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Economics of Maternal and Child Nutrition

其他書名	Food Fortification with Vitamin A in Tanzania
出版	University of Toronto, 2018
URL	http://books.google.com.hk/books?id=vN09zwEACAAJ&hl=&source=gbs_api

註釋In 2011, Tanzania mandated the fortification of edible oil with vitamin A to help address its vitamin A deficiency public health problem. By 2015, only 16 percent of edible oil met the standards for adequate fortification. The MASAVA project initiated the production and distribution of unrefined sunflower oil fortified with vitamin A by small- and medium-scale producers in the Manyara and Shinyanga regions of Tanzania. A quasi-experimental non-equivalent control group research trial and an economic evaluation were conducted to study 1) the determinants of vitamin A deficiency in children aged 6 to 59 months, 2) the effectiveness of fortification by small- and medium-scale producers and fortification standards, and 3) the cost-effectiveness of fortification in preventing vitamin A deficiency. Data collection was conducted through a household baseline survey with a sample of 568 mother and child pairs before the intervention and a follow-up survey 18 months later. This study found that the primary determinants of vitamin A deficiency in young children at the time of the baseline household survey were not being breastfed and the low retinol binding protein concentration level of mothers. This study demonstrated that fortification by small- and medium-scale producers was feasible and may have increased the mean retinol binding protein concentration levels in children but did not have a significant effect on the prevention of vitamin A deficiency due to insufficient coverage. Mandatory fortification standards and fortification by large-scale producers increased the mean retinol binding protein levels in children by 3.5 μg/ml as well as reduced the prevalence of vitamin A deficiency by 21.4 percentage points in the Shinyanga region. From a social perspective, the incremental cost of fortification could be as low as US$0.13, $0.06 and $0.02 per litre for small-, medium- and large-scale producers respectively. The estimated cost per disability-adjusted life year averted was $281 for large-scale producers and could be as low as $626 for medium-scale and $1,507 for small-scale producers under ideal conditions. According to World Health Organization thresholds, this is very cost-effective for large- and medium-scale producers, and cost-effective for small-scale producers.