Abstract

Anemia remains a major public-health burden in Nigeria, especially among children under five and women of 
reproductive age. Large-scale food fortification (LSFF), adding iron and other micronutrients to widely consumed 
staples and condiments, is recommended by WHO as a cost-effective population intervention to prevent and reduce 
micronutrient deficiencies, including iron deficiency anemia. Nigeria has enacted mandatory and voluntary 
fortification policies for staples (wheat and maize flour) and other vehicles, but program impact has been uneven due 
to low coverage of fortified products, compliance gaps, variable bioavailability of iron compounds used, dietary 
inhibitors, infection burden (notably malaria and helminths), and monitoring constraints. A growing body of 
evidence from efficacy trials, program evaluations, and reviews shows that appropriately designed fortification 
(correct iron compound, sufficient fortification level, high coverage, and robust monitoring) can raise iron stores and 
hemoglobin in target populations; however, real-world effectiveness depends on implementation quality. This 
review synthesizes current evidence from national surveillance, program assessments, trials conducted in Nigeria 
and the region, and international guidance, identifies key barriers and enabling factors, and proposes programmatic 
and research priorities to maximize LSFF’s contribution to anemia reduction in Nigeria.