Cost analysis as a vitamin A program design and evaluation tool: a case study

of the Philippines
Vitamin A deficiency (VAD) is a serious and widespread public health problem in the
Philippines. Initiated in 1993, the Philippines National Vitamin A Supplementation Program
(NVASP) is one of the oldest, most mature and comprehensive of its kind. This paper presents a
cost-effectiveness and effciency analysis of the NVASP and of a hypothetical program of vitamin
A fortification of wheat flour that was conducted to inform policymakers as to how to modify the
program. Employing a proxy effectiveness indicator of VAD - the intake of <70% of the
recommended daily allowance of vitamin A - in a series of simulations using individual child
consumption data, the analysis finds that fortification is more effcient in reducing inadequate
vitamin A intake (IVAI) compared to the NVASP. Due to the nature of food consumption
patterns, however, fortification alone, is not enough. At what is regarded as the maximum
politically acceptable fortification level, there will still be 2.2 million (29%) Filipino children
aged 1259 months who will have IVAI. An investigation of the cost and effciency of
geographically targeted supplementation programs reveals that maintaining a universal
supplementation program in urban areas and, in rural areas, introducing a targeted program to
only the poorest municipalities (where the prevalence of VAD is the highest) will provide a more
acceptable public health policy response than fortification alone. Such a policy will reduce
incremental direct Government expenditures on vitamin A programs by nearly 20% and will
reduce the number of children with IVAI to 900,000 (12%) Filipino children. The paper
describes the fortification and supplementation programs, and how their costs were estimated.
Lessons for program designers and policymakers in other countries in which vitamin A
deficiency constitutes a public health problem are also discussed. 7 2000 Elsevier Science Ltd.
All rights reserved.
Keywords: Cost-effectiveness analysis; Health care financing; Vitamin A; Micronutrients;
Public policy

The effect of vitamin A-fortified coconut cooking oil on the serum retinol
concentration of Filipino children 4-7 years old
A 6-month intervention trial was conducted among 542 Filipino children aged 4 to 7 years to
determine the effect of vitamin A-fortified coconut cooking oil intake on their vitamin A status
and to identify factors that influence this. Children were randomly assigned to the Experimental
group, with vitamin A-fortified cooking oil ration; to Control-1 group with unfortified cooking
oil ration; and to Control-2 group without cooking oil ration. In all groups, childrens serum
retinol concentration improved. Relative change in serum retinol concentration was significantly
higher among the Experimental group, with one-third of total vitamin A intake coming from
vitamin A-fortified cooking oil intake, than in the Control groups, with more than half of intake
from other vitamin A-rich foods. Determinants of post-intervention serum retinol concentration
included baseline serum retinol concentration, caregivers education, receipt of high-dose
vitamin A capsule, interaction between consumption of vitamin A-fortified cooking oil and of
other vitamin A-rich foods, and between households purchasing cooking oil and food
expenditure. Intake of vitamin A-fortified cooking oil combined with vitamin A-rich foods was
necessary to increase serum retinol concentration. It is recommended to vigorously promote the
consumption of vitamin A-fortified cooking oil together with other vitamin A-rich sources to
sustain the prevention and control of vitamin A deficiency.
Key Words: vitamin A fortified coconut cooking oil, vitamin A status, serum retinol
concentration, weight for height, Filipino children, Philippines

Vitamin A fortified cooking oil improved nutritional status and

reduce infection incidents of Vietnamese children
PPT

Vitamin A concentration was stable on cooking oil in the room temperature after 9 months of
storage. Almost vitamin A concentration still remains after boiling. Regular consumption of
vitamin A cooking oil improved serum retinol, Hb concentration, weight aged 3-5 years and has
less frequency of diarrheal episodes

The Costs and Effectiveness Of Three Vitamin A Interventions In Guatemala

Abtract--The purpose of the study presented in this paper was to estimate, using secondary
sources of data, the cost and effectiveness of three programs to combat vitamin A deficiency in
Guatemalathe national sugar fortification program, a targeted capsules distribution program
and the promotion of home food production combined with nutrition education--and to draw
conclusions concerning priorities for Guatemala. Data on the costs and coverage were collected
from implementing agencies in Guatemala. Coverage data were converted into a common set of
impact indicators. Sensitivity analyses were conducted on variables whose precise value was
uncertain. Potential impacts of improvements in program performance operations were also
explored. The analysis found the cost per high-risk person achieving adequate vitamin A to be

US$ 0.98 for fortification, US$ 1.68-1.86 for capsule distribution and US$ 3.10-4.16 for food
production/education. Fortification is the most efficient option if vitamin A levels in sugar are
maintained at reasonable levels. Where fortified sugar is not consumed and vitamin A deficiency
is highly prevalent, small-scale, targeted, complementary interventions such as capsules and food
production/education may be appropriate for sustained/broader impacts. Copyright ~() 1996 E
Key words--vitamin A, programs, cost-effectivenessier

Retensi Vitamin A Pada Minyak Goreng Curah Yang Difortifikasi Vitamin A

Dan Produk Gorengannya
Susenas data shows that almost 100 % of the Indonesian people consume cooking oil regularly
with an average per capita consumption of more than 20 gram/day. Palm oil is a dominant
cooking oil in Indonesian market. Approximately 70 % of palm oil is sold bulk in the market,
which is commonly called as minyak curah. Previous studies recommended that cooking oil,
particularly the bulk palm oil, should be used as the vehicle in vitamin A fortification. The
objective of the study was to evaluate the retention of vitamin A in foods that were fried using
the fortified bulk palm oil. The selected food products were the most frequently consumed food
by school children in Barranglompo Island, Makassar City, i.e of roti lasuna, roti kambu,
jalangkote, and ikan kembung como goreng. The study showed that the retention of vitamin A
significantly decreased with increasing number of frying repetition, but in general, the loss of
vitamin A was less than 50% after the third frying. The retention of vitamin A after the first,
second and third frying was in range of 81-94%, 64-77%, and 51-63% respectively.
Key words: fortification, vitamin retention, unbranded palm oil, vitamin
KONSUMSI MINYAK GORENG DAN VITAMIN A PADA BEBERAPA KELOMPOK
UMUR DI DUA KABUPATEN
Pemerintah Indonesia segera melaksanakan program fortifikasi wajib minyak goreng curah
dengan vitamin A. Studi pilot fortifikasi vitamin A sukarela minyak goreng menemukan setelah
satu tahun, serum vitamin A meningkat signifikan pada 5 kelompok umur tetapi tidak signifikan
pada kelompok 12-23 bulan. Tulisan ini bertujuan mengetahui tingkat konsumsi minyak goreng

dan vitamin A dari makanan yang merupakan factor penyebab naik atau tidak naiknya status
vitamin A pada enam kelompok. Studi potong lintang dilakukan di Tasikmalaya dan Ciamis
mencakup total 1.594 subjek anak 6 bulan - 9 tahun, wanita usia subur, dan ibu menyusui dari
keluarga miskin. Konsumsi minyak goreng dikumpulkan di tingkat rumah tangga dengan recall
frekuensi pembelian dan volume yang dibeli sedangkan tingkat individu dengan recall konsumsi
makanan 2x24 jam termasuk makanan yang dimasak dengan minyak goreng. Hasil penelitian
sebagian besar (96,2%) membeli minyak goreng curah dalam plastik, dibeli setiap 1-3 hari
(70,6%), dengan volume < 250 mL (73,9%). Rerata konsumsi minyak goreng di rumah tangga
27,5+1,0 mL/kapita/hari lebih tinggi dibanding rerata konsumsi di tingkat individu 22,3+0,5
mL/kapita/hari. Konsumsi minyak goreng menurut kelompok umur berbeda signifikan dengan
konsumsi untuk anak 6-11 bulan, 12-23 bulan, 24-59 bulan, 5-9 tahun, WUS, dan ibu menyusui
masing-masing 2,4+0,4, 13,3+0,8, 23,0+1,0, 30,5+1,3, 33,5+1,2, 33,1+1,3 mL/hari. Kesimpulan
penelitian konsumsi minyak goreng paling rendah pada anak 6-11 dan 12-23 bulan dibanding
kelompok lainnya, yang memberi kontribusi tidak naiknya serum vitamin A pada kelompok 1223 bulan, dibanding anak 6-11 bulan yang masih mendapat vitamin A dari ASI ataupun
kelompok lainnya karena konsumsi minyak goreng yang jauh lebih tinggi. [Penel Gizi Makan
2015, 38(1): 1-10]
Kata kunci: minyak goreng, konsumsi makanan