An Ex Ante Analysis of the Impact and Cost-Effectiveness of Biofortified High-Provitamin A and High-Iron Banana in Uganda

Book excerpt: Uganda has made notable progress in reducing micronutrient deficiencies in recent years, but the prevalence of vitamin A deficiency (VAD) and anemia among children under 5 remain unacceptably high. According to World Health Organization criteria, VAD remains a public health problem in Uganda, and anemia is a severe problem. In this paper we explore the potential contribution to reducing both of these deficiencies using a genetically modified, high–provitamin A and high-iron banana (HPVAHIB) that is currently being developed. We present an ex ante analysis of the costs and nutritional benefits of HPVAHIB. Using the Ugandan National Household Survey of 2005/06, we analyzed the production and consumption patterns of highland cooking banana (nakinyika) and sweet banana (sukalindizi). Informed by the empirical findings, we developed geographically differentiated adoption, production, consumption, and diffusion patterns for several types of HPVAHIB. Based on households’ reported quantities of each type of banana currently consumed, we estimated the number of people consuming each banana and the quantities they consume, and then simulated the additional intakes of vitamin A and iron and estimated the number of disability-adjusted life years (DALYs) saved attributable to each. Combining the health impacts with the estimated costs of the project, three impact measures of the HPVAHIB are developed: the cost per DALY saved, the benefit–cost ratio, and the internal rate of return. Eighteen scenarios are estimated. The base scenario, which includes only the biofortification of cooking banana with provitamin A at a level equal to 400 percent its intrinsic provitamin A content, estimates that the net present cost per DALY saved of HPVAHIB is US$62, its benefit–cost ratio is 16, and its internal rate of return is 31 percent. According to criteria established by the World Health Organization and the World Bank, the HPVAHIB project is a “very cost-effective” health intervention.