Net benefit and cost-effectiveness of universal iron containing multiple micronutrient powders for young children in 78 countries: a microsimulation study Lancet Global Health 2020 Vol 8 e1071-80
Sant-Rayn Pasricha, Adrian Gheorghe, Fayrouz Sakr-Ashour, Amrita Arcot, Lynnette Neufeld, Laura E Murray-Kolb, Parminder S Suchdev, Michael Bode
Walter and Eliza Hall Institute of Medical Research, Melbourne; University of Melbourne; The Royal Melbourne Hospital; The Peter MacCallum Cancer Centre; Imperial College London, University of Maryland, College Park, Pennsylvania State University USA; Global Alliance for Improved Nutrition, Geneva, Switzerland; Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, USA; Emory University, Atlanta, USA; Queensland University of Technology, Brisbane
International Union of Nutrition Sciences
Dietary iron deficiency is considered the major cause of anaemia in children worldwide.
The main intervention to control anaemia in children, as recommended by the World Health Organisation, has been to deliver iron-containing micronutrient powders that can be mixed into food, enabling a food-based approach for delivering iron to young children.
However, data had indicated that the intervention can exacerbate the risk of diarrhoea and malaria due to the fact that iron is essential for certain pathogenic micro-organisms to thrive, causing infection, and thereby potentially causing more net harm than good.
The aim of the study was to determine country-specific net benefit or harm and cost effectiveness of universal provision of multiple micronutrient powders to children aged 6 months.
To learn whether micronutrient powders offered a net overall benefit on health outcomes in children, when the associated risks from infection were taken into account, the researchers, using microsimulation analysis, were able to integrate huge amounts of data from each of 78 countries on anaemia, malaria and diarrhoea, as well as health care and public health information. This enabled them to simulate potential outcomes for five million children per country and determine the net health benefit (or harm) and cost-effectiveness of using micronutrient powders in different settings. Data included countries predominantly in Africa, Asia and Latin America.
The microsimulation model the researchers developed was able to estimate net country-specific disability-adjusted life-years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to anaemia, malaria, and diarrhoea averted (or increased) by provision of a 6-month course of MNPs to children aged 6 months and compared to children with no intervention, who would be followed up for an additional 6 months (ie, to age 18 months). Anaemia prevalence was derived from Demographic and Health Surveys or similar national surveys, and malaria and diarrhoea incidence were sourced from the Global Burden of Disease Study. Program and health-care costs were modelled to determine cost per DALY averted (in $US).
Without the cutting-edge computer simulation to make sense of such a large data, it would have taken thousands of years to manually assess.
Seventy-eight countries (46 countries in Africa, 20 in Asia or the Middle East, and 12 in Latin America) were included in the analysis, which simulated 5 million children per country. In 54 of the 78 countries analysed, it was concluded that there is a net benefit in the use of micronutrient powders to combat childhood anaemia. However, in the remaining 24 countries, the researchers found the use of micronutrient powders may actually cause a net harm.
For governments aiming to efficiently and cost-effectively reduce the burden of anaemia in their countries this is important research. The study’s findings included 78 individual reports that are available to inform policy makers with accurate actionable information that balances the expected benefits on anaemia reduction against possible risks of infection.
The researchers noted that the net health benefits of MNPs vary between countries, are highest where prevalence of moderate and severe anaemia is greatest but infection prevalence is smallest and are ameliorated when coverage of the intervention is poor. Their data provides country-specific guidance to national policy makers and will assist them to choose whether to invest in an MNP intervention program. It will also offer researchers a framework to define environments where beneficial outcomes from these interventions might be expected.
This research provides an example of human-relevant research using advanced technology to inform nutritional guidelines in place of animal models in nutritional research.