Abstract
Introduction: This paper models the effects of a home-fortification program (using Sprinkles which contain zinc and iron and other micronutrients), in Pakistan, a country with high levels of infant mortality, anemia, and diarrhea. It uses the results of randomized trials of the effect of Sprinkles on anemia and on longitudinal prevalence of diarrhea.
Methods: Based on previous literature, the effect of Sprinkles on intermediate outcomes (diarrhea and anemia) is linked to longer-term outcomes (infant and young child mortality, and cognitive achievement and hence adult wages). Three different measures of cost effectiveness are presented: the cost per death averted (effect via zinc supplementation on reduction of longitudinal prevalence of diarrhea); the cost per ‘disability adjusted life year’ (DALY) saved (same modality); and the gain in earnings due to higher cognitive functioning for each dollar spent (effect via iron supplementation on reduced anemia).
Results: We estimated that the cost per death averted is $406 ($273–$3248), the cost per DALY saved is $12.2 ($8–$97) and the present value of the gain in earnings is $37 ($18- $51) for each dollar spent on the Sprinkles program. These estimates were developed for a low-income country (GDP per capita = $417) with a high infant mortality rate (IMR = 83/1000), high prevalence of anemia (93%), and high mean longitudinal prevalence of diarrhea (17%).
Discussion: These outcomes are particularly favourable in Pakistan. The outcomes are more favourable when used with children 6–12 months. Further longer-run field trials of Sprinkles with larger populations would be helpful.
MeSH terms: Home fortification, zinc deficiency, iron deficiency, anemia, diarrhea, costeffectiveness, Sprinkles
Résumé
Introduction: Un modèle a été utilisé pour évaluer l’effet d’un programme pour enrichir les aliments à domicile (en utilisant les suppléments Sprinkles contenant du zinc et du fer, ainsi que d’autres micronutriments) au Pakistan, un pays où les taux de mortalité infantile, d’anémie et de diarrhée sont élevés. Le modèle comprend les résultats d’essais cliniques randomisés de l’effet des Sprinkles sur l’anémie et sur la prévalence longitudinale de la diarrhée.
Méthode: La documentation existante suggère que les effets des Sprinkles à moyen terme (sur la diarrhée et l’anémie) sont liés à certains effets à plus long terme (baisse de la mortalité infantile et post-infantile, meilleur développement cognitif, et donc revenus plus élevés à l’âge adulte). Nous présentons trois mesures différentes de l’efficacité par rapport au coût: le coût par décès évité (en réduisant la prévalence longitudinale de la diarrhée grâce à la supplémentation en zinc); le coût par « année de vie épargnée pondérée par l’invalidité » (DALY) (toujours grâce à la supplémentation en zinc); et le gain de revenus dû à un fonctionnement cognitif supérieur pour chaque dollar dépensé (en réduisant la prévalence de l’anémie grâce à la supplémentation en fer).
Résultats: Nous avons estimé que, pour chaque dollar dépensé sur le programme Sprinkles, le coût par décès évité est de 406 $ (273 $–3 248 $), le coût par DALY épargnée est de 12,20 $ (8 $–97 $), et le gain de revenus actuel est de 37 $ (18 $–51 $). Ces estimations ont été élaborées pour un pays à faible revenu (PNB par habitant = 417 $) avec un taux élevé de mortalité infantile (TMI = 83/1 000), une prévalence élevée d’anémie (93 %) et une prévalence longitudinale moyennement élevée de diarrhée (17 %).
Discussion: Ces résultats sont particulièrement favorables dans un environnement aux taux élevés de mortalité infantile, d’anémie et de diarrhée comme le Pakistan. Les résultats sont plus favorables chez les enfants âgés de 6 à 12 mois. Il serait utile de mener d’autres essais avec les suppléments Sprinkles, sur le terrain, à plus long terme et avec un plus grand nombre de participants.
Footnotes
Acknowledgements: This study was supported in part by grants from the Canadian Institutes of Health Research and the HJ Heinz Foundation.
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