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

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          Abstract

          Objective

          To 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.

          Design

          The 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.

          Setting

          Districts of Faisalabad and Hyderabad in Pakistan.

          Subjects

          Households with 6–23-month-old children stratified by socio-economic strata.

          Results

          The 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.

          Conclusions

          Price 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.

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          Most cited references21

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          Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?

          The Lancet, 382(9890), 452-477
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            Iron deficiency and brain development.

            Iron deficiency (ID) is common in pregnant women and infants worldwide. Rodent models show that ID during gestation/lactation alters neurometabolism, neurotransmitters, myelination, and gene/protein profiles before and after iron repletion at weaning. Human infants with iron deficiency anemia test lower in cognitive, motor, social-emotional, and neurophysiologic development than comparison group infants. Iron therapy does not consistently improve developmental outcome, with long-term differences observed. Poorer outcome has also been shown in human and monkey infants with fetal/neonatal ID. Recent randomized trials of infant iron supplementation show benefits, indicating that adverse effects can be prevented and/or reversed with iron earlier in development or before ID becomes severe or chronic. This body of research emphasizes the importance of protecting the developing brain from ID.
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              The effects of iodine deficiency in pregnancy and infancy.

              Iodine requirements are increased ≥ 50% during pregnancy. Iodine deficiency during pregnancy can cause maternal and fetal hypothyroidism and impair neurological development of the fetus. The consequences depend upon the timing and severity of the hypothyroidism; the most severe manifestation is cretinism. In moderate-to-severely iodine-deficient areas, controlled studies have demonstrated that iodine supplementation before or during early pregnancy eliminates new cases of cretinism, increases birthweight, reduces rates of perinatal and infant mortality and generally increases developmental scores in young children by 10-20%. Mild maternal iodine deficiency can cause thyroid dysfunction but whether it impairs cognitive and/or neurologic function in the offspring remains uncertain. Two meta-analyses have estimated that iodine-deficient populations experience a mean reduction in IQ of 12-13.5 points. In nearly all regions affected by iodine deficiency, salt iodisation is the most cost-effective way of delivering iodine and improving maternal and infant health. © 2012 Blackwell Publishing Ltd.
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                Author and article information

                Journal
                Public Health Nutr
                Public Health Nutr
                PHN
                Public Health Nutrition
                Cambridge University Press (Cambridge, UK )
                1368-9800
                1475-2727
                18 July 2018
                October 2018
                : 21
                : 15
                : 2893-2906
                Affiliations
                [1 ] Winterthur Institute of Health Economics, Zurich University of Applied Sciences , Winterthur, Switzerland
                [2 ] Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
                [3 ] Department of Paediatrics and Child Health, The Aga Khan University , 74800 Karachi, Pakistan
                [4 ] Robert Harding Chair in Global Child Health & Policy, The Hospital for Sick Children, Toronto, Ontario, Canada
                Author notes
                [* ] Corresponding author: Email zulfiqar.bhutta@ 123456aku.edu
                Author information
                http://orcid.org/0000-0003-1821-2944
                Article
                S1368980018001660 00166
                10.1017/S1368980018001660
                6149007
                30017015
                6cb6a112-e634-4d80-9557-c8dc79c61d34
                © The Authors 2018

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 October 2017
                : 11 May 2018
                : 24 May 2018
                Page count
                Figures: 6, Tables: 7, Pages: 14
                Categories
                Research Paper
                Public Policies

                Public health
                pakistan,malnutrition,micronutrient,children,cost-effective,complementary food,subsidy
                Public health
                pakistan, malnutrition, micronutrient, children, cost-effective, complementary food, subsidy

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