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The cost-effectiveness of small-quantity lipid-based nutrient supplements for prevention of child death and malnutrition and promotion of healthy development: modelling results for Uganda
- Katherine P Adams, Stephen A Vosti, Charles D Arnold, Reina Engle-Stone, Elizabeth L Prado, Christine P Stewart, K Ryan Wessells, Kathryn G Dewey
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- Journal:
- Public Health Nutrition / Volume 26 / Issue 10 / October 2023
- Published online by Cambridge University Press:
- 22 August 2023, pp. 2083-2095
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Objective:
Recent meta-analyses demonstrate that small-quantity lipid-based nutrient supplements (SQ-LNS) for young children significantly reduce child mortality, stunting, wasting, anaemia and adverse developmental outcomes. Cost considerations should inform policy decisions. We developed a modelling framework to estimate the cost and cost-effectiveness of SQ-LNS and applied the framework in the context of rural Uganda.
Design:We adapted costs from a costing study of micronutrient powder (MNP) in Uganda, and based effectiveness estimates on recent meta-analyses and Uganda-specific estimates of baseline mortality and the prevalence of stunting, wasting, anaemia and developmental disability.
Setting:Rural Uganda.
Participants:Not applicable.
Results:Providing SQ-LNS daily to all children in rural Uganda (> 1 million) for 12 months (from 6 to 18 months of age) via the existing Village Health Team system would cost ∼$52 per child (2020 US dollars) or ∼$58·7 million annually. SQ-LNS could avert an average of > 242 000 disability-adjusted life years (DALYs) annually as a result of preventing 3689 deaths, > 160 000 cases of moderate or severe anaemia and ∼6000 cases of developmental disability. The estimated cost per DALY averted is $242.
Conclusions:In this context, SQ-LNS may be more cost-effective than other options such as MNP or the provision of complementary food, although the total cost for a programme including all age-eligible children would be high. Strategies to reduce costs, such as targeting to the most vulnerable populations and the elimination of taxes on SQ-LNS, may enhance financial feasibility.
In situ and in vitro estimation of mineral release from common feedstuffs fed to cattle
- D. ZANETTI, A. C. B. MENEZES, F. A. S. SILVA, L. F. COSTA E SILVA, P. P. ROTTA, E. DETMANN, T. E. ENGLE, S. C. VALADARES FILHO
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- Journal:
- The Journal of Agricultural Science / Volume 155 / Issue 7 / September 2017
- Published online by Cambridge University Press:
- 13 June 2017, pp. 1160-1173
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The objective of the current study was to quantify the dry matter (DM) digestibility, and total ash (TA) and mineral release from 12 concentrate and 12 forage feedstuffs commonly fed to cattle using in situ and in vitro methods. Concentrate and forage feedstuffs were incubated in the rumen of ruminally cannulated beef bulls at eight different time points. Two different trials were conducted for concentrates and forages, with maximum incubation time of 72 and 120 h, respectively. The residue from samples incubated for 24 h were treated with pepsin and hydrochloric acid to simulate abomasum digestion in vitro. The initial and residual samples after in situ and in vitro incubations were measured. An asymptotic model was adopted for estimating solubility of minerals, disappearance rate of DM, and TA. Correlations between feedstuff contents and mineral release were evaluated. Residual samples from rumen fermentation after 24 h were incubated in simulated abomasal conditions and mineral release was measured. Cluster analysis was performed to group feedstuffs in relation to TA release. Large variability was observed between concentrate and forage feedstuffs for all constituents analysed. Large variability was observed for the effective ruminal degradation of TA and individual mineral release. When feedstuffs were clustered according to the immediately soluble fraction (‘a’), the insoluble by potentially releasable fraction (‘b’) and the release rate of ‘b’ (‘kd’,/h) estimates of TA ruminal release, four groups were identified. From group ‘1’ to group ‘4’, an increase in the soluble fraction and a reduction in both moderate releasable fraction and release rate was observed. Neutral detergent fibre content had a negative correlation with mineral release in the rumen, while mineral content had a positive correlation. These results demonstrate that mineral solubilization in the digestive tract is not the limiting factor for mineral absorption from the feedstuffs tested.
Looking Backward, Looking Forward: MLA Members Speak
- April Alliston, Elizabeth Ammons, Jean Arnold, Nina Baym, Sandra L. Beckett, Peter G. Beidler, Roger A. Berger, Sandra Bermann, J.J. Wilson, Troy Boone, Alison Booth, Wayne C. Booth, James Phelan, Marie Borroff, Ihab Hassan, Ulrich Weisstein, Zack Bowen, Jill Campbell, Dan Campion, Jay Caplan, Maurice Charney, Beverly Lyon Clark, Robert A. Colby, Thomas C. Coleman III, Nicole Cooley, Richard Dellamora, Morris Dickstein, Terrell Dixon, Emory Elliott, Caryl Emerson, Ann W. Engar, Lars Engle, Kai Hammermeister, N. N. Feltes, Mary Anne Ferguson, Annie Finch, Shelley Fisher Fishkin, Jerry Aline Flieger, Norman Friedman, Rosemarie Garland-Thomson, Sandra M. Gilbert, Laurie Grobman, George Guida, Liselotte Gumpel, R. K. Gupta, Florence Howe, Cathy L. Jrade, Richard A. Kaye, Calhoun Winton, Murray Krieger, Robert Langbaum, Richard A. Lanham, Marilee Lindemann, Paul Michael Lützeler, Thomas J. Lynn, Juliet Flower MacCannell, Michelle A. Massé, Irving Massey, Georges May, Christian W. Hallstein, Gita May, Lucy McDiarmid, Ellen Messer-Davidow, Koritha Mitchell, Robin Smiles, Kenyatta Albeny, George Monteiro, Joel Myerson, Alan Nadel, Ashton Nichols, Jeffrey Nishimura, Neal Oxenhandler, David Palumbo-Liu, Vincent P. Pecora, David Porter, Nancy Potter, Ronald C. Rosbottom, Elias L. Rivers, Gerhard F. Strasser, J. L. Styan, Marianna De Marco Torgovnick, Gary Totten, David van Leer, Asha Varadharajan, Orrin N. C. Wang, Sharon Willis, Louise E. Wright, Donald A. Yates, Takayuki Yokota-Murakami, Richard E. Zeikowitz, Angelika Bammer, Dale Bauer, Karl Beckson, Betsy A. Bowen, Stacey Donohue, Sheila Emerson, Gwendolyn Audrey Foster, Jay L. Halio, Karl Kroeber, Terence Hawkes, William B. Hunter, Mary Jambus, Willard F. King, Nancy K. Miller, Jody Norton, Ann Pellegrini, S. P. Rosenbaum, Lorie Roth, Robert Scholes, Joanne Shattock, Rosemary T. VanArsdel, Alfred Bendixen, Alarma Kathleen Brown, Michael J. Kiskis, Debra A. Castillo, Rey Chow, John F. Crossen, Robert F. Fleissner, Regenia Gagnier, Nicholas Howe, M. Thomas Inge, Frank Mehring, Hyungji Park, Jahan Ramazani, Kenneth M. Roemer, Deborah D. Rogers, A. LaVonne Brown Ruoff, Regina M. Schwartz, John T. Shawcross, Brenda R. Silver, Andrew von Hendy, Virginia Wright Wexman, Britta Zangen, A. Owen Aldridge, Paula R. Backscheider, Roland Bartel, E. M. Forster, Milton Birnbaum, Jonathan Bishop, Crystal Downing, Frank H. Ellis, Roberto Forns-Broggi, James R. Giles, Mary E. Giles, Susan Blair Green, Madelyn Gutwirth, Constance B. Hieatt, Titi Adepitan, Edgar C. Knowlton, Jr., Emanuel Mussman, Sally Todd Nelson, Robert O. Preyer, David Diego Rodriguez, Guy Stern, James Thorpe, Robert J. Wilson, Rebecca S. Beal, Joyce Simutis, Betsy Bowden, Sara Cooper, Wheeler Winston Dixon, Tarek el Ariss, Richard Jewell, John W. Kronik, Wendy Martin, Stuart Y. McDougal, Hugo Méndez-Ramírez, Ivy Schweitzer, Armand E. Singer, G. Thomas Tanselle, Tom Bishop, Mary Ann Caws, Marcel Gutwirth, Christophe Ippolito, Lawrence D. Kritzman, James Longenbach, Tim McCracken, Wolfe S. Molitor, Diane Quantic, Gregory Rabassa, Ellen M. Tsagaris, Anthony C. Yu, Betty Jean Craige, Wendell V. Harris, J. Hillis Miller, Jesse G. Swan, Helene Zimmer-Loew, Peter Berek, James Chandler, Hanna K. Charney, Philip Cohen, Judith Fetterley, Herbert Lindenberger, Julia Reinhard Lupton, Maximillian E. Novak, Richard Ohmann, Marjorie Perloff, Mark Reynolds, James Sledd, Harriet Turner, Marie Umeh, Flavia Aloya, Regina Barreca, Konrad Bieber, Ellis Hanson, William J. Hyde, Holly A. Laird, David Leverenz, Allen Michie, J. Wesley Miller, Marvin Rosenberg, Daniel R. Schwarz, Elizabeth Welt Trahan, Jean Fagan Yellin
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- Journal:
- PMLA / Publications of the Modern Language Association of America / Volume 115 / Issue 7 / December 2000
- Published online by Cambridge University Press:
- 23 October 2020, pp. 1986-2078
- Print publication:
- December 2000
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10 - Selection for rural-to-urban migrants in Guatemala
- Edited by Lawrence M. Schell, State University of New York, Albany, Malcolm Smith, University of Durham, Alan Bilsborough, University of Durham
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- Urban Ecology and Health in the Third World
- Published online:
- 26 December 2009
- Print publication:
- 21 January 1993, pp 144-162
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Summary
Previous studies of rural-to-urban migration have led to difficulties in distinguishing migration antecedents from migration consequences. Failure to control for key factors such as migration history, age at migration, and duration of migration measures make results difficult to interpret. A prospective study conducted in rural Guatemala allowed for comparisons on a large and diverse set of anthropometric, psychological and socioeconomic variables between eventual urban migrants and rural sedentes as early as age 3 years. Results indicate that eventual migrants may have been absent from the village more often than sedentes even at this young age, suggesting that these children may have been part of families with a history of circular migration. Evidence for selective migration (i.e. migration of individuals who are in some way ‘ better off ’than the originating population) was found in two of the four study villages, where eventual migrants were larger and of better socioeconomic status at age 3 than sedentes. Few differences were found in the other two villages. Differences generally persisted subsequent to migration. Patterns seen are indicative of the economic and social systems characteristic of the individual villages: the two villages in which selective migration was seen offer little to deter individuals from leaving, while the other two villages provide greater economic opportunity for residents. Rural regional differences should be carefully considered in future studies of rural-to-urban migration.