Preventing blindness: vitamin-A fortified "Ultra Rice" 

Last fall, small concrete mixers were turning as usual in rural Indonesia, but not to pour footings for new buildings. Instead, their operators were laying foundations of another kind. They were using the machines to mix Ultra Rice — a new vitamin A-fortified food product — with local commercial rices, to improve the health of communities. 

Conducted by researchers at the Program for Appropriate Technology in Health (PATH) and the Micronutrient Initiative, the field trials in Indonesia's Kupang district hold promise for people where vitamin A deficiency disorders are common. Loss of vision is the most obvious result of this global public health problem, which often culminates in death. According to the World Health Organization, Bangladesh, India, Indonesia, Nepal and the Philippines are among the 23 countries at highest risk. Each year, up to 2.5 million deaths and 500,000 cases of blindness could be prevented if at-risk populations had access to adequate vitamin A. 

Staple food 

Rice is a staple food for most vitamin A-deficient populations. Although vitamin pills are almost universally available, some groups view pills as something to take only during an illness, or as too expensive to take at all. Ultra Rice is "a technology which works by giving people the vitamin in the most natural way, in the foods they are used to eating," says Mahshid Lotfi, a senior program specialist at the Micronutrient Initiative, which is housed at IDRC. "You don't have to change people's attitudes, their way of life, what they eat — you don't have to do any of the things that always prove very difficult to do, and even more difficult to sustain." 

Leading cause of blindness 

Vitamin A deficiency is the single largest cause of blindness on Java, Indonesia's most populous island, where it accounts for at least 20% of blindness cases among preschool children. In some villages, the prevalence of active xerophthalmia, a deficiency-related disorder that clouds the cornea, is as high as 7%. However, even in places where severe cases are uncommon, the existence of mild vitamin A deficiency can have adverse implications for health and survival. 

Developed with funding from the Micronutrient Initiative, Ultra Rice looks just like rice, but blends broken rice grains into a paste with vitamin A, binders and stabilizers designed to withstand tropical heat and humidity. Ultra Rice grains are then reconstructed using machines similar to commercial pasta makers, which operators can adjust to mimic the appearance of any one of the world's dozens of natural rice varieties. Ultra Rice is then mixed with natural rices at ratios of between 1:200 (0.5%) and 1:100 (1%), depending on patterns of rice consumption and the degree of vitamin A deficiency. 

Taste tests 

In informal taste tests conducted in 1994, some Indonesians were able to identify the Ultra Rice, particularly when it was present at higher proportions in the final blend. However, they were more likely to spot differences between varieties of local rice. The idea of using a concrete mixer to produce fortified rice blends flowed out of extensive research and field testing by PATH. 

Pricing Ultra Rice 

During the trials held last year, parents were quick to grasp the significance of Ultra Rice, says Dr Lotfi. Mothers in the Kupang district were well aware that the slightly whiter grains of what they called Beras VitA (beras is the Indonesian word for rice; vitA means both life and vitamin A), held benefits for their children — and said they were willing to pay a small premium for it. However, to gain acceptance, Ultra Rice cannot cost much more than regular rice, especially in Indonesia where the government controls prices of this staple. And the children who most need this product tend to be in families that are least able to pay more. 

"Price is very important," says Dr Lotfi. "In Indonesia, rice is not just a commodity, it's important politically. You can't tamper with it, because the whole nation lives on rice." 

Not a new idea 

Fortification of foods is not a new idea in the North. Food processors routinely add vitamins or trace elements to milk, breakfast cereals, fruit juices and even salt. But this practice is far less common elsewhere, with the exception of iodized salt, which is rapidly spreading in the developing world. Dr Lotfi hopes the Micronutrient Initiative and PATH can help make the consumption of Ultra Rice and other fortified foods a part of life throughout the South. To further this goal, the two organizations were finalizing negotiations in late 1996 that will clear the way for technology transfers to any interested nations, via the donation of all relevant patents on the production of Ultra Rice to PATH. 

Keane Shore is an Ottawa-based writer and editor. 

Resource Contacts: 

Dr. Mahshid Lotfi, Senior Program Specialist, The Micronutrient Initiative, Ottawa, Ontario; Tel: (613) 236-6163, ext. 2482; Fax: (613) 236-9579; E-mail: mlotfi@idrc.ca 

PATH Canada, 170 Laurier Avenue West, Suite 902, Ottawa, Ontario, Canada K1P 5V5; Tel: (613) 233-0623; Fax: (613) 230-8401 

Links to explore ...

Related IDRC articles and publications:

New Weapon in War on Micronutrient Deficiencies, by Michael Boulet

Children's Health in Ghana's North, by Jason Lothian

The Micronutrient Initiative

Additional resources:

MN-Net Home Page: An Information Resource on Micronutrient Malnutrition

International Vitamin A Consultative Group (IVACG)

Opportunities for Micronutrient Interventions

Vitamin A Deficiency

VAD Prevalence and Control Program Data: Indonesia

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