Document Detail

Vitamin A fortification in Uganda: comparing the feasibility, coverage, costs, and cost-effectiveness of fortifying vegetable oil and sugar.
MedLine Citation:
PMID:  20707225     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Twenty-eight percent of Ugandan preschool children suffer from vitamin A deficiency. With vitamin A supplementation covering only a third of children under 5 years of age, fortification is essential to reduce their vitamin A deficiency-related disease burden. At present, the only widely consumed food in Uganda that is fortified with vitamin A is vegetable oil. OBJECTIVE: To compare the feasibility, coverage, costs, and cost-effectiveness of fortifying vegetable oil and sugar with vitamin A in order to assess, from a public health policy perspective, whether sugar should also be fortified. METHODS: The 2005/6 Uganda Household Budget Survey was used to analyze households' apparent consumption levels of sugar and vegetable oil and to model the additional intake of vitamin A, assuming the sugar and oil fortification levels are those set by the Uganda Bureau of Standards. RESULTS: The annual incremental private sector cost of vitamin fortification is US $555,668 for oil and US $2,644,765 for sugar. Assuming that oil and sugar fortification are both effective in reducing vitamin A deficiency by 30% among those who consume these foods, the estimated cost per disability-adjusted life year (DALY) averted is US $82 for sugar and US $18 for oil. Vitamin Afortification of vegetable oil is 4.6 times more cost-effective than vitamin A fortification of sugar. If sugar were to be fortified, the 17% of Ugandans who purchase sugar but do not purchase oil would become new beneficiaries of vitamin A fortification. This would increase the coverage of vitamin A-fortified foods by 31% and reduce the percentage of Ugandans without any coverage to 25%. Those most at risk for vitamin A deficiency-members of rural, poor households-would benefit disproportionately from the introduction of sugar fortification. CONCLUSIONS: Although the lack of information on the vitamin A deficiency status of consumers of oil and sugar precludes making definitive conclusions, the increased coverage and cost per DALY averted due to sugar fortification suggests-based on World Health Organization guidelines-that the Government of Uganda should pursue sugar fortification.
John L Fiedler; Ronald Afidra
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Food and nutrition bulletin     Volume:  31     ISSN:  0379-5721     ISO Abbreviation:  Food Nutr Bull     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-08-16     Completed Date:  2010-09-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7906418     Medline TA:  Food Nutr Bull     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  193-205     Citation Subset:  IM    
HarvestPlus, International Food Policy Research Institute, Washington, DC 20006, USA.
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MeSH Terms
Cost-Benefit Analysis
Costs and Cost Analysis
Dietary Sucrose*
Family Characteristics
Feasibility Studies
Food, Fortified* / economics
Guidelines as Topic
Nutrition Policy* / economics
Nutrition Surveys
Plant Oils*
Socioeconomic Factors
Vitamin A / administration & dosage*,  economics
Vitamin A Deficiency / epidemiology,  mortality,  prevention & control*
World Health Organization
Reg. No./Substance:
0/Dietary Sucrose; 0/Plant Oils; 11103-57-4/Vitamin A

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