Assessing Zambia's industrial fortification options: Getting beyond changes in prevalence and cost-effectiveness
Assessing Zambia's industrial fortification options: Getting beyond changes in prevalence and cost-effectiveness
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DOI：
10.1177/156482651303400413
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发表时间：
2013-12-01
影响因子：
1.9
通讯作者：
Guyondet, Christophe
中科院分区：
文献类型：
--
作者：
Fiedler, John L.;Lividini, Keith;Guyondet, Christophe
背景自1998年规定在糖中添加维生素A以来，赞比亚的强化计划没有改变，但该国仍然受到微量营养素缺乏率高的困扰。提供基于证据的营养强化方案，以期重振赞比亚营养强化方案。赞比亚2006年的生活条件监测调查用于估计维生素A、铁和锌的表观摄入量，以及表观消费水平和四种强化手段的覆盖率。14个替代食品强化组合建模，其成本，影响，平均成本效益，和增量成本效益计算使用三种替代影响措施。替代性的影响措施导致投资组合的不同排序。最具成本效益的组合是植物油，根据所使用的影响衡量标准，植物油每残疾调整生命年节省的成本为糖的12%至25%。然而，强化植物油对公众健康的影响相对较小。除了成本效益之外，还引入了其他标准，用于对投资组合进行排序。分析了公共卫生影响的大小、总成本以及随着时间的推移逐步采用多种车辆组合的增量成本效益。通过测量摄入不足发生率的变化来评估强化组合低估了影响。一种更敏感的措施，也考虑到了估计平均需求量（DURS）差距的变化，是通过基于剂量反应的方法来估计节省的DURS数量。目前存在成本效益高的强化干预组合，对公共卫生有重大影响，价格可变，有助于改善赞比亚人的营养状况。
Background. 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.Objective. To provide evidence-based fortification options with the hope of reinvigorating the Zambian fortification program.Methods. 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.Results. 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.Conclusions. 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.