To use dietary modeling to predict the effectiveness of iron intervention programs, given existing and potential micronutrient (MN) delivery platforms and dietary patterns.
We completed 24-h dietary recalls and biomarker analyses among women (n = 912) and children 1-4 y (n = 883) in the North, South, and YaoundÃ©/Douala in Cameroon. We applied National Cancer Institute and full probability methods to estimate usual nutrient intake and phytate:iron ratios to estimate absorption. We simulated the “reach” (proportion exposed to MN delivery platforms), and “effective coverage” (proportion predicted to achieve iron adequacy following an intervention) of the current wheat flour (WF) fortification program and potential new programs, such as fortified bouillon cubes (BC) and MN powders.
The estimated reach of individual programs ranged from 37%-93% for women and 37%-92% for children; respective figures for effective coverage were 4%-21% and 6%-30%. WF fortified with 60 mg iron/kg flour reduced the estimated prevalence of inadequate intake from 83% to 72% in women and from 67% to 52% in children nationally. This reduction was greatest in YaoundÃ©/Douala, where WF consumption was highest. Among children, adding MN powder (through Child Health Days) further reduced iron inadequacy to 31% compared to 48% for BC. Among women, with the combination of BC and WF, iron inadequacy was still 67%.
Program reach overestimates the likely impact of interventions on dietary adequacy. Additional programs beyond WF are needed to achieve adequate iron intake in some regions; progress should be monitored using biomarkers of iron status.