Micronutrient-fortified rice improves haemoglobin, anaemia prevalence and cognitive performance among schoolchildren in Gujarat, India: a case-control study

Abstract

Anaemia is a public health problem in India. A case-control, quasi-experimental study was conducted to evaluate the effect of a multiple micronutrient fortified rice intervention among school children (6–12 years) through the midday meal programme in Gujarat, India, over 8 months. The fortified rice provided approximately 10% Recommended Dietary Allowance of iron; 25–33% of vitamin A, thiamine, niacin and vitamin B6; and 100% of folic acid and vitamin B12. Outcomes of interest included haemoglobin concentration, anaemia prevalence, and cognitive performance. Cognitive performance was evaluated using J-PAL-validated Pratham reading and mathematics testing tools. 973 children completed the study (cases n = 484; controls n = 489). The intervention significantly increased mean haemoglobin by 0.4 g/dL (p = 0.001), reduced anaemia prevalence by 10% (p < 0.00001), and improved average cognitive scores by 11.3 points (p < 0.001). Rice fortification can help address anaemia in settings where rice is a staple food.

Keywords:

• Rice fortification
• iron
• haemoglobin
• anaemia
• micronutrients
• cognition

Acknowledgments

The authors would like to express their gratitude to the James Percy Foundation for supporting this program, and to the many children, parents, and teachers who made this evaluation possible. Appreciation is also extended to Rahul Tripathi and Vikas Chand for their contributions to ensuring effective implementation of the program. A special thanks to the Akshaya Patra Foundation for making high-quality fortified rice available in Gujarat and for providing support in gathering the necessary approvals for study implementation. We are grateful to Nielsen India Pvt. Ltd. for data collection and monitoring. We also appreciate the review of PATH’s global director of Maternal, Newborn, Child Health and Nutrition, Dr. Cyril Engmann, for his valuable inputs into the manuscript.

Disclosure statement

No potential conflicts of interest are reported by the author(s).

Additional information

Funding

This work was financially supported by the James Percy Foundation [1101191].