The Cost of Expanding Ethiopia’s Salt Iodization Program to Include Multiple Micronutrients
Background: With near universal consumption of salt and technological advances that have made its fortification with multiple micronutrients feasible, salt has great potential for public health impact as a delivery vehicle for not only iodine but also multiple micronutrients. Decisions around modify...
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Elsevier
2025-08-01
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| Series: | Current Developments in Nutrition |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2475299125029695 |
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| author | Katherine P Adams Dawd Gashu Elias Asfaw Zegeye MG Venkatesh Mannar Levente L Diosady N Ananth E Louise Ander |
| author_facet | Katherine P Adams Dawd Gashu Elias Asfaw Zegeye MG Venkatesh Mannar Levente L Diosady N Ananth E Louise Ander |
| author_sort | Katherine P Adams |
| collection | DOAJ |
| description | Background: With near universal consumption of salt and technological advances that have made its fortification with multiple micronutrients feasible, salt has great potential for public health impact as a delivery vehicle for not only iodine but also multiple micronutrients. Decisions around modifying existing salt standards to include additional micronutrients should consider not only potential impacts but also stakeholder-specific costs. Objectives: We aimed to estimate the total and incremental cost of expanding Ethiopia’s salt iodization program to include folic acid (dual fortified salt), folic acid and vitamin B-12 (triple fortified salt), or folic acid, vitamin B-12, and zinc (quadruple fortified salt). Methods: We developed activity-based cost models to estimate salt fortification costs over a 10-y time horizon (2024–2033). Model assumptions and parameters were primarily based on interviews with Ethiopian stakeholders in industry and government and nongovernmental partners. Results: The estimated annual average per capita cost of Ethiopia’s existing salt iodization program was ∼$2.1 million (2021 US dollars) or ∼$7/metric ton (MT) of fortified salt (∼$0.02/y). Expanding the program to include folic acid, which could be sprayed onto salt along with the iodine, would increase the annual average per capita cost to ∼$2.5 million, or ∼$8.30/MT (∼$0.02/y). Annually, the costs of triple and quadruple fortified salt programs, which would require encapsulating the additional micronutrients as a solid premix to help ensure stability, were ∼$18 million (∼$59/MT; $0.13 per capita) and $19 million (∼$63/MT; ∼$0.14 per capita), respectively. Premix costs accounted for approximately half of the total cost of the iodized and dual fortified salt programs and ∼90% of triple and quadruple fortified salt. Conclusions: If Ethiopia considers modifying its existing salt iodization standard to include 1 or more additional micronutrients, there will be many important considerations, including costs and affordability. The cost estimates presented in this study can complement evidence of the potential for multiple fortified salt to reduce micronutrient deficiencies. |
| format | Article |
| id | doaj-art-4f9e72bb2dbf4874932ccc5b561d321b |
| institution | Kabale University |
| issn | 2475-2991 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Current Developments in Nutrition |
| spelling | doaj-art-4f9e72bb2dbf4874932ccc5b561d321b2025-08-24T05:13:57ZengElsevierCurrent Developments in Nutrition2475-29912025-08-019810750810.1016/j.cdnut.2025.107508The Cost of Expanding Ethiopia’s Salt Iodization Program to Include Multiple MicronutrientsKatherine P Adams0Dawd Gashu1Elias Asfaw Zegeye2MG Venkatesh Mannar3Levente L Diosady4N Ananth5E Louise Ander6Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA, United States; Corresponding author.Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, EthiopiaEconomics Department, University of KwaZulu-Natal, Durban, South Africa; Africa Centers for Disease Control and Prevention, Health Economics and Financing Division, Addis Ababa, EthiopiaDepartment of Chemical Engineering & Applied Chemistry, University of Toronto, Toronto, CanadaDepartment of Chemical Engineering & Applied Chemistry, University of Toronto, Toronto, CanadaNutrition Impact Solutions Inc., Toronto, CanadaSchool of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire, United Kingdom; Inorganic Geochemistry, Centre for Environmental Geochemistry, British Geological Survey, Nottingham, United KingdomBackground: With near universal consumption of salt and technological advances that have made its fortification with multiple micronutrients feasible, salt has great potential for public health impact as a delivery vehicle for not only iodine but also multiple micronutrients. Decisions around modifying existing salt standards to include additional micronutrients should consider not only potential impacts but also stakeholder-specific costs. Objectives: We aimed to estimate the total and incremental cost of expanding Ethiopia’s salt iodization program to include folic acid (dual fortified salt), folic acid and vitamin B-12 (triple fortified salt), or folic acid, vitamin B-12, and zinc (quadruple fortified salt). Methods: We developed activity-based cost models to estimate salt fortification costs over a 10-y time horizon (2024–2033). Model assumptions and parameters were primarily based on interviews with Ethiopian stakeholders in industry and government and nongovernmental partners. Results: The estimated annual average per capita cost of Ethiopia’s existing salt iodization program was ∼$2.1 million (2021 US dollars) or ∼$7/metric ton (MT) of fortified salt (∼$0.02/y). Expanding the program to include folic acid, which could be sprayed onto salt along with the iodine, would increase the annual average per capita cost to ∼$2.5 million, or ∼$8.30/MT (∼$0.02/y). Annually, the costs of triple and quadruple fortified salt programs, which would require encapsulating the additional micronutrients as a solid premix to help ensure stability, were ∼$18 million (∼$59/MT; $0.13 per capita) and $19 million (∼$63/MT; ∼$0.14 per capita), respectively. Premix costs accounted for approximately half of the total cost of the iodized and dual fortified salt programs and ∼90% of triple and quadruple fortified salt. Conclusions: If Ethiopia considers modifying its existing salt iodization standard to include 1 or more additional micronutrients, there will be many important considerations, including costs and affordability. The cost estimates presented in this study can complement evidence of the potential for multiple fortified salt to reduce micronutrient deficiencies.http://www.sciencedirect.com/science/article/pii/S2475299125029695large-scale food fortificationmultiple fortified saltcost modelEthiopiafolic acidzinc |
| spellingShingle | Katherine P Adams Dawd Gashu Elias Asfaw Zegeye MG Venkatesh Mannar Levente L Diosady N Ananth E Louise Ander The Cost of Expanding Ethiopia’s Salt Iodization Program to Include Multiple Micronutrients Current Developments in Nutrition large-scale food fortification multiple fortified salt cost model Ethiopia folic acid zinc |
| title | The Cost of Expanding Ethiopia’s Salt Iodization Program to Include Multiple Micronutrients |
| title_full | The Cost of Expanding Ethiopia’s Salt Iodization Program to Include Multiple Micronutrients |
| title_fullStr | The Cost of Expanding Ethiopia’s Salt Iodization Program to Include Multiple Micronutrients |
| title_full_unstemmed | The Cost of Expanding Ethiopia’s Salt Iodization Program to Include Multiple Micronutrients |
| title_short | The Cost of Expanding Ethiopia’s Salt Iodization Program to Include Multiple Micronutrients |
| title_sort | cost of expanding ethiopia s salt iodization program to include multiple micronutrients |
| topic | large-scale food fortification multiple fortified salt cost model Ethiopia folic acid zinc |
| url | http://www.sciencedirect.com/science/article/pii/S2475299125029695 |
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