Some Strategies to Reduce Risk the women who currently attend antenatal clinics, only the costs of the iron and the addi tional time of the visit were included. However, expansion of coverage for iron supplemen tation purposes beyond current coverage of antenatal visits requires attributing the full cost of the necessary visits to the intervention Results Q Even though many groups in the population are likely to benefit from iron fortification, nly the impact on iron deficiency anaemia in pregnant women(with an impact on mater- nal health and prenatal mortality) has been included in the analysis. This understates the benefit, but these effects probably account for more than 95% of total deaths averted by fortification. Despite this, supplementation and fortification at 50% coverage are estimated to lead to increases in population health of almost 59 million and 29 million DALYs in turn globally when implemented over a 10-year period Supplementation yields greater improvements in population health than fortification in all subregions with high child mortality(all D and E subregions), and at all levels of coverage. In the other subregions, supplementation has a larger impact on population health than fortification for equivalent levels of coverage. On a global basis, supplementation at 80%would gain just over 9 million DALYs per year compared to doing nothing On the other hand, fortification is always less costly than supplementation because it does not require a visit to a provider, and the unit cost of supplementation increases sharply with increasing coverage. This means that the cost-effectiveness of fortification is always lower than the cost-effectiveness of supplementation, regardless of the coverage of fortifi cation. It, then, is the preferred option at low levels of resource availability However, in some settings iron fortification is hindered by the absence of ideal food rehicles that are eaten in sufficient quantities and it might be difficult to ensure coverage even as high as 50%. It is also hindered by the absence of ideal iron compounds that would be favorably absorbed, are stable and nonreactive, with little colour, and no taste of their own. Where people's diets are not based around cereal flours or another convenient food vehicle, supplementation is still a cost-effective option. Indeed, in areas with a high preva lence of iron-deficiency anaemia, it is still very cost-effective to spend the higher amounts on supplementation to achieve the greater population benefit. It is less cost-effective to take this option in areas where the burden from iron deficiency anaemia is relatively low, although the cost-effectiveness of switching from fortification to supplementation is be tween one and three times gDP per capita so does not fall into the band of cost-ineffective VITAMIN A DEFICIENCY Vitamin A deficiency is negligible in the European region of WHO, while deaths due to pneumonia and diarhoea are negligible in AMR-A and WPR-A. The following interven- tions are not evaluated in those areas Vitamin A supplementation. Oral vitamin A supplements are provided to all children nder five years of age twice a year at a health centre. The dose is 200 000 i.u. for children from their first birthday. For those less than one year of age, the dose is 50 000-100 000 it Effectiveness of the intervention is adjusted by adherence. Vitamin A fortification. Fortification of a food staple with vitamin A (in this case as- sumed to be sugar), whether locally produced or imported or whether for industrial or domestic use, is assured through legislation. The amount of vitamin A required is calculatSome Strategies to Reduce Risk 111 the women who currently attend antenatal clinics, only the costs of the iron and the addi￾tional time of the visit were included. However, expansion of coverage for iron supplemen￾tation purposes beyond current coverage of antenatal visits requires attributing the full cost of the necessary visits to the intervention. Results Even though many groups in the population are likely to benefit from iron fortification, only the impact on iron deficiency anaemia in pregnant women (with an impact on mater￾nal health and prenatal mortality) has been included in the analysis. This understates the benefit, but these effects probably account for more than 95% of total deaths averted by fortification. Despite this, supplementation and fortification at 50% coverage are estimated to lead to increases in population health of almost 59 million and 29 million DALYs in turn globally when implemented over a 10-year period. Supplementation yields greater improvements in population health than fortification, in all subregions with high child mortality (all D and E subregions), and at all levels of coverage. In the other subregions, supplementation has a larger impact on population health than fortification for equivalent levels of coverage. On a global basis, supplementation at 80% would gain just over 9 million DALYs per year compared to doing nothing. On the other hand, fortification is always less costly than supplementation because it does not require a visit to a provider, and the unit cost of supplementation increases sharply with increasing coverage. This means that the cost-effectiveness of fortification is always lower than the cost-effectiveness of supplementation, regardless of the coverage of fortifi￾cation. It, then, is the preferred option at low levels of resource availability. However, in some settings iron fortification is hindered by the absence of ideal food vehicles that are eaten in sufficient quantities and it might be difficult to ensure coverage even as high as 50%. It is also hindered by the absence of ideal iron compounds that would be favorably absorbed, are stable and nonreactive, with little colour, and no taste of their own. Where people’s diets are not based around cereal flours or another convenient food vehicle, supplementation is still a cost-effective option. Indeed, in areas with a high preva￾lence of iron-deficiency anaemia, it is still very cost-effective to spend the higher amounts on supplementation to achieve the greater population benefit. It is less cost-effective to take this option in areas where the burden from iron deficiency anaemia is relatively low, although the cost-effectiveness of switching from fortification to supplementation is be￾tween one and three times GDP per capita so does not fall into the band of cost-ineffective interventions. VITAMIN A DEFICIENCY Interventions Vitamin A deficiency is negligible in the European region of WHO, while deaths due to pneumonia and diarrhoea are negligible in AMR-A and WPR-A. The following interven￾tions are not evaluated in those areas. Vitamin A supplementation. Oral vitamin A supplements are provided to all children under five years of age twice a year at a health centre. The dose is 200 000 i.u. for children from their first birthday. For those less than one year of age, the dose is 50 000–100 000 i.u. Effectiveness of the intervention is adjusted by adherence. Vitamin A fortification. Fortification of a food staple with vitamin A (in this case as￾sumed to be sugar), whether locally produced or imported or whether for industrial or domestic use, is assured through legislation. The amount of vitamin A required is calculated