scholarly journals Reducing micronutrient deficiencies in Pakistani children: are subsidies on fortified complementary foods cost-effective?

2018 ◽  
Vol 21 (15) ◽  
pp. 2893-2906 ◽  
Author(s):  
Simon Wieser ◽  
Beatrice Brunner ◽  
Christina Tzogiou ◽  
Rafael Plessow ◽  
Michael B Zimmermann ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Iron Deficiency ◽  
Vitamin A ◽  
Iodine Deficiency ◽  
Iron Deficiency Anaemia ◽  
Vitamin A Deficiency ◽  
Cost Effective ◽  
Micronutrient Deficiencies ◽  
Deficiency Anaemia ◽  
The Cost

AbstractObjectiveTo estimate the cost-effectiveness of price subsidies on fortified packaged complementary foods (FPCF) in reducing iodine deficiency, iron-deficiency anaemia and vitamin A deficiency in Pakistani children.DesignThe study proceeded in three steps: (i) we determined the current lifetime costs of the three micronutrient deficiencies with a health economic model; (ii) we assessed the price sensitivity of demand for FPCF with a market survey in two Pakistani districts; (iii) we combined the findings of the first two steps with the results of a systematic review on the effectiveness of FPCF in reducing micronutrient deficiencies. The cost-effectiveness was estimated by comparing the net social cost of price subsidies with the disability-adjusted life years (DALY) averted.SettingDistricts of Faisalabad and Hyderabad in Pakistan.SubjectsHouseholds with 6–23-month-old children stratified by socio-economic strata.ResultsThe lifetime social costs of iodine deficiency, iron-deficiency anaemia and vitamin A deficiency in 6–23-month-old children amounted to production losses of $US 209 million and 175 000 DALY. Poor households incurred the highest costs, yet even wealthier households suffered substantial losses. Wealthier households were more likely to buy FPCF. The net cost per DALY of the interventions ranged from a return per DALY averted of $US 783 to $US 65. Interventions targeted at poorer households were most cost-effective.ConclusionsPrice subsidies on FPCF might be a cost-effective way to reduce the societal costs of micronutrient deficiencies in 6–23-month-old children in Pakistan. Interventions targeting poorer households are especially cost-effective.

scholarly journals Nutritional and health status of primary school children in rural Uganda

2012 ◽  
Vol 12 (50) ◽  
pp. 5862-5880
Author(s):  
H Acham ◽  
◽  
JK Kikafunda ◽  
T Tylleskar ◽  
MK Malde ◽  
...  
Keyword(s):  
Health Status ◽  
Iron Deficiency ◽  
Vitamin A ◽  
Nutritional Status ◽  
Iodine Deficiency ◽  
School Children ◽  
Vitamin A Deficiency ◽  
Primary School Children ◽  
Prevalence Rates ◽  
Deficiency Anaemia

Poor nutrition and health can affect children’s education. The nutritional status of school children (9-15 years) was assessed in Kumi district, Eastern Uganda in 2006-2007. Selection of schools was done using modified cluster sampling involving 34 schools (n=645). Assessments for nutritional status were done anthropometrically (height and weight), biochemically (iron, n=145; iodine, n=87; and vitamin A, n=145) and assessment for health status was done following the formal ether concentration technique for examination for intestinal helminths (n=189) and a quick malaria (n=119) test for malaria parasites. Prevalence rates for stunting, underweight and thinness were 8.7% (95CI 6.7-11.1); 13.0% (95CI 10.6-15.8); and 10.1% (95CI 7.9-12.6), respectively of which males and the older age group of children were more affected. Prevalence rates for iodine deficiency, anaemia, iron deficiency and vitamin A deficiency (VAD) were 3.4% (95CI 0.9-9.1); 24.1% (95CI 17.7-31.6); 82.1% (95CI 75.2-87.7); and 30.3% (95CI 23.3- 38.2), respectively. Anaemia (measured as haemoglobin status), iron deficiency (measured as serum Ferritin) and VAD (measured as serum retinol) were higher among females (26.3%, 95CI 17.5-36.7; 83.8%, 95CI 74.4-90.7; 33.8%, 95CI 24.0-44.6) compared to males (21.5%, 95CI 12.8-32.8; 80%, 95CI 69.0-88.4; 26.2%, 95CI 16.6-37.8). Geohelminth (S.mansoni & N.americanus) and malaria parasitemia were 4.8% and 46.2%, respectively. Prevalence rates for stunting, iodine deficiency and geohelminth infections were low. The high prevalence rates of wasting/thinness, underweight, iron and vitamin A deficiencies show these as significant public health problems among school children in Kumi district. There is a need to focus attention on nutritional and health conditions of school children to improve their conditions. Much can be done to prevent malaria infection by promoting the use of Insecticide Treated Nets and chemoprophylaxis. The biennial dosage with albendazole for deworming, and universal use of iodized salt in Uganda are success stories that should continue; iron deficiency anaemia can be controlled through nutrition education, provision of nutritious school meals coupled with control of malaria and deworming. Since many children attend school, such services if delivered through school systems would assist those school children who most need them.

scholarly journals Iron deficiency anaemia-an old enemy

2004 ◽  
Vol 10 (6) ◽  
pp. 754-760 ◽  
Author(s):  
K. Bagchi
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anaemia ◽  
Eastern Mediterranean ◽  
Eastern Mediterranean Region ◽  
Public Health Problem ◽  
Micronutrient Deficiencies ◽  
Childbearing Age ◽  
Iron Supplements ◽  
Deficiency Anaemia ◽  
Targeted Interventions

Anaemia has remained a widespread public health problem in countries of the Eastern Mediterranean Region. Prevalence figures vary from a low of 17% to a high of over 70% among preschool children; from 14% to 42% among adolescents and from 11% to over 40% among women of childbearing age. Although the prevalence of anaemia has often been used as a proxy indicator for iron deficiency anaemia, this approach is not valid in settings where the etiology of anaemia is complex or unknown or where other micronutrient deficiencies of folate, vitamin B12 and vitamin A can co-exist. An integrated, multifactorial and multisectoral approach has to be adopted comprising targeted interventions to provide iron supplements to especially vulnerable segments of the population, in particular pregnant women; food-based approaches to increase iron intake through food fortification and dietary diversification; and other measures combined with iron interventions where other causes of anaemia are prevalent

The use of faecal immunochemical testing in the decision-making process for the endoscopic investigation of iron deficiency anaemia

2020 ◽  
Vol 58 (2) ◽  
pp. 232-239
Author(s):  
Lorena Rodriguez-Alonso ◽  
Francisco Rodriguez-Moranta ◽  
Alexandra Ruiz-Cerulla ◽  
Claudia Arajol ◽  
Katja Serra ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Postmenopausal Women ◽  
Iron Deficiency Anaemia ◽  
Cost Effective ◽  
Accurate Method ◽  
Diagnostic Study ◽  
Gi Tract ◽  
Deficiency Anaemia ◽  
Blood Haemoglobin ◽  
A Prospective Study

AbstractBackgroundBlood loss from the gastrointestinal (GI) tract is the most common cause of iron deficiency anaemia (IDA) in adult men and postmenopausal women. Gastroduodenal endoscopy (GDE) and colonoscopy are frequently recommended, despite uncertainty regarding the coexistence of lesions in the upper and lower GI tract. The faecal immunochemical test (FIT) measures the concentration of faecal haemoglobin (f-Hb) originating only from the colon or rectum. We aimed to assess whether the FIT was able to select the best endoscopic procedure for detecting the cause of IDA.MethodsA prospective study of 120 men and postmenopausal women referred for a diagnostic study of IDA were evaluated with an FIT, GDE and colonoscopy. The endoscopic finding of a significant upper lesion (SUL) or a significant bowel lesion (SBL) was considered to be the cause of the IDA.ResultsThe diagnoses were 35.0% SUL and 20.0% SBL, including 13.3% GI cancer. In the multivariate analysis, the concentration of blood haemoglobin (b-Hb) <9 g/dL (OR: 2.60; 95% CI 1.13–6.00; p = 0.025) and non-steroidal anti-inflammatory drugs NSAIDs (2.56; 1.13–5.88; p = 0.024) were associated with an SUL. Age (0.93; 0.88–0.99; p = 0.042) and f-Hb ≥ 15 μg Hb/g faeces (38.53; 8.60–172.50; p < 0.001) were associated with an SBL. A “FIT plus gastroscopy” strategy, in which colonoscopy is performed only when f-Hb ≥15 μg Hb/g faeces, would be able to detect 92.4% of lesions and be 100% accurate in the detection of cancer while avoiding 71.6% of colonoscopies.ConclusionsThe FIT is an accurate method for selecting the best endoscopy study for the evaluation of IDA. An FIT-based strategy is more cost-effective than the current bidirectional endoscopy-based strategy and could improve endoscopic resource allocation.

scholarly journals Addressing Female Iron-Deficiency Anaemia in India: Is Vegetarianism the Major Obstacle?

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Anu Rammohan ◽  
Niyi Awofeso ◽  
Marie-Claire Robitaille
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anaemia ◽  
Large Scale ◽  
Public Health Problem ◽  
Cost Effective ◽  
Vegetarian Diet ◽  
Major Public Health Problem ◽  
Daily Consumption ◽  
Indian Women ◽  
Deficiency Anaemia

Objectives. We examined the influence of vegetarian diet on the risk of developing anaemia among Indian women and suggest initiatives for addressing diet-related iron-deficiency anaemia. Methods. We analysed data on diet, social class, and haemoglobin levels from the nationally representative Indian National Family and Health Survey 2005/06 for a sample of 81,301 women aged 15–49 years using logistic regression models. Results. After controlling for individual-level factors and household level socioeconomic characteristics, daily consumption of meat, fish, and eggs was associated with lower odds of being moderately or severely anaemic. Our analysis also revealed that economic characteristics such as being from higher wealth quintiles, being in paid employment, and rural residence reduced the odds of having iron-deficiency anaemia among Indian women. Discussion. As a large proportion of Indians subsist on iron-poor vegetarian diets for religious, economic, and cultural reasons, large-scale iron supplementation and fortification of commonly consumed vegetarian foodstuffs constitute a feasible, culturally appropriate, and cost-effective strategy for addressing this major public health problem. Consumption of cheap iron-rich foodstuffs should be promoted. Effective poverty alleviation and hookworm prevention programs are also important. Large-scale cohort and intervention studies are urgently required to further define the influence of vegetarianism on iron deficiency anaemia in India.

scholarly journals Eggs Represent a Cost-Effective Approach in Delivering Protein, Choline, Vitamin A and Vitamin D in the American Diet of Children and Adults

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1471-1471
Author(s):  
Yanni Papanikolaou ◽  
Victor Fulgoni
Keyword(s):  
Vitamin D ◽  
Cost Effectiveness ◽  
Vitamin A ◽  
Protein Delivery ◽  
Cost Effective ◽  
Food Groups ◽  
Funding Sources ◽  
Key Barrier ◽  
Nutrient Profiles ◽  
The Cost

Abstract Objectives Cost has been identified as a key barrier in preventing many Americans from consuming recommended nutrients from healthy eating patterns. The purpose of the current study was to examine the cost-effectiveness of eggs for delivering selected nutrients (i.e., protein, vitamin A, choline, vitamin D) in children and adults. Methods The present analysis used dietary intake data from the National Health and Nutrition Examination Survey 2013–2016 (2–18 years-old, N = 956; 19+ years-old, N = 2424). Cost and nutrient profiles for What We Eat in America food categories were compared to whole eggs. Food cost and the cost of nutrients were obtained from the Center for Nutrition Promotion and Policy food cost database. Results Of 15 main food groups examined, whole eggs ranked third for cost-effectiveness per 100 g (excluding beverages), such that eggs cost $0.35 per 100 g, with dairy and grains representing the first and second most cost-effective foods at $0.23 and $0.27 per 100 g, respectively. In children and adults, eggs represented a cost-effective food for protein delivery, such that eggs provided nearly 2.7 and 3.7% of all protein in the diet, respectively, at a cost of about $0.03 per g of protein. Eggs contributed 3.8% and 6.0% of all vitamin A in the diet of children and adults, at a cost of approximately $0.002 and $0.003 per RAE mcg of vitamin A, respectively. In children and adolescents 2–18 years-old, nearly 12% of all choline in the diet is delivered at a cost of approximately $0.002 per mg of choline. Similarly, in adults 19+ years-old, eggs provide nearly 14.8% of all dietary choline in the diet at a cost of approximately $0.002 per mg of choline. Eggs provide nearly 5% and 9.5% of all vitamin D in the diet of children and adults, at a cost of approximately $0.21 and $0.22 per mcg of vitamin D, respectively. Overall, eggs ranked as the most cost-effective food for delivering protein, choline, and vitamin A, and third for vitamin D in children. In adults, eggs ranked as the most cost-effective food for delivering protein and choline, second for vitamin A, and third for vitamin D. Conclusions In summary, eggs represent a cost-effective food choice for delivery of protein and several shortfall nutrients (choline, vitamin A, and vitamin D) in the American diet. Funding Sources The study was supported by the Egg Nutrition Center.

scholarly journals Reassessing the Cost-Effectiveness of High-Provitamin A Bananas to Reduce Vitamin A Deficiency in Uganda

2021 ◽  
Vol 5 ◽  
Author(s):  
Marta Kozicka ◽  
Julia Elsey ◽  
Beatrice Ekesa ◽  
Susan Ajambo ◽  
Enoch Kikulwe ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Vitamin A Deficiency ◽  
Cost Effective ◽  
Provitamin A ◽  
Disability Adjusted Life ◽  
Alternative Scenarios ◽  
And Shifts ◽  
The Cost ◽  
Disability Adjusted Life Year ◽  
Promotion Campaigns

There are two high-provitamin A (pVA) banana-based interventions potentially available in Uganda—biofortified genetically modified (GM) banana and fast-tracked banana landraces from outside Uganda that are naturally high in provitamin A (nHpVA). Based on the newest country statistics and using adoption scenarios obtained through focus group discussions and expert interviews, we assess obstacles and opportunities for adoption as well as cost-effectiveness of these interventions. In two alternative scenarios for the GM banana (M9 matooke), we assume 40% and 64% adoption rates, which would result in US$29,374,151 and US$63,259,415 in income saved, respectively. As an alternative, for the symmetrical scenarios, we calculate that if the nHpVA banana (Apantu plantain, native of Ghana) were to be adopted, US$46,100,148 and US$76,364,988 in income would be saved. Taking into account the full cost of R&amp;D, we estimate that the M9 matooke could save one disability-adjusted life year (DALY) at a cost of US$67.37 at best and US$145.09 at worst. We estimate that the Apantu plantain could save one DALY at a cost of US$50.54 at best and US$83.72 at worst. Our DALY analysis estimates that all assessed HpVA banana interventions are extremely cost-effective in all scenarios, following both the World Bank's and the WHO criteria. Nevertheless, successful interventions would require extensive promotion campaigns and shifts in agricultural value chains.

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