Impacts of micronutrient intervention programs on effective coverage and lives saved: Modeled evidence from Cameroon

Abstract

Policymakers are committed to improving nutritional status and to saving lives. Some micronutrient intervention programs (MIPs) can do both, but not to the same degrees. We apply the Micronutrient Intervention Modeling tool to compare sets of MIPs for (1) achieving dietary adequacy separately for zinc, vitamin A (VA), and folate for children and women of reproductive age (WRA), and (2) saving children's lives via combinations of MIPs. We used 24‐h dietary recall data from Cameroon to estimate usual intake distributions of zinc and VA for children 6–59 months and of folate for WRA. We simulated the effects on dietary inadequacy and lives saved of four fortified foods and two VA supplementation (VAS) platforms. We estimated program costs over 10 years. To promote micronutrient‐specific dietary adequacy, the economic optimization model (EOM) selected zinc‐ and folic acid–fortified wheat flour, VA‐fortified edible oils, and bouillon cubes, and VAS via Child Health Days in the North macroregion. A different set of cost‐effective MIPs emerged for reducing child mortality, shifting away from VA and toward more zinc for children and more folic acid for WRA. The EOM identified more efficient sets of MIPs than the business‐as‐usual MIPs, especially among programs aiming to save lives.

Estimating the cost and cost‐effectiveness of adding zinc to, and improving the performance of, Burkina Faso's mandatory wheat flour fortification programme

“…Among the evidence with effectiveness metrics comparable with effective coverage, a modelling analysis of the potential cost‐effectiveness of fortifying maize flour with zinc in Zambia found that the incremental cost per person achieving adequate intake of zinc was $4.40 (Fiedler et al, 2013 ), although the cost of maize flour fortification included zinc plus eight other generally more expensive micronutrients. In another analysis, Vosti et al ( 2023 ) estimated that the cost per child effectively covered via zinc fortification of wheat flour in Cameroon ranged from $0.44 to $0.62, depending on the assumed level of compliance with the national standard, which is similar to our findings in the context of Burkina Faso. In Cameroon, however, wheat flour is widely consumed (92% of WRA) (Engle‐Stone & Brown, 2015 ), which has contributed to the success of the introduction of mandatory wheat flour fortification in that country, including a 1‐year‐post‐fortification reduction in the prevalence of low plasma zinc concentrations from 39% to 21% and 47% to 28% among WRA and children, respectively, in the cities of Yaoundé and Douala (Engle‐Stone et al, 2017 ).…”

“…, although the cost of maize flour fortification included zinc plus eight other generally more expensive micronutrients. In another analysis,Vosti et al (2023) …”