Assessing Zambia's Industrial Fortification Options: Getting beyond Changes in Prevalence and Cost-Effectiveness

Abstract

Background.

Zinc-enriched fertilisers as a potential public health intervention in Africa

“…However, the potential of new varieties to deliver greater concentrations of Zn in the grain depends on there being plant-accessible Zn stores in the soil, thus breeding and agronomic biofortification strategies are likely to be complementary. Fielder et al (2013) estimated that fortifying maize meal with a premix containing Zn at large-scale mills in Zambia could save 5657 DALYs annually of which 1757 were due to Zn deficiency, at a cost of US$ 401 per DALY saved. The cost per DALY saved is favourable compared to application of Zn via the soil and equivalent or slightly more expensive than via foliar spray, although it should be noted that this is not a direct comparison as the premix also contained iron and vitamin A. Flour fortification during milling currently has limited reach in Zambia as few households purchase maize flour from large, centralised milling factories and those that do are generally wealthier with greater baseline Zn intakes (Fielder et al 2013).…”

“…Fielder et al (2013) estimated that fortifying maize meal with a premix containing Zn at large-scale mills in Zambia could save 5657 DALYs annually of which 1757 were due to Zn deficiency, at a cost of US$ 401 per DALY saved. The cost per DALY saved is favourable compared to application of Zn via the soil and equivalent or slightly more expensive than via foliar spray, although it should be noted that this is not a direct comparison as the premix also contained iron and vitamin A. Flour fortification during milling currently has limited reach in Zambia as few households purchase maize flour from large, centralised milling factories and those that do are generally wealthier with greater baseline Zn intakes (Fielder et al 2013). Thus, while application of Zn to crops via the soil is approximately 10-fold more expensive than via foliar sprays or fortification of flour at centralised mills, it has the potential to reach more households and consequently be more equitable in outcome.…”

“…These data are available for eight of the ten focus countries in this study (Ethiopia, Ghana, Kenya, Malawi, Mali, Nigeria, Tanzania and Zambia). For example, Fielder et al (2013) estimate mean and median intakes of Zn in Zambia of 5.8 and 4.4 mg capita −1 day −1 and a 73.1 % prevalence of inadequate Zn intakes, compared to US Institute of Medicine dietary requirements of Zn. An advantage of household surveys is that they allow subnational resolution of dietary estimates and shed light on distributional issues.…”

“…Previously, Stein et al (2006) estimated that biofortification via breeding for high-Zn rice and wheat varieties could save up to 55 % of the 2.8 million DALYs lost annually due to Zn deficiency in India at a cost of US$ 0.68 and 8.80 per DALY saved, for optimistic and pessimistic scenarios respectively. Fielder et al (2013) estimated that fortifying maize meal with a premix containing vitamin A, iron and Zn at large-scale mills in Zambia could save 5657 DALYs annually of which 1757 were due to Zn deficiency, at a cost of US$ 401 per DALY saved. Similar studies have not yet been conducted for fertilisers and so the aim of this review is to assess the cost-effectiveness of Zn fertilisers in reducing disease burdens due to dietary Zn deficiency.…”

Valuing increased zinc (Zn) fertiliser-use in Pakistan

“…In comparison, Stein et al (2006) estimated that biofortification of high-Zn rice and wheat varieties through breeding could save up to 55 % of the 2.8 M DALYs lost annually due to Zn deficiency in India at a cost of US$ 0.68-8.80 per DALY saved. Fiedler et al (2013) estimated that fortifying maize meal with a premix containing Zn at large-scale mills in Zambia could save 5657 DALYs annually, of which 1757 were due to Zn deficiency, at a cost of US$ 401 per DALY saved. While the cost-effectiveness of these interventions varies considerably, it is also necessary to take into account the socioeconomic realities in each target country.…”