Maize meal fortification is associated with improved vitamin A and iron status in adolescents and reduced childhood anaemia in a food aid-dependent refugee population

Public Health Nutr. 2008 Jul;11(7):720-8. doi: 10.1017/S1368980007001486. Epub 2007 Dec 21.


Objective: To assess changes in the Fe and vitamin A status of the population of Nangweshi refugee camp associated with the introduction of maize meal fortification.

Design: Pre- and post-intervention study using a longitudinal cohort.

Setting: Nangweshi refugee camp, Zambia.

Subjects: Two hundred and twelve adolescents (10-19 years), 157 children (6-59 months) and 118 women (20-49 years) were selected at random by household survey in July 2003 and followed up after 12 months.

Results: Maize grain was milled and fortified in two custom-designed mills installed at a central location in the camp and a daily ration of 400 g per person was distributed twice monthly to households as part of the routine food aid ration. During the intervention period mean Hb increased in children (0.87 g/dl; P < 0.001) and adolescents (0.24 g/dl; P = 0.043) but did not increase in women. Anaemia decreased in children by 23.4% (P < 0.001) but there was no significant change in adolescents or women. Serum transferrin receptor (log10-transformed) decreased by -0.082 microg/ml (P = 0.036) indicating an improvement in the Fe status of adolescents but there was no significant decrease in the prevalence of deficiency (-8.5%; P = 0.079). In adolescents, serum retinol increased by 0.16 micromol/l (P < 0.001) and vitamin A deficiency decreased by 26.1% (P < 0.001).

Conclusions: The introduction of fortified maize meal led to a decrease in anaemia in children and a decrease in vitamin A deficiency in adolescents. Centralised, camp-level milling and fortification of maize meal is a feasible and pertinent intervention in food aid operations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anemia, Iron-Deficiency / blood
  • Anemia, Iron-Deficiency / epidemiology
  • Anemia, Iron-Deficiency / therapy*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Food, Fortified*
  • Hemoglobins / analysis*
  • Humans
  • Infant
  • Iron / administration & dosage*
  • Iron / blood
  • Longitudinal Studies
  • Male
  • Nutritional Requirements
  • Nutritional Status
  • Nutritive Value
  • Public Health
  • Refugees
  • Treatment Outcome
  • United Nations
  • Vitamin A / administration & dosage*
  • Vitamin A / blood
  • Vitamin A Deficiency / blood
  • Vitamin A Deficiency / epidemiology
  • Vitamin A Deficiency / therapy*
  • Zambia
  • Zea mays / chemistry


  • Hemoglobins
  • Vitamin A
  • Iron