1. Iran has an u5MR of 39[1]. Anemia is considered a public health problem in Iran. Its prevalence ranges from 20 to 43% among pregnant and lactating women, 33.4% among women of childbearing, 15 to 30% among preschool children, and less than 10% among adult men, suggesting that it is mainly iron deficiency induced anemia. Wheat flour is the basic staple food in Iran with an average daily per capita consumption of 400 g.
2. MIÕs highest priority this year was to increase the coverage of fortified flour through its introduction in Fars province; and to encourage the government and industry towards national scale fortification.
Iron fortified foods:
3. Flour fortification with iron and folic acid has been launched in Fars province with investment from the MI and the government of Iran. By implementing fortification, Fars province joined the Bushehr province which was already fortifying flour with earlier support from the MI. Fortified flour now reaches a combined population of 4.8 million. Based on the same model, the Ministry of Health extended flour fortification to three other provinces with support from the World Bank and the Fars province model will be used while developing a national plan for flour fortification. An additional 2 million people are currently being reached in Sistan and Baluchestan provinces through World Bank support. In Oct 2005, The Iranian Millers Association announced that the country was poised to adopt national scale flour fortification from April 2006. With this positive momentum and support from stakeholders, MI funding to Iran will phase out in 2006.
A note on the Quality Control system in Iran:
A model quality control (QC) system to monitor the iron level in flour (and in bread) is being implemented in Fars province. This is a QC system which is carried out by different entities and at different levels: flour mills personnel, Food Safety and Environmental Health staff, Health Environment Department, Food and Drug Reference Laboratories, and Deputy Health/Nutrition Department. The following system which involves stringent monitoring system may not be needed once fortification becomes a routine practice but the QC system has been working well to establish new programs:
- At the manufacture level, semi-quantitative spot tests are conducted by a flour milling technician, using an adapted version of a standard method. This test is conducted at every shift, that is, at least 3 times a day. Results are recorded in forms provided by the Food Safety Department, checked during the supervision visits and collected on a monthly basis;
- Food Safety Department conducts weekly inspection visits to flour mills, checks and collects the results of the semi-quantitative spot tests, provides assistance to the mills if necessary, and takes samples of fortified flour according to a pre-established schedule for quantitative analysis;
- Environment Health conducts weekly inspection to bakeries and takes samples of bread for quantitative analysis (In Fars province, both Food Safety and Environmental Health are administratively together but it may be different in other provinces);
- Food and Drug Reference Laboratories receive samples from Food Safety/Environmental Health Department, analyze those using spectrophotometric methods and communicate the results to the Food Safety Department, after comparing the quantitative and semi-quantitative tests results on the same sheet (semi-quantitative data are copied to Food and Drug Lab).
- Follow-up corrective actions will be taken by the Ministry of Health focal point if any discrepancies are identified at any of these steps.
4. Yemen has an u5MR of 113[2]; urinary iodine figures[3] of 1998 indicate 17.3µg/l; prevalence of anemia is 18.3%. Yemen is one of the poorest countries of the region and is considered to be one of countries that have serious malnutrition including high vitamin mineral deficiencies for the region.
5. MIÕs highest priorities this year were to: provide support to launch sustainable flour fortification through industry involvement; phase out support to flour fortification by the end of 2007; and explore opportunities for assistance to strengthen salt iodization.
Iron fortified foods
6. After 6 years flour fortification has been launched in Yemen. The MI provided orientation to millers on quality assurance, quality control and other related areas. Additional MI support for premix in the first six months, complemented by support from UNICEF, government and industry, flour fortification enabled two of the 5 large flour mills to fortify flour covering 40 % of population. This year, national level flour fortification successfully reached 40% of the population with fortified flour.
7. As a result of advocacy and technical assistance, the standards and quality control commission of Yemen announced that all merchants, importers and millers adhere to the requirements that all wheat flour be fortified with iron and folic acid as of July 10 2005.
Iodized salt:
8. MI will work with UNICEF to commission a technical assessment mission to identify gaps in the USI program and to identify opportunities to improve the coverage. The assessment is scheduled to take place in early 2006 following which MI will consider support aimed to increase coverage.
For further information please contact Annie Wesley: awesley@micronitrient.org