intervention with alternatives (e.g., raising the iron fortification level; changing the type of iron used). However, reviewing iron fortification levels was not part of this committee's task.

Both objectives of the pilot study involve improving the micronutrient status of a target population. The benefit to be gained from the project depends on raising the population from a state of vitamin C deficiency to a state of vitamin C sufficiency. There is no benefit to be gained from raising the population's intake or absorption of a nutrient if the amount is already satisfactory. Thus, the measures of effectiveness depend not only on the success of nutrient delivery to, and consumption by, a target population but also on the previous status of the population.

U.S. food aid is used for two purposes: developmental aid and emergency relief. Approximately 88 percent of U.S.-supplied fortified, blended food is used for developmental purposes. Developmental aid uses food primarily in school feeding programs, maternal and child health (MCH) programs, and food-for-work projects where the food is used as a substitute for money to pay for labor on development projects. Developmental food aid is rarely the sole source of food for a family, and since there is no evidence of vitamin C deficiency in populations receiving this type of food aid there is no rationale for increasing vitamin C in food aid commodities for this purpose.

Many recipients of developmental food aid are iron deficient (OMNI, 1994; Toole, 1994; Beaton, 1995). However, doubling the vitamin C content of fortified, blended foods to improve iron absorption may be much less cost-effective than increasing the iron content of such foods above their present levels of fortification, or of increasing iron in the diet by other means. Research data to support either intervention are insufficient.

Emergency relief food aid is distributed to refugees and other distressed populations (famine sufferers or other displaced populations) in camps. A small proportion of refugee populations has been shown to be vitamin C deficient when unfortified food was given (Ranum and Chomé, 1997). All of these populations were in the eastern Sahel (greater Horn of Africa and Kenya). Except for some recent reports of Bhutanese refugees in Nepal, no other refugee populations have shown documented evidence of vitamin C deficiency, including many others in the rest of Africa.

If the proposal under consideration is to increase the fortification levels of vitamin C in all CSB and WSB, then the cost of such an intervention must be measured against the small number of beneficiaries who are actually in need of the nutrient. For any project of a given size and cost, the cost-effectiveness is lower (that is, better) if the proportion of the population in need is higher.

The cost-effectiveness analysis uses as a basis for comparison the nutrient content of blended foods at present levels of fortification that could not be purchased under the Public Law (P.L.) 480 Title II program because the money was spent increasing the vitamin C fortification. This is a conservative basis for comparison because the nutrient content of other usual food aid commodities



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