By Marilyn Collins
Marilyn Collins is a retired Director of the Government Food and Drug Analyst Derpartment
The Ministry of Public Health has placed emphasis on iron deficiency anaemia during this year’s observance of “Nutrition Awareness Week”. It highlighted statistics from local survey on iron deficiency anaemia undertaken in 2012 in collaboration with the Pan American Health Organization PAHO which revealed that iron deficiency anaemia affects 41% of pregnant women, 24% of young children and 20.8% of school-age children.
In a previous Ministry of Public Health/PAHO survey for the period 1996 to 1997 the prevalence of iron deficiency anaemia in pregnant women was 52%; for children under 5 years 47.9 % and for adults 15 to 30 years, 42%.
Since the 1997 survey there have been several strategies applied to improve the iron status of vulnerable groups in Guyana. The iron supplementation programme was reviewed. In addition to provision of iron supplements for pregnant women, “Sprinkles” containing iron was made available to both pregnant women and children under two years. There were intensive education programmes in maternal and child nutrition, such as the IDB Basic Nutrition Project, under which Maternal and Child Health staff from various health clinics were trained and provided with the necessary health promotional material.
There was also information, education and communication programmes (IEC), one of which, under the IDB project, focused on education for pregnant women and care givers about the use and benefits of “Sprinkles”. Aspects of the country’s food based dietary guidelines (FBDGs) focused on dietary diversity and the use of iron rich foods. Breastfeeding promotion continued. Fortification of wheaten flour continued. Critically, two very important guidance documents were developed. These were the Protocol for the Detection, Prevention and Treatment of Iron Deficiency Anaemia, and the Policy for the Prevention and Control of Anaemia in Guyana.
These programmes have secured some measure of success in achieving improvements in the iron status of the population. However, there are still challenges, as revealed by the most recent survey. Thus the need for the anaemia reduction programme to be considered as a public health dilemma with the cohesive implementation of all strategies.
It should be highlighted that not all anaemia is due to iron deficiency even though it is known to be most common.
Even though iron fortification was used as one of the strategies to address iron deficiency anaemia in Guyana it lacked the necessary governmental policy directive that all wheaten flour imported into Guyana should be iron fortified. It also lacked the necessary enforcement, certification and monitoring by competent authorities, to ensure that wheaten flour available to consumers was suitably fortified.
This was unnecessary during the PL 480 Agreement era, which culminated in 2004, because wheaten flour was milled, fortified and solely distributed by the National Flour Milling Company here in Guyana, in accordance to the Guyana National Bureau of Standards product specifications. However, with the advent of trade liberalization and the opening of the market wheaten flour began to be imported from varied sources. The need to implement systems to ensure the continued fortification and monitoring of wheaten flour became less robust, since it required a multi-sectorial approach to guarantee success. It requires the collaboration of the Ministry of Public Health, Ministry of Trade and the Guyana Revenue Authority to oversee importation, testing and certification.
Wheaten flour is allowed for dietary variety and meal composition, thus it is a suitable vehicle for the iron fortification. The iron content in the flour samples taken by the Ministry of Public Health/PAHO survey in 2012 ranged from 1.20 mg/100 g to 4.20 mg/100 g. According to Guyana Standard Specification for Wheat Flour, GYS 33:2003, iron content should be not be less than 2.9 mg/100 g and not more than 4.3 mg/100 g.
Food fortification is an established strategy to address micronutrient deficiencies such as iron anaemia. A fortification progamme as defined by Codex Alimentarious, the International Standard Setting Body for food, as “the addition of one or more essential nutrients to a food whether or not it is normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiency of one or more nutrients in the population or specific populations or groups.”
Fortification is one of the effective means of addressing such deficiencies. In some countries a single food matrix is used for multiple fortification with various micronutrients (fortificants). The major consideration in choosing such food matrix is to ensure that the fortified food will be consumed by the population at risk in adequate amounts considering other sources of the fortificant. In addition the fortificant should not in any way react with the food, or its effect affected by the food matrix. The selection of a non heme iron fortificant is determined based on the food vehicle with consideration of colour effects, off flavours and bioavailability.
In recognizing anaemia as a public health issue and the need to implement strategies to address this health concern it is hoped that serious consideration will be given to establishing an all-encompassing cohesive programme. Inclusive in this programme should be iron fortification of wheaten flour with the attendant regulatory practices in place.Iron fortification could be a successful contributor to the reduction of iron deficiency anaemia if properly crafted, implemented and monitored. It is reiterated that recognition is given that not all anaemia is due to iron deficiency even though it is the most common cause
