Fortified wheat flour and anaemia in Jordanian pre-school children
What it found
In two national surveys of pre-school children in Jordan, anaemia fell from 40·4 % in 2007 to 33·9 % in 2009, after wheat flour fortified with multiple micronutrients was introduced.
The surveys were done in children, not in animals or cells.
What they found
Studies in people
Anaemia fell over time
The share of pre-school children with anaemia dropped from 40·4 % in 2007 to 33·9 % in 2009. The authors call this a fall from a severe to a moderate public health problem.
Biggest drops in some groups
The fall was larger in children over 24 months, children in cities, children from rich households, children who had never been breast-fed and well-nourished children. For example, it fell by 17·0 points in children who had never been breast-fed.
Groups still at higher risk
In both surveys, anaemia was strongly linked to being 24 months old or younger, living in a poor household, breast-feeding for 6 months or more, poor nourishment, low mother's education and having an anaemic mother.
Where the fall did not happen
Anaemia did not fall in children living in rural areas or in the north and south regions, and it did not fall in children with moderate or severe stunting. In the south it rose from moderate to severe.
Other findings
Fortified flour supply gaps
The authors note that only 44·1 % of bread samples from households tested positive for iron, and that 84·6 % of mills did not fortify flour for five of sixteen months because they did not receive the premix.
What the authors conclude
“The public health problem of childhood anaemia declined from severe in 2007 to moderate in 2009, after the implementation of wheat flour fortification with multiple micronutrients in Jordan.”
Also in their conclusions
- They say the study provides evidence that the public health problem of anaemia in Jordanian pre-school children shifted from severe to moderate after the wheat flour fortification programme began.
- They say anaemia still affects one-third of pre-school children in Jordan, and that children aged 24 months or younger, those in low socio-economic groups such as rural areas, those living with anaemic mothers and those exclusively breast-fed for 6 months or more are at increased risk.
- They encourage continuing to fortify wheat flour with multiple micronutrients in addition to iron and folic acid, and call for health education, a focus on parents and rural areas, and expanding fortification to other foods such as milk and rice.
How it was done
The authors wanted to see whether anaemia and its related factors in pre-school children changed after Jordan began fortifying wheat flour with multiple micronutrients. They say evidence is needed from developing countries on how fortified wheat flour affects children's health.
They looked back at data from two national surveys of children aged 6 to 59 months in Jordan, one in 2007 and one in 2009. The surveys covered 3789 children in 2007 and 3447 children in 2009, tested 16 to 20 months and 34 to 36 months after fortification began.
What it can’t tell you
- The surveys were cross-sectional, so the authors say they cannot establish a cause-and-effect relationship between the fortified flour and the fall in anaemia.
- The authors say the fall in anaemia over the two years could also be due to other changes not related to the fortification programme, such as seasonal differences in food and temperature between the two surveys.
- Anaemia was defined only by blood haemoglobin level, so the authors could not tell what type of anaemia each child had.
Who paid
- Authors work at
- Tokyo Medical and Dental University, Japan
The paper
- Title
- Decline in the prevalence of anaemia among children of pre-school age after implementation of wheat flour fortification with multiple micronutrients in Jordan
- Type
- Study
- Evidence
- Studies in people
- Summarised from
- Full text
- Cite
- Al Rifai R, Nakamura K, Seino K (2016). Decline in the prevalence of anaemia among children of pre-school age after implementation of wheat flour fortification with multiple micronutrients in Jordan. Public health nutrition. doi:10.1017/S1368980015002785Free full textPubMed 26434612DOI
Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error