Micronutrient status of Palestinian school children following salt and flour fortification: a cross-sectional study

Salwa Massad,Marwah Abdalla,Wahida Karmally,Mehari Gebre-Medhin,Paula Bordelois,Umaiyeh Khammash,Richard J Deckelbaum,Omar Dary,Steve Holleran

doi:10.1186/s40795-020-00367-2

Abstract

BackgroundIn 1996 and in 2006, Palestine initiated salt iodization and multiple micronutrient fortification of wheat flour, respectively as a strategy to prevent deficiencies of these nutrients. In 2009, we assessed the impact of these interventions on the health and nutritional status of schoolchildren residing in the West Bank.MethodsWe surveyed a sample of 22 schools run by the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the Palestinian Government. We randomly selected students from the first (mean age 6.7 years [SD 0.5]), sixth (11.8 years [0.6]), and ninth grades (14.8 years [0.6]). Data were obtained from 1484 (99%) of 1500 students planned for enrollment.ResultsOur results suggest that iodine intake appears adequate and there was essentially no iodine deficiency. As to the status of other micronutrients, the main nutritional micronutrient risks for schoolchildren in the West Bank continue to be low serum levels of iron, zinc, and vitamin B-12; folate levels were seemingly high. The overall prevalence of anemia was 9.6%, but there were pockets of anemia in certain districts. Almost 42% of the anemia in our sample was explained by iron deficiency. There were significant differences in iron deficiency between girls and boys, 29.5% vs. 15.7%, respectively (p = 0.0001). There were no cases of lead toxicity in the studied sample.ConclusionsWheat flour and salt fortification has had a major influence on improving the micronutrient status of Palestinian children, for some but not all micronutrients. The recommended key blood and biochemical parameters to be incorporated in the surveillance system are iron, zinc, and vitamin B12.

Highlights

In 1996 and in 2006, Palestine initiated salt iodization and multiple micronutrient fortification of wheat flour, respectively as a strategy to prevent deficiencies of these nutrients
The most common type of anemia in all Arab countries is iron deficiency anemia; about 50% of anemia cases are due to iron deficiency, this proportion varies between different population groups and regions [5]
Our results indicate that the main nutritional micronutrient risks for schoolchildren in the West Bank continue to be low serum levels of iron, zinc, and vitamin B-12; folate levels were seemingly high; and for the whole population iodine intake appears adequate

Summary

Introduction

In 1996 and in 2006, Palestine initiated salt iodization and multiple micronutrient fortification of wheat flour, respectively as a strategy to prevent deficiencies of these nutrients. Micronutrient deficiencies are a major global health problem. Vitamin A, iron, and zinc deficiencies have the largest remaining disease burden among the micronutrients considered [1]. While adequate nutritional status is an obvious building block of Micronutrient deficiencies are among the key nutrition challenges facing the Eastern Mediterranean Region (EMR) and the Arab world. Several micronutrient deficiencies including low levels of iron, iodine, zinc, calcium, folate, and vitamins A and D are still being reported from (2020) 6:38 many countries of EMR, among children and women of childbearing age [4]. When compared to other developing countries, anemia in the Arab world appears to be a moderate public health problem, with prevalence ranging from 20 to 40% [5]. The most common type of anemia in all Arab countries is iron deficiency anemia; about 50% of anemia cases are due to iron deficiency, this proportion varies between different population groups and regions [5]

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Conclusion