Assessing Zambia's industrial fortification options: Getting beyond changes in prevalence and cost-effectiveness
Since fortification of sugar with vitamin A was mandated in 1998, Zambia's fortification program has not changed, while the country remains plagued by high rates of micronutrient deficiencies.To provide evidence-based fortification options with the hope of reinvigorating the Zambian fortification pr...
| Main Authors: | , , , , , , , |
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| Format: | Journal Article |
| Language: | Inglés |
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SAGE Publications
2013
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| Subjects: | |
| Online Access: | https://hdl.handle.net/10568/152954 |
| _version_ | 1855537920238157824 |
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| author | Fiedler, John L. Lividini, Keith Kabaghe, Gladys Zulu, Rodah Tehinse, John Bermudez, Odilia I. Jallier, Vincent Guyondet, Christophe |
| author_browse | Bermudez, Odilia I. Fiedler, John L. Guyondet, Christophe Jallier, Vincent Kabaghe, Gladys Lividini, Keith Tehinse, John Zulu, Rodah |
| author_facet | Fiedler, John L. Lividini, Keith Kabaghe, Gladys Zulu, Rodah Tehinse, John Bermudez, Odilia I. Jallier, Vincent Guyondet, Christophe |
| author_sort | Fiedler, John L. |
| collection | Repository of Agricultural Research Outputs (CGSpace) |
| description | Since fortification of sugar with vitamin A was mandated in 1998, Zambia's fortification program has not changed, while the country remains plagued by high rates of micronutrient deficiencies.To provide evidence-based fortification options with the hope of reinvigorating the Zambian fortification program.Zambia's 2006 Living Conditions Monitoring Survey is used to estimate the apparent intakes of vitamin A, iron, and zinc, as well as the apparent consumption levels and coverage of four fortification vehicles. Fourteen alternative food fortification portfolios are modeled, and their costs, impacts, average cost-effectiveness, and incremental cost-effectiveness are calculated using three alternative impact measures.Alternative impact measures result in different rank orderings of the portfolios. The most cost-effective portfolio is vegetable oil, which has a cost per disability-adjusted life-year (DALY) saved ranging from 12% to 25% of that of sugar, depending on the impact measure used. The public health impact of fortified vegetable oil, however, is relatively modest. Additional criteria beyond cost-effectiveness are introduced and used to rank order the portfolios. The size of the public health impact, the total cost, and the incremental cost-effectiveness of phasing in multiple vehicle portfolios over time are analyzed.Assessing fortification portfolios by measuring changes in the prevalence of inadequate intakes underestimates impact. A more sensitive measure, which also takes into account change in the Estimated Average Requirement (EAR) gap, is provided by a dose—response-based approach to estimating the number of DALYs saved. There exist highly cost-effective fortification intervention portfolios with substantial public health impacts and variable price tags that could help improve Zambians' nutrition status. |
| format | Journal Article |
| id | CGSpace152954 |
| institution | CGIAR Consortium |
| language | Inglés |
| publishDate | 2013 |
| publishDateRange | 2013 |
| publishDateSort | 2013 |
| publisher | SAGE Publications |
| publisherStr | SAGE Publications |
| record_format | dspace |
| spelling | CGSpace1529542024-11-15T08:53:01Z Assessing Zambia's industrial fortification options: Getting beyond changes in prevalence and cost-effectiveness Fiedler, John L. Lividini, Keith Kabaghe, Gladys Zulu, Rodah Tehinse, John Bermudez, Odilia I. Jallier, Vincent Guyondet, Christophe biofortification nutrition trace elements retinol zinc food policies household consumption nutrition surveys food fortification household surveys food intake Since fortification of sugar with vitamin A was mandated in 1998, Zambia's fortification program has not changed, while the country remains plagued by high rates of micronutrient deficiencies.To provide evidence-based fortification options with the hope of reinvigorating the Zambian fortification program.Zambia's 2006 Living Conditions Monitoring Survey is used to estimate the apparent intakes of vitamin A, iron, and zinc, as well as the apparent consumption levels and coverage of four fortification vehicles. Fourteen alternative food fortification portfolios are modeled, and their costs, impacts, average cost-effectiveness, and incremental cost-effectiveness are calculated using three alternative impact measures.Alternative impact measures result in different rank orderings of the portfolios. The most cost-effective portfolio is vegetable oil, which has a cost per disability-adjusted life-year (DALY) saved ranging from 12% to 25% of that of sugar, depending on the impact measure used. The public health impact of fortified vegetable oil, however, is relatively modest. Additional criteria beyond cost-effectiveness are introduced and used to rank order the portfolios. The size of the public health impact, the total cost, and the incremental cost-effectiveness of phasing in multiple vehicle portfolios over time are analyzed.Assessing fortification portfolios by measuring changes in the prevalence of inadequate intakes underestimates impact. A more sensitive measure, which also takes into account change in the Estimated Average Requirement (EAR) gap, is provided by a dose—response-based approach to estimating the number of DALYs saved. There exist highly cost-effective fortification intervention portfolios with substantial public health impacts and variable price tags that could help improve Zambians' nutrition status. 2013-12 2024-10-01T13:55:23Z 2024-10-01T13:55:23Z Journal Article https://hdl.handle.net/10568/152954 en Limited Access SAGE Publications Fiedler, John L.; Lividini, Keith; Kabaghe, Gladys; Zulu, Rodah; Tehinse, John; Bermudez, Odilia I.; Jallier, Vincent; and Guyondet, Christophe. 2013. Assessing Zambia's industrial fortification options: Getting beyond changes in prevalence and cost-effectiveness. Food and Nutrition Bulletin 34(4): 501-519. https://doi.org/10.1177/156482651303400413 |
| spellingShingle | biofortification nutrition trace elements retinol zinc food policies household consumption nutrition surveys food fortification household surveys food intake Fiedler, John L. Lividini, Keith Kabaghe, Gladys Zulu, Rodah Tehinse, John Bermudez, Odilia I. Jallier, Vincent Guyondet, Christophe Assessing Zambia's industrial fortification options: Getting beyond changes in prevalence and cost-effectiveness |
| title | Assessing Zambia's industrial fortification options: Getting beyond changes in prevalence and cost-effectiveness |
| title_full | Assessing Zambia's industrial fortification options: Getting beyond changes in prevalence and cost-effectiveness |
| title_fullStr | Assessing Zambia's industrial fortification options: Getting beyond changes in prevalence and cost-effectiveness |
| title_full_unstemmed | Assessing Zambia's industrial fortification options: Getting beyond changes in prevalence and cost-effectiveness |
| title_short | Assessing Zambia's industrial fortification options: Getting beyond changes in prevalence and cost-effectiveness |
| title_sort | assessing zambia s industrial fortification options getting beyond changes in prevalence and cost effectiveness |
| topic | biofortification nutrition trace elements retinol zinc food policies household consumption nutrition surveys food fortification household surveys food intake |
| url | https://hdl.handle.net/10568/152954 |
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