Treatment of Anemia with Iron-fortified Rice in a School Lunch Program in Burundi

Abstract

Objectives: This cluster-randomized trial tested the efficacy of fortified rice for the treatment of anemia in Burundi. Ultra Rice® (UR) premix kernels were manufactured to contain 100% of the recommended nutrient intakes (RNI) for iron, zinc, thiamin, and folic acid for children 7-9 years. The operational feasibility of providing a stable fortified rice product was also assessed in the Burundian context. Methods: Twelve schools were randomly assigned to receive either UR fortified rice or traditional rice for seven months through a school feeding program. Hemoglobin status was evaluated at baseline and follow-up. Data were collected on the organoleptic acceptability of fortified rice, micronutrient stability with the UR technology, and the blend homogeneity of the rice. Results: Anemia was highly prevalent in schools in Muyinga Province. The fortified rice product was considered acceptable to the local community, maintained stable micronutrient levels, and blended homogeneity. Over the course of the study, anemia status and hemoglobin levels improved in both the control and intervention groups. The intervention did not lead to a significantly greater change in hemoglobin level among those children eating fortified rice (β=0.085 g/dl, 95% CI: -0.21-0.38). Conclusions: High prevalence of fever among the children and the high zinc content of the UR formulation are likely responsible for the non-significant improvement in hemoglobin. Anemia interventions in Burundi should implement multiple strategies to eliminate both iron deficiency and infectious causes of anemia. The zinc content of a multiple micronutrient grain should be studied more carefully to maximize iron uptake. *Funded by USDA/NIFA.