PMID- 24791584
OWN - NLM
STAT- MEDLINE
DCOM- 20140529
LR  - 20170214
IS  - 0379-5721 (Print)
IS  - 0379-5721 (Linking)
VI  - 35
IP  - 1
DP  - 2014 Mar
TI  - Managing the vitamin A program portfolio: a case study of Zambia, 2013-2042.
PG  - 105-25
AB  - BACKGROUND: Micronutrient deficiencies continue to constitute a major burden of 
      disease, particularly in Africa and South Asia. Programs to address micronutrient 
      deficiencies have been increasing in number, type, and scale in recent years, 
      creating an ever-growing need to understand their combined coverage levels, 
      costs, and impacts so as to more effectively combat deficiencies, avoid putting 
      individuals at risk for excess intakes, and ensure the efficient use of public 
      health resources. OBJECTIVE: To analyze combinations of the two current 
      programs--sugar fortification and Child Health Week (CHW)--together with four 
      prospective programs--vegetable oil fortification, wheat flour fortification, 
      maize meal fortification, and biofortified vitamin A maize--to identify Zambia's 
      optimal vitamin A portfolio. METHODS: Combining program cost estimates and 
      30-year Zambian food demand projections, together with the Zambian 2005 Living 
      Conditions Monitoring Survey, the annual costs, coverage, impact, and 
      cost-effectiveness of 62 Zambian portfolios were modeled for the period from 2013 
      to 2042. RESULTS: Optimal portfolios are identified for each of five alternative 
      criteria: average cost-effectiveness, incremental cost-effectiveness, coverage 
      maximization, health impact maximization, and affordability. The most likely 
      scenario is identified to be one that starts with the current portfolio and takes 
      into account all five criteria. Starting with CHW and sugar fortification, it 
      phases in vitamin A maize, oil, wheat flour, and maize meal (in that order) to 
      eventually include all six individual interventions. CONCLUSIONS: Combining cost 
      and Household Consumption and Expenditure Survey (HCES) data provides a powerful 
      evidence-generating tool with which to understand how individual micronutrient 
      programs interact and to quantify the tradeoffs involved in selecting alternative 
      program portfolios.
FAU - Fiedler, John L
AU  - Fiedler JL
FAU - Lividini, Keith
AU  - Lividini K
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Food Nutr Bull
JT  - Food and nutrition bulletin
JID - 7906418
RN  - 11103-57-4 (Vitamin A)
SB  - IM
MH  - Child
MH  - Cost-Benefit Analysis/economics/methods/statistics & numerical data
MH  - Food, Fortified/*economics/*statistics & numerical data
MH  - Humans
MH  - Program Evaluation/economics/*methods/*statistics & numerical data
MH  - Vitamin A/economics/*therapeutic use
MH  - Vitamin A Deficiency/*drug therapy/economics
MH  - Zambia
EDAT- 2014/05/06 06:00
MHDA- 2014/05/30 06:00
CRDT- 2014/05/06 06:00
PHST- 2014/05/06 06:00 [entrez]
PHST- 2014/05/06 06:00 [pubmed]
PHST- 2014/05/30 06:00 [medline]
AID - 10.1177/156482651403500112 [doi]
PST - ppublish
SO  - Food Nutr Bull. 2014 Mar;35(1):105-25. doi: 10.1177/156482651403500112.