAge and other
characteristics
NFHS-5 (2019-21)NFHS-4 (2015-16)Percentage change
BMIWomen18.722.918% Decrease
BMIMen16.220.220% Decrease
Iron folic
consumption
among
mothers when they
were pregnant
for 100 days or more44.130.346% Increase
Iron folic
consumption
among
mothers when they
were pregnant
for 180 days or more2614.481% Increase
Nutritional Status
of Children under 5
years
stunted (height-for-age)35.538.48% Decrease
Nutritional Status
of Children under 5
years
wasted (weight-for-height)19.3218% Decrease
Nutritional Status
of Children under 5
years
underweight (weight-for-age)32.135.810% Decrease
Sourse: NFHS-5 (2019-21)

These numbers underscore the urgency for interventions to address nutritional deficiencies on a large scale. One significant aspect that emerges from the data is the deficiency of folic acid, which plays a crucial role in preventing birth defects.

Changes in prevalence of anaemia among children age 6–59 months from NFHS-4 (2015–16) to NFHS-5 (2019–20).

Source: Created using ArcGIS Pro 2.6 (https://arcgis.pro/download-arcgis-pro-2-6-for-free/)

It’s disheartening to note that many of these defects are preventable, yet they persist due to inadequate nutrition. This revelation emphasizes the importance of fortifying staple foods like rice with essential nutrients, ensuring that individuals, especially vulnerable populations like pregnant women and young children, receive the necessary micronutrients for optimal health.

Table: 2 Percentage of children aged 6–59 months classified as having anaemia (Hb < 11.0 g/dl) by background characteristics, National Family Health Survey, 2016–21

Background characteristicNFHS-4NFHS-5Differencep– value
PrevalenceNumber of childrenp– valuePrevalenceNumber of childrenp– value
Child’s Age (in months)  p < 0.001  p < 0.001  
 6–868.410271 75.27998 6.8p < 0.001
 9–1168.610980 78.78566 10.1p < 0.001
 12–1771.222607 8017107 8.8p < 0.001
 18–2369.922842 78.216391 8.3p < 0.001
 24–3562.345188 70.534155 8.2p < 0.001
 36–4752.347601 6133825 8.7p < 0.001
 48–5944.745547 53.434711 8.7p < 0.001
Sex of the Child  p = 0.862  p = 0.322  
 Male58.4106802 67.279515 8.8p < 0.001
 Female58.798233 6773237 8.3p < 0.001
Birth order  p < 0.001  p < 0.001  
 155.675222 65.661967 10p < 0.001
 2–359.594191 67.775806 8.2p < 0.001
 4–563.721369 70.412119 6.7p < 0.001
 6 or more64.77069 71.22324 6.5p < 0.001
Mother’s education  p < 0.001  p < 0.001  
 No schooling64.961867 71.422223 6.5p < 0.001
  < 5 years complete6012247 707432 10p < 0.001
 5–7 years complete58.732632 70.323497 11.6p < 0.001
 8–9 years complete56.633181 68.531030 11.9p < 0.001
 10–11 years complete55.123756 66.122747 11p < 0.001
 12 or more years complete51.737085 62.545822 10.8p < 0.001
Mother’s anaemia status  p < 0.001  p < 0.001  
 Not anaemic50.685663 6061920 9.4p < 0.001
 Mildly anaemic62.383309 68.740152 6.4p < 0.001
 Moderately anaemic71.327990 74.646149 3.3p < 0.001
 Severely anaemic75.71885 77.13281 1.4p = 0.253
Residence  p < 0.001  p < 0.001  
 Urban5656237 64.242917 8.2p < 0.001
 Rural59.5148798 68.3109835 8.8p < 0.001
Religion  p < 0.001  p < 0.001  
 Hindu58.7160878 67.5122437 8.8p < 0.001
 Muslim59.534233 66.823317 7.3p < 0.001
 Christian44.84149 53.13441 8.3p < 0.001
 Sikh56.32632 70.31940 14p < 0.001
 Buddhist/Neo-Buddhist571622 71.1815 14.1p < 0.001
 Jain53220 72.3252 19.3p < 0.001
 Other68.41302 67550 -1.4p < 0.001
Social group  p < 0.001  p < 0.001  
 Scheduled Castes60.645208 69.536135 8.9p < 0.001
 Scheduled Tribes63.321411 72.414481 9.1p < 0.001
 Other backward Class58.690237 65.265009 6.6p < 0.001
 Other54.246649 65.835749 11.6p < 0.001
 Don’t know61.91530 73.31379 11.4p < 0.001
Wealth quintile  p < 0.001  p < 0.001  
 Lowest6452483 71.530961 7.5p < 0.001
 Second59.745355 69.332889 9.6p < 0.001
 Middle58.940598 67.132072 8.2p < 0.001
 Fourth54.437100 64.230741 9.8p < 0.001
 Highest51.829500 62.626089 10.8p < 0.001
Total58.5205035 67.1152752 8.6p < 0.001
Source: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-16398-w

Rice, being a staple food for a significant portion of the global population, presents a unique opportunity for fortification initiatives to make a widespread impact. By enriching rice with key nutrients such as folic acid, iron, and other vitamins and minerals, we can effectively address multiple nutritional deficiencies in one stroke. This approach not only offers a practical solution to improve public health but also holds the potential to alleviate the burden on healthcare systems by reducing the prevalence of preventable diseases and birth complications.

Following three phases are envisaged for the full implementation of the initiative

As we delve into the ambitious initiative aimed at fortifying rice to address widespread nutritional deficiencies, it’s essential to understand the strategic roadmap laid out for its full implementation. The initiative unfolds in three distinct phases, each designed to progressively expand coverage and impact across the country.

  • Phase-I marks the initial step in this transformative journey, focusing on the coverage of Integrated Child Development Services (ICDS) and the Pradhan Mantri POSHAN Abhiyaan (PM POSHAN) in India. This phase, slated for completion by March 2022, is already in motion, reflecting the commitment to swift action in tackling malnutrition. Through the integration of existing programs and resources, Phase-I lays the groundwork for broader interventions to follow.
  • Building upon the foundation set in Phase-I, Phase-II aims to extend coverage to include the Targeted Public Distribution System (TPDS) and Other Welfare Schemes (OWS) in all targeted districts, with a particular emphasis on areas with high exposure to stunting. With 291 districts identified for focused attention, Phase-II represents a critical juncture in the initiative’s evolution. By incorporating additional support systems and targeting vulnerable communities, this phase aims to deepen the impact and reach of rice fortification efforts, thereby laying the groundwork for sustained progress.
  • The final phase, Phase III, represents the culmination of efforts to scale up rice fortification initiatives nationwide. Building upon the achievements of Phases I and II, Phase III seeks to extend coverage to encompass all remaining districts across the country by March 2024. This comprehensive approach ensures that no corner of the nation is left untouched by the benefits of fortified rice, thereby promoting equity and inclusivity in addressing malnutrition.

Benefits of Fortified Rice:

  • Precise Micronutrient Addition: The quantity of micronutrients added to fortified rice is carefully calculated, minimizing the risk of nutrient overdose.
  • Maintained Intrinsic Characteristics: Fortification methods are designed to preserve the taste, appearance, and texture of rice, ensuring consumer acceptance and satisfaction.
  • Wide Reach: Fortified rice has already been integrated into programs like the Mid-Day Meal scheme for school children and is set to be available at Public Distribution System (PDS) and Anganwadi centers. This ensures that vulnerable communities can quickly benefit from improved nutrition.

Limitations of Fortified Rice:

  • Communication Gap: There exists a significant communication gap between consumers and fortified products. Awareness campaigns led by community health workers are essential to educate the public about the benefits of consuming fortified rice.
  • Limited Benefit for Certain Groups: Population segments such as infants, young children, and elderly individuals who consume relatively small amounts of food may derive fewer benefits from fortified foods, potentially limiting the impact of fortification initiatives

Methodology:

A review of national and international studies was conducted to evaluate the efficacy and effectiveness of fortified rice in addressing micro-nutrient deficiencies. Various sources, including online databases, government websites, and research papers, were consulted to gather evidence on the impact of fortified rice on health outcomes.

Results and Discussion:

The review of studies revealed a consistent positive impact of fortified rice on anaemia prevalence and nutritional status among women and children. Several interventions demonstrated significant improvements in haemoglobin levels and cognitive performance, highlighting the effectiveness of fortified rice in addressing micro-nutrient deficiencies.

Rice Fortification Effectiveness Studies (National)

Rice fortification has emerged as a promising strategy to combat nutritional deficiencies, particularly in regions where rice serves as a staple food. Numerous studies have been conducted to assess the effectiveness of fortified rice in improving health outcomes, with compelling results from various parts of India.

  • In a study conducted by TATA Trusts in 2020^[4], focusing on Gadchiroli, Maharashtra, intervention through the Public Distribution System (PDS) led to a notable reduction of 21.4% in the prevalence of anaemia among 104 women, adolescent girls, and children over one year. This highlights the tangible impact of fortified rice consumption on combating anaemia in vulnerable populations.
  • Mahapatra and colleagues conducted a study in Gujarat, India, in 2021^[5], involving 973 children aged 6-12 years. The intervention, implemented through the mid-day meal program over eight months, resulted in a significant increase in hemoglobin levels by 0.4g/dL. Moreover, anaemia prevalence decreased by 10%, accompanied by improvements in cognitive scores, underscoring the multifaceted benefits of fortified rice on child health and development.
  • In another noteworthy study by Hussain et al. in 2014^[6], focusing on Indian school children, fortified rice consumption over six months led to a significant increase in hemoglobin and serum ferritin levels. Importantly, sensory evaluations revealed that fortified rice was indistinguishable from normal rice, addressing concerns about acceptability and palatability.
  • Additionally, Thankachan et al. conducted a study in Bangalore, India, in 2010^[7], involving 258 children aged 6-12 years. The study assessed the effects of extruded fortified rice kernels (FRK) and found significant improvements in Vitamin B12 and homocysteine concentrations after six months. Moreover, there was notable enhancement in physical performance among the participants, indicating the comprehensive benefits of fortified rice beyond addressing specific nutrient deficiencies.

Discussion:

the evidence from both efficacy and effectiveness studies provides compelling support for the fortification of rice with iron, folic acid, and Vitamin B12. These studies have consistently shown a reduction in the prevalence of anemia among women and significant improvements in cognitive power and physical performance among children.

Such findings underscore the potential of fortified rice as a viable solution to address nutritional deficiencies and improve overall health outcomes, particularly in vulnerable populations. By fortifying rice with essential micronutrients, we have the opportunity to make meaningful strides in combating malnutrition and promoting better health and well-being across communities.

Rice Fortification Effectiveness Studies (International)

  • In Brazil, Arcanjo et al. (2013)^[11] conducted a study involving 171 children aged 10-23 months. The children were administered rice fortified with iron once per week for 18 weeks. The results revealed a significant increase in hemoglobin levels and a reduction in anemia among the infants, highlighting the efficacy of weekly iron-fortified rice supplementation.
  • Moving on to Indonesia, Hardinsyak et al. (2016)^[10] explored the efficacy of fortified rice in a randomized clinical trial involving 216 school teenage girls. The fortified rice, containing 2% of rice kernel, was assessed for acceptability and impact on hemoglobin concentration. The study found that the fortified rice was organoleptically accepted and led to a mean increase of 3.8g/L in hemoglobin concentration among the participants.
  • Similarly, in Mexico, Hotz et al. (2008)^[9] investigated the impact of fortified rice on women aged 18-49 years old. Over a period of six months, participants were administered rice fortified with 13mg/day of iron for five days per week. The study reported a remarkable 80% reduction in the overall prevalence of anemia. Moreover, significant reductions in both anemia and iron deficiency were observed, demonstrating the effectiveness of fortified rice in addressing these nutritional deficiencies.
  • In the Philippines, Angeles-Agdeppa et al. (2011)^[8] conducted a study involving mothers (n=392) and their children aged 6–9 years (n=424). The study assessed hemoglobin levels in both mothers and children before and after supplementation with fortified rice. While statistically significant improvements in hemoglobin levels and anemia were observed in children, similar improvements were not found in their mothers.

Discussion:

A wealth of international research indicates that fortified rice stands as a potent intervention for enhancing micronutrient status, provided optimal quantities of micronutrients and fortificant forms are employed alongside effective technology.

Studies have consistently demonstrated the efficacy of fortified rice in increasing levels of crucial micronutrients such as iron, zinc, folic acid, niacin, and various vitamins including A, B1, B6, and B12. These findings underscore the versatility and potential of fortified rice to address widespread nutrient deficiencies, particularly in populations vulnerable to malnutrition. However, it’s imperative to ensure the careful selection of fortification ingredients and methods, tailored to the specific needs of diverse communities, to maximize the impact of fortified rice interventions globally.

Conclusion:

Rice fortification emerges as a promising intervention to combat vitamin and mineral deficiency among women and children. By leveraging government initiatives and scaling up distribution efforts, fortified rice has the potential to significantly improve health outcomes and reduce the burden of malnutrition. However, sustained efforts and continued research are essential to realize the full potential of rice fortification in addressing global nutrition challenges.

References:

  1. NFHS-5
  2. https://gil.gujarat.gov.in/pdf/Vol9/Newsletter_PDS_06092012.pdf
  3. https://wcd.nic.in/integrated-child-development-services-icds-scheme
  4. Rice fortification pilot study in Gadchiroli, Maharashtra (2020). Endline evaluation & impact assessment report. TATA Truts.
  5. Mahapatra S, Parker ME, Dave N, Zobrist SC, Shajie Arul D, King A, Betigeri A, Sachdeva R.(2021) Micronutrient-fortified rice improves haemoglobin, anaemia prevalence and cognitive performance among schoolchildren in Gujarat, India: a case-control study. International Journal of Food Sciences and Nutrition.
  6. Hussain, S.Z., Singh, B. and Rather, A.H. (2014) Efficacy of micronutrient fortified extruded rice in improving the iron and vitamin A status in Indian schoolchildren. International Journal of Agriculture and Food Science Technology
  7. Thankachan P, Rah JH, Thomas T, Selvam S, Amalrajan V, Srinivasan K, Steiger G, Kurpad AV.(2012) Multiple micronutrient-fortified rice affects physical performance and plasma vitamin B-12 and homocysteine concentrations of Indian school children. The Journal of nutrition.
  8. Angeles-Agdeppa, I., Saises, M., Capanzana, M., Juneja, L. R., & Sakaguchi, N. (2011). Pilot-scale commercialization of iron-fortified rice: effects on anemia status. Food and nutrition bulletin, 32(1), 3–12. https://doi.org/10.1177/156482651103200101
  9. Hotz C, Porcayo M, Onofre G, García-Guerra A, Elliott T, Jankowski S, Greiner T.(2008) Efficacy of iron-fortified Ultra Rice in improving the iron status of women in Mexico. Food and Nutrition Bulletin
  10. Hardinsyah, I., Briawan, D., Budianto, S., Hustina, P., Ghifari, N. and Suhandono, S., (2016). Production and clinical impact study of micronutrients fortified rice for teen girls in Islamic boarding school in Medan, Indonesia. Final report. West Java: Food and Nutrition Society of Indonesia (Perhizi Pangan Indonesia).
  11. Arcanjo FP, Santos PR, Leite ÁJ, Mota FS, Segall SD. (2013) Rice fortified with iron given weekly increases hemoglobin levels and reduces anemia in infants: a community intervention trial. Int. J. Vitam. Nutr. Res
  12. Archana Gupta, Dr. Saba Khan, Rice Fortification: An Effective Approach To Eliminate Vitamin and Mineral Deficiency among women and children.
  13. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-16398-w

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