Fortification of Complementary Foods: A Review of Products and Program Delivery

Fortified complementary foods (FCF) and home fortificants - single-sachet micronutrient powders (MNP) or small-quantity lipid-based nutrient supplements (SQ-LNS) to be added to a child's food immediately before consumption - have been shown to be efficacious to improve the micronutrient status and some functional outcomes in children 6-23 months of age. The objective of this chapter is to describe and discuss the latest advances related to the composition and delivery of FCF products, including home and commercial fortification. For FCF and MNPs, there is guidance to ensure that products are safe and aligned with recommendations. Impact, however, can be achieved only if adequate attention is paid to program design and implementation, including the choice of the delivery platform, and ensuring availability, accessibility, acceptability, coverage, and utilization by the target population. Well-targeted programs such as social protection programs, health services, community-based vendors (referred to as market based), child health weeks, and emergency programs have all been used as delivery platforms for FCF and MNPs. To date, guidance for formulation and programmatic experience with the distribution of SQ-LNS is limited. An in-depth understanding of the local context and culture, and the design and implementation of program components, including behavior change interventions that respond to those, can increase program coverage and product utilization. Using rigorous process evaluation would permit to adapt programs to increase their potential for impact, strengthen the evidence related to how programs work, and allow the development of program guidance to increase effective implementation.