Consultancy - Fortification Standards
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Background and Justification
The Sultanate of Oman is a high income country of 4.2 million people. Over the past 40 years, economic stability and income growth have gone hand-in-hand with rapid reductions in child and maternal mortality, universal child immunization, universal primary education, and strong political will to address the rights of women and girls. At the national level, undernutrition in children has consistently declined over the past few decades. The prevalence of underweight in children decreased from 24.4% in 1991 to 8.6% in 2009. In contrast, stunting prevalence has only declined from 10.6% in 1999 to 9.8% in 2009. In March 2018, the Nutrition Department at the Ministry of Health and UNICEF launched the findings of the Oman National Nutrition Survey (ONNS) which was conducted the previous year. The findings have given cause to review a number of national programs, including those related to food fortification.
The most recent assessment of the anemia prevalence in Oman indicate severe and moderate public health problems in children and women, respectively. Some micronutrient deficiencies are widespread and others remain unmeasured. Specifically, vitamin D deficiency has been shown to affect one out of four women of reproductive age; however, vitamin D has yet to be assessed on a representative sample of children. Moreover, the high rate of consanguineous marriage in Oman may increase the prevalence of recessively inherited hemoglobinopathies, resulting in an increased prevalence of anemia.
In addition to prioritizing nutrition in the national health policy, Oman’s government has implemented various programs to address micronutrient deficiencies over the past two decades, including salt iodization, fortification of wheat flour with iron and folate, and fortification of edible oil with vitamins A and D. In addition, Omani health facilities carry out nutrition screening during the well-child checks and Oman's schools routinely collect nutrition and health data from students. Oman’s flour fortification program mandates the addition of 1.5 ppm of folic acid and 60 ppm of elemental iron. This program was implemented in 1996. Currently, it covers more than 75% of Oman’s population and has been associated with the reduction in rates of Spina Bifida. In addition, a previous survey found a lower prevalence of iron deficiency in women living in households where more fortified flour was consumed.
According to Oman’s current fortification standards, 1.5 ppm of folic acid is added to wheat flour. This fortification level is below the WHO guidelines that recommend that 2.6 ppm of folic acid should be added if per capita wheat flour consumption is between 75-149 grams per day. The ONNS estimated that consumption of wheat products is 97 grams per person per day. In addition, folate deficiency affects about one out of ten women. Therefore, increasing the quantity of folic acid to be added to wheat flour should be considered. Oman currently does not mandate the fortification of wheat flour with vitamin B12, and including vitamin B12 in the wheat flour fortification standards should also be considered as a strategy to reduce the vitamin B12 deficiency prevalence.
These are some highlights of the ONNS findings, which also made recommendations to reduce vitamin D deficiencies through the fortification of vegetable oil, and measure fortification compliance of flour, bread and oil. Due to high consumption of vegetable oil and the existing oil fortification policy, vitamin D fortification would be an effective approach to reach the majority of the Omani population by using an existing public health program and infrastructure. Fortification of foods with vitamin D has been successfully implemented in the United States and Canada and was added to Jordan's wheat flour fortification program in 2010.
Recognizing this significant need to enhance the nutritional status of women and children, the Government of Oman (GoO) and UNICEF’s Joint Country Programme 2017-2020 is focusing on Integrated Early Childhood Development (IECD) and nutrition as one of its key priorities. The aim is to address major barriers that contribute to stunting, wasting, anaemia, and the need for improved feeding practices and care-seeking behaviours. Efforts will cut across government sectors for health and nutrition, education, and social development for more coherent and streamlined delivery of services for young children and greater accountability by service providers. This is in line with the GoO National Five Year Plan 2016-2020 priority to ensure that pre-school age children thrive and are prepared to learn at school which will further contribute to the achievement of the SDG targets to: reduce the under-5 mortality rate (3.2) and the prevalence of stunting among children under-5 years (2.2).
Scope of Work
This consultancy is based on a request from the Ministry of Health in Oman, to review Oman’s fortification standards to ensure they align with WHO standards and address the ONNS findings on key micronutrient deficiencies.
Purpose and Objectives
The main objectives of this consultancy are:
Expected Deliverables and timeline
No. of days (estimated) = 2 days
No. of days (estimated) = 4 days
No. of days (estimated) = 3 days
Expected places of travel, insurance, per diem, payments and responsibilities between UNICEF and the consultant team:
Qualification & Specialized knowledge
An institution or team of consultants is sought for this assignment with specialized knowledge in:
Submission of proposal
Interested candidates should include in their proposals the following:
The Offer should be in two parts: Part A – Technical; Part B – Financial, of no more than 5 pages.
Part A: Technical
Part B: Financial
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