Reducing micronutrient deficiencies in Pakistani children: are subsidies on fortified complementary foods cost-effective?

Abstract

ObjectiveTo estimate the cost-effectiveness of price subsidies on fortified packaged complementary foods (FPCF) in reducing iodine deficiency, iron-deficiency anaemia and vitamin A deficiency in Pakistani children.DesignThe study proceeded in three steps: (i) we determined the current lifetime costs of the three micronutrient deficiencies with a health economic model; (ii) we assessed the price sensitivity of demand for FPCF with a market survey in two Pakistani districts; (iii) we combined the findings of the first two steps with the results of a systematic review on the effectiveness of FPCF in reducing micronutrient deficiencies. The cost-effectiveness was estimated by comparing the net social cost of price subsidies with the disability-adjusted life years (DALY) averted.SettingDistricts of Faisalabad and Hyderabad in Pakistan.SubjectsHouseholds with 6–23-month-old children stratified by socio-economic strata.ResultsThe lifetime social costs of iodine deficiency, iron-deficiency anaemia and vitamin A deficiency in 6–23-month-old children amounted to production losses of $US 209 million and 175 000 DALY. Poor households incurred the highest costs, yet even wealthier households suffered substantial losses. Wealthier households were more likely to buy FPCF. The net cost per DALY of the interventions ranged from a return per DALY averted of $US 783 to $US 65. Interventions targeted at poorer households were most cost-effective.ConclusionsPrice subsidies on FPCF might be a cost-effective way to reduce the societal costs of micronutrient deficiencies in 6–23-month-old children in Pakistan. Interventions targeting poorer households are especially cost-effective.

Marketing and infant and young child feeding in rapidly evolving food environments

“…The use of fortified infant foods has been included in strategies to improve child nutrition after age 6 months since they can improve the intake of iron, zinc, and other nutrients often lacking in diets of young children (Campos Ponce, Polman, Wieringa, & Doak, ; Leyvraz et al, ; Lutter et al, ; Plessow, Arora, Brunner, & Wieser, ; Wieser et al, ; WHO, ). They have been shown to lead to enhanced growth (Diana et al, ; Ten Year Strategy to Reduce Vitamin and Mineral Deficiencies Maternal Infant and Young Child Working Group Formulation Subgroup, ) and improved iron status (Faber, Kvalsvig, Lombard, & Benadé, ; Lutter, ).…”

The Early Introduction of Complementary (Solid) Foods: A Prospective Cohort Study of Infants in Chengdu, China

“…Favorable gut colonization through continued breastfeeding beyond six months of age may promote tolerance, as well as provide protective factors when complementary feeding is initiated [12]. The late introduction of nutritious complementary foods (after six months of age) predisposes infants to micronutrient deficiencies, especially in lower income countries [13,14].…”

High impact health service interventions for attainment of UHC in Africa: A systematic review

“…Promotion of nutrient-rich diets through price subsidies, tax incentives and disincentives, and cash incentives effectively averted DALYs caused by malnutrition. Examples of effective price subsidies strategies included; price subsidies for fortified packaged infant cereals (F-PICs) for under 2's within poorer households [29], price subsidies on fortified packaged complementary foods (FPCF) for children in different wealth quintiles [30]. Cash incentives such as standard cashback (SCB), double cash (DCB), and fresh food vouchers (FFV) also had a significant impact on nutrition outcomes in children under five years of age [31].…”

“…Exclusive breastfeeding for the first 6 months of life was an effective disease prevention strategy in averting DALYs for malnutrition [44]. Examples of nutrition modifications to prevent disease included; daily iron sulphate II supplementation [45], complementary feeding practices in infants six months to 3 years of age [44] and zinc supplementation for LTRIs [30] and diarrhoeal diseases [46].…”

“…Promotion of nutrient-rich diets through price subsidies, tax incentives and disincentives, and cash incentives effectively avert DALYs caused by malnutrition. These have been discussed within the early childhood section [29][30][31][32][33][34][35]61]. Population-wide ORT interventions were important for diarrhoeal diseases [25].…”