Efficiency of an Iron Fortified Wheat Flour for the Correction and Prevention of Iron Deficiency Anemia in Children Aged 18-59 Months in Salapoumbe (East Cameroon): Randomized Controlled Double-Blind Clinical Trial

Abstract

Problem: The iron fortification of wheat flour widely consumed in Cameroon can help fight against iron deficiency anemia for children under 5 years. Objective: To assess the efficiency of iron-fortified wheat flour in the correction and prevention of iron deficiency anemia in children aged 18-59 months in Salapoumbe, Cameroon. Methodology: A randomized, controlled, double-blind clinical trial was conducted for 6 months on 205 anemic children, 106 in the treatment group and 99 in the control group. Regardless of their usual diet, under direct supervision, all received morning and evening, 50 g of wheat flour containing a standard amount of micronutrients with the exception of 3.75 mg of iron fumarate in the fortified iron group. Before the intervention, all these children had benefited from anthropometric measurements, blood sampling and systematic deworming, repeated at 3 months and 6 months. The 2 groups were compared to mean hemoglobin, ferritin adjusted CRP (ferritin / CRP), serum iron, transferrin saturation (TS), and anemia, iron deficiency and iron deficiency anemia. Results: Compared to the control group, children consuming the iron-fortified cereal had significantly higher adjusted mean hemoglobin level (10.0\(\pm\)1.8 vs. 9.7\(\pm\)1.4g/dL, respectively; p=0.023), ferritin adjusted for CRP (16.1\(\pm\)8.3 vs. 9.5\(\pm\)7.5\(\mu\)g/L, p<0.001), serum iron (14.5\(\pm\)3.9 vs. 11.2\(\pm\)4.4\(\mu\)g/dL; p<0.001), and transferrin saturation (19.0\(\pm\)17.4 vs. 10.7\(\pm\)12.5%; p<0.001) at 6-mo. The prevalence of anemia, iron deficiency, and iron deficiency anemia also decreased by a significantly larger extent in the fortified group vs. control group (all p<0.001). In addition, at the end of intervention children of fortified group showed a significant higher weight gain (p=0.027) and weight for age improvement (p=0.016) than control group. Conclusion: Fortified wheat flour with 7.5 mg iron fumarate administered daily for 6 months corrects and prevents iron deficiency anemia and improves nutritional status in children aged 18-59 months in Salapoumbe.