The role of policy on fortification in food processing and value addition in Malawi and Mozambique—a systematic review

Food fortification is a public health strategy for tackling micronutrient deficiencies in sub-Saharan Africa. This systematic review explores the policies governing food fortification in Malawi and Mozambique. By comparing policy implementation, regulatory mechanisms and outcomes, this review aims to identify best practices, challenges, and opportunities to strengthen fortification programs across the region. All applicable evidence collated from reports and articles published between 2000 and 2025, databases from key organizations, and reports/literature received from key informants were systematically reviewed. A total of 29 reports were selected based on the inclusion and exclusion criteria and subjected to risk of bias assessment. The key issues include high fortification costs, lack of technical knowledge and expertise, equipment limitations, quality control issues and regulatory compliance. Malawi's mandatory fortification, enacted in 2011, has demonstrated higher compliance rates, supported by robust monitoring mechanisms, albeit with limited reach into informal food processing sectors that serve rural populations. Mozambique's voluntary fortification guidelines, which became mandatory in 2016, exhibit lower compliance but greater flexibility in accommodating small and medium-scale processors. This review recommends monitoring quality and reporting, results-based implementation, stakeholder and community engagement, support and incentives to the food industries, and reduction of bureaucratic burdens to achieve effective fortification programs. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251113300, identifier PROSPERO (CRD420251113300).