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Government of Ethiopia, Nutrition International and partners introduce double-fortified salt to reduce neural tube defects in Ethiopia
The Ministry of Health, Ministry of Industry and Ministry of Trade and Regional Integration in collaboration with the Ethiopian Public Health Institute and Nutrition International, in partnership with the University of California-Davis and the University of Toronto, with support from the Gates Foundation, are leading a nationwide effort to scale up double-fortified salt with iodine and folic acid. This initiative, a global first, is designed to reduce the risk of neural tube defects and iodine deficiency disorders in Ethiopia.
Posted on January 16, 2026
Addis Ababa, ETHIOPIA – Today, senior government leaders, technical experts and key partners convened for a high-level national dissemination to accelerate the introduction of double-fortified salt with iodine and folic acid (DFS-IoFA) across Ethiopia.
Hosted by the Ministry of Health, Ministry of Industry, and the Ministry of Trade and Regional Integration in collaboration with the Ethiopian Public Health Institute (EPHI) and Nutrition International, in partnership with the University of California-Davis, and the University of Toronto, with support from the Gates Foundation, the launch marks a pivotal milestone in Ethiopia’s efforts to prevent neural tube defects (NTDs) and improve maternal and newborn health.
“Today marks a historic step in Ethiopia’s efforts to protect mothers and children from preventable birth defects,” said Dr. Mekdes Daba, Ethiopia’s Minister of Health. “By introducing double-fortified salt with iodine and folic acid across the county, we can protect families, strengthen communities and give every child the healthiest possible start in life.”
Ethiopia carries the highest reported burden of NTDs in Africa, with 80 cases per 10,000 live births — more than three times the continental average. NTDs are severe birth defects of the brain and spine and are largely caused by insufficient maternal folate before conception and within the first 28 days of pregnancy. The most common forms of these defects include spina bifida and anencephaly, which can result in early neonatal deaths or long-term disabilities that require lifelong care, placing a heavy emotional and financial burden on families.
DFS-IoFA builds upon Ethiopia’s successful universal salt iodization program, which already reaches over 90% of households, providing an innovative, equitable and cost-effective way to improve folate intake and prevent NTDs nationwide. A double-blind randomized control trial recently conducted in Ethiopia confirmed the positive impact of double-fortified salt, demonstrating it rapidly and substantially raises folate levels among women aged 15-49 in such a way that it will prevent neural tube defects, stillbirths, and low birthweight.
Similarly, large-scale industrial pilot production of DFS-IoFA at Green Star Trading PLC, a central iodization facility (CIF) located in Hawassa, Ethiopia, confirmed that both iodine and folic acid remain stable for more than 10 months under local heat and humidity, with more than 94% of both micronutrients retained from factory to household and with no detectable difference in taste or smell.
“Double-fortified salt is a game-changing intervention for Ethiopia, giving families a practical, daily way to prevent devastating birth defects,” said Tiringo Kinfegabriel, Country Director for Ethiopia, Nutrition International. “Nutrition International is proud to partner with the Government and EPHI to translate research and expertise into a safe, sustainable program that reaches those who need it most — turning evidence into lasting impact for generations.”
By leveraging the existing technological infrastructure and technical capabilities at the 14 CIFs that majorly supply the country’s edible salt demand, production of DFS-IoFA can begin in the short term, with minimal equipment upgrades and brief capacity building training. Quality control will be fully domestic, with the laboratory capacity of the regulatory body strengthened with the support from EPHI’s national reference laboratory and rapid test kits for folic acid rolling out across all regions in 2026.
Beyond its health benefits, DFS-IoFA is also a sound economic investment by reducing healthcare costs, improving productivity and long-term gains for families and communities. Furthermore, once established, DFS-IoFA production will only add US $0.01 per capita per year to the cost of iodized salt.
In November 2025, the Project Advisory Committee on one hand, and the Food Fortification Steering Committee on the other, both chaired by the Ministry of Industry and co-chaired by the Ministry of Health, unanimously endorsed the full evidence package and recommended immediate progression to mandatory national standards.
“Ethiopia has made great strides in reducing iodine deficiency and introducing DFS-IoFA is the next step in protecting maternal and child health,” said Dr. Mesay Hailu, Director General, EPHI. “With rigorous research, industrial testing and robust quality control, EPHI is ensuring that this intervention is safe, effective and domestically giving our country the tools to improve birth outcomes for generations.”
Nutrition International has been a key partner in Ethiopia’s DFS-IoFA initiative, providing technical expertise and guidance on research, product development and policy engagement. Working closely with the Government of Ethiopia, and in partnership with EPHI and University of California-Davis and University of Toronto, Nutrition International has supported the design and implementation of the clinical trial, supported industrial pilot testing and facilitated knowledge sharing with global partners. This leadership, alongside our financial investment, demonstrates Nutrition International’s strong commitment to advancing evidence-based policy formulation and action-oriented decision-making, confirming that DFS-IoFA is safe, effective and scalable.
Today’s ceremonial commitment formalizes a unified national roadmap, including strategies for mandatory fortification, aligning with Ethiopia’s National Food and Nutrition Policy, the Seqota Declaration and the UN Sustainable Development Goals, positioning the country, Ethiopia, as a global leader in nutrition and reinforcing its commitment to giving every child the healthiest possible start in life.
About Nutrition International
Nutrition International is a global nutrition organization headquartered in Ottawa, Canada. For more than 30 years, with the longstanding support of the Government of Canada, we have focused on delivering cost-effective, high-impact, nutrition interventions to people in need. Working alongside governments as an expert ally, we combine deep technical expertise with a flexible approach, increasing impact without increasing complexity or cost. In more than 60 countries, primarily in Asia and Africa, Nutrition International nourishes people to nourish life.
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