{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T13:07:15Z","timestamp":1777640835001,"version":"3.51.4"},"reference-count":49,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2017,10,2]],"date-time":"2017-10-02T00:00:00Z","timestamp":1506902400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Nestl\u00e9 Research Center"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Food Nutr Bull"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>In Pakistan, nearly half of children younger than 5 years are stunted, and 1 in 3 is underweight. Micronutrient deficiencies, a less visible form of undernutrition, are also endemic. They may lead to increased morbidity and mortality as well as to impaired cognitive and physical development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To estimate the lifetime costs of micronutrient deficiencies in Pakistani children aged between 6 and 59 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We develop a health economic model of the lifetime health and cost consequences of iodine, iron, vitamin A, and zinc deficiencies. We assess medical costs, production losses in terms of future incomes lost, and disability-adjusted life-years (DALYs). The estimation is based on large population surveys, information on the health consequences of micronutrient deficiencies extracted from randomized trials, and a variety of other sources.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Total societal costs amount to US$46 million in medical costs, US$3,222 million in production losses, and 3.4 million DALYs. Costs are dominated by the impaired cognitive development induced by iron-deficiency anemia in 6- to 23-month-old children and the mortality caused by vitamin A deficiency. Costs are substantially higher in poorer households.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Societal costs amounted to 1.44% of gross domestic product and 4.45% of DALYs in Pakistan in 2013. These costs hinder the country's development. They could be eliminated by improved nutrition of 6- to 59-month-old children and public health measures. Our results may contribute to the design of cost-effective interventions aiming to reduce micronutrient deficiencies in early childhood and their lifetime consequences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0379572117720012","type":"journal-article","created":{"date-parts":[[2017,10,3]],"date-time":"2017-10-03T14:03:38Z","timestamp":1507039418000},"page":"485-500","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":20,"title":["Societal Costs of Micronutrient Deficiencies in 6- to 59-month-old Children in Pakistan"],"prefix":"10.1177","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1821-2944","authenticated-orcid":false,"given":"Simon","family":"Wieser","sequence":"first","affiliation":[{"name":"Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatrice","family":"Brunner","sequence":"additional","affiliation":[{"name":"Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Tzogiou","sequence":"additional","affiliation":[{"name":"Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafael","family":"Plessow","sequence":"additional","affiliation":[{"name":"Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael B.","family":"Zimmermann","sequence":"additional","affiliation":[{"name":"Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Farebrother","sequence":"additional","affiliation":[{"name":"Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sajid","family":"Soofi","sequence":"additional","affiliation":[{"name":"Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zaid","family":"Bhatti","sequence":"additional","affiliation":[{"name":"Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imran","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zulfiqar A.","family":"Bhutta","sequence":"additional","affiliation":[{"name":"Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2017,10,2]]},"reference":[{"key":"bibr1-0379572117720012","doi-asserted-by":"publisher","DOI":"10.3390\/nu5041384"},{"key":"bibr2-0379572117720012","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60076-2"},{"key":"bibr3-0379572117720012","volume-title":"National Nutrition Survey Pakistan 2011","year":"2012"},{"key":"bibr4-0379572117720012","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9781139225793.010"},{"key":"bibr5-0379572117720012","doi-asserted-by":"publisher","DOI":"10.1017\/S2040174409990158"},{"key":"bibr6-0379572117720012","volume-title":"Global Nutrition Report 2015: Actions and Accountability to Advance Nutrition and Sustainable Development","author":"Haddad L","year":"2015"},{"key":"bibr7-0379572117720012","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-13-1167"},{"key":"bibr8-0379572117720012","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0136581"},{"key":"bibr9-0379572117720012","volume-title":"Pakistan Demographic and Health Survey 2012-13","author":"National Institute of Population Studies (NIPS) [Pakistan] and ICF International","year":"2013"},{"key":"bibr10-0379572117720012","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60937-X"},{"key":"bibr11-0379572117720012","volume-title":"Assessment of Iodine Deficiency Disorders and Monitoring Their Elimination. 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