Anaemia control: Lessons from the flour fortification programme

Objectives: Anaemia is an important public health problem in Iran; therefore, a programme of. our forti. cation with iron was launched in two pilot provinces. The present study was conducted in January 2009 to evaluate the effectiveness and process of this programme. Study design: A 'before-and-after study' was conducted to evaluate the effectiveness of the flour fortification programme, and the process of the programme was evaluated using a cross-sectional study. Methods: To evaluate the effectiveness of the programme, blood haemoglobin and ferritin levels were measured in sample populations from Bushehr and Golestan provinces. The target population was women aged 15-49 years. Iron content was measured in samples of. our and bread to evaluate the. our forti. cation process in these two national pilot provinces. Results: The total study population was 600 women from Bushehr province and 652 women from Golestan province. Similar trends were found in the indicators of anaemia/iron deficiency among the women studied in both provinces. The flour fortification programme only appears to have had a beneficial effect on ferritin levels (iron deficiency) in the two provinces. The prevalence of iron-deficiency anaemia before and after the intervention did not differ significantly in either province. Interestingly, the prevalence of anaemia (low haemoglobin) was significantly higher after the intervention in women from both provinces. The coverage of fortified. our and bread was 90% and 98.7% in Bushehr province, and 94.1% and 95% in Golestan province, respectively. Conclusions: In areas where anaemia is not mainly due to iron deficiency, an iron forti. cation programme might decrease the prevalence of iron deficiency without affecting the prevalence of anaemia. (C) 2009 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.