Micronutrient deficiencies affect an estimated 2 billion people globally, with sub-Saharan Africa carrying a disproportionate share of the burden — iron, vitamin A, iodine, zinc, calcium, selenium, folate and vitamin B12 deficiencies remain widespread across the region. Large-scale food fortification, the practice of adding these micronutrients to commonly consumed, industrially processed foods, has long been considered one of the most cost-effective tools available to address the problem at a population level. A comprehensive 2026 review of progress across East, Central and Southern Africa, however, finds that success has been strikingly uneven across different food categories.
The review, covering countries within the East Central Africa Health Community and the Southern Africa Development Community, found solid, if imperfect, progress on wheat and maize flour fortification — the staple carbohydrates most African fortification programmes were originally built around decades ago. Cooking oil and sugar fortification, by contrast, lag substantially behind, leaving a meaningful gap in population-level micronutrient intake even in countries with otherwise well-established fortification legislation.
Why oil and sugar matter as fortification vehicles
Cooking oil and sugar were identified as fortification vehicles for specific nutritional reasons. Oil is a natural, low-cost carrier for fat-soluble vitamin A, since the vitamin requires dietary fat for proper absorption in the body — making fortified oil arguably a more biologically efficient delivery mechanism than some alternatives. Sugar, meanwhile, has historically been targeted in fortification programmes (most famously in Central America) specifically for vitamin A delivery given its near-universal consumption across income levels, including in households too poor to regularly afford more nutrient-dense foods.
The gap between flour's fortification success and oil and sugar's lagging progress appears to reflect a combination of factors: regulatory frameworks and monitoring systems that were built first and most robustly around milling industries, less consolidated and harder-to-regulate oil and sugar production and import sectors in many countries, and enforcement capacity that hasn't kept pace with the broader ambitions written into national fortification legislation.
The African Union has set the target — implementation is the harder part
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The African Union's Heads of State formally adopted a Declaration on Scaling-up Food Fortification and Biofortification in Africa in 2022, embedding fortification progress into the continent's Comprehensive African Agricultural Development Programme review process — meaning fortification performance is now something individual governments report on and are held accountable for at a continental level. That policy architecture exists; what the 2026 review suggests is that translating high-level continental commitments into consistent fortification of every intended food category remains a slower, more uneven process on the ground.
Research also points to a related complication undermining fortification's real-world impact: aflatoxin contamination, a separate but connected food safety issue affecting maize and groundnuts across the region, has been shown to reduce the bioavailability of vitamin A, iron and zinc — meaning even successfully fortified foods can deliver less nutritional benefit than intended if consumed alongside contaminated staples.
What closing the gap would take
Public health researchers reviewing the region's progress point to a fairly consistent set of recommendations: strengthening quality monitoring and enforcement specifically for oil and sugar producers and importers, harmonising fortification standards across countries to simplify compliance for regional manufacturers operating in multiple markets, and better tracking of actual population-level micronutrient intake to verify that fortification programmes are delivering the intended health outcomes rather than existing only on paper.
Why this is a story worth watching
Fortification's appeal has always been its efficiency — reaching large populations through foods they already buy and consume, without requiring behaviour change or expensive supplementation programmes. Wheat and maize flour fortification's relative success across the region shows the model works when implementation and enforcement are prioritised. Closing the remaining gap in oil and sugar fortification represents one of the more achievable near-term wins available to African governments already committed, at least on paper, to solving the continent's hidden hunger problem.
