Review of the National Wheat Flour Fortification Program in Egypt - Assessing Compliance of Mills Fortifying Flour/Baladi Bread with Folate and Iron and Estimating Consumption of Fortified Flour in Women of Reproductive Age with HIECS Data.

ABSTRACT

Objectives: To evaluate outcomes of the Government of Egypt national wheat flour fortification program, including fortification level of flour at mills and the estimation of fortified flour/baladi bread intake using Egypt Household Income, Expenditure, and Consumption Survey (HIECS) data to determine the contribution of fortification to dietary intake of iron and folic acid (FA) among women of reproductive age (WRA). Methods: Flour samples were collected from 53 mills and analyzed for iron content using atomic absorption spectrometry. HIECS 2010/2011 data was used to estimate average consumption of fortified flour and iron and folic acid intake of WRA using the FAO adjustment factors for calculating adult equivalent consumption units. Results: 95% of the flour samples collected at the mills during the audit were fortified at optimal levels or above. In the region with highest prevalence of deficiency, Lower Egypt, women's estimated daily intake of fortified flour was lower as compared with other regions, but still provided over 24% and 48% of RDA of iron and FA, respectively. In Upper Egypt, consumption of fortified flour and intake of iron and FA was highest providing over 33% and 60% of RDA, respectively. Conclusions: The fortified flour is reaching those in need and is significantly increasing dietary intake of iron and FA among WRA. Together with the monitoring of the fortification levels at the mills this data allows tracking of the coverage and consumption of fortified foods in Egypt. An adaptation of the HIECS data collection tool could further improve the estimate of fortified food intake.