{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T09:11:09Z","timestamp":1790673069834,"version":"4.1.0"},"reference-count":29,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T00:00:00Z","timestamp":1628121600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"UC Davis Medical Student Research Fellowship"},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["1170661"],"award-info":[{"award-number":["1170661"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Food Nutr Bull"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Policy makers aiming to reduce micronutrient deficiencies (MNDs) and their health effects must choose among alternative definitions of impact when evaluating cost-effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Estimate the cost-effectiveness of a mandatory wheat flour fortification program for reducing cases of MNDs (iron, zinc, folate, vitamin B12), anemia and neural tube defects (NTDs) averted, and disability-adjusted life years (DALYs) averted in urban Cameroon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A 13-year predictive model was developed, including a 3-year start-up period and 10 years of program activity. Costs were estimated using historical program budgets. Effects were calculated based on observed changes in prevalence of MND and anemia 1 year postfortification and predicted reductions in NTDs based on NTD burden and wheat flour intake. Total DALYs averted were estimated for anemia and NTDs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The program cost \u223c$2.4 million over 13 years and averted an estimated \u223c95 000 cases of maternal anemia and \u223c83 500 cases of iron deficiency among children after 1 year. Cost\/case-year averted for MNDs ranged from $0.50 for low plasma folate to $3.30 for iron deficiency and was $2.20 for maternal anemia. The program was predicted to avert 1600 cases of NTDs over 10 years at \u223c$1500 per case averted. Estimated cost\/DALY averted was $50 for NTDs and $115 for anemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In Cameroon, cost-effectiveness of wheat flour fortification varied by the measure of impact employed, but was classified as \u201cvery cost-effective\u201d for all outcomes using World Health Organization criteria. Policy makers and their advisors must determine how best to use information on program costs and benefits to inform their decisions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03795721211020716","type":"journal-article","created":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T05:25:35Z","timestamp":1628141135000},"page":"551-566","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Predicted Effects and Cost-Effectiveness of Wheat Flour Fortification for Reducing Micronutrient Deficiencies, Maternal Anemia, and Neural Tube Defects in Yaound\u00e9 and Douala, Cameroon"],"prefix":"10.1177","volume":"42","author":[{"given":"Arram","family":"Noshirvan","sequence":"first","affiliation":[{"name":"University of California Davis School of Medicine, Sacramento, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Wu","sequence":"additional","affiliation":[{"name":"University of California Davis School of Medicine, Sacramento, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6253-5818","authenticated-orcid":false,"given":"Hanqi","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Nutrition, University of California Davis, Davis, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Kagin","sequence":"additional","affiliation":[{"name":"Kagin\u2019s Consulting, Vacaville, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen A.","family":"Vosti","sequence":"additional","affiliation":[{"name":"Department of Agricultural and Resource Economics, University of California Davis, Davis, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Ndjebayi","sequence":"additional","affiliation":[{"name":"Helen Keller International, Yaound\u00e9, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jules Guintang","family":"Assiene","sequence":"additional","affiliation":[{"name":"Helen Keller International, Yaound\u00e9, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismael","family":"Teta","sequence":"additional","affiliation":[{"name":"Helen Keller International, Yaound\u00e9, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Nankap","sequence":"additional","affiliation":[{"name":"UNICEF, Yaound\u00e9, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2446-6166","authenticated-orcid":false,"given":"Reina","family":"Engle-Stone","sequence":"additional","affiliation":[{"name":"Department of Nutrition, University of California Davis, Davis, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,8,5]]},"reference":[{"key":"bibr1-03795721211020716","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60937-X"},{"key":"bibr2-03795721211020716","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-06-508325"},{"key":"bibr3-03795721211020716","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldt015"},{"key":"bibr4-03795721211020716","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12720"},{"key":"bibr5-03795721211020716","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13527"},{"key":"bibr6-03795721211020716","volume-title":"Hunger and Malnutrition. 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Review of existing models to predict reductions in neural tube defects due to folic acid fortification, and model results using data from Cameroon.\n                      Adv Nutr\n                      . 2021; doi:10.1093\/advances\/nmab083.","DOI":"10.1093\/advances\/nmab083"},{"key":"bibr12-03795721211020716","volume-title":"Meeting Report: Interim Consensus Statement","author":"WHO, FAO, UNICEF, GAIN, MI, &amp; FFI","year":"2009"},{"key":"bibr13-03795721211020716","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-13-S3-S1"},{"key":"bibr14-03795721211020716","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyq028"},{"key":"bibr15-03795721211020716","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13548"},{"key":"bibr16-03795721211020716","doi-asserted-by":"publisher","DOI":"10.1093\/cdn\/nzz076"},{"key":"bibr17-03795721211020716","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/16.3.326"},{"key":"bibr18-03795721211020716","volume-title":"Global Burden of Disease Study 2016 (GBD 2016) Disability Weights","author":"Global Burden of Disease Collaborative Network","year":"2017"},{"key":"bibr19-03795721211020716","unstructured":"World Health Organization Cameroon\u00a0\u2013 Life expectancy at birth. 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