The Effects of an Oil and Wheat Flour Fortification Program on Pre-School Children and Women of Reproductive Age Living in Côte d’Ivoire, a Malaria-Endemic Area

Abstract

Anemia and micronutrient deficiencies are widespread in sub-Saharan Africa, but the impact of food fortification is still debated. The objective of this study was to estimate the iron and vitamin A status of preschool children (PSC) and women of reproductive age (WRA) in households consuming fortified oil and wheat flour. The survey was cross-sectional in a rural and an urban area. Data on demographics, socioeconomic status, and fortified foods were collected at households. Hemoglobin (Hb), retinol binding protein (RBP), ferritin, soluble transferrin receptors (sTfR), subclinical inflammation, and Plasmodium spp. infection data were collected. In PSC, vitamin A deficiency (VAD) was prevalent, but for each 1 mg retinol equivalents (RE)/kg of oil consumed, RBP increased by 0.37 μmol/L (p = 0.03). In WRA, there was no significant VAD in the population (0.7%). Anemia was found in 92.2% of rural and 56.3% of urban PSC (p < 0.001). PSC with access to adequately fortified flour had Hb concentrations 15.7 g/L higher than those who did not (p < 0.001). Hb levels increased by +0.238 g/L per mg/kg increase in iron fortification levels (p < 0.001). The national program fortifying vegetable oil with vitamin A and wheat flour with iron and folic acid may have contributed to improved micronutrient status of PSC from two areas in Côte d’Ivoire.

Reducing the burden of iron deficiency anemia in Cote D’Ivoire through fortification

“…In the Cote d'Ivoire, iron fortification of wheat flour became mandatory in 2007 as part of the fortification policy [10]. Despite its mandatory nature, subsequent surveys evaluating the impact of this policy showed that only around 50% of the flour samples complied with the mandated levels of iron fortification limiting the potential impact [11,14]. Rohner et al conclude that despite this policy, the prevalence of IDA remains high and that there is still a need for additional iron-fortified food vehicles to reduce the burden [11].…”

Addressing the Challenge of Iodine Deficiency in Developing Countries

“…A recent study demonstrated that fortification of vegetable oil with other micronutrient such as vitamin A and iron improved the nutritional status in the study participants. 34 An additional advantage offered by fortification of these other vehicles is the prevention of hypertension associated with increased salt intake. …”

Biofortified crops for tackling micronutrient deficiencies – what impact are these having in developing countries and could they be of relevance within Europe?

“…Malaria infection can cause further distortion which must be taken into account (Rohner et al . ). Also of particular relevance in developing countries, intestinal helminth infections can affect nutritional status in many ways, including by reducing micronutrient absorption, increasing anaemia risk due to worms feeding on the blood and causing loss of appetite (WHO ).…”