What Can I Do About Nutritional Anemia?

• If your country has a flour fortification program, compare the nutrient standards to the World Health Organization recommendations for wheat and maize flour fortification. In particular, look at the type of iron and amount of iron used. If your country has a rice fortification program, compare the standards to the recommendations in Table 3 of this article in the Annals of the New York Academy of Sciences. If your fortification standard is not consistent with those recommendations, and no other foods are effectively fortified with those nutrients, the fortification program may not be achieving the desired health impact. Begin the legal process to update the fortification standard.
• Review your fortification legislation to see if imported premix (the powdery blend of vitamins and minerals added to flour) and fortified rice kernels are exempt from value added tax, tariffs, and duties. If not, seek to allow this exemption as a relief to industry partners who pay the recurring cost of buying these items.
• If your country does not have a fortification program, consider forming a National Fortification Alliance to work toward preventing nutritional anemia by fortifying staple foods with multiple nutrients. See other topics to consider when planning a fortification program.

• If you currently fortify wheat flour and maize flour, review and practice the elements of internal monitoring, good manufacturing practice (GMP), and hazard analysis and critical control points (HACCP) listed here.
• If you do not currently fortify wheat flour and maize flour, review the technical topics for effectively implementing a flour fortification program. Determine what you would need to begin fortification.
• If you are a member of a flour milling association, put fortification on the agenda of your next association meeting. Discuss how the association members can work together to help improve or begin your country’s fortification program.

• See a strategic paper prepared for the World Health Organization’s Western Pacific Regional Office for factors determining the feasibility of fortifying rice. Identify places in your rice distribution channels where fortification would be feasible.
• When considering a source for fortified rice kernels, review the suggestions in this article in Global Milling Advances.

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• Identify the best source of anemia data and determine the primary causes of anemia in your country. Seek to share this data with your country’s National Fortification Alliance to inform fortification standards.
• Remember that fortification is a preventive measure; it does not take the place of providing clinical treatment to people with nutritional anemia.
• Research evidence of other health issues caused by nutrient deficiencies, such as neural tube birth defects due to insufficient folic acid. Recommend other nutrients to be included in the fortification standard based on this evidence.

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• When you eat iron-rich foods such as red meat, include foods that are high in vitamin C as this helps you absorb iron.
• If you have a choice between fortified and unfortified rice and foods made with fortified or unfortified flour, choose the fortified products to increase your nutritional intake.
• Voice your support for fortification to members of the National Fortification Alliance if your country has such a committee.

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