Fortified bouillon cubes are seen as a way to curb malnutrition in Africa

IBADAN, Nigeria (AP) — In her cramped, dimly lit kitchen, Idowu Bello leans over a gas cooker while stirring a pot of eba, the thick starchy West African staple made from cassava root. Kidney problems and chronic exhaustion forced the 56-year-old Nigerian woman to retire from teaching, and she switches between cooking with gas or over a wood fire depending on the fuel she can afford.

Financial constraints also limit the food Bello has on hand even though doctors have recommended a nutrient-rich diet both to improve her weakening health and to help her teenage daughter, Fatima, grow. Along with eba, on the menu today is melon soup with ponmo, an inexpensive condiment made from dried cowhide.

“Fish, meat, eggs, fruits, vegetables and even milk are costly these days,” Bello, 56, said, her lean face etched with worry.

If public health advocates and the Nigerian government have their way, malnourished households in the West African nation soon will have a simple ingredient available to improve their intake of key vitamins and minerals. Government regulators on Tuesday are launching a code of standards for adding iron, zinc, folic acid and vitamin B12 to bouillon cubes at minimum levels recommended by experts.

While the standards will be voluntary for manufacturers for now, their adoption could help accelerate progress against diets deficient in essential micronutrients, or what is known in nutrition and public health circles as “hidden hunger.” Fortified bouillon cubes could avert up to 16.6 million cases of anemia and up to 11,000 deaths from neural tube defects in Nigeria, according to a new report from the Bill & Melinda Gates Foundation.

“Regardless of economic situation or income level, everyone uses seasoning cubes,” Bello said as she unwrapped and dropped one in her melon soup.

Making do with smaller portions and less nutritious foods is common among many Nigerian households, according to a recent government survey on dietary intake and micronutrients. The survey estimated that 79% of Nigerian households are food insecure.

The climate crisis, which has seen extreme heat and unpredictable rainfall patterns hobble agriculture in Africa's troubled Sahel region, will worsen the problem, with several million children expected to experience growth problems due to malnutrition between now and 2050, according to the Gates Foundation report released Tuesday.

“Farmlands are destroyed, you have a shortage of food, the system is strained, leading to inflation making it difficult for the people to access foods, including animal-based proteins,” Augustine Okoruwa, a regional program manager at Helen Keller Intl, said, highlighting the link between malnutrition and climate change.

Dietary deficiencies of the micronutrients the government wants added to bouillon cubes already have caused a public health crisis in Nigeria, including a high prevalence of anemia in women of child-bearing age, neural tube defects in newborn babies and stunted growth among children, according to Okoruwa.

Helen Keller Intl, a New York-based nonprofit that works to address the causes of blindness and malnutrition, has partnered with the Gates Foundation and businesses and government agencies in Africa to promote food fortification.

In Nigeria, recent economic policies such as the cancellation of gasoline subsidies are driving the country’s worst cost-of-living crisis in generations, further deepening food hardship for the low-income earners who form the majority of the country’s working population.

Globally, nearly 3 billion people are unable to access healthy diets, 71% of them in developing countries, according to the World Health Organization.

The large-scale production of fortified foods would unlock a new way to “increase micronutrients in the food staples of low-income countries to create resilience for vulnerable families,” the Gates Foundation said.

Bouillon cubes — those small blocks of evaporated meat or vegetable extracts and seasonings that typically are used to flavor soups and stews — are widely consumed in many African countries, nearing 100% household penetration in countries like Nigeria, Senegal, Ivory Coast, and Cameroon, according to a study by Helen Keller Intl.

That makes the cubes the “most cost-effective way” to add minerals and vitamins to the diets of millions of people, Okoruwa said.

No Nigerian manufacturers already include the four micronutrients at the recommended levels, but there is industry interest.

Sweet Nutrition, located in Ota, near Lagos in Nigeria's southwest, started adding iron to some of its products in 2017. Marketing manager Roop Kumar told The Associated Press it was a “voluntary exercise” to contribute to public health.

“But we are taking trials and looking at further fortification” with the launch of the new regulatory framework, Kumar said.

Although NASCON Allied Industries, a Nigerian company that produces table salt and seasoning cubes, currently does not make products with any of the four micronutrients, quality control manager Josephine Afolayan said fortification is a priority.

“If we’re successful, that would mean that the fortified bouillon seasoning cubes in so many Nigerian dishes would also contribute to improving the micronutrient content of the dishes in my country,” Ladidi Bako-Aiyegbusi, the director of nutrition at Nigeria’s Ministry of Health and Social Welfare, wrote in the Gates Foundation report.

The Associated Press receives financial support for news coverage in Africa from the Bill & Melinda Gates Foundation and for news coverage of women in the workforce and in statehouses from Melinda French Gates’ organization, Pivotal Ventures.

Despite the promise of enriching a product that most people have in their pantries, some challenges need to be addressed. One is the “campaign of calumny” in a region where science-led interventions in the food sector have sometimes faced resistance from interest groups, Okoruwa said.

Educating people about the benefits of fortified products may help counter any possible disinformation campaign, said Yunusa Mohammed, the head of the food group at the Standards Organization of Nigeria, the government regulator for consumer products.

There is also the need to make fortified cubes affordable for struggling households like Bello's, where a pile of firewood she uses to cook outdoors on an open flame is stacked against a wall.

“What we can do is to influence the government and industry on rebates on the importation of raw materials as a public health intervention,” Mohammed said.

Food fortification is not new in Nigeria. Most of the salt consumed in the country is iodized, and products such as wheat flour, cooking oil and sugar are fortified with vitamin A by law. But the requirement for adding the four vitamins and minerals to bouillon is the most comprehensive fortification regulation to date.

Although Nigerian companies do not have to enrich their seasoning cubes yet, experts think setting standards that producers must follow if they choose to will make a difference.

A working group involving representatives from companies, regulatory agencies, research groups and development organizations is in place to accelerate voluntary compliance.

“Ultimately, we will make the bouillon fortification mandatory after seeing the acceptance of the voluntary regulations in the industry,” Mohammed said.

The Associated Press’ climate and environmental coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

Dr Augustine Okoruwa, a nutrition expert at Hellen Keller International, speaks during in an interview with The Associated Press in Ota, Nigeria, Thursday, Sept. 12, 2024. (AP Photo/Sunday Alamba)

Workers package bouillon cubes at the Sweet Nutrition factory in Ota, Nigeria, Thursday, Sept. 12, 2024. (AP Photo/Sunday Alamba)

A worker checks bouillon cubes ahead of packaging at the Sweet Nutrition factory in Ota, Nigeria, Thursday, Sept. 12, 2024. (AP Photo/Sunday Alamba)

Workers collect bouillon cubes packages at the Sweet Nutrition factory in Otta, Nigeria, Thursday, Sept. 12, 2024. (AP Photo/Sunday Alamba)

Idowu Bello, 56, buys cowhide to prepare a pot of soup in Ibadan, Nigeria, Friday, Sept. 13, 2024. (AP Photo/Sunday Alamba)

Idowu Bello, 56, buys onions to prepare a pot of soup at a market in Ibadan, Nigeria, Friday, Sept. 13, 2024. (AP Photo/Sunday Alamba)

Idowu Bello, 56, poses for a photograph inside her house in Ibadan, Nigeria, Friday, Sept. 13, 2024. (AP Photo/Sunday Alamba)

Idowu Bello, 56, prepares a meal in her kitchen in Ibadan, Nigeria, Friday, Sept. 13, 2024. (AP Photo/Sunday Alamba)

LITHIA, Fla. (AP) — Florida residents slogged through flooded streets, gathered up scattered debris and assessed damage to their homes on Friday after Hurricane Milton smashed through coastal communities and spawned a barrage of deadly tornadoes.

At least nine people were dead, but many expressed relief that Milton wasn’t worse. The hurricane spared densely populated Tampa a direct hit, and the lethal storm surge that scientists feared never materialized. Gov. Ron DeSantis warned people to not let down their guard, however, citing ongoing safety threats including downed power lines and standing water that could hide dangerous objects.

“We’re now in the period where you have fatalities that are preventable,” DeSantis said Friday. “You have to make the proper decisions and know that there are hazards out there."

Arriving just two weeks after the devastating Hurricane Helene, Milton flooded barrier islands, tore the roof off the Tampa Bay Rays ' baseball stadium and toppled a construction crane.

As homeowners assessed damage to their property, about 2.2 million customers in Florida remained without power Friday morning, according to poweroutage.us. The 260,000 people in St. Petersburg were told to boil water before drinking, cooking or brushing their teeth, until at least Monday.

The state’s vital tourism industry started to return to normal, meanwhile, with several theme parks preparing to reopen. The state's busiest airport was also scheduled to fully reopen Friday.

Warnings were heeded and lessons learned. When 8 feet (2.4 meters) of seawater flooded Punta Gorda during Hurricane Helene last month, 121 people had to be rescued, Mayor Lynne Matthews said. Milton brought at least 5 feet (1.5 meters) of flooding, but rescuers only had to save three people.

“So people listened to the evacuation order,” Matthews said.

The flooding from Milton's heavy rains was still causing problems in other areas, however.

Crews from the Hillsborough County Sheriff’s Office were assisting with rescues of people, including a 92-year-old woman, who were stranded in rising waters along the Alafia River on Friday morning. The river is 25 miles (40 kilometers) long and runs from eastern Hillsborough County, east of Tampa, into Tampa Bay.

Animals were being saved, too. Cindy Evers helped rescue a large pig stuck in high water Friday at a strip mall in Lithia east of Tampa. She had already rescued a donkey and several goats after the storm.

“I’m high and dry where I’m at and I have a barn and 9 acres,” said Evers, adding she will soon start to work to find the animals’ owners.

In Riverview, named because of its proximity to the Alafia River, a small bridge over a creek washed out, blocking Canadian Del Ockey from the home where he spends the six coldest months of the year.

Two planks over the now trickling creek are the only way he can get to his house. He rented a car and parked it on the other side, making a run Friday morning to get gas and fix a chain saw that broke as he was cutting down fallen trees around his home.

Ockey said he's used to hurricanes, having built his house 26 years ago, but Milton was different.

“We’ve had seven or eight of them come before, but nothing like this one. This was big-time,” Ockey said.

Before noon on Friday, cars with residents returning to evacuated homes in southwest Florida crept along in a slow-moving line of traffic across Interstate 75, also known as Alligator Alley. Many had evacuated to the state’s Atlantic Coast near Fort Lauderdale and Miami. On Thursday evening, bucket trucks, fuel tankers, portable bathroom trailers and a convoy of emergency vehicles streamed toward the hardest-hit areas.

Finding gas was still a challenge. Fuel stations were still closed as far away as Ocala, more than a two and a half hour drive north of where the storm made landfall as a Category 3 near Siesta Key in Sarasota County on Wednesday night.

As residents rushed back to their homes to assess the damages, tourists who had come for a vacation found that Florida theme parks including Walt Disney World, Universal Orlando and SeaWorld had reopened Friday.

Orlando International Airport, the state’s busiest, said departures for domestic flights and international flights would resume Friday, after resuming domestic arrivals Thursday evening. The airport had minor damage, including a few leaks and downed trees. Southwest Florida International Airport in Fort Myers also reopened Friday.

MacDill Air Force Base in Tampa and Patrick Space Force Base near Cocoa Beach remain closed, with only authorized personnel allowed on the bases. MacDill, home to U.S. Central Command and Special Operations Command, experienced some damage and flooding, Air Force officials said. Patrick was spared any significant damage.

In Clearwater, Jelvin Glenn said it took less than an hour early Thursday for water to rise to his waist inside his apartment. He and seven kids, ranging in age from 3 to 16, were trapped in the brown, foul floodwaters for about three hours before an upstairs neighbor opened their home to them.

Later Thursday, first responders arrived in boats to ferry them away from the building.

“Sitting in that cold nasty water was kind of bad," Glenn said.

Short-term survival is now turning into long-term worries. A hotel is $160 a night. Everything inside Glenn's apartment is gone. And it can take time to get assistance.

“I ain't going to say we’re homeless," Glenn said. "But we’ve got to start all over again.”

The Federal Emergency Management Agency has enough money to deal with the immediate needs of people impacted by Hurricanes Helene and Milton but will need additional funding at some point, FEMA administrator Deanne Criswell said Friday.

The disaster assistance fund helps pay for the swift response to hurricanes, floods, earthquakes and other disasters across the U.S. Congress recently replenished the fund with $20 billion — the same amount as last year.

Farrington reported from St. Petersburg, Florida. Associated Press journalists Terry Spencer outside of Fort Lauderdale, Florida; Stephany Matat in Fort Pierce, Florida; Freida Frisaro in Fort Lauderdale; Lolita Baldor in Washington; and Jeffrey Collins in Columbia, South Carolina; contributed to this report.

A Spring Oaks resident checks out the rising floodwaters from the Little Wekiva River on Spring Oaks Blvd. in his neighborhood in Altamonte Springs, Fla., Friday, Oct. 11, 2024. Central Florida rivers are forecast to crest in the coming days because of the excessive rainfall from Hurricane Milton. (Joe Burbank/Orlando Sentinel via AP)

A home on Little Wekiva Road in the Spring Oaks neighborhood in Altamonte Springs, Fla is reflected in the floodwaters from the Little Wekiva River, Friday, Oct. 11, 2024. Central Florida rivers are forecast to crest in the coming days because of the excessive rainfall from Hurricane Milton. (Joe Burbank/Orlando Sentinel via AP)

A linesman contractor for Duke Energy works on power lines along Forest City Road in Orlando. Friday, Oct. 11, 2024. As of Friday morning, 2.2 million Floridians were reported to still be without power. (Joe Burbank/Orlando Sentinel via AP)

Spring Oaks resident Earline Gonzales talks about the rising waters from the Little Wekiva River in her flooded neighborhood in Altamonte Springs, Fla., Friday, Oct. 11, 2024. Central Florida rivers are forecast to rise in the coming days because of the excessive rainfall from Hurricane Milton. (Joe Burbank/Orlando Sentinel via AP)

The damaged roof of Ron and Jean Dyer's beachfront condo at Bahia Vista Gulf is seen alongside the sand-swamped Jetty Villas, after the passage of Hurricane Milton, on the island of Venice, Fla., Friday, Oct. 11, 2024. (AP Photo/Rebecca Blackwell)

Hurricane Milton damage is seen to the beachfront condominium community of Bahia Vista Gulf, on the island of Venice, Fla., Friday, Oct. 11, 2024. (AP Photo/Rebecca Blackwell)

A member of the Pasco County Sheriff's Office goes out to help residents trapped in their homes as waters rise after Hurricane Milton caused the Anclote River to flood, Friday, Oct. 11, 2024, in New Port Richey, Fla. (AP Photo/Mike Carlson)

A bridge going over a small creek is seen damaged by Hurricane Milton, Friday, Oct. 11, 2024, in Riverview, Fla. The road is the only access point into a community. (AP Photo/Julio Cortez)

A lifeguard hut is on its side after Hurricane Milton at Clearwater Beach, Fla., on Friday, Oct. 11, 2024 (AP Photo/Haven Daley)

Clean up continues at Clearwater Beach, Fla., after Hurricane Milton on Friday, Oct. 11, 2024 in (AP Photo/Haven Daley)

FILE - Neighborhoods with debris from tornadoes are visible in the aftermath of Hurricane Milton, Oct. 10, 2024, in Fort Pierce, Fla. (AP Photo/Gerald Herbert)

Public work employees remove sand that was pushed to the streets by wind and storm surge from Hurricane Milton, Friday, Oct. 11, 2024, in Fort Myers Beach, Fla. (AP Photo/Marta Lavandier)

Renel Prophet carries a chainsaw to get it repaired after it broke while cleaning out down trees in his property, which became unaccessible during Hurricane Milton, Friday, Oct. 11, 2024, in Riverview, Fla. (AP Photo/Julio Cortez)

Public work employees remove sand from the roadways, that was pushed to the streets by Hurricane Milton, Friday, Oct. 11, 2024, in Fort Myers Beach, Fla. (AP Photo/Marta Lavandier)

Del Ockey, a seasonal Florida resident from Canada, walks near the damaged bridge from Hurricane Milton, that leads onto his property, Friday, Oct. 11, 2024, in Riverview, Fla. (AP Photo/Julio Cortez)

Del Ockey, a seasonal Florida resident from Canada, walks near the damaged bridge to his property from Hurricane Milton, Friday, Oct. 11, 2024, in Riverview, Fla. (AP Photo/Julio Cortez)

A man who identified himself as Jesse walks out through floodwaters of the Anclote River after Hurricane Milton hit the region, Thursday, Oct. 10, 2024, in New Port Richey, Fla. (AP Photo/Mike Carlson)

A tree toppled by Hurricane Milton lies atop a stately home in Siesta Key, Fla., Thursday, Oct. 10, 2024. (AP Photo/Rebecca Blackwell)

A truck drives down a flooded street in Siesta Key, Fla., following the passage of Hurricane Milton, Thursday, Oct. 10, 2024. (AP Photo/Rebecca Blackwell)

A broken sign and other debris lie alongside Gilligan's Island Bar & Grill after the passage of Hurricane Milton, in Siesta Key, Fla., Thursday, Oct. 10, 2024. (AP Photo/Rebecca Blackwell)

People from Sarasota, Fla., visit a familiar beach on Siesta Key, Fla., which they say was already decimated by Hurricane Helene, and lost feet more of sand coverage in Hurricane Milton, Thursday, Oct. 10, 2024. (AP Photo/Rebecca Blackwell)

A car backs up after encountering deeper water on a flooded street in Siesta Key, Fla., following the passage of Hurricane Milton, Thursday, Oct. 10, 2024. (AP Photo/Rebecca Blackwell)

Natasha Ducre surveys the kitchen of her devastated home, which lost most of its roof during the passage of Hurricane Milton, in Palmetto, Fla., Thursday, Oct. 10, 2024. Ducre, her husband, three children, and two grandkids rode out the storm in a government shelter and returned to find their home unlivable and much of their furniture and belongings destroyed by rainwater. (AP Photo/Rebecca Blackwell)

A piece of debris is wrapped high around a tree in Siesta Key, Fla., following the passage of Hurricane Milton, Thursday, Oct. 10, 2024. (AP Photo/Rebecca Blackwell)

A tree lies atop a stately home in Siesta Key, Fla., following the passage Hurricane Milton, Thursday, Oct. 10, 2024. (AP Photo/Rebecca Blackwell)

A pick up drives past a guard gate on a flooded street in Siesta Key, Fla., following the passage Hurricane Milton, Thursday, Oct. 10, 2024. (AP Photo/Rebecca Blackwell)

Flood waters recede after Hurricane Milton, on streets where piles of debris from Hurricane Helene flooding, sit outside many homes, in Siesta Key, Fla., Thursday, Oct. 10, 2024. (AP Photo/Rebecca Blackwell)