Micronutrient Deficiencies Among Children May Be Endemic in Underprivileged Areas in Jordan

Dmin Ibrahim Khatib, Sa'ad S. Hijazi


Objectives: In late 2002, this Ministry of Education sponsored a survey aimed at assessing nutrition and growth statuses of young school children in underprivileged areas in Jordan. It aimed to substantiate the drastic findings of a preceding survey and to highlight other aspects of the problem, including the dietary consumption patterns.

Methods: This was a cross-sectional study of 468 school children from 43 villages, affiliated to eight disadvantaged areas of Jordan. All these were eligible recipients of the School Snack Service (SSS) program. Subjects were selected randomly from a sample originally drawn by Jordan Department of Statistics, DOS. Randomly selected school children aged 5.5 to 10.0 years were representing the first three elementary grades. The HPLC technique was employed in measuring concentrations of serum retinol (SRC) and α-tocopherol. The measurements of the anthropometric indicators and hemoglobin and serum ferritin levels were carried out. Relevant dietary information was collected. Immediately afterwards, students began receiving the SSS for another full scholastic year.

Results: Approximated average prevalence rates were for stunting 15 %, anemia (hemoglobin concentration < 110 g/L) 19.9 %, and subclinical VAD (SRC< 200 µg/L), 32.9 %. Proportion of children at risk of becoming deficient (SRC <300 but =>200 µg/L) was 58.3 %. Serum ferritin value was 18.3 (SD± 8.8) µg/L; unexpectedly, ferritin had significant correlation with vitamin A status but not with hemoglobin level. Vitamin A intakes were seemingly inadequate, as suggested by the laboratory assessment data. However, dietary data failed to lead to the same conclusion.

Conclusion: Stunting dominates the growth profile of children in primary schools of underdeveloped areas. Associated with vitamin E deficiency and anemia, VAD strongly suggests the existence of a severe grade of nutritional deprivation which pushes toward endemicity of the nutritional problem. Based on this conclusion, a cascade of interventional nutrition programs followed. In 2003 and 2004 two Royal Philanthropies were issued and led to the emergence of two pioneering interventional programs: the ‘multi-vitamin tablet’ for all schools and the ‘multi-micronutrient’ - fortified biscuits for the poor school children. The latest in sequence has been the year 2006, as it depended the implementation of the second "Wheat Flour Fortification” program, the fortificants in which have included nine micronutrients which are: vitamin A, iron, folic acid, and zinc and five major B-vitamins (B1, B2, B3, B6, and B12).


Vitamin A (VA), serum retinol concentration (SRC), vitamin A deficiency (VAD), hemoglobin (Hb), ferritin (Fer), stunting

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