Association between national mandatory flour fortification legislation and anemia prevalence among children 24-59 months of age: Findings from Demographic and Health Surveys across 18 countries between 2015 and 2018 Pubblico

Abstract

Objectives: To determine whether there is an association between anemia prevalence in children aged 24-59 months and national mandatory flour fortification legislation.

Design: We conducted an ecologic analysis using retrospective, cross-sectional, population-based, multi-country Demographic and Health Surveys from 2015 through 2018. National-level flour fortification legislation was applied as individual-level exposure. Anemia was defined by hemoglobin concentrations under 11.0 g/dL. Crude and adjusted prevalence odds ratios (cPOR & aPOR) and 95% confidence intervals (CI) were estimated using logistic regression analysis, accounting for complex survey design.

Setting: Demographic and Health Surveys, conducted using two-stage sampling design, from 18 countries.

Participants: Children between 24 and 59 months of age residing in the selected countries whose mothers were interviewed and who were tested for hemoglobin (n=53,576).

Results: In countries with national mandatory flour fortification legislation, 48.72% of children were anemic compared to 45.88% in countries without such legislation. Residence in a country with mandatory flour fortification legislation was associated with a 12% increased prevalence odds of anemia among children aged 24-59 months (cPOR=1.12; 95% CI: 1.05, 1.20). However, after adjusting for potential confounding due to country of residence and interactions with urban-rural residence and education, the association was no longer significant (aPOR: 0.96, 95% CI: 0.73, 1.26).

Conclusions: Our study suggests that nationally mandated flour fortification legislation is not associated with child anemia prevalence. The cross-sectional nature of our study design limits our ability to make a causal inference; our findings are hypothesis-generating. Longitudinal studies are needed to examine fortification policy and childhood anemia.

Table of Contents

ABSTRACT 1

INTRODUCTION 2

METHODS 5

Study Population 5

Study Design 6

Outcome Variable 6

Primary Exposure Variable 7

Covariates 8

Statistical Analysis 10

RESULTS 11

DISCUSSION 13

REFERENCES 20

TABLES 28

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Parola chiave	Children Food Fortification Maize Flour Anemia Flour Fortification Hemoglobin Demographic and Health Surveys Wheat Flour Enrichment
Committee Chair / Thesis Advisor	Kancherla, Vijaya, Emory University

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