期刊论文详细信息
BMC Public Health
Evaluating the cost-effectiveness of preventive zinc supplementation
Jesse Heitner1  Günther Fink1 
[1] Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, 02115 Boston, MA, USA
关键词: ALRI;    Diarrhea;    Cost-effectiveness;    Zinc supplementation;   
Others  :  1128301
DOI  :  10.1186/1471-2458-14-852
 received in 2014-06-27, accepted in 2014-08-06,  发布年份 2014
PDF
【 摘 要 】

Background

Even though the WHO currently recommends zinc for diarrhea management, no consensus has been reached with respect to routine distribution of zinc for preventive reasons. We reviewed the health impact of preventive zinc interventions, and evaluated the relative cost effectiveness of currently feasible interventions.

Methods

Using the latest relative risk estimates reported in the literature, we parameterized a health impact model, and calculated the expected benefits of zinc supplementation in a representative low-income country. We then computed the cost and cost-effectiveness for three delivery mechanisms: the direct distribution of zinc supplements, the distribution of micronutrient biscuits including zinc, and the distribution of zinc through water filtration systems.

Results

Combining all health outcomes and impact estimates, we find that systematic zinc supplementation among children of ages one to five would avert 1.423 DALYs per 100 households and year in least developed countries. The estimated cost per DALY is US$ 606 for pill supplementation, US$ 1211 for micronutrient biscuits, and US$ 879 per DALY saved for water filtration systems.

Conclusions

Preventive zinc supplementation to children of ages 1–5 appears to be a highly cost-effective intervention in typical developing country settings. More research will be needed to determine the most effective mechanism to deliver zinc to this target population.

【 授权许可】

   
2014 Fink and Heitner; licensee BioMed Central Ltd.

【 预 览 】
附件列表
Files Size Format View
20150222171100706.pdf 548KB PDF download
Figure 1. 69KB Image download
【 图 表 】

Figure 1.

【 参考文献 】
  • [1]Hess SY, Lönnerdal B, Hotz C, Rivera JA, Brown KH: Recent advances in knowledge of zinc nutrition and human health. In International Zinc Nutrition Consultative Group Technical Document No 2 Systematic reviews of zinc intervention strategies Edited by Brown KH, Hess SY. 2009.
  • [2]IZiNCG: Assessment of the risk of zinc deficiency in populations and options for its control. Food Nutr Bull 2004, 25:91-204.
  • [3]Caulfield L, Black R: Zinc deficiency. In Comparative quantification of health risks: Global and regional burden of disease attributable to select major risk factors. Edited by Ezzati M, Lopez A, Rodgers A, Murray C. Geneva: World Health Organization; 2004.
  • [4]WHO: Clinical management of acute diarrhoea. Geneva/New York: World Health Organization/UNICEF; 2004.
  • [5]WHO: Implementing the new recommendations of the clinical management of diarrhoea. Geneva: World Health Organization; 2006.
  • [6]Gulani A, Bhatnagar S, Sachdev HP: Neonatal zinc supplementation for prevention of mortality and morbidity in breastfed low birth weight infants: systematic review of randomized controlled trials. Indian Pediatr 2011, 48(2):111-117.
  • [7]Hotz C: The potential to improve zinc status through biofortification of staple food crops with zinc. Food Nutr Bull 2009, 30(1):172-178.
  • [8]Lira P, Ashworth A, Morris S: Effect of zinc supplementation on the morbidity, immune function, and growth of low-birth-weight, full-term infants in northeast Brazil. Am J Clin Nutrition 1998, 68(2 Suppl):418S-424S.
  • [9]Yakoob MY, Theodoratou E, Jabeen A, Imdad A, Eisele TP, Ferguson J, Jhass A, Rudan I, Campbell H, Black RE, Bhutta ZA: Preventive zinc supplementation in developing countries: impact on mortality and morbidity due to diarrhea, pneumonia and malaria. BMC Public Health 2011, 11(Suppl 3):23.
  • [10]Zeng L, Zhang L: Efficacy and safety of zinc supplementation for adults, children and pregnant women with HIV infection: systematic review. Trop Med Int Health 2011, 16(12):1474-1482.
  • [11]Olivares M, Pizarro F, Ruz M, López de Romaña D: Acute inhibition of iron bioavailability by zinc: studies in humans. Biometals 2012, 25(4):657-664.
  • [12]Baqui A, Walker C, Zaman K, El Arifeen S, Chowdhury H, Wahed M, Black R, Caulfield L: Weekly iron supplementation does not block increases in serum zinc due to weekly zinc supplementation in Bangladeshi infants. J Nutr 2005, 135(9):2187-2191.
  • [13]Brown KH, Peerson JM, Baker SK, Hess SY: Preventive zinc supplementation among infants, preschoolers, and older prepubertal children. Food Nutr Bull 2009, 20(1):12-40.
  • [14]Nguyen P, Grajeda R, Melgar P, Marcinkevage J, Flores R, Ramakrishnan U, Martorell R: Effect of Zinc on Efficacy of Iron Supplementation in Improving Iron and Zinc Status in Women. J Nutr Metab 2012., (216179)
  • [15]Rossander-Hultén L, Brune M, Sandström B, Lönnerdal B, Hallberg L: Competitive inhibition of iron absorption by manganese and zinc in humans. Am J Clin Nutr 1991, 54(1):152-156.
  • [16]Hess SY, Brown KH: Impact of zinc fortification on zinc nutrition. Food Nutr Bull 2009, 30(1):79-107.
  • [17]Gibson RS, Anderson VP: A review of interventions based on dietary diversification or modification strategies with the potential to enhance intakes of total and absorbable zinc. Food Nutr Bull 2009, 30(1):108-143.
  • [18]WHO: CHOosing Interventions that are Cost Effective (WHO-CHOICE). Geneva: WHO; 2004.
  • [19]Stein AJ: Micronutrient malnutrition and the impact of modern plant breeding on public health in India: How cost-effective is biofortification?. Cuvillier: Göttingen; 2006.
  • [20]Meenakshi JV, Johnson NL, Manyong VM, DeGroote H, Javelosa J, Yanggen DR, Naher F, Gonzalez C, García J, Meng E: How Cost-Effective is Biofortification in Combating Micronutrient Malnutrition? An Ex ante Assessment. World Dev 2010, 38(1):64-75.
  • [21]Gold MR, Siegel JE, Russell LB, Weinstein MC: Cost-Effectiveness in Health and Medicine. Oxford: Oxford University Press; 1996.
  • [22]WHO: Making Choices in Health: WHO Guide to Cost-Effectiveness Analysis. Geneva: WHO; 2003.
  • [23]WHO: Global Burden of Disease 2004 Update: Disability Weights for Diseases and Conditions. Geneva: World Health Organization; 2004.
  • [24]UNPD: World Population Prospects 2012. New York: United Nations Population Division; 2012.
  • [25]MEASURE DHS: DHS Stat Compiler. Calverton, MD: Measure DHS; 2012. http://www.statcompiler.com/ webcite
  • [26]UNICEF: The state of the world’s children 2012: Children in an urban world. Edited by UNICEF. New York: UNICEF; 2012.
  • [27]Umeta M, West C, Haidar J, Deurenberg P, Hautvast J: Zinc supplementation and stunted infants in Ethiopia: a randomised controlled trial. Lancet 2000, 355(9220):2021-2026.
  • [28]Roth DE, Richard SA, Black RE: Zinc supplementation for the prevention of acute lower respiratory infection in children in developing countries: meta-analysis and meta-regression of randomized trials. Int J Epidemiol 2010, 39:795-808.
  • [29]Robberstad B, Strand T, Black R, Sommerfelt H: Cost-effectiveness of zinc as adjunct therapy for acute childhood diarrhoea in developing countries. Bull World Health Organ 2004, 82(7):523-531.
  • [30]Nga TT, Winichagoon P, Dijkhuizen MA, Khan NC, Wasantwisut E, Furr H, Wieringa FT: Multi-Micronutrient-Fortified Biscuits Decreased Prevalence of Anemia and Improved Micronutrient Status and Effectiveness of Deworming in Rural Vietnamese School Children. J Nutr 2009, 139:1-9.
  • [31]Aggarwal R, Sentz J, Miller MA: Role of Zinc Administration in Prevention of Childhood Diarrhea and Respiratory Illnesses: A Meta-analysis. Pediatr Rev 2007, 119(1120):1120-1130.
  • [32]Patel AB, Mamtani M, Badhoniya N, Kulkarni H: What zinc supplementation does and does not achieve in diarrhea prevention: a systematic review and meta-analysis. BMC Infect Dis 2011., 11(122) http://www.biomedcentral.com/1471-2334/11/122 webcite
  • [33]Lassi ZS, Haider BA, Bhutta ZA: Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months. Cochrane Database Syst Rev 2010., 12CD005978
  • [34]Ninh N, Thissen J, Collette L, Gerard G, Khoi H, Ketelslegers J: Zinc supplementation increases growth and circulating insulin-like growth factor I (IGF-I) in growth-retarded Vietnamese children. Am J Clin Nutr 1996, 63(4):514-519.
  • [35]Ruel M, Rivera J, Santizo M, Lönnerdal B, Brown K: Impact of zinc supplementation on morbidity from diarrhea and respiratory infections among rural Guatemalan children. Pediatr Rev 1997, 99(6):808-813.
  • [36]Richard S, Zavaleta N, Caulfield L, Black R, Witzig R, Shankar A: Zinc and iron supplementation and malaria, diarrhea, and respiratory infections in children in the Peruvian Amazon. Am J Trop Med Hyg 2006, 75(1):126-132.
  • [37]Chhagan M, Van den Broeck J, Luabeya K, Mpontshane N, Tucker K, Bennish M: Effect of micronutrient supplementation on diarrhoeal disease among stunted children in rural South Africa. Eur J Clin Nutr 2009, 63(7):850-857.
  • [38]Baqui A, Zaman K, Persson L, El Arifeen S, Yunus M, Begum N, Black R: Simultaneous weekly supplementation of iron and zinc is associated with lower morbidity due to diarrhea and acute lower respiratory infection in Bangladeshi infants. J Nutr 2003, 133(12):4150-4157.
  • [39]Lind T, Lönnerdal B, Stenlund H, Gamayanti I, Ismail D, Seswandhana R, Persson L: Am J Clin Nutr. A community-based randomized controlled trial of iron and zinc supplementation in Indonesian infants: effects on growth and development 2004, 80(3):729-736.
  • [40]Penny M, Marin R, Duran A, Peerson J, Lanata C, Lönnerdal B, Black R, Brown K: Randomized controlled trial of the effect of daily supplementation with zinc or multiple micronutrients on the morbidity, growth, and micronutrient status of young Peruvian children. Am J Clin Nutrition 2004, 79(3):457-465.
  • [41]Alarcon K, Kolsteren P, Prada A, Chian A, Velarde R, Pecho I, Hoeree T: Effects of separate delivery of zinc or zinc and vitamin A on hemoglobin response, growth, and diarrhea in young Peruvian children receiving iron therapy for anemia. Am J Clin Nutrition 2004, 80(5):1276-1282.
  • [42]Long K, Montoya Y, Hertzmark E, Santos J, Rosado J: A double-blind, randomized, clinical trial of the effect of vitamin A and zinc supplementation on diarrheal disease and respiratory tract infections in children in Mexico City. Mexico Am J Clin Nutrition 2006, 83(3):693-700.
  • [43]Brown K, López de Romaña D, Arsenault J, Peerson J, Penny M: Comparison of the effects of zinc delivered in a fortified food or a liquid supplement on the growth, morbidity, and plasma zinc concentrations of young Peruvian children. Am J Clin Nutr 2007, 85(2):538-547.
  • [44]Wuehler S, Sempértegui F, Brown K: Dose-response trial of prophylactic zinc supplements, with or without copper, in young Ecuadorian children at risk of zinc deficiency. Am J Clin Nutr 2008, 87(3):723-733.
  • [45]Shankar A, Genton B, Baisor M, Paino J, Tamja S, Adiguma T, Wu L, Rare L, Bannon D, Tielsch J, West K, Alpers M: The influence of zinc supplementation on morbidity due to Plasmodium falciparum: a randomized trial in preschool children in Papua New Guinea. Am J Trop Med Hyg 2000, 62(6):663-669.
  • [46]Bhandari N, Bahl R, Taneja S, Strand T, Mølbak K, Ulvik R, Sommerfelt H, Bhan M: Effect of routine zinc supplementation on pneumonia in children aged 6 months to 3 years: randomised controlled trial in an urban slum. BMJ 2002, 324(7350):1358.
  • [47]Brown KH, Rivera JA, Bhutta Z, Gibson RS, King JC, Lonnerdal B, Ruel MT, Sandtrom B, Wasantwisut E, Hotz C: International Zinc Nutrition Consultative Group (IZiNCG) technical document #1. Assessment of the risk of zinc deficiency in populations and options for its control Food Nutr Bull 2004, 25(1 Suppl 2):S99-S203.
  • [48]Brown KH, Peerson JM, Rivera J, Allen LH: Effect of supplemental zinc on the growth and serum zinc concentrations of prepubertal children: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2002, 75(6):1062-1071.
  • [49]Mori R, Ota E, Middleton P, Tobe-Gai R, Mahomed K, Bhutta ZA: Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst Rev 2012., 7CD000230
  • [50]Krebs NF: Overview of zinc absorption and excretion in the human gastrointestinal tract. J Nutr 2000, 130(5S Suppl):1374S-1377S.
  • [51]Lonnerdal B: Dietary factors influencing zinc absorption. J Nutr 2000, 130(5S Suppl):1378S-1383S.
  • [52]Salgueiro MJ, Zubillaga M, Lysionek A, Caro R, Weill R, Boccio J: Fortification strategies to combat zinc and iron deficiency. Nutr Rev 2002, 60(2):52-58.
  • [53]Chang S, El Arifeen S, Bari S, Wahed MA, Rahman KM, Rahman MT, Mahmud AB, Begum N, Zaman K, Baqui AH, Black RE: Supplementing iron and zinc: double blind, randomized evaluation of separate or combined delivery. Eur J Clin Nutr 2010, 64(2):153-160.
  • [54]Sazawal S, Black RE, Ramsan M, Chwaya HM, Stoltzfus RJ, Dutta A, Dhingra U, Kabole I, Deb S, Othman MK, Kabole FM: Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial. Lancet 2006, 367(9505):133-143.
  • [55]Zlotkin S, Arthur P, Schauer C, Antwi KY, Yeung G, Piekarz A: Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children. J Nutr 2003, 133(4):1075-1080.
  • [56]Soofi S, Cousens S, Iqbal SP, Akhund T, Khan J, Ahmed I, Zaidi AK, Bhutta ZA: Effect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: a cluster-randomised trial. Lancet 2013, 382(9886):29-40.
  • [57]Salam RA, MacPhail C, Das JK, Bhutta ZA: Effectiveness of Micronutrient Powders (MNP) in women and children. BMC Public Health 2013, 13(Suppl 3):S22.
  • [58]Das JK, Salam RA, Kumar R, Bhutta ZA: Micronutrient fortification of food and its impact on woman and child health: a systematic review. Systematic reviews 2013, 2:67.
  • [59]Tran CD, Miller LV, Krebs NF, Lei S, Hambidge KM: Zinc absorption as a function of the dose of zinc sulfate in aqueous solution. Am J Clin Nutr 2004, 80(6):1570-1573.
  • [60]Solomons NW, Romero-Abal ME, Weiss G, Michalke B, Schumann K: Bioavailability of zinc from NutriSet zinc tablets compared with aqueous zinc sulfate. Eur J Clin Nutr 2011, 65(1):125-131.
  • [61]Bongaarts J: Household size and composition in the developing world in the 1990s. Popul Stud 2001, 55(3):263-279.
  • [62]Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B, International Child Development Steering Group: Developmental potential in the first 5 years for children in developing countries. Lancet 2007, 369:60-70.
  • [63]Black RE, Allen LH, Bhutta ZA, Caulfield LE, Onis M, Ezzati M, Mathers C, Rivera J: Maternal and child undernutrition: global and regional exposures and health consequences. Lancet Infect Dis 2008, 371(9608):243-260.
  • [64]Brooks W, Yunus M, Santosham M, Wahed M, Nahar K, Yeasmin S, Black R: Zinc for severe pneumonia in very young children: double-blind placebo-controlled trial. Lancet 2004, 363(9422):1683-1688.
  • [65]Srinivasan M, Ndeezi G, Mboijana C, Kiguli S, Bimenya G, Nankabirwa V, Tumwine J: Zinc adjunct therapy reduces case fatality in severe childhood pneumonia: a randomized double blind placebo-controlled trial. BMC Med 2012., 10(14) http://www.biomedcentral.com/1741-7015/10/14 webcite
  • [66]Gitanjali B, Weerasuriya K: Journal of Pharmacology and Pharmacotherapeutics. The curious case of zinc for diarrhea: Unavailable, unprescribed, and unused 2011, 2(4):225-229.
  • [67]World Food Programme Special Nutritional Products Webpage. http://www.wfp.org/nutrition/special-nutritional-products webcite
  • [68]Siegfried N, Irlam JH, Visser ME, Rollins NN: Micronutrient supplementation in pregnant women with HIV infection. Cochrane Database Syst Rev 2012., 3CD009755
  • [69]Humphreys EH, Smith NA, Azman H, McLeod D, Rutherford GW: Prevention of diarrhoea in children with HIV infection or exposure to maternal HIV infection. Cochrane Database Syst Rev 2010., 6CD008563
  • [70]Islam S, Loots DT: Diabetes, metallothionein, and zinc interactions: A review. Biofactors 2007, 29:203-212.
  • [71]Lai J, Moxey A, Nowak G, Vashum K, Bailey K, McEvoy M: The efficacy of zinc supplementation in depression: Systematic review of randomised controlled trials. J Affect Disord 2012, 136:e31-e39.
  • [72]Nagalla S, Ballas SK: Drugs for preventing red blood cell dehydration in people with sickle cell disease. Cochrane Database Syst Rev 2012., 7CD003426
  • [73]Kulier R, de Onis M, Gulmezoglu AM, Villar J: Nutritional interventions for the prevention of maternal morbidity. Int J Gynaecol Obstet 1998, 63(3):231-246.
  • [74]Worthington HV, Clarkson JE, Eden OB: Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev 2007., 4CD000978
  • [75]Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM: Water, sanitation, and hygiene interventions to reduce diarrhoea in developed countries: a systematic review and meta-analysis. Lancet Infect Dis 2005, 5(1):42-52.
  • [76]Zwane AP, Kremer M: What works in fighting diarrheal diseases in developing countries? a critical review. The World Bank Research Observer 2007, 22(1):1-24.
  • [77]Kremer M, Leino J, Miguel E, Zwane AP: Spring cleaning: rural water impacts, valuation and property rights institutions. Q J Econ 2011, 126:145-205.
  文献评价指标  
  下载次数:0次 浏览次数:3次