The term "micronutrient" refers to vitamins and minerals. Most of these cannot be made in the human body. They must be part of the diet or taken as supplements. The human body needs them only in small amounts. For example, a person needs about a teaspoon of iodine over an entire lifetime to ward off the debilitating effects of goitre. Hence the prefix "micro." Failure to ensure an adequate intake of these small quantities could lead to devastating effects called deficiency diseases. These deficiencies can be severe leading to clinical conditions or even marginal deficiencies which could not be observed as any symptoms of a disease but the body lacks these vitamins and minerals.

There are many of these micronutrients. Three of them –iron, vitamin A, and iodine – are the most important ones through out the world :
(a) they are the ones most often found to be deficient in people's diets;
(b) their deficiency leads to grave health, social and economic consequences; and
(c) there are cost-effective strategies, such as fortification and supplementation, to overcome these deficiencies.

Food fortification generally means adding needed micronutrients, as premixes, to staple foods (including condiments) which are produced in commercial units such as flour mills, and commonly consumed in any country. For example, in Venezuela, Ecuador, Brazil and Grenada, wheat and corn flour are fortified with iron and B vitamins. Sugar is fortified with vitamin A in Guatemala, while salt is fortified with iodine in almost every country. Other examples of foods fortified in developing countries include milk, beverages, weaning foods, flat breads, curry powder, rice, biscuits, fish sauce and processed noodles.

Fortified foods can be effective only if they are eaten. Therein lies the challenge. While the technology to fortify a variety of foods with one or more nutrients in medium to large scale commercial units is available and established, there is a distinct knowledge gap in the technology needed for food fortification in small scale units such as tiny flour mills, especially those located in poor, remote regions, serving populations most affected by nutritional deficiencies. In addition, those populations must not only accept the fortified foods, they must afford to pay for it.

On the other hand, supplementation is useful as a short to medium term preventive as well as therapeutic measure when combatting nutritional deficiencies. Supplementation is the provision of nutrients in a tablet, capsule, syrup, tonic or an injection. For example, in drought stricken and other areas where people are at risk of vitamin A deficiency, giving vitamin A supplements to infants older than 6 months and to mothers within 6 weeks of child delivery is widely practised. Where goitre and cretinism are evident, supplementation with iodized oil is an effective solution while salt iodization is being introduced on a commercial scale.
Developing a nutrition strategy, whether involving fortification or supplementation, requires:

Nutrition Needs Assessment:

Before any country embarks upon the program of fortification of staple foods, it must primarily :
(a) identify nutrient deficiencies, their causes, their impact, and the characteristics of the affected or target population (age groups, gender, diets, living/sanitation conditions, income levels, occupations, access to healthcare, etc.) in any given developing country;

(b) for a given deficiency, determine the appropriate nutrients, required nutrient levels and make a preliminary assessment of the suitability of fortification versus other means such as dietary modification and supplementation, drawing on practices employed in comparable situations by NGOs such as UNICEF, WFP, WHO, MI and CARE. A literature search is also recommended. The fortification strategy should consider the total nutrition intake of the target population from all the foods, beverages and any medications they consume;

(c) estimate the nutrient composition of either the premix to be used for fortification, or the supplement to be distributed, as permitted by the existing health or food manufacturing regulations in the target country.

Nutrient Specification:

(a) Having estimated the desired nutrient needs for a given population, and selected fortification or supplementation as the appropriate strategy, one must find out who are the formulators of such premixes available in the country.

(b) The choice of companies who may be contacted for product, pricing and related information could be subject to a number of considerations, including proximity, technical competence and experience in developing premixes, local representation, previous sales to a given organization, and compliance with specific quality assurance standards and overall reliability as a potential supplier

(c) It is equally important to ensure that those premix companies receive information that defines one's needs very clearly, if one expects to establish reasonable dialogue that can lead to successful procurement. From the manufacturers' perspective, the more information they have about the user's local conditions (dietary habits, living conditions, cultural traits, economy, infrastructure, literacy, etc.), the easier it will be to respond to the prospective customer. The initial inquiry sent to premix manufacturers should:
• indicate desired nutrients, target population, and fortification levels (e.g., indicate how much of the target population's recommended daily allowance is to be met);
• indicate preference for fortification or supplementation. If it is the former, indicate the food to be fortified. Provide details on food preparation and consumption, e.g., indicate if people grow a specific grain, how they process it (e.g., milling), what foods are prepared with it, how it is cooked, the frequency and amount of consumption, local peculiarities about colour, taste, texture etc. of the food before and after cooking. If supplementation is preferred, indicate the desired potency, format, frequency of dosage and how the supplements will be stored and distributed to the target population. Where possible, provide details of previous experience using either strategy; request product literature, specifications, use restrictions, pricing, suggested dosing methods and product samples from manufacturers. Enquire if a company is willing to customize a product for your needs. Also indicate how long your program may run.

The responses from manufacturers interested in supplying, say, a premix for fortification, may seek the following information that is specific to that country and the food to be fortified:

(a) national regulations on fortification that cover recommended daily allowances for specific nutrients, labeling/nutrition information on fortified food packaging, product testing, permitted colouring and other additives etc. Regulations that may be governed by local religious or other cultural dictates;

(b) depending on the food to be fortified, how the food is processed, cooked and consumed, which carrier substance (e.g., starch, flour) may be used, and in what format, texture, colours and quantities;

(c) if the food to be fortified is a cereal or other grain, the milling facilities that are available, and the degree of automation or
sophistication in milling equipment;

(c) the equipment available for dosing the premix, e.g., a blender, the degree to which it is automated and the types of materials it can handle;

(d) local storage facilities (especially if climate control is necessary for both the premixes and fortified food, as well as local climatic conditions;

(e) given local climate, storage and product distribution conditions, the permitted levels of antioxidants, antifungal agents and any other preservatives that may be necessary;

(f) premix format – powder, granules, pellets, liquid/oil base, etc.– that is suitable for fortification;

(g) premix packaging (e.g., material, moisture or sunlight protected, size, shape), labeling (including language, nutrition information and use instructions) and testing requirements;

(h) fortified food packaging, labeling including marketing and or advertising considerations, testing;

(i) premix import restrictions, potential distribution methods, training of mill operators, promotional campaign to educate healthcare workers a nd customers;

(j) premix procurement conditions (e.g., buyer – private or public sector, local or international organization, purchasing period,
financing constraints, on-site support).

There could be other issues such as the manufacturer's need to conduct product development and testing in that country, run a test marketing campaign and repackage the premix locally.

Once all of these points are looked at in detail, a successful micronutrient fortification program can be launched in a country.