scholarly journals Societal Costs of Micronutrient Deficiencies in 6- to 59-month-old Children in Pakistan

2017 ◽  
Vol 38 (4) ◽  
pp. 485-500 ◽  
Author(s):  
Simon Wieser ◽  
Beatrice Brunner ◽  
Christina Tzogiou ◽  
Rafael Plessow ◽  
Michael B. Zimmermann ◽  
...  
Keyword(s):  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Large Population ◽  
Cost Effective ◽  
Medical Costs ◽  
Deficiency Anemia ◽  
Micronutrient Deficiencies ◽  
Societal Costs ◽  
Life Years ◽  
Production Losses

Background: In Pakistan, nearly half of children younger than 5 years are stunted, and 1 in 3 is underweight. Micronutrient deficiencies, a less visible form of undernutrition, are also endemic. They may lead to increased morbidity and mortality as well as to impaired cognitive and physical development. Objective: To estimate the lifetime costs of micronutrient deficiencies in Pakistani children aged between 6 and 59 months. Methods: We develop a health economic model of the lifetime health and cost consequences of iodine, iron, vitamin A, and zinc deficiencies. We assess medical costs, production losses in terms of future incomes lost, and disability-adjusted life-years (DALYs). The estimation is based on large population surveys, information on the health consequences of micronutrient deficiencies extracted from randomized trials, and a variety of other sources. Results: Total societal costs amount to US$46 million in medical costs, US$3,222 million in production losses, and 3.4 million DALYs. Costs are dominated by the impaired cognitive development induced by iron-deficiency anemia in 6- to 23-month-old children and the mortality caused by vitamin A deficiency. Costs are substantially higher in poorer households. Conclusions: Societal costs amounted to 1.44% of gross domestic product and 4.45% of DALYs in Pakistan in 2013. These costs hinder the country's development. They could be eliminated by improved nutrition of 6- to 59-month-old children and public health measures. Our results may contribute to the design of cost-effective interventions aiming to reduce micronutrient deficiencies in early childhood and their lifetime consequences.

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 Micronutrient Deficiencies, Over- and Undernutrition, and Their Contribution to Anemia in Azerbaijani Preschool Children and Non-Pregnant Women of Reproductive Age

Nutrients ◽  
2018 ◽  
Vol 10 (10) ◽  
pp. 1483 ◽  
Author(s):  
James Wirth ◽  
Tamerlan Rajabov ◽  
Nicolai Petry ◽  
Bradley Woodruff ◽  
Nafisa Shafique ◽  
...  
Keyword(s):  
Risk Factors ◽  
Iron Deficiency ◽  
Vitamin A ◽  
Vitamin B12 ◽  
Pregnant Women ◽  
Iron Deficiency Anemia ◽  
Vitamin A Deficiency ◽  
Deficiency Anemia ◽  
Micronutrient Deficiencies ◽  
Folate And Vitamin B12

Data on the nutritional situation and prevalence of micronutrient deficiencies in Azerbaijan are scarce, and knowledge about anemia risk factors is needed for national and regional policymakers. A nationally representative cross-sectional survey was conducted to assess the prevalence of micronutrient deficiencies, over- and undernutrition, and to disentangle determinants of anemia in children and women in Azerbaijan. The survey generated estimates of micronutrient deficiency and growth indicators for children aged 0–59 months of age (6–59 months for blood biomarkers) and non-pregnant women 15–49 years of age. Questionnaire data, anthropometric measurements, and blood samples were collected to assess the prevalence of under- and over-nutrition, anemia, iron deficiency, and iron deficiency anemia, in both groups. In children only, vitamin A deficiency and zinc deficiency were also assessed. In women only, folate and vitamin B12 deficiencies and vitamin A insufficiency were assessed. In total, 3926 household interviews were successfully completed with a response rate of 80.6%. In the 1455 children, infant and young child feeding practices were relatively poor overall; the prevalence of wasting and stunting were 3.1% and 18.0%, respectively; and 14.1% of children were overweight or obese. The prevalence of anemia was 24.2% in 6–59 months old children, the prevalence of iron deficiency was 15.0% in this age group, and the prevalence of iron deficiency anemia was 6.5%. Vitamin A deficiency was found in 8.0% of children, and zinc deficiency was found in 10.7%. Data from 3089 non-pregnant women 15–49 years of age showed that while undernutrition was scarce, 53% were overweight or obese, with increasing prevalence with increasing age. Anemia affected 38.2% of the women, iron deficiency 34.1% and iron deficiency anemia 23.8%. Vitamin A insufficiency was found in 10.5% of women. Folate and vitamin B12 deficiency were somewhat more common, with prevalence rates of 35.0% and 19.7%, respectively. The main risk factors for anemia in children were recent lower respiratory infection, inflammation and iron deficiency. In women, the main risk factors for anemia were iron deficiency and vitamin A insufficiency. Anemia is a public health problem in Azerbaijani children and women, and additional efforts are needed to reduce anemia in both groups.

Review of the Micronutrient Situation in Rwanda

2021 ◽  
Vol 42 (1) ◽  
pp. 133-154
Author(s):  
Joanne E. Arsenault ◽  
Deanna K. Olney
Keyword(s):  
Life Cycle ◽  
Young Children ◽  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Grey Literature ◽  
Age Groups ◽  
Reproductive Age ◽  
Micronutrient Deficiencies ◽  
Micronutrient Malnutrition ◽  
Context Specific

Background: Rwanda’s commitment to reducing malnutrition is evident in their multisectoral nutrition policy and wide array of nutrition partners. However, the prevalence of micronutrient deficiencies and the suitability of current strategies to address existing deficiencies is unclear. Objective: To review the available evidence related to the prevalence of micronutrient deficiencies across the life cycle and strategies in place to address them. Methods: We reviewed scientific and grey literature on nutritional problems in Rwanda, emphasizing micronutrient deficiencies and anemia, and current strategies to address micronutrient malnutrition. Results: Overall, there is scant evidence related to the types and prevalence of micronutrient deficiencies among populations across the life cycle in Rwanda. Existing evidence is primarily limited to outdated or small regional surveys focusing on iron or vitamin A among women and young children. Surveys have assessed the prevalence of anemia and indicate that anemia is very high among young children and moderately high among other age-groups. However, there are limited data on the context-specific causes of anemia in Rwanda across population groups. Current nutrition strategies mainly target women and young children and are primarily designed to reduce vitamin A deficiency and/or anemia caused by micronutrient deficiencies. Conclusions: Rwanda has many nutrition programs in place that address micronutrient deficiencies in young children and a few for women of reproductive age. However, gaps exist in knowledge of the extent of different types of micronutrient deficiencies among all populations across the life cycle and whether the delivery of nutrients through current programs is meeting actual needs.

scholarly journals Effect of Drying on β-Carotene, α Carotene, Lutein and Zeaxanthin Content in Vegetables and Its Application for Vegetable Seasoning

2020 ◽  
Vol 141 ◽  
pp. 02007
Author(s):  
Kullamethee Piyarach ◽  
Kamnerd Nipawan ◽  
Chumphukhaw Chadapon ◽  
Suwannasit Daluwan ◽  
Rotjanapun Kunjana
Keyword(s):  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Cost Effective ◽  
Food Preservation ◽  
Daily Consumption ◽  
Overall Acceptability ◽  
Chinese Kale ◽  
Pepper Powder ◽  
Air Dryer ◽  
Β Carotene

In plant based food with dark-green, yellow and orange color, beta (β)-carotene, alpha (α)-carotene, lutein and zeaxanthin are predominating carotenoids contributing to an eyesight improvement. Among food preservation methods, drying using cabinet hot air dryer is one of the most cost-effective options and therefore, this investigation was aimed to study the carotenoids content in vegetables after drying and optimize the vegetable seasoning product. Based on customer survey, carrot, pumpkin, Chinese kale and long coriander were selected for the experiment, accessibility and have met the requirement of final moisture content, less than 10%. Our results demonstrated that drying period of sliced carrots and pumpkins was 360 min, while in Chinese kale and long coriander was 240 min. Amounts of carotenoids in carrot and long coriander were greatly remaining after drying. Drying of Chinese kale had little effect on carotenoids content. While, dried pumpkin may cause a major loss of β-,α-carotene and lutein content over 50%. Regarding to development of vegetable seasoning powder, Just about right and Hedonic 9 point tests were used for a sensory evaluation. The optimal seasoning formula consisted of 66. 8% mixed dried ground vegetables, 13.4% sugar, 8.8% salt, 6.7% garlic powder, and 4.3% white pepper powder. The overall acceptability of the product was rated as moderately liked, containing β-carotene, α-carotene, lutein and zeaxanthin content as 178.04±3.39, 58.81±1.83, 158.89±4.16, 0.98±0.01 μg/g, respectively (vitamin A approximately 29.67 μg RE/g). Fortification of vegetable seasoning powder for daily consumption may improve the eye vision and reduce the rate of vitamin A deficiency.

scholarly journals Human milk sIgA antibody in relation to maternal nutrition and infant vulnerability in northern Kenya

2019 ◽  
Vol 2019 (1) ◽  
pp. 201-211 ◽  
Author(s):  
Masako Fujita ◽  
Katherine Wander ◽  
Nerli Paredes Ruvalcaba ◽  
Eleanor Brindle
Keyword(s):  
Vitamin A ◽  
Human Milk ◽  
Maternal Nutrition ◽  
Diarrheal Disease ◽  
Vitamin A Deficiency ◽  
Microbial Colonization ◽  
Deficiency Anemia ◽  
Immune Protection ◽  
Northern Kenya ◽  
Arm Circumference

Abstract Background The maternal buffering hypothesis posits that human lactation biology can buffer milk against the mild-to-moderate malnutrition that occurred routinely in evolutionary history through the mobilization of maternal body reserves. This perspective may provide insights for understanding human milk immune content variation, such as milk sIgA, which protects infants’ intestines from microbial colonization and prevents diarrheal disease. Objective To investigate how maternal delivery of sIgA to milk may vary in a way that can buffer milk against maternal malnutrition, while taking into consideration infants’ varying needs for immune protection across age or by sex. Methodology A cross-sectional study analyzed archived milk specimens from breastfeeding mothers in Ariaal communities of northern Kenya surveyed during the 2006 Horn-of-Africa drought. Multiple regression models for ln-transformed sIgA were constructed using maternal nutrition, infant age/sex and their interactions as predictors. Maternal nutrition variables included iron-deficiency anemia (IDA), vitamin A deficiency (VAD) and mid-upper arm circumference (MUAC). Infant vulnerability was considered high in young age and/or male sex. Results and implications Milk sIgA did not significantly differ by maternal IDA. Milk sIgA increased with infant age and maternal MUAC (n = 202). Significant interactions were observed between infant age and maternal VAD and between infant sex and maternal MUAC, such that milk sIgA content was low for younger infants particularly among VAD mothers, while among mothers with low MUAC, sIgA was lower for male infants. Results imply that mothers’ ability to deliver/buffer milk sIgA may be lowered when nutritional stress is combined with high infant vulnerability to infection. Lay Summary Human milk sIgA antibody content was low for younger infants among vitamin A deficient mothers. Among mothers with small arm-circumference, milk sIgA was lower for sons. Double burden of raising young or male infants with high needs for immune protection and being malnourished, might lower maternal sIgA delivery to milk.

scholarly journals Isolated and combined prevalence of anemia, vitamin A deficiency and zinc deficiency in preschool children 12-72 months for the government of Paraíba

2014 ◽  
Vol 27 (3) ◽  
pp. 301-310 ◽  
Author(s):  
Dixis Figueroa Pedraza ◽  
Márcia Cristina Sales
Keyword(s):  
Vitamin A ◽  
Zinc Deficiency ◽  
School Children ◽  
Vitamin A Deficiency ◽  
Serum Zinc ◽  
Nutritional Deficiencies ◽  
Simultaneous Occurrence ◽  
Micronutrient Deficiencies ◽  
Serum Retinol ◽  
Prevalence Of Anemia

OBJECTIVE: To estimate the isolated and combined prevalence of anemia, vitamin A deficiency and zinc deficiency in pre-school children, as well as the distribution of isolated deficiencies according to gender, age and prior supplementation with vitamin A. METHODS: Cross-sectional study with pre-school children in the state of Paraíba, Brazil. Analysis of the average concentrations of hemoglobin, serum retinol and serum zinc, according to gender, age and previous vitamin A supplementation of children were carried out as well as the risk of simultaneous occurrence of micronutrient deficiencies in the presence of these deficiencies. RESULTS: The prevalence of anemia, vitamin A deficiency and zinc deficiency were 15.4%, 23.3% and 13.8%, respectively. The anemia was significantly associated with age (p<0.01). Children previously supplemented by vitamin A had higher serum retinol concentrations than children without supplements, an effect that was not observed for concentrations of hemoglobin or serum zinc. The prevalence of anemia associated with vitamin A deficiency was 5.8%, with the chance of vitamin A deficiency and anemia coexist 2.21 times (95%CI=1.03-4.84) higher in the case of vitamin A deficiency or anemia rather than in the absence of these conditions. CONCLUSION: The high prevalence of micronutrient deficiencies which are important in child growth, as well as the coexistence of nutritional deficiencies, point out the need to strengthen nutrition intervention strategies that consider this issue.

scholarly journals Improving the Dietary Vitamin A Content of Rural Communities in South Africa by Replacing Non-Biofortified White Maize and Sweet Potato with Biofortified Maize and Sweet Potato in Traditional Dishes

Nutrients ◽  
2019 ◽  
Vol 11 (6) ◽  
pp. 1198 ◽  
Author(s):  
Laurencia Govender ◽  
Kirthee Pillay ◽  
Muthulisi Siwela ◽  
Albert Thembinkosi Modi ◽  
Tafadzwanashe Mabhaudhi
Keyword(s):  
South Africa ◽  
Rural Communities ◽  
Vitamin A ◽  
Sweet Potato ◽  
Vitamin A Deficiency ◽  
Nutritional Composition ◽  
Dietary Vitamin ◽  
Micronutrient Deficiencies ◽  
Isoleucine Leucine ◽  
Lower Protein

Biofortification of staple crops has a potential for addressing micronutrient deficiencies, such as vitamin A deficiency (VAD), which are prevalent in South Africa. The poor acceptability of provitamin A (PVA)-biofortified foods could be improved by combining them with other food items to produce modified traditional dishes. The nutritional composition of the dishes could also be improved by the modification. The study aimed to investigate the effect of replacing white maize and cream-fleshed sweet potato (CFSP)] with PVA-biofortified maize and orange-fleshed sweet potato (OFSP) on the nutritional composition of South African traditional dishes. The protein, fibre, total mineral (ash), lysine, and iron concentrations of the PVA maize phutu (traditional porridge) composite dishes (control), were not significantly different (P > 0.05) from those of white maize phutu composite dishes. However, the PVA concentration of PVA maize phutu composite dishes was higher than that of the white phutu composite dishes (P > 0.05). The OFSP had a significantly lower protein concentration, but a significantly higher (P > 0.05) fibre, ash, lysine, isoleucine, leucine, and PVA concentration, relative to the CFSP. The findings indicate that composite dishes in which white maize is replaced with PVA-biofortified maize, and switching over from CFSP to OFSP, would contribute to combating VAD in South Africa, and in other developing counties.

Metformin (Met): A cost-effective adjunct therapy with enzalutamide (Enza) for metastatic castrate-resistant prostate cancer (mCRPC)?

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 340-340
Author(s):  
Jordan Hill ◽  
Mike Paulden ◽  
Christopher McCabe ◽  
Peter Venner ◽  
Brita Lavender Danielson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Large Population ◽  
Cost Effective ◽  
Expert Elicitation ◽  
Decision Analytic Model ◽  
Lifetime Horizon ◽  
Adjunct Therapy ◽  
Life Years ◽  
Effective Adjunct

340 Background: Several new therapies have changed the landscape of prostate cancer (PCa) treatment, primarily due to their effectiveness in treating patients with mCRPC. Enza has garnered much attention, but is relatively expensive (~$3175/month). Met is less expensive (~$8.00/month) and has been used for decades to treat patients with non-insulin dependent diabetes. Two recent large population-based studies of PCa have demonstrated that diabetics taking Met had improved PCa specific and overall survival compared to those not taking Met. As a result, we hypothesized that Met has the potential to be a cost-effective adjunct therapy to Enza, although it is not currently used as such. Methods: We constructed a Markov-based decision analytic model to compare the cost-effectiveness of Enza alone versus Enza combined with Met. Through expert elicitation, we assumed that adding Met to Enza increases its efficacy by 15%. All other costs, utilities, and transition probabilities were derived from existing literature or expert elicitation. Effectiveness was measured using quality-adjusted life years (QALYs). Costs and QALYs were considered over a lifetime horizon and discounted at 5% per annum. Cost-effectiveness was considered using a willingness to pay threshold of $50 000/QALY. Results: Adding Met to Enza increases expected lifetime costs per patient by $83 651, and improves the expected effectiveness of treatment by 3.74 QALYs, compared to Enza alone. The incremental cost-effectiveness ratio is $22 374/QALY. Accounting for parameter uncertainty, adding Met to Enza has a 72% probability of being cost-effective. Conclusions: Although Met is not currently used as an adjunct therapy to Enza, doing so would likely be cost-effective provided it is as effective as we have assumed in our model. Additionally, our results indicate that the combination of Enza and Met could be among the most cost effective interventions in oncology. However, given the uncertainty around the effectiveness of such an adjunct therapy, our results support the need for further clinical trials to provide more robust evidence of the effectiveness of such a combination therapy in clinical practice.

Multiple Fortification of Beverages

1998 ◽  
Vol 19 (2) ◽  
pp. 168-171 ◽  
Author(s):  
Denis Barclay
Keyword(s):  
Vitamin A ◽  
Raw Materials ◽  
Cost Effective ◽  
Target Population ◽  
Micronutrient Deficiencies ◽  
Organoleptic Characteristics ◽  
Multiple Micronutrient ◽  
Materials Used ◽  
Processing And Storage ◽  
And Storage

Diet-related micronutrient deficiencies rarely occur in isolation; deficiencies of iodine and vitamin A or of iron and vitamin A or zinc are often observed in the same populations. In addition, widespread deficiencies of some micronutrients, for example, zinc and calcium, may often go undiagnosed because of the absence of specific and sensitive status indicators. Multiple micronutrient supplementation can be more effective in improving nutritional status than supplementation with single key micronutrients; therefore, the multiple fortification of appropriate food vectors, including beverages, is of interest from the nutritional standpoint. Beverages fortified with multiple micronutrients include dairy products, chocolate beverages, fruit juices, and soya-based drinks. As well as the documented or estimated micronutrient deficiencies and the requirements of the target population or consumer group, the conception of such a multiply fortified beverage must take into account a number of other important factors. The choice of the chemical form of the fortification micronutrients should be made with consideration of bioavailability, the effects on the organoleptic characteristics of the particular beverage, and cost. The initial calculation of the composition of the micronutrient premix should include the levels of micronutrients in the raw materials used and the estimated losses of specific micronutrients during processing and storage. Preliminary production and storage trials are then needed to determine the actual losses. The composition of the micronutrient premix may then be finalized. Interactions, both positive and negative, between fortification micronutrients may also need to be considered. For example, the bioavailability of iron may be enhanced by the addition of vitamin C, whereas mineral–vitamin and vitamin–vitamin interactions can accelerate the destruction of some vitamins. To render quality control procedures simple and cost-effective, only a limited number of fortification micronutrients, which are especially sensitive to losses and which are easy to measure, may be analysed. Simple, inexpensive, and rigorous analytical methods for such measurements are now available.

scholarly journals Basis for changes in the global burden of disease estimates related to vitamin A and zinc deficiencies in the GBD 2017 and 2019 studies

2021 ◽  
pp. 1-20
Author(s):  
Sonja Y. Hess ◽  
Alexander C. McLain ◽  
Haley Lescinsky ◽  
Kenneth H. Brown ◽  
Ashkan Afshin ◽  
...  
Keyword(s):  
Vitamin A ◽  
Zinc Deficiency ◽  
Burden Of Disease ◽  
Disease Burden ◽  
Vitamin A Deficiency ◽  
Global Burden Of Disease ◽  
Global Burden ◽  
Micronutrient Deficiencies ◽  
Global Prevalence ◽  
Additional Information

Abstract Background: The Global Burden of Disease (GBD) Study provides estimates of death and disability from 87 risk factors, including some micronutrient deficiencies. Objectives: To review methodological changes that led to large differences in the disease burden estimates for vitamin A and zinc deficiencies between the GBD 2017 and 2019 Studies. Methods: GBD publications were reviewed; additional information was provided by GBD researchers. Results: Vitamin A deficiency prevalence is based on plasma retinol concentration, whereas the estimate for zinc deficiency prevalence uses dietary adequacy as a proxy. The estimated global prevalence of vitamin A deficiency for children aged 1-4 years in the year 2017 decreased from 0.20 (95%CI 0.17-0.24) in GBD 2017 to 0.16 (95%CI 0.15-0.19) in GBD 2019, while the global prevalence of zinc deficiency did not change between the two studies (0.09 (95%CI 0.04-0.17) and 0.09 (95%CI 0.03-0.18)). New to 2019 was that meta-analyses were performed using Meta Regression – Bayesian, Regularized, Trimmed (MR-BRT), a method developed for GBD. Due to this and multiple other methodological changes the estimated number of deaths due to vitamin A deficiency dropped from 233,000 (179,000–294,000) to 24,000 (3,000–50,000) from GBD 2017 to 2019, and for zinc deficiency from 29,000 (1,000–77,000) to 2,800 (700–6,500), respectively. Conclusion: The changes in the estimated disease burdens due to vitamin A and zinc deficiencies in the GBD reports from 2017 to 2019 are due primarily to changes in the analytical methods employed, so may not represent true changes in disease burden. Additional effort is needed to validate these results.

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