This summary report describes a study which was part of the Dar es Salaam Mobile Phone Public Services

Monitoring Project funded by the World Bank in cooperation with Twaweza. The survey is implemented by a group of independent consultants. 1 The main aim of this survey was to assess how much citizens of Dar es Salaam know about food fortification and its possible health benefits. The study is based on mobile phone interviews with 323 citizens in all three city districts.2
Food fortification is the process of adding vitamins and vital minerals to widely consumed food types. Fortification has the potential to effectively and sustainably reduce malnutrition, particularly in urban areas where citizens mainly rely on processed food. While the most common form of fortification in Tanzania is adding iodine to salt, plans have been developed as part of the National Nutrition Strategy for large-scale fortification of maize flour, cooking oil and wheat flour by 2012. But how much do citizens who are living in urban areas know about fortification? What is the level of awareness about the benefits of fortification? These are some of the questions that this report aims to address.3 Low level of awareness about fortification among citizens To assess the level of awareness on the issue of fortified food, respondents were asked if they knew what food fortification is. Results suggest knowledge on this issue to be limited, as only 4 in 10 respondents report to have heard about food fortification (40.8%). Those respondents that have heard about it were asked what they thought its main health benefits are. The most frequently mentioned health benefits are a general strengthening of the body (mentioned by 74.6%), that it improves the health of children (mentioned by 22.4%) and that it makes children grow faster (mentioned by 18.6%) . Only half of respondents have heard of iodized salt In Tanzania, iodine insufficiency is a prevalent health problem that can lead to serious physical and mental harm, particularly among children. At the same time, the country has seen much progress in the availability and consumption of iodized salt. The 2010 Tanzania Demographic and Health Survey (DHS) showed that 82% of households used salt that contained iodine. The DHS also showed that in Dar es Salaam, consumption of iodized salt was almost universal (98.3%). However, while nearly all households in the city consume iodized salt, many citizens do not seem to be aware of this, as only about half of the respondents in this study report to have heard of iodized salt (52%). Among respondents who report to have some knowledge about why iodized salt is healthier than regular
1

The Dar es Salaam Mobile Phone Monitoring Project is implemented by Kevin Croke, Johannes von Engelhardt and Dorica Andrew in collaboration with Datavision. For more information, see http://monitor.publictransparency.org/ 2 All reported figures are based on weighted sample data. Weights were constructed to account for the stratified sampling strategy of the initial baseline survey as well as to correct for non-response and dropout bias in the subsequent mobile phone panel waves. 3 Knowledge about nutrition and food fortification is crucial for those in charge of a households food supplies and consumption. This survey therefore focused on household members who are responsible for buying and preparing food.

salt, the two most commonly mentioned health benefits are the prevention of goiters (mentioned by 62.1%) and a general strengthening of the body (mentioned by 37.9%).

Most citizens do not know if their food is fortified The survey also included questions about the actual consumption of (iodized) salt and of other food types suitable for fortification, namely maize flour, wheat flour and cooking oil. Most respondents purchase salt at the market (64.3%) while about 1 in 3 respondents buy it in the shop (30.2%). The overwhelming majority of respondents buy pre-packaged (94.6%) rather than loose salt (4.6%). In line with the general lack of awareness regarding iodized salt shown above, only half of the interviewees know if the salt they buy contains added iodine (48.2.%). In contrast to salt, maize flour is mainly bought at a shop or kiosk (80.9%) while 12.0% have their maize ground by a hammermill. 8 in 10 interviewees report to mainly buy pre-packaged maize flour in a branded bag (78.5%) and 1 in 10 buy it loose (9.5%). Even though there is no fortified maize flour available on the Tanzanian market, respondents were also asked if they knew whether the type of maize flour they use contains any added iron, vitamins minerals. A large majority of respondents have no knowledge about this (80.4%), while 12.3% state that they typically buy fortified maize flour. A similar pattern emerges with respect to wheat flour. Most respondents buy wheat flour at a shop or kiosk (80.0%), predominantly in a branded bag (81.9%). Wheat flour is currently not fortified in Tanzania. When asked about the wheat flour they typically use, 85.4% of the respondents do not know if the wheat flour they purchase contains added trace elements or vitamins, while 1 in 10 respondents report that they typically buy fortified wheat flour (9.4%). Similarly to flour, cooking oil is also mostly bought at a shop (92.9%) and only very rarely at a market (2.8%). The most commonly used types of cooking oil are sunflower oil (42.3%) and Sesame oil (16.3%). Strikingly, 1 in 5 interviewees do not know what kind of oil they typically use for cooking Graph 1 Does the product you use contain added iodine/iron/vitamins/minerals?

(20.4%). About half of the interviewed respondents either buy bottled cooking oil (48.7%) or make use of a re-usable container (45.4%). Three quarter of the interviewees do not know if their cooking oil has been fortified (75.5%). Again, while there is no fortified cooking oil available in Tanzania, more than 1 in 5 respondents state that the cooking oil they typically buy is fortified (containing added vitamin A) (22.6%).

Conclusion In conclusion, the results of this study suggest that the level of knowledge about food fortification amongst citizens of Dar es Salaam is very limited. Less than half of the interviewees report to have heard about the concept of fortified food. This lack of awareness is even more visible when respondents are asked about their own consumption behavior: with the exception of iodated salt, only a relatively small proportion of interviewees are able to tell if the food they consume has been fortified and some respondents even falsely report to buy fortified food..