Assessment of Jordan's Wheat Flour Fortification External Monitoring System

Abstract

Objectives: To assess the performance of the external monitoring system utilized in Jordan according to the CDC criteria for surveillance systems. Methods: The performance of the external monitoring system was assessed qualitatively following the CDC's Updated Guidelines for Evaluating Public Health Surveillance Systems. Specifically, seven attributes of the system (simplicity, flexibility, data quality, acceptability, representativeness, timeliness, and stability) were assessed. Results: The monitoring system uses five key indicators that are representative, simple to collect, and collected in a flexible manner. Indicators include 1) monthly production of wheat flour, 2) monthly number of 25 kg premix boxes used, 3) average addition rate (calculated), 4) addition rate as a % of 250 g/MT target (calculated), and 5) iron concentration in flour sample. While data on production of fortified flour and premix utilization can be provided in a timely manner, on-site mill monitoring and flour sample collection are more challenging due to resource constraints. Conclusions: The frequent collection of a small number of indicators can provide program managers with timely information with which to base decisions, and successfully documents the performance of each mill and the whole fortification program. Moreover, the system is acceptable to participating agencies and millers and is stable due to mandatory fortification legislation which provides the legal framework for external monitoring. This system can serve as a model for other national fortification programs considering external monitoring approaches. Citation: Wirth JP et al. Nutrients, 11:4741-4759,2013.