Stakeholders have called for the adoption of mandatory standards to fortify bouillon cubes with folate (vitamin B9) and vitamin B12, arguing that the policy could significantly reduce preventable birth defects and improve maternal and child health in Nigeria.

They noted that although Nigeria introduced voluntary standards for bouillon fortification in September 2024, voluntary compliance has not delivered the population-wide impact needed to address widespread micronutrient deficiencies.

The stakeholders, therefore, advocated mandatory fortification of bouillon cubes with folate and vitamin B12 while urging continued implementation of mandatory fortification of flour, edible oil and other appropriate food vehicles.

Their call comes amid growing concern over Nigeria’s burden of neural tube defects (NTDs), with nearly 11,000 babies estimated to be born each year with preventable conditions linked primarily to folate deficiency.

Micronutrient deficiency remains a major but often overlooked public health challenge in Nigeria, affecting children’s cognitive development, maternal health and overall well-being.

According to UNICEF Nigeria, millions of children suffer from severe food poverty, anaemia and developmental stunting despite showing few visible signs of malnutrition.

Findings published in The Lancet also highlight the scale of hidden hunger globally, estimating that one in every two preschool-aged children and two in every three women of reproductive age suffer from at least one micronutrient deficiency, with the highest burden recorded in South Asia and sub-Saharan Africa.

Experts attribute the problem to poor dietary diversity, food insecurity, poverty, low consumption of animal-source foods, limited awareness of preconception nutrition and inadequate access to nutritional supplementation before pregnancy. Vitamin B12 deficiency remains particularly common among populations with limited access to animal-source foods.

They explained that neural tube defects, including spina bifida, anencephaly and encephalocele, develop during the first few weeks of pregnancy, often before a woman knows she is pregnant, making adequate nutrition before conception and during early pregnancy essential.

Available data show that neural tube defects occur at a rate of about 14.2 cases per 10,000 live births. With an estimated 7.5 million births annually in Nigeria, this translates to almost 11,000 affected babies each year.

Although folate deficiency is the leading preventable cause of neural tube defects, studies have shown that population-wide folate fortification can reduce their incidence by up to 70 per cent without requiring individual behavioural change.

Experts stressed that folate and vitamin B12 should be addressed together because the two nutrients are metabolically interdependent.

They described bouillon cubes as an ideal vehicle for fortification because they are consumed regularly by virtually every Nigerian household, regardless of income level, geographical location, or ethnicity.

Evidence supporting the approach comes from the CoMIT Trial conducted in West Africa.

The double-blind, randomised controlled study involved more than 2,000 participants, including children aged two to five years, women of reproductive age and lactating mothers.

Participants received either bouillon fortified with folic acid, vitamin B12, iron, zinc, iodine, and vitamin A, or control bouillon containing only iodine.

The findings showed significant increases in serum folate levels, reduced folate deficiency among women of reproductive age and consistent improvements across age and sex groups.

Researchers also recorded significant improvements in vitamin B12 levels among participants, with reductions in deficiency among lactating women and young children sustained throughout the nine-month study.

According to the stakeholders, the findings demonstrate that bouillon cubes can serve as an effective population-level vehicle for delivering folate and vitamin B12, particularly vitamin B12, which is obtained mainly from animal-source foods. They, however, cautioned that not all micronutrients are suitable for fortification through bouillon cubes.

Iron and zinc, they explained, are better delivered through flour fortification because of challenges relating to taste, colour stability and bioavailability when added to seasoning cubes.

Clinical nutritionist and digital health educator, Odukoya Fiyinfoluwa, popularly known as YourDietBoy, supported mandatory fortification but stressed that the policy should improve the nutritional value of bouillon cubes already consumed by Nigerians rather than encourage greater consumption.

He warned that bouillon cubes remain a significant source of sodium, which is associated with hypertension, stroke, heart disease and kidney disease. According to him, any fortification policy should be accompanied by efforts to reduce sodium intake and promote healthier diets.

Fiyinfoluwa said the success of mandatory fortification should be measured by improvements in folate and vitamin B12 status, reductions in neural tube defects and better maternal nutrition outcomes.

He added that food fortification should complement, not replace dietary diversification, nutrition education, maternal supplementation and access to quality antenatal care.

The Director-General of the National Agency for Food and Drug Administration and Control (NAFDAC), Prof. Mojisola Adeyeye, told The Guardian that the agency is exploring the use of bouillon cubes as an additional vehicle for food fortification.

She said NAFDAC is collaborating with the Global Alliance for Improved Nutrition (GAIN) to assess the feasibility of using the widely consumed seasoning cubes to deliver essential micronutrients to Nigerians. According to her, the initiative forms part of the agency’s broader strategy to strengthen large-scale food fortification nationwide.

Adeyeye added that NAFDAC’s Food Safety and Applied Nutrition Directorate is expanding food fortification programmes while digitising the monitoring and reporting system to improve compliance, oversight and traceability of fortified food products.

Also speaking, President of the Spina Bifida and Hydrocephalus Association of Nigeria (SBHAN), Hassan Funmilayo, said public awareness of neural tube defects remains low despite the lifelong health and economic burden they impose on affected families.

He called for sustained awareness campaigns in schools, communities, and healthcare facilities to educate prospective parents about the importance of adequate nutrition before and during pregnancy.

Funmilayo noted that although neural tube defects occur relatively infrequently, with some studies estimating about three cases per 1,000 births, the cost of treatment, rehabilitation and long-term care places enormous financial, emotional and social pressure on affected families.

He explained that many neural tube defects, particularly spina bifida, are associated with folate deficiency during the earliest stages of pregnancy and urged women of reproductive age to ensure adequate folic acid intake before conception and during early pregnancy, noting that many pregnancies are unplanned.

Funmilayo added that SBHAN is intensifying advocacy for stronger food fortification policies to ensure that commonly consumed foods, including bread, noodles and other staples, are fortified with essential micronutrients such as folic acid.

According to him, similar interventions have significantly reduced neural tube defects in several countries and could substantially lower the burden of preventable birth defects in Nigeria.