combating iron deficiency [: project evaluation]

The evaluation covers the period from the late-1970's to 11/91. The project, which funds three separate programs, has generated many impressive achievements that would not have been possible without USAID support. (1) The program at the International Center for Control of Nutritional Anemia (ICCNA) at the University of Kansas has been a leader in identifying conditions that enhance iron absorption, developing new systems for delivering biologically available iron via iron supplementation and fortification strategies (of which fortification is the more effective approach). The use of iron EDTA as an iron source holds considerable promise in bypassing the effect of major absorption inhibitors found in many foods. ICCNA has also developed methods to evaluate iron status and has trained developing country personnel to monitor and evaluate iron improvement programs. (2) The program at Rutgers University has made notable progress in dealing with the difficult technological problems in the iron fortification of rice without sacrificing color, flavor, texture, and acceptability. If proven successful, the technology should be applicable to other foods and should benefit from the scientific resources of ICCNA. (3) The International Nutritional Anemia Consultative Group (INACG) at the Nutrition Foundation, Inc. has been effective in heightening professionals' awareness of the iron deficiency problem and in communicating developments in this field through international meetings and scientific reviews. These programs have involved professionals from developing countries, bilateral and multilateral organizations, NGO's PVO's, and the food industry. However, their role in influencing policymakers and in advocating fortification programs has been limited. All three programs have involved professionals from developing countries, bilateral and multilateral organizations, NGO's, PVO's, and private food companies. Progress to date strongly warrants continuation of support. Specific recommendations are as follows. (1) Given the importance of iron deficiency research, USAID should spearhead an international coalition to support such research. The project needs an advocacy component to reach USAID decisionmakers, in Washington and in the field, to galvanize their support. (2) USAID should support field trials with a direct impact on the iron deficiency problem, in particular the iron delivery systems developed at ICCNA and the fortification methods developed at Rutgers. (3) To sustain the project's achievements, all three grantees need to be involved in capacity building at the developing country level. (4) The Agency should consider fortifying Title II commodities and blends using systems developed at ICCNA, and should seek country-level approval for use of iron EDTA through the Codex Alimentarius Commission in order to facilitate iron fortification in developing countries.