Objectives
Micronutrient deficiencies (MNDs) are a serious but often invisible form of malnutrition. They increase the morbidity and mortality in children and undermine their cognitive and physical development. MNDs are endemic in children under 5 in Pakistan. This study estimated the societal costs of MNDs in a birth cohort of Pakistani children affected by MNDs between the ages of 6 and 59 months. It followed an incidence based approach by calculating the cost-consequences of MNDs in childhood over the whole lifetime.
Methods
We developed a health economic model estimating the lifetime health and cost consequences of iodine, iron, vitamin A, and zinc deficiency. The model proceeds in 4 steps: 1) Stratify the population by 2 age groups (6-23 months and 24-59 months) and 10 socio-economic strata. 2) Assess the level of MNDs in each of the 20 sub-groups. 3) Identify the health consequences of MNDs. 4) Quantify the resulting medical costs and production losses in terms of US-Dollars and intangible costs in terms of disability-adjusted life-years (DALYs). The estimation was based on 2 large population surveys on nutrition and health status, information on the health consequences of MNDs extracted from randomised trials and a variety of other sources. Robustness of results was explored with univariate and probabilistic sensitivity analysis.
Results
Total societal costs of the MNDs amounted to USD 64 million in medical costs, USD 3,137 million in production losses and 3.3 million DALYs in intangible costs. Costs were dominated by MNDs in 6-23 month-old children with 89.6% of production losses and 79.3% of intangible costs. The high costs in the 6-23 month-old children were mainly due to the impaired cognitive development induced by iron deficiency in this age group and to the mortality caused by vitamin A deficiency. Iron deficiency was responsible for approximately two thirds of production losses and intangible costs. Costs were substantially higher in poorer households.
Conclusions
The societal costs of MNDs in 6-59-month-old children amounted to 1.35% of gross domestic product and 4.27% of DALYs in Pakistan in 2013. 6-23 month-old children were especially affected due to the irreversible effects of iron deficiency on cognitive development. MNDs contribute to a malnutrition-based poverty trap affecting the overall development of the country. The cost of MNDs could be eliminated by improved nutrition and by public health measures. Our results may contribute to the design of effective and cost-effective interventions aiming to reduce MNDs in early childhood.
