title: Estimating the Effective Coverage of Programs to Control Vitamin A Deficiency and Its Consequences Among Women and Young Children in Cameroon.
abstract: BACKGROUND
  To compare the cost-effectiveness of nutrition programs, the anticipated nutritional benefits of each intervention must be expressed using a common metric.
  
  
  OBJECTIVE
  We present the methodology for estimating the benefits of vitamin A (VA)-related interventions among women and children in Cameroon.
  
  
  METHODS
  We estimated "reach" (proportion of the population that receives a program), "coverage" (proportion that is deficient and receives a program), and "effective coverage" (proportion that "converts" from inadequate to adequate VA intake following an intervention) using dietary data collected during a national survey in 3 macro-regions of Cameroon (North, South, and Yaoundé/Douala). Effective coverage of programs such as (bio)fortification and micronutrient powders was estimated by adding the dietary VA contributed by the intervention to baseline VA intakes, including the contribution of increased maternal VA intake to infant VA intake through increases in breast milk VA. For interventions that provide VA-related benefits through other pathways (eg, periodic high-dose VA supplements and deworming), we developed alternative methods of estimating "daily VA intake equivalents. "
  
  
  RESULTS
  Baseline VA intakes and intervention reach varied by geographic macro-region. On average, estimates of program reach were greater than the effective coverage estimates by ∼50%. Effective coverage varied by intervention package and macro-region, ranging from <20 000 (deworming, Yaoundé/Douala) to >400 000 (micronutrient powder or VA supplement, North) children effectively covered per year.
  
  
  CONCLUSIONS
  These estimates of effective coverage, along with macro-region-specific information on the costs of each intervention package, serve as inputs into an economic optimization model to identify the most cost-effective package of VA interventions for each macro-region of Cameroon.
authors.affiliation: Department of Nutrition, University of California-Davis, Davis, CA, USA renglestone@ucdavis.edu.
authors.forename: Reina
authors.initials: R
authors.lastname: Engle-Stone
authors.affiliation: Helen Keller International, Yaoundé, Cameroon.
authors.forename: Martin
authors.initials: M
authors.lastname: Nankap
authors.affiliation: Helen Keller International, Yaoundé, Cameroon.
authors.forename: Alex O
authors.initials: AO
authors.lastname: Ndjebayi
authors.affiliation: Department of Agricultural and Resource Economics, University of California-Davis, Davis, CA, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Vosti
authors.affiliation: Department of Nutrition, University of California-Davis, Davis, CA, USA Bill & Melinda Gates Foundation, Seattle, WA, USA.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D002163:Cameroon / Q000453:epidemiology; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D005260:Female; D005527:Food, Fortified; D006801:Humans; D007223:Infant; D039382:Maternal Nutritional Physiological Phenomena; D008875:Middle Aged; D008962:Models, Theoretical; D009313:National Health Programs; D018673:Nutrition Policy; D015397:Program Evaluation; D014801:Vitamin A / Q000008:administration & dosage; D014802:Vitamin A Deficiency / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D014801:Vitamin A
keywords: Cameroon; Vitamin A; dietary assessment; effective coverage