Use of cost-effectiveness as a framework for assessing alternate iron supplementation and fortification strategies : the Jamaica case (1992)

The two most commonly implemented iron deficiency control interventions are included in the study: iron supplementation for pregnant women and fortification of cereal flour. The analyses are done using existing data, with small additional primary data collected on key variables. An objective of this analysis was to develop an approach that can be used in other countries, or to assess other options in Jamaica, without the need for extensive primary data collection. In the example of iron supplementation for pregnant women, the national program in effect during 1992-93 is compared with a modified program in which improved supplies, elimination of universal screening, and provision of free supplements only to those at high risk are included. The results show that of 60,000 pregnant women eligible for iron supplementation, only 26,000 were benefiting from it in 1992-93. With the modifications proposed, the program would benefit another 16,000 women -- all of them government clients. The costs to government can be reduced from the estimated US$4.32 per woman benefited to US$1.42 per women benefited. Participant costs can be reduced by half. The example of the iron fortification program demonstrates trade-offs in higher costs and higher bioavailability of newer fortificants such as iron-EDTA when compared with less readily absorbed iron currently in use. The study raises other strategic issues such as the lack of interventions directed to benefit infants and young children. This points to the need for a mix of interventions that would include fortification of food consumed by weaning age infants, and supplements not only for women but for infants and young children as well. While dietary deficiencies appear to be the primary cause of iron deficiency in Jamaica, in other countries, malaria and intestinal parasites may be important etiological factors, and comprehensive intervention packages to combat iron deficiency will need to address these components as well. (Author abstract)