Impacts of micronutrient intervention programs on effective coverage and lives saved: Modeled evidence from Cameroon.

Policymakers are committed to improving nutritional status and to saving lives. Some micronutrient intervention programs (MIPs) can do both, but not to the same degrees. We apply the Micronutrient Intervention Modeling tool to compare sets of MIPs for (1) achieving dietary adequacy separately for zinc, vitamin A (VA), and folate for children and women of reproductive age (WRA), and (2) saving children's lives via combinations of MIPs.

Comparing estimated cost-effectiveness of micronutrient intervention programs using primary and secondary data: evidence from Cameroon.

Designing a cost-effective portfolio of micronutrient intervention programs is complex and generally undertaken with limited data. We developed the MINIMOD-Secondary Data (MINIMOD-SD) tool, which uses household consumption and expenditure survey data and other secondary data to estimate apparent nutrient intakes and model the effectiveness and cost-effectiveness of micronutrient intervention programs. We present the SD tool methodology and results in the context of Cameroon, with a particular focus on vitamin A (VA) for children and folate for women of reproductive age (WRA).

Predicted Effects and Cost-Effectiveness of Wheat Flour Fortification for Reducing Micronutrient Deficiencies, Maternal Anemia, and Neural Tube Defects in Yaoundé and Douala, Cameroon.

Background: Policy makers aiming to reduce micronutrient deficiencies (MNDs) and their health effects must choose among alternative definitions of impact when evaluating cost-effectiveness.

Objective: Estimate the cost-effectiveness of a mandatory wheat flour fortification program for reducing cases of MNDs (iron, zinc, folate, vitamin B12), anemia and neural tube defects (NTDs) averted, and disability-adjusted life years (DALYs) averted in urban Cameroon.

Methods: A 13-year predictive model was developed, including a 3-year start-up period and 10 years of program activity.

Strategies to achieve adequate vitamin A intake for young children: options for Cameroon.

Meeting children's vitamin A (VA) needs remains a policy priority. Doing so efficiently is a fiscal imperative and protecting at-risk children during policy transitions is a moral imperative. Using the Micronutrient Intervention Modeling tool and data for Cameroon, we predict the impacts and costs of alternative VA intervention programs, identify the least-cost strategy for meeting targets nationally, and compare it to a business-as-usual (BAU) strategy over 10 years.

Weighing the risks of high intakes of selected micronutrients compared with the risks of deficiencies.

Several intervention strategies are available to reduce micronutrient deficiencies, but uncoordinated implementation of multiple interventions may result in excessive intakes. We reviewed relevant data collection instruments and available information on excessive intakes for selected micronutrients and considered possible approaches for weighing competing risks of intake above tolerable upper intake levels (ULs) versus insufficient intakes at the population level. In general, population-based surveys in low- and middle-income countries suggest that dietary intakes greater than the UL are uncommon, but simulations indicate that fortification and supplementation programs could lead to high intakes under certain scenarios.

An Economic Optimization Model for Improving the Efficiency of Vitamin A Interventions: An Application to Young Children in Cameroon.

Background: Vitamin A (VA) intervention programs in developing countries do not generally consider spatial differences in needs or in intervention costs. New data from Cameroon reveal nonuniform spatial distributions of VA deficiency among young children and of costs of some of the programs designed to address them.

Methods: We develop a spatially explicit, intertemporal economic optimization tool that makes use of subnational dietary intake data and VA intervention program costs to identify more efficient sets of interventions to improve VA nutrition among young children aged 6 to 59 months in Cameroon.

Measuring the Costs of Vitamin A Interventions: Institutional, Spatial, and Temporal Issues in the Context of Cameroon.

Background: To address vitamin A (VA) deficiency, an array of interventions have been developed for increasing VA status among young children. With numerous possible combinations of interventions, however, comes the need to take decisions regarding which intervention or combination of interventions is most cost effective for achieving VA deficiency reduction targets.

Methods: Detailed intervention-specific, "macro-region"-level data in Cameroon are used to generate estimates of the costs associated with delivering VA to children aged 6 to 59 months.

Use of Optimization Modeling for Selecting National Micronutrient Intervention Strategies: An Example Based on Potential Programs for Control of Vitamin A Deficiency in Cameroon.

Vitamin and mineral (micronutrient [MN]) deficiencies are common in lower income countries, especially among young children and women of reproductive age. These deficiencies are cause for serious concern because of their high prevalence and their associated complications, which include depressed immune function and increased risk and severity of infections, impaired neurocognitive development, and anemia, which together result in elevated mortality and reduced human productive capacity. A broad range of different intervention strategies are available to control MN deficiencies.