Sant-Rayn Pasricha1, Adrian Gheorghe2, Fayrouz Sakr-Ashour3, Amrita Arcot4, Lynnette Neufeld5, Laura E Murray-Kolb4, Parminder S Suchdev6, Michael Bode7. 1. Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia; Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia; Diagnostic Haematology, The Royal Melbourne Hospital, and Clinical Haematology at The Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia. Electronic address: pasricha.s@wehi.edu.au. 2. Global Health and Development, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. 3. Department of Nutrition and Food Science, University of Maryland, College Park, MD, USA. 4. Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA. 5. Global Alliance for Improved Nutrition, Geneva, Switzerland. 6. Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Pediatrics and Emory Global Health Institute, Emory University, Atlanta, GA, USA. 7. School of Mathematics, Queensland University of Technology, Brisbane, QLD, Australia.
Abstract
BACKGROUND: Universal home fortification of complementary foods with iron-containing multiple micronutrient powders (MNPs) is a key intervention to prevent anaemia in young children in low-income and middle-income countries. However, evidence that MNPs might promote infection raises uncertainty about whether MNPs give net health benefits and are cost-effective. We aimed to determined country-specific net benefit or harm and cost-effectiveness of universal provision of MNPs to children aged 6 months. METHODS: We developed a microsimulation model to estimate net country-specific disability-adjusted life-years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to anaemia, malaria, and diarrhoea averted (or increased) by provision of a 6-month course of MNPs to children aged 6 months, compared with no intervention, who would be followed up for an additional 6 months (ie, to age 18 months). Anaemia prevalence was derived from Demographic and Health Surveys or similar national surveys, and malaria and diarrhoea incidence were sourced from the Global Burden of Disease Study. Programme and health-care costs were modelled to determine cost per DALY averted (US$). Additionally, we explored the effects of reduced MNP coverage in a sensitivity analysis. FINDINGS: 78 countries (46 countries in Africa, 20 in Asia or the Middle East, and 12 in Latin America) were included in the analysis, and we simulated 5 million children per country. 6 months of universal distribution of daily MNPs, assuming 100% coverage, produced a net benefit (DALYs averted) in 54 countries (24 in Africa, 19 in Asia and the Middle East, 11 in Latin America) and net harm in 24 countries (22 in Africa, one in Asia, and one in Latin America). MNP intervention provided a benefit on YLDs associated with anaemia, but these gains were attenuated and sometimes reversed by increases in YLLs associated with malaria and diarrhoea, reducing the benefits seen for DALYs. In the 54 countries where MNP provision was beneficial, the median benefit was 28·1 DALYs averted per 10 000 children receiving MNPs (IQR 20·6-40·4), and median cost per DALY averted was $3576 (IQR 2474-4918). DALY effects positively correlated with moderate and severe anaemia prevalence in Asia, the Middle East, and Latin America, but correlated inversely in Africa. Suboptimal coverage markedly reduced DALYs averted and cost-effectiveness. INTERPRETATION: Net health benefits of MNPs vary between countries, are highest where prevalence of moderate and severe anaemia is greatest but infection prevalence is smallest, and are ameliorated when coverage of the intervention is poor. Our data provide country-specific guidance to national policy makers. FUNDING: International Union of Nutrition Sciences.
BACKGROUND: Universal home fortification of complementary foods with iron-containing multiple micronutrient powders (MNPs) is a key intervention to prevent anaemia in young children in low-income and middle-income countries. However, evidence that MNPs might promote infection raises uncertainty about whether MNPs give net health benefits and are cost-effective. We aimed to determined country-specific net benefit or harm and cost-effectiveness of universal provision of MNPs to children aged 6 months. METHODS: We developed a microsimulation model to estimate net country-specific disability-adjusted life-years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to anaemia, malaria, and diarrhoea averted (or increased) by provision of a 6-month course of MNPs to children aged 6 months, compared with no intervention, who would be followed up for an additional 6 months (ie, to age 18 months). Anaemia prevalence was derived from Demographic and Health Surveys or similar national surveys, and malaria and diarrhoea incidence were sourced from the Global Burden of Disease Study. Programme and health-care costs were modelled to determine cost per DALY averted (US$). Additionally, we explored the effects of reduced MNP coverage in a sensitivity analysis. FINDINGS: 78 countries (46 countries in Africa, 20 in Asia or the Middle East, and 12 in Latin America) were included in the analysis, and we simulated 5 million children per country. 6 months of universal distribution of daily MNPs, assuming 100% coverage, produced a net benefit (DALYs averted) in 54 countries (24 in Africa, 19 in Asia and the Middle East, 11 in Latin America) and net harm in 24 countries (22 in Africa, one in Asia, and one in Latin America). MNP intervention provided a benefit on YLDs associated with anaemia, but these gains were attenuated and sometimes reversed by increases in YLLs associated with malaria and diarrhoea, reducing the benefits seen for DALYs. In the 54 countries where MNP provision was beneficial, the median benefit was 28·1 DALYs averted per 10 000 children receiving MNPs (IQR 20·6-40·4), and median cost per DALY averted was $3576 (IQR 2474-4918). DALY effects positively correlated with moderate and severe anaemia prevalence in Asia, the Middle East, and Latin America, but correlated inversely in Africa. Suboptimal coverage markedly reduced DALYs averted and cost-effectiveness. INTERPRETATION: Net health benefits of MNPs vary between countries, are highest where prevalence of moderate and severe anaemia is greatest but infection prevalence is smallest, and are ameliorated when coverage of the intervention is poor. Our data provide country-specific guidance to national policy makers. FUNDING: International Union of Nutrition Sciences.
Authors: Hal Drakesmith; Sant-Rayn Pasricha; Ioav Cabantchik; Chaim Hershko; Guenter Weiss; Domenico Girelli; Nicole Stoffel; Martina U Muckenthaler; Elizabeta Nemeth; Clara Camaschella; Paul Klenerman; Michael B Zimmermann Journal: Lancet Haematol Date: 2021-09 Impact factor: 18.959
Authors: Kathryn G Dewey; K Ryan Wessells; Charles D Arnold; Elizabeth L Prado; Souheila Abbeddou; Seth Adu-Afarwuah; Hasmot Ali; Benjamin F Arnold; Per Ashorn; Ulla Ashorn; Sania Ashraf; Elodie Becquey; Jaden Bendabenda; Kenneth H Brown; Parul Christian; John M Colford; Sherlie J L Dulience; Lia C H Fernald; Emanuela Galasso; Lotta Hallamaa; Sonja Y Hess; Jean H Humphrey; Lieven Huybregts; Lora L Iannotti; Kaniz Jannat; Anna Lartey; Agnes Le Port; Jef L Leroy; Stephen P Luby; Kenneth Maleta; Susana L Matias; Mduduzi N N Mbuya; Malay K Mridha; Minyanga Nkhoma; Clair Null; Rina R Paul; Harriet Okronipa; Jean-Bosco Ouédraogo; Amy J Pickering; Andrew J Prendergast; Marie Ruel; Saijuddin Shaikh; Ann M Weber; Patricia Wolff; Amanda Zongrone; Christine P Stewart Journal: Am J Clin Nutr Date: 2021-11-02 Impact factor: 7.045