Decline in the prevalence of anaemia among children of pre-school age after implementation of wheat flour fortification with multiple micronutrients in Jordan

Objective To examine changes in the prevalence of anaemia and its correlates among children of pre-school age after implementation of wheat flour fortification with multiple micronutrients in Jordan. Design Retrospective analysis of the data from two repeated national cross-sectional panels of pre-school children. Setting The two surveys were conducted in 2007 and 2009, 16-20 months and 34-36 months, respectively, after implementation of wheat flour fortification with multiple micronutrients in Jordan. Anaemia was considered if Hb level was <11 g/dl. An anaemia prevalence of ≥40 % was considered a severe public health problem, while that of 20-39·9 % was considered a moderate public health problem. Subjects A total of 3789 and 3447 children aged 6-59 months tested in 2007 and 2009, respectively. Results The prevalence of anaemia in pre-school children declined from 40·4 % in 2007 to 33·9 % in 2009 (adjusted OR=0·74; P<0·001). The decline in the prevalence in 2009 as compared with 2007 was more pronounced among children aged >24 months (-13·7 points), children living in urban areas (-8·0 points), children from rich households (-9·0 points), children who had never been breast-fed (-17·0 points) and well-nourished children (-6·8 points). In both surveys, presence of childhood anaemia was strongly associated with child age ≤24 months, living in poor households, breast-feeding for ≥6 months, malnourishment, poor maternal education and maternal anaemia. Conclusions 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.