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Helping to Combat Anaemia in Haiti

IAEA-Supported Study Provides Information for the National Wheat Flour Fortification Programme in Haiti

Study participants in Haiti waiting for the test meal. (Photo: Isabelle Herter-Aeberli, ETH Zurich)

Anaemia is a public health problem in Haiti. 61% of children younger than 5 years (72% of which are under 2 years old), 50% of pregnant women and 34% of lactating mothers are anaemic (figures from 2006).

Food fortification – that is, fortification of staple foodstuffs with iron and other necessary nutrients – offers an effective way to combat anaemia. In Haiti, wheat flour is consumed by the entire population in both urban and rural areas. In February 2017, the country issued a law making it obligatory to fortify wheat flour with iron, folic acid, B vitamins and zinc.

As part of this effort, the Haitian Government requested the IAEA to help inform their choice of the most cost-efficient iron fortificant to add to the flour. A study was conducted by the Human Nutrition Laboratory of ETH Zurich in collaboration with the nutrition team of the Ministry of Health, supported by the IAEA’s technical cooperation programme[1]. Twenty mothers and their children participated in the study, which measured their absorption of iron from flour fortified with ferrous fumarate[2], NaFeEDTA[3], or a combination of the two. The study outcomes demonstrated differences in the bioavailability of the two iron fortificants from wheat flour and identified NaFeEDTA as the more efficient fortificant compound in both groups. However, given its cost, a slightly higher fortification level of ferrous fumarate was found to be more cost-effective. The results have provided a basis for defining the level and type of iron fortificant(s) to add to wheat flour in the national fortification programme.

Impressions from the dissemination workshop; Cornelia Loechl, Section Head Nutritional & Health-related Environ. Studies, NAHU, IAEA. (Photo: Isabelle Herter-Aeberli/ETH Zurich )

The study results were disseminated on 16 May 2017 at Haiti’s National Laboratory of Public Health by principal investigator Isabelle Herter-Aeberli from the ETH Zurich team. IAEA technical officer Cornelia Loechl provided an introduction on the use of stable isotope techniques for nutritional evaluations and an overview of the IAEA’s contributions to nutrition.

In his opening statement to the workshop, the Director General of the Ministry of Health emphasized the importance of the long-standing collaboration between Haiti and the IAEA and highlighted the impact of the study results on national programming. The Director of Nutrition at the Ministry of Health moderated the discussions of the study results and guided the outline of the next steps. Representatives of the milling industry in Haiti, the UN family (UNICEF and WFP), Ministries (Ministry of Health, Ministry of Commerce), academia, and NGOs encouraged the reactivation of the multi-disciplinary and multi-sectorial fortification committee and the set-up of an effective quality control system. They also appreciated the IAEA initiative of sharing study results with national stakeholders.

The study has strengthened the collaboration between the National Laboratory of Public Health and nutrition at the Ministry of Health, which will serve as future platform for public health nutrition research and provide high quality data for policy makers and programme planning.

Test meal – bread with melted cheese to which the stable isotopes were added. (Photo: Isabelle Herter-Aeberli/ETH Zurich)

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[1] The four year IAEA Technical Cooperation project HAI6004 is supporting Haiti in reducing malnutrition among children younger than 5 years using stable isotopes. One of the concrete results of the project has been the completion of this study on iron bioavailability from fortified wheat flour that was presented already at a symposium at the Micronutrient Forum Global Conference in Mexico in October 2016.

[2] Ferrous fumarate is the iron(II) salt of fumaric acid used to supplement iron intake. This iron compound is poorly soluble in water but soluble in dilute acid.

[3] NaFeEDTA or sodium iron (Fe3+) ethylenediaminetetraacetic acid is a water soluble iron compound used to fortify especially grain-based products.