Energy and nutrient consumption inequity among urban residents of Ethiopia: Implications for the effectiveness of large-scale food fortification

Abstract

Abstract Intra-household energy and nutrient inequity occurs when food is distributed differentially, leaving some members without adequate nutrition. If unaddressed, this can reduce the effectiveness of food based nutrition interventions. This study assessed energy and micronutrient intake inequities among urban Ethiopian households before and after wheat flour and edible oil fortification. Using 24-hour dietary recall data from the 2013 Ethiopian Household Food Consumption Survey, we analyzed 375 households with adult men and women. The Ethiopian mandatory fortification standard for wheat flour and edible oil was considered in the simulation. Usual intake estimates and fortification modeling were performed using the Simulating Intake of Micronutrients for Policy Learning and Engagement (SIMPLE) macro 1-day method. Inequity ratios were calculated by comparing energy and nutrient intakes with dietary requirements for each group. Prefortification, the median nutrient consumption was generally higher among men, except for vitamin A. Fortification of wheat flour with zinc and vitamin B1, along with vitamin A-fortified vegetable oil, led to a 26–74 percentage point reduction in nutrient inadequacy among all participants. Men could benefit more from zinc and vitamin A fortification, whereas women could benefit more from vitamin B1 fortification. Inequity estimates before and after fortification ranged from 1 to 1.5, favoring men. A lthough intra-household food allocation was not directly assessed, observed differences in nutrient intake between men and women suggest gender-related disparities that should be considered in nutrition interventions.