A tablet that costs less than 5 gourdes (or US$0.08) could end up saving more than 15,000 Haitian lives over the next 12 years, according to new research for Haiti Priorise.
Haiti Priorise is a research project in which experts study the costs and effects of different approaches to solving Haitian challenges, from education and economic initiatives to environmental ones.
Some of the highest returns on investment are those identified by Stephen Vosti of the University of California, Davis, and colleagues, in an examination of Haitian nutrition.
Professor Vosti has studied micronutrient malnutrition – when the body lacks the necessary vitamins and minerals to thrive. He identifies two different approaches: preventative nutritional investments, and those that treat malnutrition in babies.
Anemia and micronutrient deficiencies affect a large proportion of the population in Haiti. An estimated 21% of children born in the last three years had a low birth weight, although birth weight was reported in only one quarter of births. According to the most recent data, half of women of reproductive age and 65% of preschool children were anemic, or lacking in healthy red blood cells. Anemia in pregnancy is associated with an increased risk of infant mortality, preterm delivery, and low birth weight.
Providing pregnant women with calcium and other micronutrients would reduce the risk of anemia as well as pre-eclampsia or eclampsia, potentially dangerous complications that occur during or after pregnancy.
Each micronutrient tablet costs three gourdes ($0.05), or even less for calcium alone. Spending 7.6 billion gourdes ($117.6 million) would avert 15,200 deaths over 12 years, the majority of them newborns. It would prevent 18,800 cases of anemia in pregnant women, and it would make Haitians 79.8 billion gourdes ($1.2 billion) wealthier, because healthier adults can earn more money. It would mean 120,591 pre-term births would be avoided, and 200,000 newborns would not be of low birth-weight. All told, every gourde spent on this initiative would generate benefits worth ten gourdes.
Between the ages of 6 and 24 months, Vosti and his coauthors look at another way to help: we can provide young children with micronutrient sachets to prevent anemia and micronutrient deficiencies. A sachet for one day costs just one gourde ($0.02), and children need sachets for four months each year. This is very cheap, costing just over 157 million gourdes ($2.4 million) to reach 1.4 million children over 12 years.
Around 417,690 cases of anemia will be averted over 12 years for pre-school aged children. Every gourde spent will generate benefits to Haiti worth 8 gourdes.
However, getting people to take pills or sachets is harder than simply improving the nutrition of the food that they are already eating. Professor Vosti and his colleagues suggest adding iron and folic acid to wheat flour, something that is done around the world. This is known as ‘fortification’ and, while it is mandatory according to Haitian law, it appears that most flour in Haiti is not fortified with these micronutrients.
Spending just 331 million gourdes ($5.1 million) on pre-mixed micronutrients, equipment and training, would save 1,300 newborn lives over 12 years, as well as avert 869,000 cases of anemia in women, 562,000 cases of anemia in pre-school aged children, and 927,000 cases of anemia in school-aged children.
These are extraordinarily high benefits for a relatively small investment. Put into monetary terms, each gourde spent would generate benefits worth 24 gourdes.
These three approaches would all aim to prevent the challenges of malnutrition before they occur. But Professor Vosti also examines how to deal with severe and moderate malnutrition in young children, which affect tens of thousands of Haitians every year.
What is required is improving and expanding the screening of malnutrition for children under 5 years of age from the current level of 70 percent to 95 percent, and providing those who need it with a therapeutic food.
This would cost about 1.18 billion gourdes ($18.3 million). Of this, one-third would cover the costs of “ready to use food” (RUTF) products, one-third would cover additional personnel costs, and one-third would cover the costs of transporting children to/from treatment centers. The same formula could be made with local ingredients, which would save about 50 million gourdes ($774,000).
A 12-year intervention will screen an additional 1.7 million children, treat approximately 351,000 additional cases, and save more than 5,700 lives.
The results of every investment in nutrition can be measured in the numbers of lives saved. This research shows that preventing and treating micronutrient malnutrition would be highly effective for Haiti.