Estimating the Micronutrient Adequacy of the Food Supply Using Food Balance Sheets for Targeted Nutrition-sensitive Agricultural Approaches: Example of Bangladesh.

Objectives: To estimate the micronutrient availability and adequacy of the food supply of Bangladesh and estimate the additional agricultural output needed to achieve nutrient adequacy. Methods: We estimated micronutrient availability of the food supply using an average of 5 years of Food and Agricultural Organization (FAO) food balance sheet data. We estimated nutrients for non-specific food commodities (e.g., other vegetables) using FAO production data supplemented with known consumption information from a dietary survey. We estimated the probability of adequacy of the food supply using a method similar to the cut-point method of estimating nutrient intake adequacy. Then, we estimated the target level of nutrient needed in the food supply to achieve 80% adequacy and amounts of micronutrient-rich foods and land needed to meet the nutrient shortfall. Results: The current food supply in Bangladesh provides very low amounts (0-1% adequacy) of calcium and vitamins A, C, and folate; and low-moderate amounts of several other micronutrients. Using vitamin A as an example, the food supply would need to provide an additional 570 mcg RAE/capita/d to achieve 80% adequacy. This could be accomplished by adding ~67g/capita/d of carrots or ~73g/capita/d of orange-flesh sweet potatoes, requiring ~4 and 6% of the country's total agricultural land, respectively. Conclusions: National food balance sheets can be used to guide agricultural policies to ensure nutrient adequacy of the food supply, recognizing the need to consider other factors like climate, season, economics, and behavior change to drive food production decisions.

An Economic Model for Optimizing Effective Coverage of MN interventions: A Case Study of Cameroon.

Objectives: Micronutrient (MN) interventions are generally undertaken at national scale. New spatially disaggregated data on MN deficiencies in Cameroon suggest that subnational strategies may be more efficient, but methods to choose among alternative interventions are needed. We developed a tool to plan and manage sub-national MN interventions for Cameroon. Methods: Data from a nationally representative multi-stage cluster survey were used to determine the spatial distribution of MN deficiencies among population sub-groups at greatest risk. Macroregion-specific data (North, South, Douala/Yaoundé) on food intake were used to predict the effects of alternative MN intervention strategies on the prevalence of inadequate MN intake and absorption. MN supplements, fortified and biofortified foods, deworming and behavioral change communication to promote breastfeeding are among the interventions examined. Costs of alternative interventions were prepared. The costs and nutritional benefits of alternative interventions are included in an economic optimization model that chooses the best combination of MN interventions to ensure adequate MN intake, at regional level, over a ten-year planning horizon, given funding and other constraints. Results: Preliminary results indicate large spatial differences in MN deficiencies, e.g., estimated prevalence of vitamin A deficiency varied from ~62% (North region) to ~22% (Northwest region). Consumption of VA-rich foods and fortifiable foods also varies spatially. Hence, program efficiency may be enhanced by adopting targeted sub-national MN intervention strategies. Conclusions: Given spatial patterns in MN deficiencies, diet-driven effectiveness of alternative MN interventions, and costs of these interventions, sub-national MN interventions may offer efficiency gains that exceed the costs of planning and implementing them.