Hashemite Kingdom of Jordan

Project Name: Evaluation of Expanded Flour Fortification

Start Date: March 2008

Background

The Government of Jordan has identified micronutrient malnutrition, particularly deficiencies in vitamin A, iron, zinc, and iodine, as a public health problem. To address this problem, Jordan has undertaken two national food fortification programs:

• In 1995, Jordan began a nationwide universal salt iodization program.
• In April 2002, Jordan began a wheat flour fortification program that included iron and folic acid. In March 2006, Jordan expanded fortification requirements to include vitamin A, zinc, thiamin, riboflavin, niacin, vitamin B-6, and cobalamin in addition to iron and folic acid.

A micronutrient status survey in Jordan was conducted in 2002 and in 2009 Jordan received assistance from the Global Alliance for Improved Nutrition (GAIN) to conduct a follow-up survey to measure the impact of the improved wheat flour fortification program.

The CDC is assisted the Government of Jordan and its partners in developing the survey protocol, training survey staff, and ensuring appropriate quality controls for collecting biomarker data, as well as analysis and reporting of the data.

Purposes

• Determine changes in the prevalence of anemia, iron deficiency, and iron deficiency anemia (IDA) in women and children between the 2002 and 2010 micronutrient surveys.
• Determine changes in the prevalence of vitamin A deficiency in children between the 2002 and 2010 micronutrient surveys.
• Determine the distribution of folate and the prevalence of deficiencies for vitamins B12, D, and A among women.
• Determine the prevalence of vitamin D deficiency among children.
• Determine the percentage of bread that is iron-fortified and the percentage of salt that is iodized in the households.

Target Group(s) 

The target groups consist of children 12 to 59 months of age and women 15 to 49 years of age.

Progress

A nationally representative survey was conducted in Spring, 2010.

Future Plans

• Use the survey results to evaluate the impact of the flour fortification program and establish the baseline prevalence of vitamin D.  
• Conduct a workshop in spring 2011 to present results and develop future plans.

Partners

• Ministry of Health, Jordan
• Department of Statistics, Jordan
• Global Alliance to Improve Nutrition (GAIN)

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