Micronutrients

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 for children and pregnant women in low-income countries.1

The illnesses

• 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

• 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

• 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

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 estimate 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:

• 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 a limited number of charities that work in this area; they employ methods with varying levels of cost-effectiveness, and some do not accept donations (for example the Micronutrient Initiative). We are still in the process of determining which, if any, to recommend, and will keep our readers updated. Global Alliance for Improved Nutrition , which we have recommended in the past, does accept donations by visiting this page.