ABSTRACT
Objectives: Biofortification is a fast emerging agricultural technology and nutrition strategy for addressing hidden hunger. The impact and cost-effectiveness of biofortified provitamin A maize (VAM) in Zambia and high zinc rice (HZR) in Bangladesh were examined. Methods: In each country, farmers' adoption, production and marketing of the biofortified crops were modeled using empirically-derived estimates of similar varieties. We used the adoption functions to estimate the probability of adoption by farmers using household consumption and expenditure survey (HCES) databases, and, combined with the IFPRI IMPACT model predictions of yearly crop production through 2042, generated annual estimates of the biofortified crop planted and harvested. Using food composition table together with the HCES-reported quantities of foods apparently consumed, we estimated the usual intake of key nutrients and the prevalence of inadequate intakes without biofortified crops. We estimated the additional nutrient intakes as the quantities of biofortified food consumed and its additional nutrient content, and measured changes in the prevalence of inadequate intakes and in the number of Disability-Adjusted Life Years (DALYs) saved. We combined the DALY estimates with cost data to derive cost-effectiveness measures, annually and over the entire 30-year period. Results: Both interventions were highly cost effective. The cost of HZR was half VAM's $23.70 per DALY saved due to HZR's relatively greater added nutrient content, zinc's greater stability, and HZR's higher adoption rate, which reflects Bangladesh's relatively more developed seed market and value chain. Conclusions: Biofortification is a promising new technology. Its impact will vary by micronutrient, crop and country-specific characteristics.
ABSTRACT
Objectives: There is an urgent need to better understand the interactions of multiple nutrition programs so that they can be managed more effectively to improve coverage and impact, reduce costs and protect persons from the risk of excess micronutrient intakes. The objective was to examine Zambia’s micronutrient program portfolio options over the next 30 years. Methods: 2006 Living Conditions Monitoring Survey food consumption and acquisition data and a Zambian food composition table were used to estimate usual intakes of calories and key micronutrients and the prevalence of inadequate intakes. The annual coverage, impact and cost of six vitamin A interventions were analyzed. The interventions included four potentially fortifiable staples, vitamin A supplementation through Child Health Week (CHW) and a biofortified high pro-vitamin A maize. All 62 possible combinations of the six interventions’ annual costs, changes in the prevalence of inadequate intake and the total number of disability-adjust life years (DALYs) saved annually were estimated from 2013-2042, drawing on the IFPRI IMPACT model’s predictions of food production and consumption patterns. Results: Oil and sugar offer the greatest coverage (67%-69%) while biofortification can reach greater than 50%. Supplementation and sugar and oil fortification produce the greatest impacts. The most cost-effective 1, 2, and 3-program interventions portfolios are oil fortification; oil plus biofortification; and oil plus biofortification and supplementation. Conclusions: Each intervention plays a significant role in combating micronutrient deficiency in Zambia. The choice of combinations of the specific vehicles and the order in which interventions are sequenced affects the optimal mix.