Vitamin A and Iron Status of Women and Young Children in Major Cities of Cameroon before and after Vitamin A Fortification of Vegetable Oil and Iron Fortification of Wheat Flour
Reina Engle-Stone *
University of California, Davis, CA, USA.
Alex Ndjebayi
Helen Keller International, Yaounde, Cameroon.
Martin Nankap
Helen Keller International, Yaounde, Cameroon.
Marie-Madeleine Gimou
Centre Pasteur du Cameroun, Yaounde, Cameroon.
Avital Friedman
Helen Keller International, New York, NY, USA.
Kenneth Brown
University of California, Davis, CA, USA.
*Author to whom correspondence should be addressed.
Abstract
Objectives: Few data are available on the effectiveness of large-scale food fortification programs. We conducted representative surveys 2 y before and 1 y after introduction of vitamin A (VA)-fortified cooking oil and iron-fortified wheat flour to assess program impact on VA and iron status in urban Cameroon.
Methods: In each survey, 10 different households were selected within each of the same 30 clusters in Douala and Yaoundé (n=~300/survey). Indicators of VA (retinol-binding protein, pRBP) and iron (ferritin; soluble transferrin receptor, sTfR) status, adjusted for presence of inflammation (CRP, AGP) and malaria, were assessed among women 15-49 y and children 12-59 mo. Staple food intake was measured by 1-week FFQ, and post-fortification oil and flour samples were collected.
Results: Oil and flour were each consumed by >80% of participants. Post-fortification, 44% of oil (85% of "branded" oil) and 76% of flour samples were fortified. Controlling for inflammation and malaria, there was no change in pRBP between pre- and post-fortification values among women (1.41 to 1.40 µmol/L) and children (0.87 to 0.88 µmol/L), but ferritin increased (women: 37 to 47 µg/L; children: 39 to 51 µg/L, both P < 0.05) and sTfR decreased (7.7 to 6.2 and 10.6 to 8.2 mg/L, P < 0.01). Prevalence of anemia decreased among women (46 to 38%, P < 0.05) but not children.
Conclusions: After 1 year of a national program, adequately-fortified products are available. Iron status indicators have increased since the initial survey; plausibility analyses will determine whether these changes are attributable to the fortification program.