The cost of various commodities/interventions to improve the vitamin C intake of refugees and other populations affected by major emergencies is listed in Table 2 in the annex. The costs include insurance and freight. Table 3 in the annex attempts to compare the costs of fortified, milled cereal (maize), non-milled, non-fortified cereal and blended cereal-legume food (CSB). The expected costs of milling are substantially greater than the cost of adding micronutrients. The cost of the fortification and the milling of the whole cereal ration and the cost of adding 100 g blended cereal-legume food (CSB) to the ration are similar. The cost of the micronutrients (including vitamin C) is not the issue; milling, which is essential for the fortification process of, for example, maize, adds about 60% to the cost. Additional costs are associated with the processing and packaging of the milled product, and the quality control of its fortification.
The extra cost for increasing the general ration by 10% is comparable to that of adding 30 g of blended cereal-legume food to the daily ration. However, at least 120 g of cereal-legume mix equivalent to 48 mg vitamin C per ration (100 g CSB manufactured by Protein Grain Products International, USA contains 40 mg vitamin C) would be necessary to cover the daily recommended requirement of 28 mg vitamin C per person in a mixed population taking into account the expected losses of vitamin C during storage and during meal preparation. Including 120 g of cereal-legume blend to the general ration would be four times more costly than increasing the general ration by 10%. However, if the product was fortified with higher levels of vitamin C e.g. 120 mg vitamin C/100 g, the cost of blended cereal-legume food as an intervention to prevent scurvy would be almost equivalent to a 10% increase in ration.
Vitamin C tablets are not expensive compared to other commodities but the cost-effectiveness of supplementation with vitamin C tablets is liable to be low because of poor coverage, and non-sustainability of this intervention over time. The cost of tomato paste, calculated at 100 g per person per day, is very high; nevertheless, it might be one of the few ways to increase vitamin C in the ration in certain situations, over the short term. The cost would be comparable to that of fresh vegetables distributed in the general ration in Nepal. The cheapest fortified special food seems to be orange juice powder, which is known to be popular. A major drawback, however is that the powder tends to be consumed in amounts well beyond the daily portion, and hence the supply is rapidly exhausted.
The cost of fortifying sugar and water depends on the degree of fortification, which in turn depends on the estimated losses of vitamin C. One thousand grams of vitamin C powder costs approximately US$ 17/-, which translates to only US $0.0005 for a 30 mg daily supplement, not including distribution.