Impacts of Vitamin A Degradation on the Effectiveness and Cost-Effectiveness of Vitamin A Fortification Programs: Modeled Evidence for Preschool Children in Nigeria

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Dietary vitamin A inadequacy remains a serious public health problem, especially among young children. Food and condiment fortification programs and policies are in place in many countries to address this issue, but degradation of the vitamin A added via fortification can reduce the quantity of vitamin A reaching consumers. We modeled the impacts of vitamin A degradation on program effectiveness and cost-effectiveness in fortified wheat flour, sugar, and (hypothetical) bouillon cubes in Nigeria. We used secondary data to estimate the prevalence of vitamin A inadequacy among young children (6-59 months), and the programs' modeled contributions to reducing vitamin A inadequacy at selected levels of vitamin A degradation. The Lives Saved Tool was used to estimate child-lives saved. Program costs were estimated using activity-based models. Vitamin A degradation had a large negative impact on program effectiveness. Over the 0% to 80% vitamin A degradation range, accounting for other existing programs, fortification of sugar (7.5 mg/kg), wheat flour (2 mg/kg), and bouillon cubes (96 mg/kg) would reduce inadequacies among children by 2.9 to 0.7 percentage points, 3.9 to 0.7 percentage points, and 20.6 to 9.6 percentage points, respectively. Over the same vitamin A degradation range, average annual child-lives saved ranged from 3984 to 769 (sugar), 3036 to 739 (wheat flour), and 15 301 to 7153 (bouillon cubes); estimated cost/child-life saved ranged from US$ 550 to US$ 2848 (sugar), US$ 1039 to US$ 4271 (wheat flour), and US$ 944 to US$ 2018 (bouillon cubes). Vitamin A fortificant selection, technological innovations in vitamin A fortificants, and/or changes in premix and fortified food handling and storage could reduce degradation; these options could increase program costs, but merit consideration.Stephen A. Vosti et al, Impacts of Vitamin A Degradation on the Effectiveness and Cost-Effectiveness of Vitamin A Fortification Programs: Modeled Evidence for Preschool Children in Nigeria, Food and Nutrition Bulletin (, ) pp. 3795721261458490. Copyright © 2026. DOI: 10.1177/03795721261458490. Users who receive access to an article through a repository are reminded that the article is protected by copyright and reuse is restricted to non-commercial and no derivative uses. Users may also download and save a local copy of an article accessed in an institutional repository for the user's personal reference. For permission to reuse an article, please follow our Process for Requesting Permission. Deposited by shareyourpaper.org and openaccessbutton.org. We've taken reasonable steps to ensure this content doesn't violate copyright. However, if you think it does you can request a takedown by emailing help@openaccessbutton.org.

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