Because bread is one of the most important staple food for the Egyptians, iron fortification should be done in a cautious and researched way, since adding iron to the flour affects the baking process of the bread.
Piloting Iron Fortification in Egypt Male: Dr. Farouk and his colleagues are working with the government and international agencies to encourage the fortification of bread flour with iron. But he knows that he has to take things one step at a time. Dr. Farouk M. Shaheen: Director, Nutritional Institute, Egypt: Balady Bread, you can say, is a staple food in Egypt like rice in the Far East. But in Egypt it is very precious for - the bread is very precious and sacred since ancient, ancient times. And we are keen that the fortification of the bread - the process will be thoroughly studied and done in a very cautious way. So that's why we decided that it must be - it has been decided that we have to, to do a pilot study in one of the governorates - not universal for the whole nation. Male: As part of the pilot study, Dr. Ibrahim is working on helping people understand that the fortification of flour is safe and necessary. Dr. Ibrahim M. Ismail: We are planning a social marketing campaign for the flour fortification project because people must know that we are getting in the-the bread what is - must be in the first [place]. You know, the whole flour contains iron but when we are milling it we exclude a lot of iron, so we need return it back - just return it back, OK? And this in a dose which is safe, in a dose which is not harmful, in a dose which is under control. Male: Dr. Ibrahim takes his work out on the road to the eastern region, Al Fayoum, where a new project to fortify bread flour with iron is scheduled for the near future. Here, he works with local nutritional educators, like Afaf, who help him talk to people and discuss any concerns they might have. Today they're visiting Sabah who's eight months pregnant. because of this she needs more iron than usual to feed her growing baby. Dr. Ibrahim M. Ismail: And because of our marketing campaign - which is a very good idea that the nutritional educator comes to the mother at home. We use nutritional educators like Afaf, we will teach her - we teach nurses, we teach her supervisors so that they can visit the home - we cannot visit all homes. We just train them how to educate the people about fortification... Male: Home visits aren't just an opportunity to talk about flour fortification - they're also a good way to teach people about the importance of eating iron rich foods. A few kilometers from Sabah's house is the Al Fayoum flour mill, one of 500 mills in Egypt, it was the first to install a simple flour fortification system. For the last two years they've been adding iron to flour used to bake biscuits for school children. In a few months time they also plan to add iron to bread flour. The iron is added in the form of ferrous sulfate, in small doses. The process is carefully monitored at every stage. In this test, the darker color means the flour now contains the recommended dosage of iron. Dr. Ibrahim wants to help people like Basma and her mother understand why iron is so important to their diet and how their eating habits can affect their iron intake. Dr. Ibrahim M. Ismail: There are many natural sources of iron given to us by God like spinach, parsley, cabbage - all of them which are rich in iron. The thing is that we need to be careful what we eat with what. we shouldn't drink tea with our meals and we need to eat our meals fresh. The problem is that we make foods which are rich in iron not rich in iron. Some of the problem with iron is absorption - iron is an element which has to be in a suitable circumstance to be absorbed: we must have some vitamin C - or fruits or vegetables which is containing vitamin C - to absorb iron well. Here in Egypt is that we are taking tea with lunch, not after lunch - no, with lunch - we are taking it with lunch! So the iron content of the food cannot be absorbed, so I take iron but I can't absorb it. Male: Basma is lucky. As well as eating an iron rich diet she is receiving iron supplements. Dr. Ibrahim M. Ismail: OK, not more than one! Male: Her prognosis is good: with luck, she won't suffer any long-term damage.