Decline in the prevalence of anaemia among children of pre-school age after implementation of wheat flour fortification with multiple micronutrients in Jordan

Abstract

Objective: To examine changes in the prevalence of anaemia and its correlates among children of pre-school age after implementation of wheat flour fortification with multiple micronutrients in Jordan. Design: Retrospective analysis of the data from two repeated national cross-sectional panels of pre-school children. Setting: The two surveys were conducted in 2007 and 2009, 16-20 months and 34-36 months, respectively, after implementation of wheat flour fortification with multiple micronutrients in Jordan. Anaemia was considered if Hb level was <11 g/dl. An anaemia prevalence of ≥40 % was considered a severe public health problem, while that of 20-39·9 % was considered a moderate public health problem. Subjects: A total of 3789 and 3447 children aged 6-59 months tested in 2007 and 2009, respectively. Results: The prevalence of anaemia in pre-school children declined from 40·4 % in 2007 to 33·9 % in 2009 (adjusted OR = 0·74; P < 0·001). The decline in the prevalence in 2009 as compared with 2007 was more pronounced among children aged >24 months (−13·7 points), children living in urban areas (−8·0 points), children from rich households (−9·0 points), children who had never been breastfed (−17·0 points) and well-nourished children (−6·8 points). In both surveys, presence of childhood anaemia was strongly associated with child age ≤24 months, living in poor households, breast-feeding for ≥6 months, malnourishment, poor maternal education and maternal anaemia. According to a global estimate based on data from 187 countries, the prevalence of anaemia has decreased from 40·2 % in 1990 to 32·9 % in 2010 (1) . The decline in prevalence was in both sexes and for all severities of anaemia. However, measurements of total years of life lived with disability (YLD), reflecting population size and disability weights, showed that anaemia was responsible for 68·3 million YLD in 2010. This was greater than 65·5 million YLD in 1990 (1) . The anaemia YLD in 2010 accounted for 8·8 % of the total for all conditions, and was more than for major depression (8·2 %), chronic respiratory diseases (6·3 %) and injuries (6·3 %) (1) . The children under 5 years were the age group that showed the highest prevalence of anaemia; this age group was the only age group with increased anaemia prevalence from 1990 to 2010 (1) .Children of pre-school age are the most vulnerable to the detrimental long-term effects of anaemia (1) . Worldwide, it is estimated that 293·1 million (47·4 %) pre-school children are anaemic (2) . In developing countries 30-80 % of pre-school children are anaemic at 1 year of age (3) . In the Eastern Mediterranean Region, 46·7 % (0·8 million) of pre-school children are anaemic, which is higher than the prevalence of 21·7 % reported from Europe and 23·1 % reported from the Western Pacific Region (2) . The WHO classifies the severity of the public health problem of anaemia in a population into severe (≥40 % prevalence), moderate (20-39·9 % prevalence) or mild (5-19·9 % prevalence) based on the population anaemia prevalen...

Review of the nutrition situation in the Eastern Mediterranean Region

“…For instance, in Morocco, a country that has implemented iron fortification of flour, the prevalence of anaemia among children aged 2-5 years decreased by 37.4% between 2006 and 2008 (136). Similarly, in Jordan, after the implementation of wheat flour fortification with multiple micronutrients, including iron, anaemia prevalence decreased from 40.4% in 2007 to 33.9% in 2009 among children aged 6-59 months (137).…”

Systematic review and meta-analysis of the effect of iron-fortified flour on iron status of populations worldwide

“…(28) HR LR Olivares, 1990 (49) LR HR ? LR LR LR LR LR LR LR Phu, 2010 (50) LR HR HR LR LR LR LR LR LR LR Rahman, 2015 (51) LR LR LR LR LR LR LR LR LR LR Rifai, 2016 (52) HR HR HR LR LR LR LR LR LR LR Rohner, 2010 (53) ? (54) HR Figure S2).…”

A randomised control trial to evaluate the clinical pharmacist's role in managing iron deficiency anaemia patients

“…Several studies were conducted in Jordan to assess anaemia prevalence . A descriptive study that used a survey to assess the reproductive and non‐reproductive health status of women in two villages in the south of Jordan found that 55.5% of the participants had a haemoglobin (Hbg) level <12 g/dl, which indicated anaemia .…”

“…[1] Several studies were conducted in Jordan to assess anaemia prevalence. [2][3][4][5][6][7] A descriptive study that used a survey to assess the reproductive and non-reproductive health status of women in two villages in the south of Jordan found that 55.5% of the participants had a haemoglobin (Hbg) level <12 g/dl, which indicated anaemia. [3] In 2010, the Jordan Ministry of Health conducted a national survey in collaboration with the Global Alliance for Improved Nutrition, US Centers for Disease Control and Prevention and the United Nations Children's Fund.…”