{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T12:58:50Z","timestamp":1777640330657,"version":"3.51.4"},"reference-count":26,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2012,3,1]],"date-time":"2012-03-01T00:00:00Z","timestamp":1330560000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Food Nutr Bull"],"published-print":{"date-parts":[[2012,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Micronutrient deficiencies exact an enormous health burden on India. The release of the National Family Health Survey results\u2014showing the relatively wealthy state of Gujarat having deficiency levels exceeding national averages\u2014prompted Gujarat officials to introduce fortified wheat flour in their social safety net programs (SSNPs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To provide a case study of the introduction of fortified wheat flour in Gujarat's Public Distribution System (PDS), Integrated Child Development Scheme (ICDS), and Mid-Day Meal (MDM) Programme to assess the coverage, costs, impact, and cost-effectiveness of the initiative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>India's 2004\/05 National Sample Survey data were used to identify beneficiaries of each of Gujarat's three SSNPs and to estimate usual intake levels of vitamin A, iron, and zinc. Comparing age- and sex-specific usual intakes to Estimated Average Requirements, the proportion of the population with inadequate intakes was estimated. Postfortification intake levels and reductions in inadequate intake were estimated. The incremental cost of fortifying wheat flour and the cost-effectiveness of each program were estimated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>When each program was assessed independently, the proportion of the population with inadequate vitamin A intakes was reduced by 34% and 74% among MDM and ICDS beneficiaries, respectively. Both programs effectively eliminated inadequate intakes of both iron and zinc. Among PDS beneficiaries, the proportion with inadequate iron intakes was reduced by 94%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Gujarat's substitution of fortified wheat flour for wheat grain is dramatically increasing the intake of micronutrients among its SSNP beneficiaries. The incremental cost of introducing fortification in each of the programs is low, and, according to World Health Organization criteria, each program is \u201chighly cost-effective.\u201d The introduction of similar reforms throughout India would largely eliminate the inadequate iron intake among persons participating in any of the three SSNPs and would have a significant impact on the global prevalence rate of inadequate iron intake.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/156482651203300102","type":"journal-article","created":{"date-parts":[[2015,11,25]],"date-time":"2015-11-25T15:59:28Z","timestamp":1448467168000},"page":"11-30","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":31,"title":["Indian Social Safety Net Programs as Platforms for Introducing Wheat Flour Fortification: A Case Study of Gujarat, India"],"prefix":"10.1177","volume":"33","author":[{"given":"John L.","family":"Fiedler","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil","family":"Babu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc-Francois","family":"Smitz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith","family":"Lividini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Odilia","family":"Bermudez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2012,3,2]]},"reference":[{"key":"bibr1-156482651203300102","volume-title":"National Family Health Survey (NFHS-1), 1991\u20131992: India","author":"International Institute of Population Studies\/ORC Macro","year":"1994"},{"key":"bibr2-156482651203300102","volume-title":"National Family Health Survey (NFHS-2), 1998\u20131999: India","author":"International Institute of Population Studies\/ORC Macro","year":"2000"},{"key":"bibr3-156482651203300102","volume-title":"National Family Health Survey (NFHS-3), 2005\u20132006: India","author":"International Institute of Population Studies\/ORC Macro","year":"2008"},{"key":"bibr4-156482651203300102","unstructured":"National Nutrition Monitoring Bureau (NNMB), National Institute of Nutrition, Indian Council of Medical Research. Prevalence of micronutrient deficiencies. NNMB Technical Report No. 22. Hyderabad, 2003."},{"key":"bibr5-156482651203300102","unstructured":"National Nutrition Monitoring Bureau (NNMB), National Institute of Nutrition, Indian Council of Medical Research. Prevalence of vitamin A deficiency among preschool children in rural areas. NNMB Technical Report No. 23. Hyderabad, 2003."},{"key":"bibr6-156482651203300102","doi-asserted-by":"publisher","DOI":"10.1596\/978-0-8213-6587-8"},{"key":"bibr7-156482651203300102","volume-title":"Analyzing the health benefits of biofortified staple crops by means of the DALY approach. HarvestPlus Technical Monograph No. 4","author":"Stein AJ","year":"2005"},{"key":"bibr8-156482651203300102","unstructured":"Bredenkamp C, Akin JS, Gragnolati M. Malnutrition and India's ICDS Program: Evidence of program impact? Presented at the Annual Meeting of the Population Association of America, 1 March 2005. Available at: http:\/\/paa2005.princeton.edu\/download.aspx?submissionId=51578. Accessed 12 December 2011."},{"key":"bibr9-156482651203300102","volume-title":"Who does India's ICDS nutrition program reach and what effect does it have?","author":"Gupta Das M","year":"2004"},{"key":"bibr10-156482651203300102","doi-asserted-by":"publisher","DOI":"10.1111\/j.0012-155X.2005.00427.x"},{"key":"bibr11-156482651203300102","unstructured":"Ministry of Consumer Affairs, Food and Public Distribution (MCAF&PA), Government of India. Annual report, 2009\u20132010. Available at: http:\/\/fcamin.nic.in. Accessed 16 November 2011."},{"key":"bibr12-156482651203300102","volume-title":"A study of the effectiveness of public distribution system in rural Tamilnadu","author":"Nakkiran S","year":"2004"},{"issue":"39","key":"bibr13-156482651203300102","first-page":"3779","volume":"36","author":"Jha S","year":"2001","journal-title":"Econ Polit Wkly"},{"key":"bibr14-156482651203300102","doi-asserted-by":"publisher","DOI":"10.1596\/0-8213-4090-5"},{"key":"bibr15-156482651203300102","volume-title":"Mid-day meal scheme: understanding critical issues with reference to Ahmedabad City. Working paper No. 2007-03-03","author":"Deodhar SY","year":"2007"},{"key":"bibr16-156482651203300102","volume-title":"Towards more benefits from Delhi's midday meal scheme","author":"Samson M","year":"2007"},{"key":"bibr17-156482651203300102","volume-title":"Planning Department. Evaluation study report on mid-day meal programme","author":"Government of NCT of Delhi","year":"2000"},{"key":"bibr18-156482651203300102","unstructured":"Statistical Registration System (SRS): Office of the Registrar General, 2008. http:\/\/censusindia.gov.in\/Vital_Statistics\/SRS_Bulletins\/SRS-Bulletin-October-2009.pdf. Accessed 12 December 2011."},{"key":"bibr19-156482651203300102","volume-title":"Wheat marketing and its efficiency in India. Working Paper Number 2006-09-03","author":"Gandhi VP","year":"2006"},{"key":"bibr20-156482651203300102","volume-title":"Food fortification: a Gujarat initiative","author":"Nanda SK","year":"2007"},{"key":"bibr21-156482651203300102","doi-asserted-by":"publisher","DOI":"10.1177\/156482650903000401"},{"key":"bibr22-156482651203300102","volume-title":"Nutritive values of Indian foods","author":"Gopalan C","year":"1991"},{"key":"bibr23-156482651203300102","unstructured":"Food and Agriculture Organization. Human energy requirements. Report of a Joint FAO\/WHO\/UNU Expert Consultation, Rome, 17\u201324 October, 2001. Food and Nutrition Technical Report Series 1, 2001."},{"key":"bibr24-156482651203300102","volume-title":"Making choices in health: WHO guide to cost-effectiveness analysis","author":"World Health Organization","year":"2006"},{"key":"bibr25-156482651203300102","unstructured":"World Bank. World Development Indicators (WDI) 2011. Available at: http:\/\/siteresources.worldbank.org\/DATASTATISTICS\/Resources\/GNIPC.pdf. Accessed 5 December 2011."},{"key":"bibr26-156482651203300102","unstructured":"Reserve Bank of India. Handbook of statistics on the Indian economy 2009\u20132010. Available at: http:\/\/rbidocs.rbi.org.in\/rdocs\/Publications\/PDFs\/0HANDB210910_F.pdf. 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