Adams Katherine P, Gashu Dawd, Zegeye Elias Asfaw, Mannar Mg Venkatesh, Diosady Levente L, Ananth N, Ander E Louise
Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA, United States.
Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia.
Curr Dev Nutr. 2025 Jul 30;9(8):107508. doi: 10.1016/j.cdnut.2025.107508. eCollection 2025 Aug.
With near universal consumption of salt and technological advances that have made its fortification with multiple micronutrients feasible, salt has great potential for public health impact as a delivery vehicle for not only iodine but also multiple micronutrients. Decisions around modifying existing salt standards to include additional micronutrients should consider not only potential impacts but also stakeholder-specific costs.
We aimed to estimate the total and incremental cost of expanding Ethiopia's salt iodization program to include folic acid (dual fortified salt), folic acid and vitamin B-12 (triple fortified salt), or folic acid, vitamin B-12, and zinc (quadruple fortified salt).
We developed activity-based cost models to estimate salt fortification costs over a 10-y time horizon (2024-2033). Model assumptions and parameters were primarily based on interviews with Ethiopian stakeholders in industry and government and nongovernmental partners.
The estimated annual average per capita cost of Ethiopia's existing salt iodization program was ∼$2.1 million (2021 US dollars) or ∼$7/metric ton (MT) of fortified salt (∼$0.02/y). Expanding the program to include folic acid, which could be sprayed onto salt along with the iodine, would increase the annual average per capita cost to ∼$2.5 million, or ∼$8.30/MT (∼$0.02/y). Annually, the costs of triple and quadruple fortified salt programs, which would require encapsulating the additional micronutrients as a solid premix to help ensure stability, were ∼$18 million (∼$59/MT; $0.13 per capita) and $19 million (∼$63/MT; ∼$0.14 per capita), respectively. Premix costs accounted for approximately half of the total cost of the iodized and dual fortified salt programs and ∼90% of triple and quadruple fortified salt.
If Ethiopia considers modifying its existing salt iodization standard to include 1 or more additional micronutrients, there will be many important considerations, including costs and affordability. The cost estimates presented in this study can complement evidence of the potential for multiple fortified salt to reduce micronutrient deficiencies.
鉴于食盐几乎被普遍食用，且技术进步使得在食盐中添加多种微量营养素成为可能，食盐作为一种载体，不仅可用于添加碘，还可用于添加多种微量营养素，因此对公共卫生具有巨大影响潜力。围绕修改现有食盐标准以纳入更多微量营养素所做的决策，不仅应考虑潜在影响，还应考虑利益相关方的特定成本。
我们旨在估算将埃塞俄比亚的食盐碘化计划扩大到纳入叶酸（双重强化盐）、叶酸和维生素B - 12（三重强化盐）或叶酸、维生素B - 12和锌（四重强化盐）的总成本和增量成本。
我们开发了基于活动的成本模型，以估算10年时间跨度（2024 - 2033年）内的食盐强化成本。模型假设和参数主要基于对埃塞俄比亚工业、政府和非政府合作伙伴等利益相关方的访谈。
埃塞俄比亚现有食盐碘化计划的估计人均年平均成本约为210万美元（2021年美元），或约为每公吨强化盐7美元（约合每年0.02美元）。将该计划扩大到纳入叶酸（可与碘一起喷洒在食盐上），将使人均年平均成本增加到约250万美元，或约为每公吨8.30美元（约合每年0.02美元）。每年，三重和四重强化盐计划的成本分别约为1800万美元（约合每公吨59美元；人均0.13美元）和1900万美元（约合每公吨63美元；约合人均0.14美元），这两个计划需要将额外的微量营养素封装成固体预混物以确保稳定性。预混物成本约占碘化盐和双重强化盐计划总成本的一半，以及三重和四重强化盐计划总成本的约90%。
如果埃塞俄比亚考虑修改其现有的食盐碘化标准以纳入一种或多种额外的微量营养素，将有许多重要因素需要考虑，包括成本和可承受性。本研究中提出的成本估计可以补充多种强化盐减少微量营养素缺乏潜力的证据。
