Search

Background Since 1961, global per capita fish consumption has nearly doubled. Much of the increase has been due to aquaculture. Bangladesh, the world's eighth largest fish producing country, has been part of this transformation. Despite having vitamin A supplementation and fortification programs, the prevalence of inadequate vitamin A intake (IVAI) in Bangladesh is very high, estimated to be 60%. The promotion of a small indigenous fish, high in vitamin A – mola carplet – offers a promising food-based approach to improving vitamin A status of the 98% of Bangladeshis who eat fish. The objective of this paper was to conduct a benefit–cost analysis of a national household pond Mola Promotion Program (MPP) in Bangladesh. Methods Using the 2005 Bangladesh Household Income and Expenditure Survey (HIES) and nutrition and health statistics, we developed baseline estimates of usual vitamin A intake, the prevalence of IVAI and disability-adjusted life years (DALYs) attributable to vitamin A deficiency (VAD). Drawing on a WorldFish project and HIES data, we designed and modeled the implementation of a MPP, and calculated the additional vitamin A intake it would provide, calculated new incidence rates of VAD-related health outcomes and estimated MPP-attributable annual changes in DALYs. The MPP's total health benefits were calculated over the program's 11-year phase-in as the annual sum of DALYs saved. The MPP's costs were estimated as the sum of the costs of a small fish program of the Fisheries Development Program plus the costs of mola brood stock, other inputs and additional farmer training-related costs. Program costs and benefits were combined to produce estimates of the cost-effectiveness of the program. Results An 11-year, $23 million project would increase average daily vitamin A intakes by 7 μg retinol activity equivalent (RAE), reduce the prevalence of IVAI by 1.1 percentage points, and save 3000 lives and 100,000 DALYs, at a cost of $194 per DALY saved. The MPP's impact would be concentrated among homestead pond-fishing households that would consume 60% of the additional mola produced. Among these, it would reduce IVAI prevalence by 7 percentage points. If the MPP was implemented for at least 20 years, it would dominate – have higher health benefits and lower total costs – than a national vitamin A wheat flour fortification program. Conclusion By World Bank and World Health Organization criteria, the MPP is a cost-effective approach to reduce the burden of micronutrient malnutrition in Bangladesh. [ABSTRACT FROM AUTHOR]

Background. Approximately 1.2 million disabilityadjusted life years (DALYs) are lost annually in Bangladesh due to deficiencies of vitamin A, iron, and zinc. Objective. To provide evidence on the coverage, costs, and cost-effectiveness of alternative fortification interventions to inform nutrition policy-making in Bangladesh. Methods. Combining the 2005 Bangladesh Household Income and Expenditure Survey with a Bangladesh food composition table, apparent intakes of energy, vitamin A, iron, and zinc, and the coverage and apparent consumption levels of fortifiable vegetable oil and wheat flour are estimated. Assuming that fortification levels are those established in official regulations, the costs and cost-effectiveness of the two vehicles are assessed independently and as a two-vehicle portfolio. Results. Vegetable oil has a coverage rate of 76% and is estimated to reduce the prevalence of inadequate vitamin A intake from 83% to 64%. The coverage of wheat flour is high (65%), but the small quantities consumed result in small reductions in the prevalence of inadequate intakes: 1.5 percentage points for iron, less than 1 for zinc, and 2 for vitamin A, while reducing average Estimated Average Requirement (EAR) gaps by 8%, 9%, and 15%, respectively. The most cost-effective 10-micronutrient wheat flour formulation costs US$1.91 million annually, saving 129,212 DALYs at a unit cost of US$14.75. Fortifying vegetable oil would cost US$1.27 million annually, saving 406,877 DALYs at an average cost of US$3.25. Sensitivity analyses explore various permutations of the wheat flour formulation. Divisional variations in coverage, cost, and impact are examined. Conclusions. Vegetable oil fortification is the most cost-effective of the three portfolios analyzed, but all three are very cost-effective options for Bangladesh. [ABSTRACT FROM AUTHOR]

Background. Globally, there is a scarcity of national food consumption data that could help to assess food patterns and nutrient intakes of population groups. Estimates of food consumption patterns and apparent intakes of energy and nutrients could be obtained from national Household Consumption and Expenditures Surveys (HCES). Objective. To use the HCES conducted in Bangladesh in 2005 (HIES2005) to estimate apparent intakes of vitamin A, iron, and zinc. Methods. Food acquisition data from HIES2005, which surveyed 10,080 households, were transformed into standard measurement units. Intrahousehold food and nutrient distribution was estimated with Adult Male Equivalent (AME) units. Adequacy of intake was assessed by comparing individual nutrient intakes with requirements and was then aggregated by households. Results. The weighted mean energy intake for the population was 2,151 kcal/person/day, with a range among divisions from 1,950 in Barisal to 2,195 in Dhaka division. The apparent intakes of vitamin A and iron were insufficient to satisfy the recommended intakes for more than 80% of the population in Bangladesh, while apparent intakes of zinc, adjusted by bioavailability, satisfied the requirements of approximately 60% of the population Conclusions. Using the HIES2005, we were able to produce estimates of apparent food consumption and intakes of some key micronutrients for the Bangladeshi population and observed wide differences among divisions. However, the methodological approaches reported here, although feasible and promising, need to be validated with other dietary intake methods [ABSTRACT FROM AUTHOR]