Selecting Micronutrient Intervention Programs to Save Lives: Evidence From Cameroon

Abstract Objectives We use the Micronutrient Intervention Modeling (MINIMOD) tool to identify and compare economically optimal sets of micronutrient (MN) programs that focus on two objectives: increasing the number of individuals achieving adequate intake of specific life-saving MNs, and saving children's lives using sets of MNs. Methods We used 24-hour dietary intake data from Cameroon to estimate usual intake of zinc and vitamin A for children 1–5 y (n = 872) and of folate for women of reproductive age (WRA) (n = 902), as well as the prevalence of inadequate intake (below the Estimated Average Requirement) for each. We simulated the effects on inadequate MN intake of single or combined fortification of wheat flour, oil, and/or bouillon cubes, as well as two delivery platforms for vitamin A supplementation (VAS). The Lives Saved Tool (LiST) was used to estimate the number of lives saved by each program, and by all combinations of them. We estimated program costs for each scenario, nationally and subnationally, over a 10-year planning time horizon. The economic optimization model was run twice to identify the most cost-effective combination of programs based on two objectives achieving adequate intake for each MN, and increasing lives saved by all MNs. Results When the policy focus is on adequate intake of specific life-saving MNs, the following national and subnational programs are most cost-effective: wheat flour fortified with zinc (95 ppm, at target level), edible oils (9 mg/kg, 75% of target) and bouillon cubes (80 ppm) both fortified with vitamin A, and VAS provided to children in the northern part of Cameroon via Child Health Days. For meeting the folate needs of WRA, wheat flour fortified with folic acid (5 mg/kg, 33% of standard) is the most cost-effective option. When the primary focus is saving lives, a very similar set of economically optimal programs emerges, which saves over 26,000 lives over 10 years. Conclusions Policymakers in Cameroon who promote mortality-reducing MN programs using adequate intake and economic efficiency as their guides can expect to save child lives in a cost-effective way. Funding Sources This work was funded by a grant from the Bill & Melinda Gates Foundation to the UC Davis, and by a gift from Mars Inc. to UC Davis to support interdisciplinary research and training in economics and nutrition.