Awareness and factors associated with reported intake of folic acid-fortified flour among women of reproductive age in Ifakara, Morogoro region, Tanzania: a cross-sectional study

Ipyana Frank Mwandelile,Susan F Rumisha,Ahmed Abade,Rose Mpembeni,Rogath Kishimba,Julius J Massaga

doi:10.1186/s40795-019-0324-5

Abstract

BackgroundFolic acid fortification of staple foods has been in place in many countries for over two decades. Studies have shown that folic acid fortification can significantly reduce incidence of neural tube defects. Tanzania adopted a mandatory fortification policy for commercially-produced wheat and maize flour in 2011. We determined factors influencing intake of folic acid-fortified flour among women of reproductive age (WRA).MethodsWe conducted a cross-sectional study among WRA during March–April 2017 in Ifakara Town Council, Morogoro region. Multistage cluster sampling was used to select study participants. We used a questionnaire to capture information on demographics, awareness of folic acid, awareness of existence of folic acid fortified flour in community and intake of folic acid fortified flour. Intake was defined as reported consumption of folic acid fortified flour products at least once within 7 days before interview. Univariate, bivariate, and multivariable logistic analyses were done to evaluate factors associated with intake of folic acid fortified flour.ResultsThe median age of the 698 participating WRA was 30 years (range: 18–49). Awareness of folic acid and folic acid fortified flour was 6.9% (95% CI: 5.2–9.0%) and 7.5% (95% CI: 5.7–9.6%), respectively. Consumption of folic acid fortified flour was 63.3% (95% CI: 59.7–66.8%). Independent factors associated with intake included being employed (aOR = 1.91; 95% CI: 1.19–3.06), having no children (nulliparity) (aOR = 2.59; 95% CI: 1.36–4.95) or having 1–4 children (aOR = 1.98; 95% CI: 1.17–3.33) (vs. 5 or more children), and folic acid awareness (aOR = 2.53; 95% CI: 1.30–4.92).ConclusionFolic acid fortified flour was used by most respondents in our study despite low awareness of existence of folic acid fortified flour in the community. Being employed, having fewer than five children, and folic acid awareness were independent factors associated with intake. We recommend scaling up of mandatory flour fortification program and doing further studies on blood folate level among women of reproductive age in Ifakara to assess fortification program effectiveness.

Highlights

Folic acid fortification of staple foods has been in place in many countries for over two decades
Being employed, having fewer than five children, and folic acid awareness were independent factors associated with intake
These findings provide a snapshot of the level of folic acid fortified flour intake among women of reproductive age (WRA) after initiation of a fortification program in Ifakara

Summary

Introduction

Folic acid fortification of staple foods has been in place in many countries for over two decades. Studies have shown that folic acid fortification can significantly reduce incidence of neural tube defects. 86 countries have regulation to mandate fortification of at least one industrially milled cereal grain [1]. Folic acid fortification of staple foods has been in place for over two decades after several studies demonstrated that it can help prevent neural tube defects (NTDs) [3]. Fortification of staple foods with folic acid allows all women to access this nutrient throughout their reproductive years and reduce the risk of NTDs without active behavioral change [3]. There are more than fifty countries with mandatory regulations for fortification of wheat flour with folic acid [4]

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