Effectiveness of Mandated Folic Acid and Iron Fortification of Wheat Flour on Anemia in Children of

62 Pages·2017·1.6 MB·English

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Nutrition Theses Department of Nutrition
Spring 5-11-2013
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Flinle Danielle Biemi
Follow this and additional works at: https://scholarworks.gsu.edu/nutrition_theses
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Biemi, Flinle Danielle, "Effectiveness of Mandated Folic Acid and Iron Fortification of Wheat Flour on
Anemia in Children of Ivory Coast." Thesis, Georgia State University, 2013.
doi: https://doi.org/10.57709/4112710
This Thesis is brought to you for free and open access by the Department of Nutrition at ScholarWorks @ Georgia
State University. It has been accepted for inclusion in Nutrition Theses by an authorized administrator of
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ACCEPTANCE

This thesis, EFFECTIVENESS OF MANDATED FOLIC ACID AND IRON
FORTIFICATION OF WHEAT FLOUR ON ANEMIA IN CHILDREN OF IVORY
COAST, by Flinle Danielle Biemi was prepared under the direction of the Master`s
Thesis Advisory Committee. It is accepted by committee members in partial fulfillment
of the requirements for the degree Master of Science in the Byrdine F. Lewis School of
Nursing and Health Professions, Georgia State University.

The Master`s Thesis Advisory Committee, as representatives of the faculty, certify that
this thesis has met all standards of excellence and scholarship as determined by the
faculty.

Vijay Ganji, PhD, RD Murugi Ndirangu, PhD
Committee Chair Committee Member

Ike Okosun, PhD
Committee Member

Date
AUTHOR`S STATEMENT

In presenting this thesis as a partial fulfillment of the requirement for the advanced
degree from the Georgia State University, I agree that the library of Georgia State
University shall make it available for the inspection and circulation in accordance with its
regulations governing materials of this type. I agree that permission to quote, to copy
from, or to publish this thesis may be granted by the professor under whose direction it
was written, by the Byrdine F. Lewis School of Nursing and Health Professions director
of graduate studies and research, or by me. Such quoting, copying, or publishing must be
solely for scholarly purposes and will not involve potential financial gain. It is understood
that any copying from or publication of this thesis which involves potential financial gain
will not be allowed without my written permission.

Flinle Danielle Biemi
NOTICE TO BORROWERS

All theses deposited in the Georgia State University library must be used in accordance
with the stipulations prescribed by the author in the preceding statement. The author of
this thesis is:

Flinle Danielle Biemi
11106 Jefferson Square Court,
Decatur, GA 30030

The director of this thesis is:

Vijay Ganji
Division of Nutrition
Byrdine F. Lewis School of Nursing and Health Professions
Georgia State University
P.O. Box 3995
Atlanta, GA 30302-3995
VITA
Flinle Danielle Biemi, MD
11106 Jefferson Square Court ● Decatur, GA 30030 ● [phone] ● [email protected]

EDUCATION GEORGIA STATE UNIVERSITY, Atlanta, GA
Master of Science in Nutrition
Graduate Certificate in Public Health
May 2013
Certification: CPR AED Certificate
December 2011
Fulbright Scholar

UNIVERSITY OF COCODY, Abidjan, Ivory Coast
Medical Doctor 2005

LANGUAGE Bilingual English and French

HEALTHCARE EXPERIENCE
Maternity Marie Houphouet, Abidjan, Ivory Coast January 2007- August
2011
Physician in the pediatric unit
 Diagnosed and provided treatment to children affected by malnourishment, HIV-AIDS,
malaria and other tropical diseases
 Provided emergency and routine health care to newborns
 Educated mothers with malnourished children
 Advised HIV-positive mothers about baby feeding for preventing mother-to-child
transmission of HIV
 Advised 20-30 women of childbearing age per week about baby feeding, maternal cares,
sexual diseases
 Lectured once a month health care providers of the maternity about topics related to
pediatric diseases
 Coordinated activities related to the prevention of HIV-AIDS transmission in the
maternity

Medical Clinic The pantheon, Abidjan, Ivory Coast March-December 2006
Physician in the pediatric unit
 Diagnosed and provided treatment to children affected by tropical diseases
 Provided health and nutritional cares to newborns

University Hospital of Cocody, Treichville, and Yopougon;
Teaching hospitals affiliated Medical School of the University of Cocody, Abidjan, Ivory
Coast
Internship
 Developed skills in diagnosing and providing care in pediatric, gynecologic, surgical and
medical units
 Provided nutritional cares to preterm and low birth weight infants
 Organized foods collect for children suffering from malnutrition conditions
VOLUNTEER EXPERIENCE
Red Cross, Abidjan, Ivory Coast January 2009-
August 2011
First Helper
 Supervised rescued activities and engaged in first aid during hostile local elections
 Supervised free consultations and drugs delivery in precarious areas

SKILLS AND AWARDS
 Golden Key International Honor Society
 Microsoft Word, Excel, Power Point, SPSS, Epi info
ABSTRACT
EFFECTIVENESS OF MANDATED FOLIC ACID AND IRON FORTIFICATION OF
WHEAT FLOUR ON ANEMIA IN CHILDREN OF IVORY COAST
By
Flinle Danielle Biemi

Purpose: Anemia in children is a major Public Health problem in developing countries
such as Ivory Coast. The fortification of wheat flour with iron and folic acid has been
mandated in this country in 2007. To date, there are no studies conducted to assess the
effectiveness of these fortification efforts. Therefore, the purpose of this study was to
determine if mandated iron and folic acid fortification of wheat flour has reduced the
prevalence of anemia in Ivory Coast children.
Methods: The study was conducted at the pediatric unit of the university hospital of
Treichville, one of the 3 main hospitals of Abidjan, the largest city of Ivory Coast. The
medical records of 467 children from 5 to 14 years old were analyzed. The period from
January 1st 2004 to December 31st 2006 was considered as pre-fortification period and
the period from January 1st 2008 to December 31st 2010 was regarded as the post-
fortification period. Data for anemia, hemoglobin, hematocrit, red blood cell count, and
MCV were compared between pre- and post-fortification periods.
Results: The results showed that there were no statistically significant difference in
prevalence of anemia and mean hemoglobin, hematocrit, red blood cells, and MCV
between pre and post-fortification periods.
Conclusion: The double fortification of wheat flour with folic acid and iron had no
significant impact on anemia in Ivorian children. This is perhaps due to the fact that
wheat flour is not widely consumed as rice and rice products are more popular in Ivory
Coast population. The Ivorian government perhaps should focus efforts on the
fortification of these products.
EFFECTIVENESS OF MANDATED FOLIC ACID AND IRON
FORTIFICATION OF WHEAT FLOUR ON ANEMIA IN CHILDREN
OF IVORY COAST

by

Flinle Danielle Biemi
MD, Ivory Coast-Abidjan, School of Medicine-University of Cocody
Fulbright Student

A Thesis Submitted to the Graduate Committee
In the Division of Nutrition
At Georgia State University
In Partial Fulfillment for the Requirement for the Degree
MASTER OF SCIENCE

Atlanta, Georgia
2013
ACKNOWLEDGEMENTS

I would like to thank the members of my thesis committee-Dr Vijay Ganji, Dr
Murugi Ndirangu, and Dr Ike Okosun- for their support and excellent guidance during
this process.
Thanks to all my instructors of the department of Nutrition and the institute of
Public Health. I am also thankful to my classmates and friends who helped me to achieve
my academic goals.
Moreover, thanks to Professor Oulai and to physicians of the pediatric unit of the
university hospital of Treichville, Abidjan- Ivory Coast who made this thesis possible.
I gratefully acknowledge the Fulbright program, the State department, the
Institute of International Education, and the US embassy in Ivory Coast for giving me
this amazing opportunity to study in the United States.
I am forever grateful to my parents, brothers, sisters, nephews, and niece for their
love, encouragement, and prayers throughout my life. I feel blessed to have all of them.
I warmly thank my Ivorian family in the US, my Fulbright fellows and all my
friends for supporting me during my stay in the US.
Above all, I thank God for His ultimate love and power in my life.

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