Reducing the burden of iron deficiency anemia in Cote D'Ivoire through fortification.

BACKGROUND: Iron deficiency anemia (IDA) is highly prevalent in the Cote d'Ivoire and has severe health and economic consequences. In this paper, we apply a health economic model to quantify the burden of IDA, and the contribution of nationwide mandatory iron fortification of wheat flour and voluntary iron fortification of condiments to the reduction of this burden. METHODS: The analysis for the population from 6 months to 64 years builds on published reviews and publicly available datasets and is stratified by age-groups and socioeconomic strata using comparative risk assessment model. RESULTS: Without the impact of these fortification strategies, the annual burden of IDA is estimated at 242,100 disability adjusted life years (DALYs) and 978.1 million USD. Wheat flour and condiment fortification contributed to a reduction of the IDA burden by approximately 5% each. CONCLUSION: In places with high prevalence of malaria and other infectious diseases, such as the Côte D'Ivoire, food fortification as a nutritional intervention should be accompanied with infectious disease prevention and control. The findings of this study provide additional input for policy makers about the magnitude of the impact and can support the conception of future fortification strategies.

Market-Driven Food Fortification to Address Dietary Needs.

The global economic and health-related burden of micronutrient deficiency is very large. Reducing these deficiencies is one of the main objectives of the Global Nutrition Targets 2025 of the WHO. To address this form of malnutrition, the WHO/FAO has defined fortification as one of the possible public health interventions, and voluntary fortification is one of the possible fortification approaches. Voluntary fortification can contribute to meeting nutritional requirements in targeted and untargeted populations as long as specific food vehicles are used and specific consumer demands are addressed. Fortified foods should be consumed regularly and need to be affordable, safe, and meet consumer preferences. Two types of fortified food groups will illustrate this form of fortification, namely targeted fortification with complementary feeding (or fortified infant cereals), and market-driven mass fortification as achieved with fortified condiments.

Association between Anaemia in Children 6 to 23 Months Old and Child, Mother, Household and Feeding Indicators.

In Low and Lower-Middle-Income countries, the prevalence of anaemia in infancy remains high. In early childhood anaemia cause irreversible cognitive deficits and represents a higher risk of child mortality. The consequences of anaemia in infancy are a major barrier to overcome poverty traps. The aim of this study was to analyse, based on a multi-level approach, different factors associated with anaemia in children 6⁻23 months old based on recent available Standard Demographic Health Surveys (S-DHS). We identified 52 S-DHS that had complete information in all covariates of interest in our analysis between 2005 and 2015. We performed traditional logistic regressions and multilevel logistic regression analyses to study the association between haemoglobin concentrations and household, child, maternal, socio-demographic variables. In our sample, 70% of the 6⁻23 months-old children were anaemic. Child anaemia was strongly associated with maternal anaemia, household wealth, maternal education and low birth weight. Children fed with fortified foods, potatoes and other tubers had significantly lower rates of anaemia. Improving overall household living conditions, increasing maternal education, delaying childbearing and introducing iron rich foods at six months of age may reduce the likelihood of anaemia in toddlerhood.

Cost-effectiveness of milk powder fortified with potassium to decrease blood pressure and prevent cardiovascular events among the adult population in China: a Markov model.

OBJECTIVE: To model the long-term cost-effectiveness of consuming milk powder fortified with potassium to decrease systolic blood pressure (SBP) and prevent cardiovascular events. DESIGN: A best case scenario analysis using a Markov model was conducted. PARTICIPANTS: 8.67% of 50-79 year olds who regularly consume milk in China, including individuals with and without a prior diagnosis of hypertension. INTERVENTION: The model simulated the potential impact of a daily intake of two servings of milk powder fortified with potassium (+700 mg/day) vs the consumption of a milk powder without potassium fortification, assuming a market price equal to 0.99 international dollars (intl$; the consumption of a milk powder without potassium fortification, assuming a market price equal to intl$0.99 for the latter and to intl$1.12 for the first (+13.13%). Both deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the results. MAIN OUTCOME MEASURES: Estimates of the incidence of cardiovascular events and subsequent mortality in China were derived from the literature as well as the effect of increasing potassium intake on blood pressure. The incremental cost-effectiveness ratio (ICER) was used to determine the cost-effectiveness of a milk powder fortified with potassium taking into consideration the direct medical costs associated with the cardiovascular events, loss of working days and health utilities impact. RESULTS: With an ICER equal to int$4711.56 per QALY (quality-adjusted life year) in the best case scenario and assuming 100% compliance, the daily consumption of a milk powder fortified with potassium shown to be a cost-effective approach to decrease SBP and reduce cardiovascular events in China. Healthcare savings due to prevention would amount to intl$8.41 billion. Sensitivity analyses showed the robustness of the results. CONCLUSION: Together with other preventive interventions, the consumption of a milk powder fortified with potassium could represent a cost-effective strategy to attenuate the rapid rise in cardiovascular burden among the 50-79 year olds who regularly consume milk in China.

Food fortification for addressing iron deficiency in Filipino children: benefits and cost-effectiveness.

Iron deficiency is one of the most widespread nutritional disorders in both developing and industrialized countries, making it a global public health concern. Anemia, mainly due to iron deficiency, affects one third of the world's population and is concentrated in women and children below 5 years of age. Iron deficiency anemia has a profound impact on human health and productivity, and the effects of iron deficiency are especially pronounced in the first 1,000 days of life. This critical window of time sets the stage for an individual's future physiological and cognitive health, underscoring the importance of addressing iron deficiency in infants and young children. This review focuses on the use of fortified foods as a cost-effective tool for addressing iron deficiency in infants and young children in the Philippines.

Predicting the health effects of switching infant feeding practices for use in decision-making.

Research has been plentiful to show pediatricians and public health practitioners the importance of exclusive breastfeeding for infant health. However, this past research is lacking in a few ways that are important for pediatricians and public health practitioners: it rarely examines broad geographies, and so cannot be generalized for different countries, it does not quantify the predicted effects of infant feeding, and it does not examine the effects of a range of feeding practices on infant health, instead focusing solely on exclusive breastfeeding. The present research simulates the effect on infant health of switching between a range of feeding practices using data from many countries. The results provide quantified estimates of the effect of switching between specific feeding practices such as exclusive breastfeeding, breastfeeding supplemented with milk liquids, or breastfeeding supplemented with solid foods and nonmilk liquids, as well as others. These quantified estimates of the effect of switching infant feeding practices can be used by pediatricians to motivate individual decisions about infant feeding and by public health practitioners and policymakers to motivate infant feeding programs and policy. Through these channels, they can hopefully play a role in improving infant health.