Folate and iron status of South African non-pregnant rural women of childbearing age, before and after fortification of foods

Objective. To assess the effect of fortification of staple foods on the folate and iron status of women of childbearing age. Design. A prospective cohort study was undertaken. Setting. Dikgale Demographic Surveillance Site, a rural area in the Capricorn district of Limpopo Province. Subjects. Non-pregnant women of childbearing age, 18 - 44 years (N=80). Outcome measures. Serum folate, ferritin, vitamin B 12, red blood cell folate and full blood count. Results. The prevalence of low serum folate (< 3ng/ml) in the study population was 27.6% before fortification; after fortification, none of the women had low serum folate. Low red cell folate (< 164 ng/ml) was observed in 26.4% of subjects before fortification, and in 1.9% of subjects after fortification. The prevalence of vitamin B 12 deficiency (< 145 pg/ml) was 6.3% during phase 1 of the study and increased to 11.3% during phase 2. Low haemoglobin levels were present in 7.5% of women before fortification, and in 5% of women after fortification. The percentage of women with low ferritin levels was similar before and after fortification (25%). Conclusion. The study shows a significant improvement in folate status in women of childbearing age approximately 9 months after fortification of maize and wheat foodstuffs in South Africa, whereas no improvement in iron status as measured by serum ferritin was observed.