The Cost of Expanding Ethiopia's Salt Iodization Program to Include Multiple Micronutrients

Area of Science:

• Public Health Nutrition
• Food Fortification
• Micronutrient Deficiency Prevention

Background:

• Salt is a near-universally consumed staple with significant potential for public health impact through micronutrient fortification.
• Technological advancements enable the fortification of salt with multiple micronutrients beyond iodine.
• Modifying salt standards requires careful consideration of potential impacts and stakeholder costs.

Purpose of the Study:

• To estimate the total and incremental costs of expanding Ethiopia's salt iodization program.
• To assess the costs of fortifying salt with folic acid (dual), folic acid and vitamin B-12 (triple), or folic acid, vitamin B-12, and zinc (quadruple).

Main Methods:

• Activity-based cost models were developed to estimate fortification costs over a 10-year period (2024-2033).
• Model assumptions and parameters were informed by interviews with Ethiopian stakeholders in industry, government, and non-governmental organizations.

Main Results:

• Existing salt iodization costs approximately $2.1 million annually per capita.
• Expanding to dual fortification (iodine + folic acid) increases costs to ~$2.5 million annually per capita.
• Triple and quadruple fortification (requiring premixes) significantly increase costs to ~$18-19 million annually per capita, with premix costs comprising ~90% of the total.

Conclusions:

• Modifying Ethiopia's salt iodization standards to include additional micronutrients necessitates a thorough evaluation of costs and affordability.
• Cost estimates presented can supplement evidence on the effectiveness of multi-micronutrient fortified salt in reducing deficiencies.