Fiedler John L, Lividini Keith, Guyondet Christophe, Bermudez Odilia I
Food Nutr Bull. 2015 Mar;36(1):57-74. doi: 10.1177/156482651503600106.
Approximately 1.2 million disability-adjusted life years (DALYs) are lost annually in Bangladesh due to deficiencies of vitamin A, iron, and zinc.
To provide evidence on the coverage, costs, and cost-effectiveness of alternative fortification interventions to inform nutrition policy-making in Bangladesh.
Combining the 2005 Bangladesh Household Income and Expenditure Survey with a Bangladesh food composition table, apparent intakes of energy, vitamin A, iron, and zinc, and the coverage and apparent consumption levels of fortifiable vegetable oil and wheat flour are estimated. Assuming that fortification levels are those established in official regulations, the costs and cost-effectiveness of the two vehicles are assessed independently and as a two-vehicle portfolio.
Vegetable oil has a coverage rate of 76% and is estimated to reduce the prevalence of inadequate vitamin A intake from 83% to 64%. The coverage of wheat flour is high (65%), but the small quantities consumed result in small reductions in the prevalence of inadequate intakes: 1.5 percentage points for iron, less than 1 for zinc, and 2 for vitamin A, while reducing average Estimated Average Requirement (EAR) gaps by 8%, 9%, and 15%, respectively. The most cost-effective 10-micronutrient wheat flour formulation costs US $1.91 million annually, saving 129,212 DALYs at a unit cost of US $14.75. Fortifying vegetable oil would cost US $1.27 million annually, saving 406,877 DALYs at an average cost of US $3.25. Sensitivity analyses explore various permutations of the wheat flour formulation. Divisional variations in coverage, cost, and impact are examined.
Vegetable oil fortification is the most cost-effective of the three portfolios analyzed, but all three are very cost-effective options for Bangladesh.
在孟加拉国，每年因维生素A、铁和锌缺乏而损失约120万个残疾调整生命年（DALYs）。
提供关于替代强化干预措施的覆盖范围、成本和成本效益的证据，为孟加拉国的营养政策制定提供参考。
将2005年孟加拉国家庭收入与支出调查与孟加拉国食物成分表相结合，估算能量、维生素A、铁和锌的表观摄入量，以及可强化植物油和小麦粉的覆盖范围和表观消费水平。假设强化水平为官方规定的水平，分别评估两种载体的成本和成本效益，并将其作为一个双载体组合进行评估。
植物油的覆盖率为76%，预计可将维生素A摄入不足的患病率从83%降至64%。小麦粉的覆盖率很高（65%），但食用量较少，导致摄入量不足患病率的降低幅度较小：铁降低1.5个百分点，锌降低不到1个百分点，维生素A降低2个百分点，同时分别将平均估计平均需求量（EAR）差距降低8%、9%和15%。最具成本效益的10种微量营养素小麦粉配方每年成本为191万美元，以14.75美元的单位成本节省129,212个残疾调整生命年（DALYs）。强化植物油每年成本为127万美元，以3.25美元的平均成本节省406,877个残疾调整生命年（DALYs）。敏感性分析探讨了小麦粉配方的各种排列组合。研究了各分区在覆盖范围、成本和影响方面的差异。
在分析的三种组合中，植物油强化是最具成本效益的，但对孟加拉国而言，所有三种都是非常具有成本效益的选择。
