In Côte d’Ivoire, malnutrition remains a major public health problem, particularly in the form of micronutrient deficiencies, often referred to as “hidden hunger” [1]. For example, anaemia affects around 51.8% of women of childbearing age in West Africa and is mainly attributed to iron deficiency, although other nutritional and infectious factors also contribute [2][3]. Furthermore, data from the Demographic and Health Survey indicate that nearly 68% of children under five and around 66% of women suffer from anaemia, highlighting the scale of the nutritional problem in the country [4]. These deficiencies have significant consequences for health, economic productivity and human development. They primarily affect the most vulnerable populations, particularly children, pregnant or breastfeeding women and the elderly [5]-[8]. Beyond Côte d’Ivoire, anaemia is also a major public health problem globally, particularly affecting the most vulnerable groups. Indeed, around 40% of children under five and 37% of pregnant women worldwide suffer from anaemia [9]. In light of this situation, the fortification of staple foods is recognised as one of the most effective and cost-effective interventions for combating micronutrient deficiencies on a large scale [10]. The Global Nutrition Report estimates that every dollar invested in food fortification can generate up to 27 dollars in economic benefits [11]. With this in mind, the fortification of wheat flour with essential micronutrients such as iron and folic acid has been adopted in several countries, including Côte d’Ivoire, where it has been mandatory since 2007 [12][13]. This strategy aims to improve the nutritional status of populations without requiring major changes in dietary habits [14].

Wheat flour is indeed a suitable vehicle for fortification due to its widespread consumption, particularly in urban areas. In Abidjan, the country’s largest urban area, bread and bakery products play a significant role in the daily diet [15]. Recent studies indicate that dietary habits, particularly those relating to wheat-based products, have changed considerably in African urban areas over the last decade as a result of rapid urbanisation and lifestyle changes [16][17]. This accessibility and frequency of consumption make wheat flour a strategic vehicle for micronutrient intake [18]. Indeed, although wheat is not produced locally, it plays a significant role in the dietary habits of the Ivorian population [19][20]. However, the effectiveness of fortification programmes depends not only on the existence of a regulatory framework, but also on the level of consumption of the products concerned, as well as the knowledge and practices of the population and stakeholders in the production and processing chain.

Recent studies show that consumers’ knowledge of fortified products often remains limited, which can affect their acceptance and use [21]. Similarly, bakers’ practices, particularly regarding the sourcing and use of flour, can play a significant role in the effectiveness of fortification programmes.

This raises several questions: to what extent do households and bakers in the municipalities of Abidjan consume and use wheat flour-based products? What is their level of knowledge and awareness regarding wheat flour fortification? And to what extent might these factors influence the effectiveness of this nutritional strategy in combating micronutrient deficiencies?

With this in mind, this study aims to analyze consumption patterns, usage practices and the level of knowledge regarding enriched wheat flour among households and bakers in four districts of Abidjan, in order to identify the factors likely to promote or limit the effectiveness of this nutritional intervention in urban areas of Côte d’Ivoire.

This study was conducted to assess the level of consumption, use and awareness of wheat flour fortification among households and bakers in four municipalities of Abidjan (Ivory Coast). The results obtained from the surveys vary.

At the household level, the socio-demographic profile reveals a study population aged between 18 and 65. The 31 - 45 age group is the most represented, accounting for 62% of respondents. This high proportion could be explained by the fact that it corresponds to a period of financial stability, which gives them a major role in managing household expenditure and food choices. These results are consistent with those reported by [26], who found a similar trend. Unlike the results obtained by [27], our study highlights a predominantly male population (61% men versus 39% women), representing a ratio of 1.6 in favour of men. These results are similar to those of [28], who reported the same trend. This situation may be explained by the fact that in Côte d’Ivoire, boys have better access to schooling than girls [29].

The educational attainment of respondents is dominated by secondary education (25.25%). However, a significant proportion of respondents have no formal education or only basic literacy skills (34.5%). Our results are similar to those of [30], who also observed a predominance of secondary education (24%). Conversely, they differ from those of [31], who found that the majority of respondents (53.33%) had not progressed beyond primary education in a study on artisanal infant cereals in Côte d’Ivoire. Furthermore, the vast majority of households (94.75%) are of Ivorian nationality and belong to various ethnic groups, among which the Mandé are the most represented (32%). This ethnic diversity illustrates the multicultural character of the city of Abidjan, characterised by the coexistence of numerous communities. Our results, however, differ from those of [27], who reported a predominance of Krou people among households in the Abidjan district. Trade constitutes the main source of income for the households surveyed ( 23.5% , 46.75%). This could be explained by current socio-economic realities, where the informal sector and entrepreneurial activities constitute the main sources of income. Similar findings have been reported in studies, which have highlighted the significant presence of women, particularly in the informal sector in Abidjan [32].

The results of this study reveal that wheat flour and its derivatives are well known to the households surveyed. This awareness of wheat flour varies significantly according to the educational level of the households surveyed. Indeed, households with secondary education (25.25%) or higher (23%) have a better understanding of wheat flour, unlike those with a low level of education. The findings are consistent with those of Nomel and her collaborators, who highlighted a significant relationship between households’ educational level and the choice of cereals used in the preparation of toh [33]. In their study, the authors observed that households with a secondary school education prefer millet over yellow maize for the preparation of this dish. Furthermore, a study conducted by the CNSA (2022) [34] also highlighted the influence of the head of household’s level of education on access to food. Indeed, the study revealed that the proportion of households reporting frequent food shortages is significantly lower when the head of household has a university education (2%) than when they have no formal education (16%). However, no significant difference was observed between men and women regarding knowledge of products made from wheat flour. Households headed by men ( 39% , 58.5%) and those headed by women ( 53.25 %, 33.75%) alike reported being familiar with these products. Similar studies where found no significant association between the gender of the head of household and food security in a survey conducted in Bangladesh [35]. According to these authors, this lack of disparity could be explained by a relatively favourable socio-cultural context, thereby allowing women to participate freely in the labour market.

In addition to assessing awareness, the survey also examined consumption levels of products made from wheat flour. The study found that these products are consumed by all the households surveyed (100%). Among the various ways in which wheat flour is consumed, bread is the main form, with nearly 68% of respondents eating it regularly (5 to 7 times a week). This high prevalence of bread consumption reflects the importance of cereals in West African diets, where they account for over 60% of daily energy intake [36]. These findings corroborate those of Niang etal. (2017) [37], who also highlighted the central role of cereals in the diets of households in Senegal. In our study, the high consumption of bread could be explained by the fact that it is a staple food, easily accessible and widely available [19]. The same case was reported in Ghana, where more than half of respondents (54.4%) consumed bread daily, with nearly 27.9% consuming it twice or more per week [38].

Similarly, Adino etal. (2024) [39] obtained similar results in their study of dietary habits and preferences regarding bakery products among urban dwellers in Ethiopia. They found that 38% of respondents consumed bread every day. Bakeries and patisseries appear to be the main sources of wheat flour-based products. The majority of households surveyed justified their choices based on criteria related to product quality, availability and hygiene standards. This trend was also reported by [40], who found that growth in the bakery products market is primarily driven by affordability, product variety and the nutritional benefits perceived by consumers. Furthermore, the study highlights the weekly use of wheat flour within households, particularly for the preparation of various dishes. Doughnuts and cakes are the main home-made dishes made with wheat flour. These findings are consistent with those of Keller International [41], who highlighted the common use of wheat flour in the preparation of doughnuts and cakes by households in Côte d’Ivoire.

However, although they regularly consume products made from wheat flour, few households are aware that this flour is rich in iron and folic acid. In fact, only 41.5% are aware of this. Awareness of wheat flour fortification varies significantly according to educational level. Thus, households with the highest level of education (39.25%) have a better understanding of this practice than those with other levels of education. This highlights the important role of education in understanding dietary practices. The low awareness observed in this study corroborates the findings of [42], who showed in a survey conducted in Burkina Faso that more than half of the respondents had never heard of fortified foods. Similarly, a study carried out in Bangladesh on the level of knowledge regarding the fortification of edible oils with vitamin A and rice revealed that Bangladeshi consumers were insufficiently informed on this subject. Only 15% of participants knew that edible oils were fortified with vitamin A, whilst only 3% knew that rice was also fortified [43].

With regard to the use of wheat flour in bakeries and patisseries, our study shows that in Côte d’Ivoire this is a predominantly male-dominated sector (85.8%). The low representation of women could be explained both by the physically demanding nature of the profession and by certain socio-cultural considerations. This male predominance is consistent with the observations of Mbatchou Ngahane et al. (2015) [44], who reported a majority of men among bakery employees in Cameroon. Furthermore, nearly half (46.7%) are aged between 31 and 45, indicating a relatively young population at the peak of their professional maturity. Similar results were reported by Mohammed Lawal et al. (2022) [45], who highlighted this same trend in a study of bakers in Ghana. The majority of respondents have completed secondary education (64.2%). This relatively high level of education could be an asset in fostering a better understanding of hygiene and quality standards. These findings are consistent with those of Abong et al. (2021) [46], who highlighted a high level of education among bakery workers in Kenya.

Wheat is the only cereal used in all the bakeries and patisseries surveyed, confirming its central role as the primary raw material used in bread-making [47]. The GMA and Malika brands largely dominate the market among the bakeries and patisseries surveyed, accounting for over 80% of the flour used. The low usage of other brands, notably Artisan and Abidjanaise, could be explained by their recent arrival on the market, which still limits their brand recognition. Bakers source their supplies mainly from large mills, which are considered the main suppliers of flour in Côte d’Ivoire. The criteria determining this choice are based primarily on the quality of the products offered, their availability and their price. These results highlight the importance of logistical and economic factors in the choice of supply chains by stakeholders in the bakery sector. Similar findings were reported by OCIS (2022) [48] in a study on the determinants of bread prices in Benin, which found that large mills accounted for 67.4% of wheat flour supply sources for bakeries. In the majority of bakeries surveyed, flour is stored directly in the production room for preservation. It is used by 63.3% of bakers within less than a week. Our findings corroborate those of Bossou et al. (2022) [49], who reported in a study conducted in Benin that 93% of bakers stored their flour for a period of 3 to 6 days. Furthermore, the study also shows that all the bakeries surveyed produce bread. However, some specialise exclusively in bread production, whilst others diversify their output by offering, in addition to bread, pastries and Viennese pastries. Nevertheless, bread remains the main product sold, with a production volume exceeding 800 loaves per day. Similar results were reported by ANSSA (2014) [50], which showed in a study conducted in Bamako that the majority of urban bakeries produce between 400 and 4900 loaves per day.

However, the survey revealed that awareness of the fortification of wheat flour with iron and folic acid remains limited among the bakers surveyed. Indeed, only 45% of respondents are aware of this practice, compared with 55% who are unaware of it. Furthermore, barely 31.7% of respondents stated that they were aware of the fortification of the flours they use, whilst the majority were unaware of it, even though the 50 kg woven polypropylene sacks in which these flours are packaged carry relevant information. This attitude of ignorance or trivialisation of the information could persist. This is all the more likely given that consumers themselves pay little attention to the nutritional information on packaging [51]. The low level of awareness observed in this study is consistent with the findings of Helen Keller International [41], who showed that in Côte d’Ivoire, the population’s level of knowledge about fortified foods remains very low. Indeed, in a survey assessing household coverage of refined vegetable oil fortified with vitamin A and soft wheat flour fortified with iron and folic acid, these authors found that only 16% of participants had ever heard of fortified foods, and that the fortification of flour (14%) and salt (5%) appeared to be less well known.

This study has certain limitations that should be borne in mind when interpreting the results. Firstly, its cross-sectional nature does not allow for the establishment of causal relationships between the variables studied. Secondly, the data were based primarily on participants’ self-reports regarding their consumption and use of wheat flour products, which may introduce recall bias or social desirability bias. Furthermore, the study was limited to four municipalities in Abidjan and the bakeries were selected in a targeted manner, which may restrict the generalisability of the results to the entire population. Finally, no direct verification of the actual fortification of the flour used was carried out at the bakeries or on the products consumed.

This study assessed the consumption habits and level of knowledge among the population of Abidjan regarding wheat flour and its fortification with iron and folic acid. It also examined how bakers and pastry chefs use this flour and their awareness of its fortification. The results show that wheat flour-based products, particularly bread, play a significant role in the diets of the households surveyed. However, knowledge of the fortification of this flour remains limited among both consumers and those involved in processing. Indeed, fewer than half of the households and bakers are aware that the wheat flour sold in Côte d’Ivoire is fortified with micronutrients. Furthermore, all the bakeries surveyed stated that they do not carry out checks or tests to verify the fortification of the flours used. These results essentially reflect the participants’ levels of awareness and reported practices. However, they do not allow for conclusions to be drawn regarding actual compliance with the fortification standards for the flours used. It is therefore necessary to strengthen awareness campaigns targeting consumers and bakery professionals, as well as to improve the mechanisms for monitoring and controlling the quality of fortified wheat flour in Côte d’Ivoire.