title: Maize meal fortification is associated with improved vitamin A and iron status in adolescents and reduced childhood anaemia in a food aid-dependent refugee population.
abstract: OBJECTIVE
  To assess changes in the Fe and vitamin A status of the population of Nangweshi refugee camp associated with the introduction of maize meal fortification.
  
  
  METHODS
  Pre- and post-intervention study using a longitudinal cohort.
  
  
  METHODS
  Nangweshi refugee camp, Zambia.
  
  
  METHODS
  Two hundred and twelve adolescents (10-19 years), 157 children (6-59 months) and 118 women (20-49 years) were selected at random by household survey in July 2003 and followed up after 12 months.
  
  
  RESULTS
  Maize grain was milled and fortified in two custom-designed mills installed at a central location in the camp and a daily ration of 400 g per person was distributed twice monthly to households as part of the routine food aid ration. During the intervention period mean Hb increased in children (0.87 g/dl; P < 0.001) and adolescents (0.24 g/dl; P = 0.043) but did not increase in women. Anaemia decreased in children by 23.4% (P < 0.001) but there was no significant change in adolescents or women. Serum transferrin receptor (log10-transformed) decreased by -0.082 microg/ml (P = 0.036) indicating an improvement in the Fe status of adolescents but there was no significant decrease in the prevalence of deficiency (-8.5%; P = 0.079). In adolescents, serum retinol increased by 0.16 micromol/l (P < 0.001) and vitamin A deficiency decreased by 26.1% (P < 0.001).
  
  
  CONCLUSIONS
  The introduction of fortified maize meal led to a decrease in anaemia in children and a decrease in vitamin A deficiency in adolescents. Centralised, camp-level milling and fortification of maize meal is a feasible and pertinent intervention in food aid operations.
authors: Centre for International Health and Development, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK. a.seal@ich.ucl.ac.uk
authors: Andrew
authors: A
authors: Seal
authors: Emmanuel
authors: E
authors: Kafwembe
authors: Ismail A R
authors: IA
authors: Kassim
authors: Mei
authors: M
authors: Hong
authors: Annie
authors: A
authors: Wesley
authors: John
authors: J
authors: Wood
authors: Fathia
authors: F
authors: Abdalla
authors: Tina
authors: T
authors: van den Briel
mesh_terms: D000293:Adolescent; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005527:Food, Fortified; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007223:Infant; D007501:Iron / Q000008:administration & dosage* / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D009751:Nutritional Requirements; D009752:Nutritional Status; D009753:Nutritive Value; D011634:Public Health; D012036:Refugees; D016896:Treatment Outcome; D014480:United Nations; D014801:Vitamin A / Q000008:administration & dosage* / Q000097:blood; D014802:Vitamin A Deficiency / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D015024:Zambia; D003313:Zea mays / Q000737:chemistry
chemical_list: D006454:Hemoglobins; D014801:Vitamin A; D007501:Iron