Predicted Effects of Current and Potential Micronutrient Intervention Programs on Adequacy of Folate and Vitamin B‐12 Intake in a National Sample of Women and Young Children in Cameroon
Authors: Luo Hanqi , Stewart Christine P , Brown Kenneth H , Engle‐Stone Reina 
Published: November 2023

Background

According to the latest national survey in Cameroon, 59% of women and 34% of non‐breastfeeding children (NBFC) had inadequate folate intake, and 62% of women and 39% of NBFC had inadequate vitamin B‐12 intake. Although interventions are available to reduce this burden, the anticipated nutritional benefit of each program, given existing coverage and dietary patterns, is uncertain.

Methods

We completed 24‐hour dietary recalls (with replicates in a subset) and analysis of blood specimens among women (n = 912) and children 12 – 59 mo of age (n = 883) during a national survey in Cameroon, with representative sampling for three geographic strata (North, South, and Yaoundé/Douala). Vitamin B‐12 intake was adjusted for absorption, and the National Cancer Institute method was applied to estimate usual intake of both nutrients. We evaluated the baseline prevalence of inadequate intake and biochemical deficiency of these nutrients, and simulated the “reach” (proportion consuming fortifiable foods or exposed to MNP delivery platforms), and “effective coverage” (proportion predicted to achieve adequate folate or B‐12 intake following an intervention) of the current wheat flour (WF) fortification program, and potential program modifications, including varying fortification levels, and introduction of additional programs, such as micronutrient powders (MNP) and fortified bouillon cubes (BC).

Results

The baseline folate and B‐12 intakes and status, and program reach varied by strata. Although the prevalence of diet inadequacy was 30% to 50% higher than that of biochemical deficiency, the ranking of geographic strata was the same for both indicators, suggesting that changes in estimated dietary adequacy can be used to predict the effect of intervention programs. The estimated reach of all programs was greater than the effective coverage by ~10% for folate and ~50% for B‐12. On average, WF fortified with folic acid at the current level (5 μg/g) is expected to reduce inadequate intake in women from 76% to 27% nationally without risk of excessive folic acid intake. This reduction was the greatest in Yaoundé/Douala (from 91% to 19%), where average WF consumption was highest. WF fortified with B‐12 (0.04 μg/g; the current target fortification level) should reduce inadequate intake from 63% to 39% for women, and from 50% to 30% for children nationally. Distributing MNP through the Child Health Day campaign (as a 60‐d supply every 6 mo) was predicted to have a minimal effect beyond that of WF. On the other hand, BC fortified with B‐12 would lower the prevalence of inadequate intake to ~20% for both women and children.

Conclusion

Program reach overestimates the likely impact of food‐based interventions on dietary adequacy. The current food fortification program can be expected to improve the adequacy of folate and B12 intakes in women and children without increasing risk of excessive folic acid intakes among women. Adding B12 fortification of BC can further reduce dietary B12 inadequacy. Evaluation of the impact of the current fortification program with biomarkers is required to confirm these findings.

Support or Funding Information

Michael and Susan Dell Foundation; Bill & Melinda Gates Foundation, Seattle, WA, USA