Abstract
More than two-thirds of women of reproductive age (WRA) in Africa are estimated to be micronutrient deficient. This is largely due to the widespread poor dietary quality and inadequate intakes of nutrient-dense foods to meet the heightened requirements for WRA. Food fortification is a cost-effective and highly recommended food-based approach for addressing these micronutrient deficiencies in low-income settings like Africa. The strategy has been implemented at different scales within the region for over 3 decades. We conducted a review to find evidence of the impact of food fortification implemented at various scales and across different population circumstances in Africa. We also sought to understand what factors may limit the impact of ongoing fortification programs on micronutrient status. We also explored findings regarding the knowledge and acceptability of fortified foods within the African population as a further barrier to the impact of food fortification on nutritional status. We found that fortification with iron and vitamin A was associated with the most variable impact from targeted and large-scale fortification programs. However, significant positive effects on nutritional status and serum biomarkers were found for food fortification with folate, iodine, and zinc among African women. Generally, fortified foods are acceptable to consumers; however, surveys assessing knowledge and preference for fortified foods found that WRA know little about food fortification and its benefits. Poor coverage of fortification, lower levels of fortificants than are recommended, and use of non-World Health Organization recommended fortificants limit the impact of food fortification on micronutrient intakes and status among WRA in Africa.