Journal of School of Public Health and

Background and Aim: Anemia is an important public health problem in Iran. The most prevalent type (50%) is iron-deficiency anemia. Flour fortification with iron and folic acid is one of the main strategies usually adopted to combat anemia. Two pilot projects were conducted in 2 Iranian provinces: the first one in Bushehr in 2001 and the second one in Golestan in 2007. The present study was conducted in January 2009 to evaluate the process and determine the effectiveness of the flour fortification pilot project in the 2 provinces.

Materials and Methods: To evaluate the effectiveness of the project, blood hemoglobin and ferritin levels were measured in a sample population of child-bearing women aged 15-49 years in Bushehr Province (n=600) and Golestan Province (n=625), selected by multi-stage sampling before and after the intervention. For process evaluation, the iron content in samples of flour and bread made from the flour were measured in a descriptive study.

Results: We found similar trends in the indicators of anemia/iron deficiency among the women in Bushehr and Golestan provinces. The flour fortification project appears to have had beneficial effects on the serum ferritin levels (low levels indicate iron deficiency) in both provinces. The prevalence of iron deficiency decreased from 22.2% to 15.7% (p<0.002) and from 26.7% to 14.6% (p<0.001), in Bushehr and Golestan, respectively. However, the prevalence of anemia was significantly higher after intervention in Golestan (p<0.001). Further analysis of the data also revealed that the intervention did not have any statistically significant effect on the prevalence of iron-deficiency anemia in either province. The coverages of fortified flour and bread were 90% and 98.7% in Bushehr and 94.1% and 95% in Golestan, respectively.

Conclusion: The flour fortification pilot project in Iran resulted in reducing prevalence of iron deficiency and improving body iron reserves in women, but it had no effect on anemia prevalence. It can be concluded that in circumstances where iron deficiency is not a major cause of anemia, interventions such as flour fortification with iron alone will not produce any significant effect.