title: Measuring the Costs of Vitamin A Interventions: Institutional, Spatial, and Temporal Issues in the Context of Cameroon.
abstract: BACKGROUND
  To address vitamin A (VA) deficiency, an array of interventions have been developed for increasing VA status among young children. With numerous possible combinations of interventions, however, comes the need to take decisions regarding which intervention or combination of interventions is most cost effective for achieving VA deficiency reduction targets.
  
  
  METHODS
  Detailed intervention-specific, "macro-region"-level data in Cameroon are used to generate estimates of the costs associated with delivering VA to children aged 6 to 59 months.
  
  
  RESULTS
  In Cameroon, our estimates of costs per effectively-covered child (ie, children at risk of inadequate intake of VA who are exposed to an intervention and who achieve adequate intake) each year (2 rounds of Child Health Days [CHDs]) were US$3.31 for VA supplements. VA fortification of edible oil and bouillon cube was US$2.95 and US$2.41, respectively, per child effectively covered per year, and biofortification of maize was US$5.30 per child effectively covered per year. Combinations of interventions could reduce costs (eg, delivering additional interventions that affect VA status through the CHDs). Spatial differences in costs within Cameroon were also evident, for example, delivering high-dose VA capsules through CHDs leads to a cost of US$0.77 per child reached in the northern regions compared to US$1.40 per child reached in the southern regions.
  
  
  CONCLUSIONS
  The costs associated with alternative VA interventions in Cameroon differ spatially, temporally, and in their cost-effectiveness. Choosing the appropriate combination of interventions can produce a more efficient portfolio of interventions to address VA deficiencies and VA-related deaths.
authors.affiliation: Kagin's Consulting, Vacaville, CA, USA justin.kagin@gmail.com.
authors.forename: Justin
authors.initials: J
authors.lastname: Kagin
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.
authors.forename: Reina
authors.initials: R
authors.lastname: Engle-Stone
authors.affiliation: Department of Ecology, University of California-Davis, Davis, CA, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Rettig
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
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
authors.initials: A
authors.lastname: Ndjebayi
mesh_terms: D002163:Cameroon / Q000453:epidemiology; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003657:Decision Making; D003710:Demography; D019587:Dietary Supplements; D005527:Food, Fortified / Q000191:economics*; D006801:Humans; D007223:Infant; D008962:Models, Theoretical; D009313:National Health Programs; D014801:Vitamin A / Q000008:administration & dosage; D014802:Vitamin A Deficiency / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D014801:Vitamin A
keywords: Cameroon; costs; micronutrient interventions; vitamin A