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Supplement: Forging Effective Strategies to Combat Iron Deficiency

Experiences and Challenges in Industrialized Countries: Control of Iron Deficiency in Industrialized Countries^{1 ,2 ,3}

Usha Ramakrishnan^*4 and Ray Yip

^* Department of International Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322 and UNICEF, Beijing, China 100600

⁴To whom correspondence should be addressed. Dept. of International Health, Emory Univ., 1518 Clifton Rd, N. E., Atlanta, GA 30322. E-mail: uramakr{at}sph.emory.edu

This paper provides a synopsis of the experience in combating iron deficiency in industrialized countries and identifies the reasons for the considerable success and future challenges. Significant progress has been made over the last century in reducing and even eliminating iron deficiency in many industrialized countries. Current estimates are that the prevalence of iron deficiency has declined to <20% in many of these countries, even among women and young children, compared with 30 to 70% in many developing countries. The reasons for this success cannot be attributed solely to a single approach but rather to a range of factors that have occurred over time as a result of both economic development and the implementation of specific policies. Several factors have contributed to improving both iron intakes and reducing iron losses; these include fortification, supplementation, dietary diversification and public health measures. For example, the decline in anemia in infants can be attributed to the introduction of iron-fortified formula and complementary foods in the 1960s to 1970s. Similarly, the enrichment and fortification of cereals with iron that began during World War II in North America and Europe is a result of effective public-private partnerships. Despite these successes, iron deficiency remains a public health concern in industrialized countries for selected subgroups such as women of reproductive age with excess menstrual losses and pregnant women who cannot meet increased requirements from the diet alone. Constant vigilance and innovative approaches for screening and combating this problem are thus still required even in developed countries.

KEY WORDS: • iron deficiency • iron fortification • control and prevention interventions

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