Storage, preparation, and usage of fortified food
aid among Guatemalan, Ugandan, and Malawian
beneficiaries: A field study report
Jonathan P. Rowe, William C. Brodegard, Oscar A. Pike, Frost M. Steele,
and Michael L. Dunn
Conclusions. Cooking fuel could be saved and
nutritional quality probably improved if relief agen-
Background. An important consideration in determining cies emphasized shorter cooking times. These data
the ability of fortified food-aid commodities to meet the can be used to simulate preparation methods in the
nutritional needs of beneficiaries is the manner in which laboratory for assessment of the nutritional impact
commodities are utilized and prepared and the degree to of cooking.
which micronutrient losses occur during handling and
cooking by the beneficiaries.
Objective. A field study was conducted in Uganda, Key words: Field study, food aid, Guatemala, Malawi,
Malawi, and Guatemala to obtain data on storage, prep- preparation, Uganda
aration, and usage of fortified blended foods provided by
the US Agency for International Development.
Methods. Interview and observational data on the use Introduction
of corn-soy blend, cornmeal, soy-fortified cornmeal, soy-
fortified bulgur, and fortified vegetable oil were collected Public Law 480 (PL 480), the Agricultural Trade Devel-
from more than 100 households and two wet-feeding opment and Assistance Act of 1954, commonly known
sites (where food is prepared and served by staff on-site) as the Food for Peace Act, provides legislative author-
in 32 vil ages.
ity for international food assistance provided by the
Results. Storage practices by beneficiaries appeared to United States. The PL 480 program is administered by
be appropriate, and all commodities observed were free the US Department of Agriculture (USDA) and the US
from off-flavors and odors. Cooking water was typical y Agency for International Development (USAID), with
obtained from boreholes or open wel s with a pH range a fundamental goal of promoting US foreign policy
of 4.7 to 7.7. Food preparation usual y took place in by enhancing food security in developing countries,
covered areas with the use of an aluminum or clay pot including alleviation of hunger, malnutrition, and their
over a wood-fueled fire. Thin or thick porridges were causes throughout the world . A large number of
the most common dishes prepared from cereal-based private voluntary organizations, as well as the World
products, with concentration ranges of 10% to 31% (wt/ Food Programme of the United Nations, utilize PL 480
wt) in water. Cooking times for porridges ranged from food commodities, donated under Title II of the Act, in
5 to 53 minutes, with a mean of 26 minutes. Tortil- their humanitarian aid programming.
las and beverages were other preparations commonly
Commodities distributed under PL 480 Title II
observed in Guatemala. Vegetable oil was typical y used include whole grains and pulses and a variety of proc-
for pan frying.
essed and blended, cereal-based foods fortified with
protein and/or micronutrients for enhanced nutrition.
Most of the fortified blended foods are distributed in
The authors are affiliated with the Department of Nutri-
Africa (> 50%), Asia (20%), and Latin America and the
tion, Dietetics and Food Science, Brigham Young University,
Provo, Utah, USA.
Caribbean (15%) .
Please direct queries to the corresponding author: Michael
Humanitarian food aid is typical y distributed to vul-
L. Dunn, S-221 ESC, Brigham Young University, Provo, UT nerable groups at greatest risk for malnutrition. These
84602 USA; e-mail: Michael_dunn@byu.edu.
foods often constitute a significant proportion of the
A portion of these data was previously presented in a beneficiaries’ total diet. Therefore, it is important to
poster at the annual meeting of the Institute of Food Tech-
nologists in Orlando, Florida, USA, June 2006.
establish that fortified food-aid commodities are being
Food and Nutrition Bulletin, vol. 29, no. 3 © 2008, The United Nations University.
J.P. Rowe et al.
utilized appropriately and delivering the maximum preparation, and usage data for five of the fortified
foods commonly distributed by USAID: corn-soy
An important consideration in determining the abil- blend, cornmeal, soy-fortified cornmeal, soy-fortified
ity of fortified food-aid commodities to meet the nutri- bulgur, and fortified vegetable oil.
tional needs of beneficiaries is the manner in which
Eight villages were visited in central Guatemala.
the foods are utilized and prepared and the degree to Visits were made to four vil ages in the province of Baja
which micronutrient losses occur during handling and Verapaz and four mountain vil ages in the province of
cooking by the beneficiaries. An informal preliminary Quiche. Storage and distribution centers in Rabinal,
study, using samples collected in the field, indicated San Martin, Chubaj, and Guatemala City were also
that traditional cooking techniques may reduce some visited. Households participating in Maternal and
micronutrients in food-aid commodities to negligible Child Health programs were exclusively visited in the
levels . If this is true, it might be prudent to use more Guatemala field study because of the increased risk of
stable, encapsulated vitamins in fortification premixes malnutrition in this vulnerable group, and because ben-
or to look for other ways to deliver labile micronutri- eficiaries were more likely to be in their homes during
ents. More accurate data from a well-designed and site visits. Data were obtained on corn-soy blend, soy-
controlled study are needed before specific changes in fortified bulgur, and vegetable oil.
fortification requirements for food aid can be recom-
Site visits in Uganda were carried out in nine vil ages
mended. These data cannot be extrapolated from the in the southern districts of Mbarara and Ntungamo
general information presently available in the literature, and five vil ages in Nakasongola. Additional visits were
because vitamin stability results are dependent on the made to observe wet-feeding programs at a World Food
specific micronutrient forms used for fortification, Programme refugee camp in Kiryandongo and a World
as well as the composition of the food matrix and Food Programme orphanage in the city of Kampala.
the exact nature of the food-preparation techniques The households visited in Uganda were participating
in HIV/AIDS, Food for Work, Maternal and Child
The purpose of this study was to obtain observa- Health, and Vulnerable Households programs. Data
tional and interview data regarding the preparation and were obtained on corn-soy blend, soy-fortified corn-
use of fortified blended foods by making site visits to meal, and vegetable oil.
the homes of food-aid beneficiaries in key distribution
In Malawi data were collected in three vil ages in
areas. Data from this field study could subsequently be Dedza District, two in Mchinji District, and three in
used to perform a simulation in which typical prepa- Thyolo District. The households visited were partici-
ration procedures could be careful y controlled in the pating in Food for Work, Chronical y Ill, and Orphan
laboratory, allowing the effect on micronutrient stabil- Household programs. Data were obtained on corn-soy
ity in fortified food-aid commodities to be accurately blend, cornmeal, and vegetable oil.
Data collected during site visits included household
demographics, sources of water used for food prepara-
tion, quality of the food aid when it was received, home
storage practices, food utilization and preparation
practices, and personal opinions regarding acceptability
Field site visits
of food aid to beneficiaries.
Data were collected by beneficiary interviews as well
The field study was carried out during July and August as objective and subjective measurements made as
2005 in the distribution areas of cooperating private commodities were prepared at meal times. Objective
voluntary organizations in Guatemala, Uganda, and measurements included storage temperature and water
Malawi. Data were collected from more than 100 activity of commodities, pH of water used for cooking,
households and two wet-feeding sites (where food is and specific data on cooking times and temperatures
prepared and served by staff on-site) in 32 different and food mass and volume. Ethical approval of the
vil ages spread across different regions of the three study was obtained from the institutional review board
countries evaluated. The field study sites were selected of Brigham Young University. Data were gathered after
on the basis of the type of programming, the amount oral informed consent had been obtained from the
and type of commodities distributed, travel logistics, participating beneficiary, with number coding used to
and the ease of cooperation with internal aid organiza- protect the beneficiary’s identity.
tions within each country.
Equipment for collecting field data included a port-
Local collaborating agencies assisted in the field able electronic balance (Ohaus, LS200), a portable
study by arranging site visits to the homes of beneficiar- water activity meter (Decagon), a pH meter (Oakton
ies, providing interpreters, and introducing researchers pHTestr1), a digital infrared/contact thermometer
to vil age leaders and beneficiaries. With this assistance, (Oakton 35625-40), and graduated cylinders for meas-
the field scientists were able to collect key storage, uring volume.
Fortified food aid
TABLE 1. Household demographics
Households with pregnant
size (mean ±
(mean ± SD)
< 2 yr (%)
5.5 ± 2.5
3.3 ± 1.5
6.0 ± 2.3
3.8 ± 2.3
6.3 ± 3.0
2.6 ± 1.8
6.0 ± 2.6
3.3 ± 1.9
Results and discussion
rations, many private voluntary organizations increase
the ration of the targeted beneficiaries to account for
Food-aid programming at visited sites
intra-household sharing. The data in table 1 indicate
that the estimate of household size by private voluntary
Food-aid programming can be broadly categorized as organizations is relatively accurate.
developmental, transitional, or emergency-focused.
Individual projects within a program area, such as Household eating patterns and contribution of food
Maternal and Child Health, Food for Work, General aid to the diet
Relief, School Feeding, etc., have specific objectives or
beneficiary targets. Most of the common project types Information on the number of meals eaten per day,
were included in the field study. Beneficiaries assisted typical approximate meal times, and the contribution
by private voluntary organizations participating in the of food aid to the overall diet was obtained from the
field study were part of Food for Work and Maternal primary caregivers of the households in Uganda and
and Child Health projects in Guatemala; Food for Malawi. Questions to elicit this information were
Work, Chronical y Ill, and Orphan Household projects added to the questionnaire after the Guatemala study
in Malawi; and Maternal and Child Health, Food for was complete.
Work, HIV/AIDS, and Vulnerable Household projects
The number of meals per day was never less than two
in Uganda. Refugee and orphanage wet-feeding pro- and was as high as five in some households. The aver-
grams conducted by the World Food Programme were age number was 3.3 ± 0.7 in Uganda (n = 21) and 2.6 ±
visited in Uganda.
0.7 in Malawi (n = 41). Typical starting times for meals
were 8 a.m., 1 p.m., and 7 p.m. Food was always eaten
Household demographics of field-study beneficiaries
on the day it was prepared, and no food was stored
for more than a few hours after it had been cooked.
Information on household demographics was obtained Sharing of food among household members was very
by interviews with the primary caregivers in the house- common; general y the food ration was distributed
holds. Data on household size, number of children among all of the members of the household.
per household, and percentage of households with
Data on the percentage of the total daily diet derived
infants and pregnant or nursing mothers are shown from food aid are shown in table 2. Just under half of
in table 1. Household size was defined as the number households in Uganda and all households in Malawi
of persons in the household consuming the fortified reported that at least 75% of their daily diet was derived
food, as reported by the primary caregiver, and varied from food aid. The lower use of food aid in Uganda may
widely from 2 to 14. The number of children in a be partly due to the fact that in that country one-third
household varied from zero to 11. Guatemala, where of beneficiaries reported selling food aid or trading it
only households participating in Maternal and Child
Health programs were visited, had the highest percent- TABLE 2. Proportion of total daily diet derived from fortified
age of households with pregnant or nursing mothers, food-aid commodities
and Uganda had the lowest. Uganda had the highest
percentage of households with infants under 2 years
% of households
< 50% ? 50 < 75% ? 75%
Data obtained from the survey as well as from private Country
voluntary organizations cooperating in the field study Uganda
indicate that an average household size of five persons Malawi
is typically used to calculate caloric requirements
when planning general rations. For supplementary Total
J.P. Rowe et al.
for other goods, whereas none in Malawi reported sel - USAID Title II fortified food-aid commodities
ing or trading food aid. The accuracy of these data is distributed
questionable, since all private voluntary organizations
reported that beneficiaries were instructed not to sell Commodity distribution data evaluated in the field
or trade food aid for other goods, and the presence of study focused on US PL 480 Title II in-kind fortified
representatives of private voluntary organizations at blended foods, and did not cover all commodities
some sites may have hindered free expression on this utilized by the private voluntary organizations and
the World Food Programme. Most World Food Pro-
Although the questionnaire differed slightly in Gua- gramme field offices procure a significant proportion
temala, the field scientists were able to determine that of their fortified blended foods from local and regional
a ration designed to last for 4 weeks was typical y con- suppliers, who may follow different manufacturing
sumed by Guatemalan beneficiaries within 2 weeks in specifications .
some cases, and almost always within 3 weeks. During
Fortified blended food commodities available for
the last week of the month, the contribution of food evaluation in the field study included corn-soy blend,
aid to total dietary intake in Guatemala was negligible. vegetable oil, soy-fortified cornmeal, soy-fortified
Trading was also found to be uncommon among the bulgur, and cornmeal. The availability of these particu-
households visited in Guatemala, most likely because lar commodities corresponds well with data from the
all of the beneficiaries visited were part of the Maternal USDA Food Aid Report indicating that corn-soy blend,
and Child Health program. Discussions with Guatema- vegetable oil, and cornmeal were the most commonly
lan private voluntary organizations indicated that Food used fortified blended foods in all Title II Programs in
for Work program beneficiaries were known to have an fiscal year 2004 .
increased level of trading.
Title II USAID fortified food-aid commodities dis-
tributed by participating private voluntary organiza-
Water sources utilized for food preparation
tions and World Food Programme agencies in Africa
include corn-soy blend, cornmeal, soy-fortified corn-
As is the case in many areas of the world, the avail- meal, soy-fortified bulgur, and fortified vegetable oil.
ability of clean water is an important issue in Uganda, Guatemalan private voluntary organizations distributed
Malawi, and Guatemala. In all of these countries, the corn-soy blend, soy-fortified bulgur, and fortified vege-
main sources of water, as reported by beneficiaries, table oil. Al commodities other than vegetable oil were
were boreholes or open wel s (table 3). Other minor dry, ground meals of relatively small particle size that
sources, reported only in Uganda, included municipal, had been fortified with vitamins and minerals. The dry
river, and spring water. The mean water pH was 6.7 ± products were packaged by USAID suppliers in woven
0.6; pH ranged from a rather acidic 4.7 in one sample, polymer bags (soy-fortified bulgur) or three-layered
reportedly drawn from a wel , to a slightly alkaline kraft-paper bags with plastic linings (corn-soy blend,
high of 7.7.
cornmeal, and soy-fortified cornmeal). Vegetable oil
The proportion of households reporting that they was refined, bleached, deodorized vegetable oil (typi-
boiled water before consumption to lower the risk cal y soybean oil) to which vitamin A had been added.
of microbial contamination varied from country to Vegetable oil was packaged in steel canisters.
country, despite the fact that private voluntary organi-
zation and government representatives emphasized Household storage practices and quality of food-aid
this practice in all areas visited. Only 50.0% of Ugan- commodities received
dan households and 19.5% of Malawian households
reported boiling their water. The lack of compliance Fortified commodities in Uganda and Malawi were typ-
is most likely due to the scarcity of firewood, the main ical y stored in the original USAID packaging in a dark
source of fuel. In Guatemala, firewood is more plenti- room. The storage areas in Guatemala were similar to
ful, and all of the homes visited reported that they those in Africa, with a few exceptions. The majority of
boiled their water.
the recipients in Guatemala stored dry commodities in
TABLE 3. Water sources
% of households
Fortified food aid
sealed plastic bags inside metal or ceramic containers. from direct sunlight. All African households used alu-
Vegetable oil in Africa was almost always stored in the minum pots for cooking, and the majority of Guatema-
original USAID metal canisters, whereas Guatemalan lan households used aluminum or ceramic pots.
recipients transferred the oil into their own plastic
Seasonings and other additives were used com-
bottles (typical y recycled PETE beverage bottles) at monly in Guatemala but only occasional y in Africa.
Guatemalan recipes often included cinnamon, herbs,
The mean temperature of the household food-storage or bananas. In Africa sugar, vegetable oil, and occasion-
sites was 25.3 ± 2.5°C in Uganda in July, 21.0 ± 1.9°C al y tomatoes and onions were added to the meals. One
in Malawi in August, and 23.1 ± 3.2°C in Guatemala reason for the infrequent use of vegetables in Africa was
the timing of the field study, which corresponded to the
The water activity of fortified dry-meal products dry season when gardens were not in production.
in household storage ranged from 0.43 in Uganda to
The dishes most commonly prepared from the com-
0.68 in Guatemala, with an overall mean of 0.58 ± 0.5 modities, as reported from interviews, are shown in
(n = 54). Data on water activity were collected during table 4. Because of cultural preferences, soy-fortified
the dry season in Uganda and Malawi and during the bulgur was not distributed in Africa. To avoid compe-
wet season in Guatemala.
tition with the native corn market, cornmeal and soy-
Visual evaluation of commodities by field scientists fortified cornmeal were not distributed in Guatemala.
revealed occasional signs of insect infestation in dry Both soy-fortified bulgur and soy-fortified cornmeal
products, but these were relatively few. In all other were distributed in only limited areas.
cases, commodity quality was good, with typical
In Uganda and Malawi, the most common prepara-
appearance and aroma. No off odors or visual signs of tion made from corn-soy blend was a thin, drinkable
spoilage were apparent.
porridge; the next most common was a very thick,
spoonable mush called “bread” in Uganda and “nsima”
Commodity use and preparation
in Malawi. The nsima or bread is made in a two-stage
process, with about one-third of the cereal meal added
Key to assessing the suitability of current fortified at the beginning and the remainder added later in the
blended foods and making recommendations on cooking process. In both Guatemala and Uganda, the
product reformulations is an understanding of how dish most commonly prepared from corn-soy blend
they are utilized and prepared in the field. The ben- was a drinkable porridge, which was of much thinner
eficiaries were asked questions about acceptability of consistency in Guatemala. The second most common
the commodities, types of food typical y prepared, and use of corn-soy blend in Guatemala was as dough for
the sources of recipes. Observations were made of the tortillas.
actual cooking times and temperatures and other key
Cornmeal was exclusively used to prepare the tra-
ditional bread or nsima products in Uganda and
Ninety-eight percent of Guatemalan beneficiaries Malawi, whereas soy-fortified cornmeal was used in a
followed recipes learned from the private voluntary similar fashion to corn-soy blend, with thin porridge
organization, and the remaining 2% used traditional predominating.
recipes. Most Ugandan beneficiaries also reported using
The most common method of preparing soy-fortified
primarily recipes from the private voluntary organiza- bulgur in Guatemala was steeping the dry meal over-
tion. In Malawi nearly all beneficiaries reported using night in a large amount of water at room temperature.
The meal absorbs water and swel s approximately three
In all three countries, all but a few households used times in volume. The steeping water is then drained
wood fires to prepare commodity-based meals. Food and typical y discarded, and the swollen soy-fortified
preparation typical y took place in covered areas, away bulgur is combined with vegetables or seasoned and
TABLE 4. Primary uses of dry-meal food-aid commodities
% of households
(n = 63)
bulgur (n = 12) cornmeal (n = 7)
(n = 41)
J.P. Rowe et al.
used as a filling in tortil as or empanadas. In a few of 0.25 kg of bulgur to 1.5 L of water.
households, the steep water was used as a beverage and
Despite the widespread use of corn-soy blend and
the soy-fortified bulgur was fed to animals. Another soy-fortified cornmeal for making thin porridge, the
preparation method involves grinding the soy-fortified cooking methods varied from household to household.
bulgur and dry roasting it in a frying pan. The toasted As previously noted, private voluntary organizations
soy-fortified bulgur meal is then mixed with water to instruct beneficiaries about the importance of boiling
make a thin beverage.
water and/or porridge products to eliminate patho-
Of the 81 households in the three countries using gens. As a result, beneficiaries would always bring the
USAID vegetable oil, 69.1% reported frying as the sole porridge to at least a low boil. This is reflected in the
use. The percentage of households reporting frying as relatively small standard deviation of the maximum
the sole use of oil ranged from 90.9% in Malawi (N = temperature during cooking. Perhaps most notable,
22) to 54.3% in Guatemala (n = 35), where oil was also however, were the large standard deviations in boiling
commonly used as an ingredient in other products. and cooking times. These differences can most likely
Some beneficiaries, for example, reported adding a few be attributed to instructions from private voluntary
spoonfuls of the fortified oil to porridge on the basis organizations. In one area, for example, all beneficiar-
of instruction received from their benefactor private ies cooked the porridge for at least 30 to 45 minutes
voluntary organization, whereas other households because the distributing private voluntary organiza-
administered several spoonfuls of oil neat as a tonic for tion understood government boiling recommenda-
persons in poor health.
tions to mean boiling food, not just water, for 30 to 45
A summary of specific preparation variables, includ- minutes.
ing formulation and cooking times and temperatures,
is shown in table 5 for the principal products prepared Commodity acceptability
from each USAID commodity. These data were col-
lected by direct measurement in households visited Overal , all commodities were received and accepted
during meal preparation times.
very favorably by beneficiaries. Differences in percep-
Information on the method of steeping soy-fortified tions of nutritional benefit were noted from country
bulgur was obtained exclusively from interviews, since to country, which were probably attributable to edu-
the bulgur had already been steeped at the time of the cational programs of private voluntary organizations
visit. All households used approximately the same ratio associated with distribution.
TABLE 5. Preparation variables for specific products
Thin porridge Corn-soy
Concentration of dry
blend or soy-
ingredients (% wt/wt)
Water temperature at
during cooking (°C)
Boiling time (min)
Total cooking time (min)
Concentration of dry
ingredients (% wt/wt)
Water temperature at
during cooking (°C)
Time to addition of 2nd
portion of dry ingredients
Total cooking time (min)
during cooking (°C)
Total cooking time (min)
Fortified food aid
The beneficiaries reported liking corn-soy blend for their greater access to fresh garden produce. A very
its nutritional value and its sensory qualities, although wide range of cooking times was observed for por-
the order of emphasis varied markedly from country to ridges. The average cooking time was much longer
country. In Uganda 65% of beneficiaries reported that than necessary, given the fact that most recommended
the nutritional aspect of corn-soy blend was what they cooking times for these products are between 5 and 10
liked most, whereas in Malawi 74% indicated that the minutes [7–9].
sensory properties were most important. Guatemalans
Household sizes in this study are general y larger
also reported very favorable acceptability of corn-soy than those used by private voluntary organizations to
blend based on sensory properties. Dislikes associated determine the amount of food aid allocated to house-
with corn-soy blend were very infrequently mentioned holds. Furthermore, the food-aid supplement typi-
and were typical y associated with general appearance, cal y constitutes a much larger proportion of the total
smel , or taste.
diet than intended. Consequently, the food is almost
Cornmeal, which is a common and widely used always exhausted before supplies are replenished each
staple in both Uganda and Malawi, was liked pre- month.
dominantly for its sensory rather than its nutritional
Another major concern is the actual nutrient delivery
qualities, especial y in Malawi (88%). The beneficiar- achieved after preparation of fortified commodities by
ies appeared to understand that cornmeal was not as the beneficiaries. The unexpectedly long cooking times
highly fortified as corn-soy blend. When asked about used by many of the beneficiaries could have a detri-
dislikes associated with cornmeal, none of the Ugandan mental effect on vitamin stability. Data from this study
beneficiaries offered any concerns, whereas nearly 30% on product preparation have been used in a laboratory
of the Malawian beneficiaries disliked the taste of the simulation to evaluate the effect of typical cooking
cornmeal, possibly due to varietal differences in corn. methods used by beneficiaries on vitamin stability in
Other reasons for dislike included color, texture, and common USAID fortified blended foods. These studies
excessive time needed to cook.
will provide information on the nutritional adequacy
Soy-fortified bulgur, soy-fortified cornmeal, and veg- of fortified humanitarian food-aid commodities as
etable oil were all well liked, and no negative comments consumed, so that appropriate recommendations can
related to these products were recorded.
be made in cases where improvements are needed.
The data from this field study suggest that USAID This study was a col aborative effort with SUSTAIN
food-aid commodities are general y well accepted by (www.sustaintech.org). The authors express apprecia-
beneficiaries. All commodities observed in beneficiary tion for the assistance provided by workers at ACDI/
homes were in good condition and free from off flavors VOCA, Africare, the AIDS Support Organization, Save
and odors. Storage practices appeared to be appropri- the Children (Uganda and Malawi), I-LIFE, Catholic
ate and adequate. Products prepared by beneficiaries Relief Services, World Vision, and the World Food
from the cereal-based foods were primarily porridge Programme, who were essential to the success of this
and thick mush; Guatemalan beneficiaries tended study. Travel funding was provided by a Brigham Young
toward greater recipe diversity, primarily because of University Mentoring Environment grant.
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