Leveraging Salt Fortification Platforms to Address Multiple-Micronutrient Deficiencies in Africa: A Policy Opportunity.

Micronutrient deficiencies remain widespread across sub-Saharan Africa, reflecting not only inadequate diets but also limitations in how current interventions are designed and delivered. Universal salt iodization (USI) has achieved broad population coverage and represents one of the most successful large-scale nutrition interventions globally. However, most fortification strategies continue to target single nutrients in isolation, missing opportunities to address overlapping deficiencies. Recent evidence from Ethiopia demonstrates that folic acid can be co-fortified with iodized salt without compromising iodine status, offering proof-of-concept that existing platforms can be leveraged for integrated micronutrient delivery. This perspective argues that integrated fortification strategies combining iodine, folic acid, and potentially other micronutrients into widely consumed vehicles offer a more efficient, scalable, and equitable pathway to improve population-level nutritional status. However, translating proof-of-concept into public health impact requires addressing key challenges: biological effectiveness, product stability, implementation feasibility, quality assurance, and population heterogeneity. We propose a policy agenda that includes regulatory reform, investment in surveillance systems, and coordinated action across health, trade, and food safety sectors. Integrated fortification should complement, not replace, broader strategies like dietary diversification and supplementation, while offering a pragmatic pathway to address overlapping micronutrient deficiencies at scale across Africa and other low- and middle-income settings.