Potential Impact of Large-Scale Food Fortification in Ethiopia: Coverage and Knowledge of Fortifiable Foods.

Large-scale food fortification (LSFF) is an effective public health measure because it may reach a large number of populations at risk using current food delivery systems. The objective of the study was to assess coverage and consumption of fortifiable foods at the household level and to assess the potential impact of LSFF on child outcomes (stunting and survival) in Ethiopia. Cross-sectional survey data on sociodemographic characteristics, dietary intake, and fortifiable food consumption were collected at the household level among 15,812 randomly selected households participating in the 2021-2024 National Food and Nutrition Strategy Baseline Survey at national and subnational levels. We modeled the impact of LSFF on child survival and stunting using the LiST approach. The overall national coverage of fortifiable edible oil, wheat flour, and salt was 89%, 29%, and 98%, respectively. Wealth was a significant predictor of the use of all fortifiable products (p < 0.001). Edible oil consumption varied significantly by education (p < 0.001), while wheat consumption varied by residence and wealth. Knowledge of fortification varied across residence, wealth, and education, highlighting a limitation in promoting current programs for fortified products. The LiST model estimates that in 2023, fortifying wheat flour with folate and zinc could save 161 and 1499 child lives, and prevent 302 and 406 cases of stunting, respectively. Increasing coverage by 10% annually from 2024 to 2029 could double these benefits. Zinc is effective at reducing both childhood deaths and stunting by improving child health in Ethiopia. Whereas folic acid is more effective at averting stunting. Still, fortification of wheat flour will have limited influence due to its low consumption, and its impact is likely to be limited to urban and peri-urban settings. Alternative food vehicles or interventions that can reach rural areas may be needed.