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估算在布基纳法索强制面粉强化计划中添加锌并改善其执行情况的成本和成本效益。

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

机构信息

Institute for Global Nutrition, University of California, Davis, California, USA.

Independent Consultant, Washington DC, District of Columbia, USA.

出版信息

Matern Child Nutr. 2023 Jul;19(3):e13515. doi: 10.1111/mcn.13515. Epub 2023 Apr 6.

Abstract

Zinc is an essential micronutrient that promotes normal growth, development and immune function. In the context of persistent dietary zinc inadequacies, large-scale food fortification can help fill the gap between intake and requirements. Burkina Faso mandates wheat flour fortification with iron and folic acid. We used activity-based cost modelling to estimate the cost of adding zinc to the country's wheat flour fortification standard assuming (1) no change in compliance with the national standard, and (2) a substantial improvement in compliance. We used household food consumption data to model effective coverage, that is, the number of women of reproductive age (WRA) predicted to achieve adequate zinc density (zinc intake/1000 kcal) with the addition of fortification to diets. Without interventions, the prevalence of inadequate dietary zinc density was ~35.5%. With no change in compliance, the annual average incremental cost of adding zinc to fortified wheat flour was $10,347, which would effectively cover <1% of WRA at an incremental cost of ~$0.54/WRA effectively covered. Improving compliance added ~$300,000/year to the cost of the fortification programme without zinc; including zinc added another ~$78,000/year but only reduced inadequate intake among WRA by 3.6% at an incremental cost of ~$0.45/WRA effectively covered. Although the incremental cost of adding zinc to wheat flour is low ($0.01/wheat flour consumer/year), given low levels of wheat flour consumption, zinc fortification of wheat flour alone contributes marginally to, but will not fully close, the dietary zinc gap. Future research should explore potential contributions of zinc to a broader set of delivery vehicles.

摘要

锌是一种必需的微量元素,可促进正常的生长、发育和免疫功能。在持续存在膳食锌摄入不足的情况下,大规模的食物强化可以帮助弥补摄入与需求之间的差距。布基纳法索规定用铁和叶酸强化小麦粉。我们使用基于活动的成本建模来估算在不改变遵守国家标准的情况下向国家小麦粉强化标准添加锌的成本,以及在大幅提高遵守标准的情况下添加锌的成本。我们使用家庭食品消费数据来模拟有效覆盖率,即通过向饮食中添加强化剂,预计有多少育龄妇女(WRA)能够达到足够的锌密度(锌摄入量/1000 千卡)。在没有干预的情况下,膳食锌密度不足的流行率约为 35.5%。如果不改变遵守情况,向强化小麦粉中添加锌的年平均增量成本为 10347 美元,这将有效地覆盖不到 1%的 WRA,增量成本约为 0.54 美元/WRA 有效覆盖。提高遵守情况将使强化方案的成本每年增加约 30 万美元,而不包括锌;包括锌后,仅将 WRA 中摄入不足的比例降低了 3.6%,增量成本约为 0.45 美元/WRA 有效覆盖。虽然向小麦粉中添加锌的增量成本很低(0.01 美元/小麦粉消费者/年),但考虑到小麦粉的低消费水平,仅强化小麦粉对膳食锌缺口的贡献微不足道,但不会完全填补。未来的研究应探讨锌对更广泛的输送载体的潜在贡献。

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