MicronutrientsNote to reader: This information is from a previous round of research. While some of it may need to be updated, the majority of it is still accurate
Micronutrients are substances that are needed only in minuscule amounts but
that enable the body to produce enzymes, hormones and other substances
essential for proper growth and development. The consequences of their
absence are severe. Iodine, vitamin A and iron are most important in global
public health terms; their lack represents a major threat to the health
and development of populations the world over, particularly children and
pregnant women in low-income countries.1
The illnesses
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Iodine deficiency
Iodine deficiency is the world's most prevalent, yet easily preventable,
cause of brain damage. Serious iodine deficiency during pregnancy
can result in stillbirth, spontaneous abortion, and congenital
abnormalities such as cretinism, a grave, irreversible form of
mental retardation that affects people living in iodine-deficient
areas of Africa and Asia. However, of far greater significance
is iodine deficiency's less visible, yet pervasive, mental impairment
that reduces intellectual capacity at home, in school and at work.2
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Vitamin A deficiency
Vitamin A deficiency is the leading cause of preventable blindness in children
and increases the risk of disease and death from severe infections. In
pregnant women, vitamin A deficiency causes night blindness and may increase
the risk of maternal mortality.3
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Iron deficiency
Iron deficiency is the most common and widespread nutritional disorder in
the world. 2 billion people — over 30% of the world's population — are
anaemic, many due to iron deficiency, and in resource-poor areas this
is frequently exacerbated by infectious diseases. Iron deficiency and
anaemia reduce the work capacity of individuals and entire populations,
bringing serious economic consequences and obstacles to national development.4
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Cost-Effectiveness
Micronutrient supplementation and fortification has garnered some support
as a highly cost-effective intervention. For example, the Copenhagen
Consensus 2008 rates micronutrient supplementation as the highest-priority
intervention, and micronutrient fortification as the third highest-priority
intervention.
We have only been able to find one cost-effectiveness estimates from
a charity which focuses on micronutrients.
The DCP2 and WHO-CHOICE
cost-effectiveness estimates are as follows:
Of interventions that aim to reduce child mortality, micronutrients
were found to be the most cost-effective by WHO-CHOICE. Indeed, when they
are given most cost-effectively — via Vitamin A and Zinc fortification
of food — they are highly cost-effective: $1,000 would save about 120
Disability Adjusted Life Years, which
is on a par with saving 4 lives.
We haven't found any cost-effectiveness analysis for iodizing salt,
another micronutrient intervention that may be extremely cost-effective.
The WHO estimates the cost of fortifying iodized salt at $0.05 per person
per year.5 The Copenhagen Consensus suggests that iodized salt has the greatest cost-benefit
ratio at 70:1. These figures look very promising, but we do not have sufficient
information to convert them into our standard metric of DALYs per $1,000.6
Other Information
Are there side-effects?
All health interventions have side-effects, both good and bad.
Positive side-effects:
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Micronutrient supplementation or fortification does not require any major lifestyle change, and there is very little cost to the recipient, in terms of travel costs and working hours lost.
- They have economic benefits, as malnutrition can severely impair
the ability to work, and can lead to cognitive impairment. These benefits
may greatly outstrip the health benefits alone: a recent study argues
that countries may lose two to three percent of their Gross Domestic
Product (GDP) as a result of iron, iodine, and zinc deficiencies.7
Conclusion
Micronutrients are one of the most important interventions to combat child malnutrition and mortality and are highly cost-effective, though they are not in the very top tier of cost-effectiveness.
There are few charities that include them as part of their activities,
and sadly we know of no organisation that both accepts personal donations
and focuses solely on micronutrients (Global
Alliance for Improved Nutrition was one of our recommended charities,
but has stopped accepting personal donations).
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