IBADAN, Nigeria (AP) — In her cramped, dimly lit kitchen, Idowu Bello leans over a gas cooker while stirring a pot of eba, the thick starchy West African staple made from cassava root. Kidney problems and chronic exhaustion forced the 56-year-old Nigerian woman to retire from teaching, and she switches between cooking with gas or over a wood fire depending on the fuel she can afford.
Financial constraints also limit the food Bello has on hand even though doctors have recommended a nutrient-rich diet both to improve her weakening health and to help her teenage daughter, Fatima, grow. Along with eba, on the menu today is melon soup with ponmo, an inexpensive condiment made from dried cowhide.
“Fish, meat, eggs, fruits, vegetables and even milk are costly these days,” Bello, 56, said, her lean face etched with worry.
If public health advocates and the Nigerian government have their way, malnourished households in the West African nation soon will have a simple ingredient available to improve their intake of key vitamins and minerals. Government regulators on Tuesday are launching a code of standards for adding iron, zinc, folic acid and vitamin B12 to bouillon cubes at minimum levels recommended by experts.
While the standards will be voluntary for manufacturers for now, their adoption could help accelerate progress against diets deficient in essential micronutrients, or what is known in nutrition and public health circles as “hidden hunger.” Fortified bouillon cubes could avert up to 16.6 million cases of anemia and up to 11,000 deaths from neural tube defects in Nigeria, according to a new report from the Bill & Melinda Gates Foundation.
“Regardless of economic situation or income level, everyone uses seasoning cubes,” Bello said as she unwrapped and dropped one in her melon soup.
A growing and multipronged problem
Making do with smaller portions and less nutritious foods is common among many Nigerian households, according to a recent government survey on dietary intake and micronutrients. The survey estimated that 79% of Nigerian households are food insecure.
The climate crisis, which has seen extreme heat and unpredictable rainfall patterns hobble agriculture in Africa's troubled Sahel region, will worsen the problem, with several million children expected to experience growth problems due to malnutrition between now and 2050, according to the Gates Foundation report released Tuesday.
“Farmlands are destroyed, you have a shortage of food, the system is strained, leading to inflation making it difficult for the people to access foods, including animal-based proteins,” Augustine Okoruwa, a regional program manager at Helen Keller Intl, said, highlighting the link between malnutrition and climate change.
Dietary deficiencies of the micronutrients the government wants added to bouillon cubes already have caused a public health crisis in Nigeria, including a high prevalence of anemia in women of child-bearing age, neural tube defects in newborn babies and stunted growth among children, according to Okoruwa.
Helen Keller Intl, a New York-based nonprofit that works to address the causes of blindness and malnutrition, has partnered with the Gates Foundation and businesses and government agencies in Africa to promote food fortification.
In Nigeria, recent economic policies such as the cancellation of gasoline subsidies are driving the country’s worst cost-of-living crisis in generations, further deepening food hardship for the low-income earners who form the majority of the country’s working population.
Globally, nearly 3 billion people are unable to access healthy diets, 71% of them in developing countries, according to the World Health Organization.
The large-scale production of fortified foods would unlock a new way to “increase micronutrients in the food staples of low-income countries to create resilience for vulnerable families,” the Gates Foundation said.
Bouillon cubes as the vehicle
Bouillon cubes — those small blocks of evaporated meat or vegetable extracts and seasonings that typically are used to flavor soups and stews — are widely consumed in many African countries, nearing 100% household penetration in countries like Nigeria, Senegal, Ivory Coast, and Cameroon, according to a study by Helen Keller Intl.
That makes the cubes the “most cost-effective way” to add minerals and vitamins to the diets of millions of people, Okoruwa said.
No Nigerian manufacturers already include the four micronutrients at the recommended levels, but there is industry interest.
Sweet Nutrition, located in Ota, near Lagos in Nigeria's southwest, started adding iron to some of its products in 2017. Marketing manager Roop Kumar told The Associated Press it was a “voluntary exercise” to contribute to public health.
“But we are taking trials and looking at further fortification” with the launch of the new regulatory framework, Kumar said.
Although NASCON Allied Industries, a Nigerian company that produces table salt and seasoning cubes, currently does not make products with any of the four micronutrients, quality control manager Josephine Afolayan said fortification is a priority.
“If we’re successful, that would mean that the fortified bouillon seasoning cubes in so many Nigerian dishes would also contribute to improving the micronutrient content of the dishes in my country,” Ladidi Bako-Aiyegbusi, the director of nutrition at Nigeria’s Ministry of Health and Social Welfare, wrote in the Gates Foundation report.
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The Associated Press receives financial support for news coverage in Africa from the Bill & Melinda Gates Foundation and for news coverage of women in the workforce and in statehouses from Melinda French Gates’ organization, Pivotal Ventures.
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Compliance and science
Despite the promise of enriching a product that most people have in their pantries, some challenges need to be addressed. One is the “campaign of calumny” in a region where science-led interventions in the food sector have sometimes faced resistance from interest groups, Okoruwa said.
Educating people about the benefits of fortified products may help counter any possible disinformation campaign, said Yunusa Mohammed, the head of the food group at the Standards Organization of Nigeria, the government regulator for consumer products.
There is also the need to make fortified cubes affordable for struggling households like Bello's, where a pile of firewood she uses to cook outdoors on an open flame is stacked against a wall.
“What we can do is to influence the government and industry on rebates on the importation of raw materials as a public health intervention,” Mohammed said.
Food fortification is not new in Nigeria. Most of the salt consumed in the country is iodized, and products such as wheat flour, cooking oil and sugar are fortified with vitamin A by law. But the requirement for adding the four vitamins and minerals to bouillon is the most comprehensive fortification regulation to date.
Although Nigerian companies do not have to enrich their seasoning cubes yet, experts think setting standards that producers must follow if they choose to will make a difference.
A working group involving representatives from companies, regulatory agencies, research groups and development organizations is in place to accelerate voluntary compliance.
“Ultimately, we will make the bouillon fortification mandatory after seeing the acceptance of the voluntary regulations in the industry,” Mohammed said.
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Taiwo Adebayo, The Associated Press