Zambia's Micronutrient Program Portfolio Options: A Vitamin A Case Study, 2013 to 2042.

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.