Evaluation Of The Effects Of Iron-Fortified Soy Sauce On Control And Prevention Of Anemia And IDA In China

Micronutrient deficiency is a public health problem which has attracted attention worldwide and ID is considered a main cause of anemia.Anemia and ID affects cognitive performence of children and adult labor ability.Anemia affects growth of fetus during pregnancy and lead to fetal and maternal mortality.The World Health Organization considered about half of the anemia is caused by ID.Food fortification is widely used in many countries to improve micronutrient status and considered cost-effective.Iron fortification has been demonstrated effective in several regions and countries.Anemia and ID threaten health of the resident in China,the largest developing country in the world,especially the health of children and pregnant women.The national nutrition survey showed that anemia prevalence decreased from 20.1%to 9.7%from 2002 to 2010-2012.Since 2004,IFSS has been promoted in the market in whole country and proved to have positive effects on anemia and ID.This study is targeted to understand the possible contribution of IFSS in control and prevention anemia and IDA through required parameters including changes of anaemia and IDA prevalence,survey conducted for IFSS coverageand consumptioneestimation of recovered numbers of population etc.Systematic review and mata-analysis and cost-effectiveness model were used in the study..Part 1.The ID and IDA prevalencesIn this study,meta analysis was used to analyze ID prevalence and IDA prevalence before IFSS project conducted.Papers and reports published during 1998-2007 were retrieved through electronic databases and included by a strict procedule of screening and review criteria.To extract the data from the screend articles,subjects were divided into children,pregnant women,and the general,R software was used to calculate the incidence of iron deficiency and iron deficiency anemia.Results showed that the rate of iron deficiency of general,children and pregnant woman was 29%?29%?35%respectively and the rate of IDA was 12%,9%,19%respectively.Part 2.The consumption survey of IFSSMarket investigation was conducted in 18 counties and cities of five provinces to collect information of the sales and the consumption of IFSS..Questionnaires designed for family information,IFSS purchase and consumption and ID status of the subjects etc.And the market information of IFSS in large retail terminal in 27 counties and cities of 8 provinces.The survey showed that 7.4%consumers have consumpted IFSS all the year,39.1%people have IFSS more than two months,53.7%people have consumpted IFSS less than two months.On average price of a bottle or 500 ml of IFSS was Y0.5 higher than that of non-fortified soy sauce.Part 3.Assessment of the effect of IFSS on IDAThe total numbers of IFSS consumers and the total numbers of consumers with improved anemia status were estimated based on the data of IFSS sales and proportions of three consumer groups from 2002 to 2012.According to the population data and the prevalence of anemia from National Bureau of Statistics of China(NBS)in 2002 and 2012,the effect of IFSS on anmemia was assessed in accordance with the total numbers of consumers recovered from anemia and the numbers of reduced from anemia.Due to lack of information ofIDA prevalence,the prevalence of 6-21 year city women IDA wasstudied.From 2002 to 2012,the contribution of IFSS on IDA reduction of 6-21 years old ruban female and on anemia of whole population were 12.0%and 22.7%,respectively.Part 4.Analysis of cost-benefits of IFSS projectThe direct and indirect costs of IFSS project were calculated,including the cost of iron fortificant and fund from government and international organizations.The benefits of IFSS consumption were calculated as rsaved losses including labor capacity of present adults,labor capacity of children in future as grown-ups,perinatal death and tdeath of pregnant women.The direct cost of the project was 35.27 million yuan,the indirect cost was 352.7 million yuan and the total cost was 387.97 million yuan.The total benefits was 30.93758 billion yuan,including 17.47231 billion yuan from the saved loss of adult labor capacity,2.57571 billion yuan from saved loss of children's future labor capacity,803.2032 million yuan from the loss of the perinatal death and 30.93758 billion yuan from saved loss of pregnant women death.The economic benefit of IFSS project was 1:79.7 based on the above data.