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

Abstract

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&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.

Overview of the Current Status of Uganda’s Banana Sector: Formalizing the Matooke Sector may not be the Best Policy Option

“…Taking the full cost of research and development into account, the GM M9 could save 19% DALY under the pessimistic scenario in comparison to the baseline DALY, and 40% under the optimistic scenario. These findings suggest that GM PVA matooke is cost-effective based on the criteria by the World Bank and World Health Organization [41].…”

“…Matooke is deficient in VA or plant-derived provitamin A carotenoids (PVA), mainly α-and β-carotenes. The overreliance on matooke arguably contributes to exacerbating VAD in the country, but simultaneously makes matooke a valuable food vehicle to deliver PVA through biofortification [40,41]. Conventional breeding methods to develop PVAbiofortified matooke are constrained by its low genetic variability, polyploidy nature, female sterility, limited seed production, and high costs for space and time requirements [23,34].…”

“…A study concerning GM bananas in Uganda concludes the better-off and bettereducated demographic segments appeared more against GM bananas both in urban and rural regions [42]. In western and central Uganda, the maximum adoption rates of GM bananas were estimated at 56% and 35%, with an average of 43% across the two regions [41]. One study further explores what variables would influence Ugandan farmers' attitudes toward GM bananas [4].…”

Zinc in plants: Integrating homeostasis and biofortification

“…For genetically biofortified crops to have a significant impact, it is imperative that there is acceptance by farmers and consumers in target populations. For example, Biodiversity International identified banana varieties naturally rich in provitamin A, and has proposed them as an option to tackle vitamin A deficiency in Uganda (Tutwiler, 2016;Paul et al, 2017Paul et al, , 2018Kozicka et al, 2021). While these varieties have been successful in Burundi and the Democratic Republic of Congo, they may struggle with Ugandan consumers as these varieties are not the preferred cultivar of cooking banana in Uganda (Ekesa et al, 2015(Ekesa et al, , 2017Paul et al, 2017Paul et al, , 2018.…”

The banana genome hub: a community database for genomics in the Musaceae

“…To complement these resources and enable various options like experimental data overlay on metabolic pathways, we set up the latest version of PathwayTools v25 [ 51 ], named MusaCyc, that comprises a comprehensive set of interfaces to cover user needs. For instance, the carotenoid pathway has been actively studied in banana [ 52 – 54 ] and the Phytoene desaturase (PDS) enzyme, that can cause albinism when disrupted, was used as a proof of concept for gene editing. Using MusaCyc, the PDS gene can be easily found ( Figure 3C ).…”