Micronutrient status of Palestinian school children following salt and flour fortification: a cross-sectional study
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RESEARCH ARTICLE
Open Access
Micronutrient status of Palestinian school children following salt and flour fortification: a cross-sectional study Salwa Massad1* , Mehari Gebre-Medhin2, Omar Dary3, Marwah Abdalla4, Steve Holleran5, Wahida Karmally6, Paula Bordelois7, Umaiyeh Khammash1 and Richard J. Deckelbaum5,8
Abstract Background: 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. In 2009, we assessed the impact of these interventions on the health and nutritional status of schoolchildren residing in the West Bank. Methods: We 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. Results: Our 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. Conclusions: Wheat 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. Keywords: Palestine, Children, Micronutrient, Anemia, Fortification
Background 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]. Most people with micronutrient deficiencies live in low income countries and are typically deficient in more than one micronutrient [2]. While adequate nutritional status is an obvious building block of * Correspondence: [email protected] 1 Juzoor for Health and Social Development, Ramallah 970, Palestine Full list of author information is available at the end of the article
human capital, it is paramount in the early stages of life. If early life nutritional demands are not met, the farreaching and long lasting consequences on both individuals and society include: poorer adult health, lower educational attainment, a diminished work capacity, and ultimately a lower lifetime earning potential [3]. Micronutrient deficiencies are among the key nutrition challenges fa
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