(PO15-20-22) Early Program Assessment of the Haryana Wheat Flour Fortification Program, India

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Presenting Author(s)

Mona Duggal, MD, MHS
– assistant professor, Postgraduate Institute of Medical Education and Research, Department of Ophthalmology, Chandigarh, Haryana, India

Co-Author(s)

JR

Jorge Rosenthal, PhD, MC
– Epidemiologist, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
MK

Manmeet Kaur, Dr, PhD
– PGIMER, Chandigarh
NS

Neha Singh, BDS, MHA
– Postgraduate Institute of Medical Education and Research School of Public Health, Chandigarh, Haryana, India
NS

Nupur Shandil, Dr, MPH
– PGIMER, Chandigarh
RD

Reena Das, MD
– Postgraduate Institute of Medical Education and Research, Department of Hematology, Chandigarh, Haryana, India
SK

Sonia Khullar, Dr, MD
– HSHRC
SD

Suresh Dalpath, MBBS, MHSc
– Deputy Director, State Health System Resource Center, Panchkula, Haryana, India
RM

Rajesh Mehta, MD
– Regional Adviser, World Health Organization South-East Asia Regional Office, New Delhi, Delhi, India
PD

Pushpa C. Deo, Dr, MD
– WHO India
RG

Rachita Gupta, PhD
– World Health Organization India Office, New Delhi, Delhi, India
NR

Neena Raina, PhD
– Director, A.i. Dept of Family Health, Gender and Life Course, World Health Organization South-East Asia Regional Office, New Delhi, Delhi, India
PB

Praveen Bhalla, Dr, MPH
– FFI India
VS

Venkat Subramanian
– FFI India
VM

Vaibhav Miglani, M.Stat.
– PGIMER, Chandigarh
JW

Jennifer L. Williams, MSN, MPH, FNP-BC
– Centers for Disease Control and Prevention, Atlanta, Georgia, United States
YL

Yeung Lorraine, Dr, MD, MPH
– Centers for Disease Control and Prevention

Disclosure(s):

Mona Duggal, MD, MHS: No relevant financial relationship(s) with ineligible companies to disclose.

Jorge Rosenthal, PhD, MC: No relevant financial relationship(s) with ineligible companies to disclose.

Objectives: In 2018, a wheat flour fortification program with iron, folic acid, and vitamin B12 fortificants was established within the government-run Public Distribution System (PDS) in Ambala District, Haryana, India to address micronutrient deficiencies. PDS provides basic food and non-food commodities to the families below poverty level at subsidised prices. This study aims to assess household fortified wheat flour consumption among PDS recipients.

Methods: In 2021, we conducted a household survey and interviewed women aged 18-49 years (WRA) about consumption of wheat flour. A systematic probability sample design was used to select 358 households with WRA from a listing of all household beneficiaries enrolled in PDS who were living in the Naraingarh and Barara communities in Ambala District where the wheat flour fortification program was implemented. We assessed the percentages of households who have received and consumed fortified wheat flour from PDS, and assessed the perceived quality of fortified wheat flour compared to non-fortified wheat flour from other sources.

Results: We were able to reach 88% of the selected households (314/358) and 291 WRA agreed to participate (response rate 93%). Almost 99% (288/291) of households were eligible to obtain fortified wheat flour through PDS and among those eligible, 285 (99%) obtained fortified wheat flour monthly. Household consumption of fortified wheat flour was 98%, and 71% consumed all the fortified wheat flour supply before consuming other non-fortified wheat flours. Among households that reported consumption of fortified wheat flour, 63% reported quality of the fortified wheat flour was similar or better than non-fortified wheat flour from other sources.

Conclusions: Receipt and consumption of fortified wheat flour among PDS beneficiaries was very high. A majority of households reported consumption of fortified wheat flour first before other non-fortified wheat flour and that the quality of fortified wheat flour was similar or better than other non-fortified wheat flour. Periodic assessment of the wheat flour fortification program would be helpful to ensure continual high consumption of fortified wheat flour by PDS beneficiaries.

Funding Sources: U.S. Centers for Disease Control and Prevention provided funding for the assessment.