Uptake of Folic Acid Fortified Flours among Women of Reproductive Age in Ifakara, Morogoro Region

Abstract

Background: Folic acid food fortification has been in place for over two decades after several studies proving folic acid beneficial effects on prevention ofneural tube defects (NTDs).Tanzania has adopted mandatory fortification policy on wheat and maize flour. Essentially all wheat flour in Tanzania is fortified.Fortified maize flour from smaller mills is also available but less common. Uptake of fortified flours is important in prevention of the micronutrient deficiency among women of reproductive age (WRA) as well as NTDs to unborn babies. However, the uptake of folic acid fortified flours among WRAis unknown. Therefore this study intended to determine awareness, uptake of folic acid fortified flours,influencing factors and reasons hindering uptake among WRA in Ifakara Town Council, Morogoro region. Methods: This was a cross sectional study involving698 WRA, conducted from March to April 2017 in Ifakara. A multistage cluster random sampling technique was used to select study participants. Pretested interviewer administered questionnairesand observation checklists were used to collect information on uptake and availability of fortified wheat and maize floursfrom local retail shops. Data were managed and analyzed by Epi Info7 and STATA 13. Association between uptake of folic acid fortified flours and independent variables was assessed using odds ratios through cross tabulations and significance testing was done using Chi square or Fishers’s exact test. P value of 0.05 was considered significant. Factors with p-value of ≤0.2 at bivariate analysis including conventional confounders such as age were entered in multiple logistic regression model to assess significant independent factors associated with fortified flours uptake among WRA and to control for potential confounders. Results: A total of 698WRA participated in the study. Awareness of folic acid and fortified flours were found to be 6.9% (5.2%-9.0%) and 7.5% (5.7%-9.6%) respectively. The uptake of fortified flours was found to be 63.3% (59.7%-66.8%). Fortified wheat flour was found available in all 9 villages involved in the study while fortified maize flour was found in only one village. Factors that were significantly associated with fortified flours uptake included; Being employed, AOR=1.99(1.27- 3.13), household size of 5 or more people, AOR=1.37(1.02-1.85) as well as nulliparity, parity of 1-4 children, AOR=2.74(1.54-4.87) and 1.92(1.17-3.13) respectively and awareness of folic acid, AOR=2.67(1.37-5.19. The common reasons mentioned to hinder uptake of fortified flours included: not knowing that the flour is fortified and unaffording to buy fortified flours. Conclusion and recommendations: Uptake of fortified flours among WRA is relatively high however, low for maize flour accompanied with low awareness of folic acidand existence of fortified flours.All9 villages involved in the study had an access to fortified wheat flour and only one village had an access to fortified maize flour. Being employed, having fewer children, household size of 5 or more people and awareness of folic acid are significant influencing factors for uptake of folic acid fortified flours.Not knowing thatflour is fortified and unaffordability were commonly mentioned hindering reasons for fortified flours uptake. To increase uptake of fortified flours, institutions like Tanzania Food and Nutrition Centre (TFNC) should be used to increase awareness on the benefits of folic acid fortified flours among women and the general community.