Evaluation of the potential effectiveness of wheat flour and salt fortification programs in five Central Asian countries and Mongolia, 2002-2007.

Background. A project for universal salt iodation with potassium iodate and wheat flour fortification with a vitamin-mineral premix was implemented in Azerbaijan, Kazakhstan, Kyrgyzstan, Mongolia, Tajikistan, and Uzbekistan between 2002 and 2007. Objective. To determine the potential effectiveness of the food fortification programs in improving the micronutrient status Of selected families in a sentinel population in each country. Methods. An area was selected in each country in a sentinel population expected to have early access to iodated salt and fortified wheat flour. Within this area an average of 40 families with a woman of reproductive age and two children between 2 and 15 years old were sampled at baseline. All the rounds of the study were carried out in women and children in the same households. Hemoglobin, serum ferritin, folic acid, and urinary iodine excretion were analyzed at baseline, one year, and three years later. Results. In the third round in 2007 significant increases were observed in the average levels of blood hemoglobin, serum ferritin and folic acid, and urinary iodine. Corresponding decreases in the prevalence of anemia and increases in serum ferritin levels, folic acid, and iodine were found. Conclusions. Salt and wheat flour fortification resulted in a significant improvement in the micronutrient status of children and women living in sentinel households in the countries participating in the Asian Development Bank project. Sentinel studies were a cost-effective way of determining potential national effectiveness.