Professor Tetanye Ekoe knows the effects of iron deficiency all too well; he sees them every day. The West African medic knows the terrible impact this type of anaemia can have on women and children in particular.
"Maternal iron deficiency during pregnancy can have devastating effects on both mother and child," the Emeritus Professor of Paediatrics says. "Reduced brain maturation in babies and maternal depression are just two of the conditions associated with it."
Professor Ekoe’s work in Cameroon has shown him that there is also a danger that the problem can be passed down through the generations.
"Untreated iron deficiency in pregnant women will be passed to the infant. If left untreated during infancy it can continue right through childhood and adolescence."
The size of the problem is shocking: one billion people suffer from anaemia caused by iron deficiency, making it the world’s most common nutritional disorder. It contributes to the deaths of 50,000 women in childbirth each year (pdf, 45 Kb). It also impairs millions of children’s physical and mental development.
But there is some good news in all of this. It is, undoubtedly, a very big problem. But Professor Ekoe’s work is showing that some of the most effective solutions in the fight against it can be very small indeed.
An essential element
The human body needs iron to make haemoglobin, the protein which carries oxygen in our blood. A lack of it slows brain function and physical movement and can weaken the immune system. Severe cases cause organ damage and even death.
The condition can have devastating wider effects such as reduced school performance and lower productivity. These erode the development potential of families, villages and entire regions.
Perhaps more shocking than the scale of the problem, though, is the fact it’s happening at all. We know what causes iron deficiency anaemia, we know how to prevent it and we know how to cure it.
Tackling the problem
Staple food fortification programmes have been very successful in reducing nutrient deficiency. They’ve included adding Vitamin A to cooking oil or sugar and folic acid to bread.
This is what led Nestlé to look for new ways of delivering iron fortification in developing countries. The idea they came up with was brilliantly simple.
Good things come in small sizes
The Maggi bouillon cube sells in vast quantities across Central and West Africa. In Nigeria alone, people buy more than 80 million of the seasoning cubes every single day. And the region has a significant iron deficiency problem.
Back in 2009 Nestlé spotted an opportunity, according to Petra Klassen-Wigger, Scientific Advisor at Nestlé’s Nutrition, Health and Wellness department. “Maggi bouillon cubes and tablets were widely consumed across the region, making them an ideal vehicle for iron fortification,” she says.
It’s not always easy to turn a simple idea into reality, though. Scientists had to find a way to add iron to the cubes without altering their taste or colour. It also needed to be easy for the body to absorb and, crucially, not push up the price. Nestlé scientists spent two years researching different forms of iron to find the right one.
"By making small alterations to other ingredients, we were eventually able to add iron to the cubes without making them more expensive," Klassen-Wigger explains.
Iron-fortified Maggi bouillon cubes have been sold across Central and West Africa since 2012. They look the same. They taste the same. But millions of people now have more iron in their diet, without any change to their habits.
Of course, food fortification is not the only answer to tackling iron deficiency.
The control of other diseases which make anaemia worse is also important. Malaria, HIV/AIDS and other infections contribute to high rates of anaemia in some areas.
The World Health Organisation also wants to tackle other nutritional deficiencies such as B12, folate and Vitamin A to help address the problem.
Along with iodine, vitamin A and zinc, iron is one of the ‘big four’ micronutrients. They are essential for growth and development but two billion people worldwide don’t get enough of them.
Ideally, everyone would have access to a variety of nutritious foods. They would provide the right amounts of the vitamins and minerals. But in many countries, particularly the world’s poorest, this isn’t always possible.
Small changes to food production can have a significant impact. In the case of iron deficiency, treatment can restore health and raise community productivity levels by as much as 20%.
That means children doing better in school, healthier families and communities able to maximise their potential.
That’s a lot to expect from a humble stock cube. But in Africa, this tiny square of flavour is already helping to achieve big things.