What Technological and Economic Elements Must be Addressed to Support the Affordability, Accessibility, and Desirability of Alternative Proteins in LMIC?

Populations in low- and middle-income countries (LMIC) typically consume less than the recommended daily amount of protein. Alternative protein (AP) sources could help combat malnutrition, but this requires careful consideration of elements needed to further establish AP products in LMIC. Key considerations include technological, nutritional, safety, social, and economic challenges. This perspective analyzes these considerations in achieving dietary diversity in LMIC, using a combination of traditional and novel protein sources with high nutritional value, namely, soy, mycoprotein, and cultivated meat. Technological approaches to modulate the technofunctionality and bitter off-tastes of plant-sourced proteins facilitate processing and ensure consumer acceptance. Economic considerations for inputs, infrastructure for production, and transportation represent key elements to scale up AP. Dietary diversification is indispensable and LMIC cannot rely on plant proteins alone to provide adequate protein intake sustainably. Investments in infrastructure and innovation are urgently needed to offer diverse sources of protein in LMIC.

Quantifying the economic impacts of COVID-19 policy responses on Canada's provinces in (almost) real time.

We develop a methodology to track and quantify the economic impacts of lockdown and reopening policies by Canadian provinces in response to the COVID-19 pandemic, using data that is available with a relatively short time lag. To do so, we adapt, calibrate and implement a dynamic, seasonally adjusted, input-output model with supply constraints. Our framework allows us to quantify potential scenarios that allow for dynamic complementarities between industries, seasonal fluctuations and changes in demand composition. Taking account of the observed variation in reopening strategies across provinces, we estimate the costs of the policy response in terms of lost hours of employment and production. Among other results, we show how a more aggressive response, even though it imposes higher economic costs in the short run, can lead to lower economic costs in the long run if it means avoiding future waves of lockdowns.

Quantification des impacts économiques des politiques associées à la COVID­19dans les provinces canadiennes en temps réel (ou presque). On développe une méthodologie pour identifier et quantifier les impacts économiques des mesures de confinement et des politiques de déconfinement dans chacune des provinces canadiennes en réponse à la pandémie de la COVID­19 en utilisant des données publiées avec un court décalage. Pour ce faire, on adapte, calibre et implémente un modèle d'entrées­sorties dynamique désaisonnalisé avec des contraintes au niveau de l'offre. Notre modèle nous permet de quantifier des scénarios potentiels qui incorporent les complémentarités dynamiques entre les industries, les fluctuations saisonnières et les changements dans la composition de la demande. En prenant en compte les variations observées dans les stratégies de déconfinement de chaque province, on estime les coûts des politiques en ce qui a trait aux pertes d'heures travaillées et de production. Parmi les autres résultats observés, on démontre qu'une réponse plus agressive, quoique plus coûteuse à court terme, peut mener à des coûts économiques moins élevés à long­terme si elle permet d'éviter des vagues de reconfinement.

Training healthcare workers increases IFA use and adherence: Evidence and cost-effectiveness analysis from Bangladesh.

Iron and folic acid (IFA) supplementation programmes are important for preventing and controlling anaemia among pregnant women in low- and middle-income countries. However, frontline health care workers often have limited capacity and knowledge, which can compromise such programmes' effectiveness. Between 2012 and 2014, Nutrition International and the Government of Bangladesh implemented a programme intended to increase IFA supplement consumption during pregnancy. The programme provided frontline health care workers with training on the benefits of IFA supplementation, the use of interpersonal communication and health promotion materials during antenatal care visits and health management information systems to track reported adherence to IFA supplementation. Using a quasi-experimental design, this study investigates the programme's effectiveness and cost-effectiveness at increasing IFA supplement consumption and adherence among pregnant women. The difference-in-differences regression analysis comparing outcomes in an intervention and comparison group concluded that the programme increased IFA consumption by an average of 45.05 supplements (P value = 0.018) and increased the share of women that reported adherence to a regime of at least 90 supplements by 40.35 percentage points (P value = 0.020). Knowledge of IFA supplement dosage and benefits also increased among frontline health care workers and pregnant women. The programme cost $47.11 USD (2018) per disability-adjusted life year averted, which is considered highly cost-effective when evaluated against several cost-effectiveness thresholds. This study suggests that the capacity building of frontline health care workers is an effective and cost-effective method of preventing and controlling anaemia among pregnant women in resource-constrained areas.

Multiple Micronutrient Supplements Are More Cost-effective Than Iron and Folic Acid: Modeling Results from 3 High-Burden Asian Countries.

BACKGROUND: Recent evidence has encouraged low- and middle-income countries to consider transitioning from long-standing iron and folic acid supplementation (IFA) to multiple micronutrient supplementation (MMS) during pregnancy; however, global guidance is limited. To facilitate national decision-making, a cost-effectiveness model to compare supplementation approaches was developed, and applied to Pakistan, India, and Bangladesh. OBJECTIVE: We evaluated the incremental cost-effectiveness of transitioning from IFA to MMS. METHODS: The effectiveness of IFA compared with MMS during pregnancy was compared using 8 health outcomes reported in 2 meta-analyses published in 2017 (Cochrane and The Lancet). Impacts on health outcomes were aggregated using disability-adjusted life years (DALYs). Costs included the supplements and their distribution through antenatal care. The incremental cost-effective ratio (ICER) for transitioning from IFA to MMS was calculated for each country under each meta-analysis scenario, and Monte Carlo simulations were applied to generate a measure of certainty around the results. RESULTS: The effectiveness of transitioning from IFA to MMS under the Cochrane scenario was smaller and less certain compared with The Lancet scenario. However, even under the Cochrane scenario, MMS would avert 4,391, 5,769, and 8,578 more DALYs than IFA per 100,000 pregnancies in Pakistan, India, and Bangladesh, respectively (62.6%, 76.8%, and 82.6% certainty). The ICER of transitioning from IFA to MMS was 41.54, 31.62, and 21.26 US dollars (USD 2016) per DALY averted, respectively. CONCLUSIONS: Despite discrepancies in the overall effect of MMS depending on the meta-analysis used, MMS is cost-effective and generates positive health outcomes for both infants and pregnant women. Whilst the effectiveness of MMS is sensitive to the prevalence of certain health outcomes under the conservative scenario (Cochrane), MMS nevertheless averts more DALYs than IFA with high certainty and should re-enter public health discussion in Pakistan, India, and Bangladesh.