Mid-term evaluation: flour fortification with iron in Iran

Iron deficiency anemia is one of the common nutritional problems in Iran. Therefore, the flour fortification with iron program was launched on May 2001, and mid-term evaluation conducted after 3 years (2004), focusing on effectiveness and coverage of the program.

Two studies have been designed: Study 1: A field trial to determine effectiveness of the program. Locations of the study were the Bushehr province (intervention group) and three districts of Fars province (control group). Target populations were women aged 15-49 years. For all women, blood samples were taken to measure hemoglobin and ferritin. In addition, data were collected on potential confounding variables and adjustments were made using a logistic regression model. Study 2: A cross sectional study to determine program coverage in Bushehr province. In this study, we measured the iron in samples of bread consumed by households and also iron content of the flour in bakeries.

The results of this study showed that the coverage of fortified flour was 100% and the coverage of fortified bread at households' level was 99.7% in Bushehr province. A total of 863 women (567 women in Bushehr province and 296 women in Fars) entered into the effectiveness study. The fortification program decreased the prevalence of low ferritin and iron deficiency anemia (low hemoglobin and low ferritin) among women. There were no significant changes in mean hemoglobin or in the prevalence of low hemoglobin.

The findings of the mid-term evaluation of the flour fortification program in Iran demonstrated that the iron fortification program has beneficial effects. Flour fortification alone will not prevent iron deficiency anemia but it is an important component of a public health strategy. Therefore, more time and information are needed for interpreting the current trends in anemia indicators.