Protecting child health and nutrition status with ready-to-use food in addition to food assistance in urban Chad: a cost-effectiveness analysis

Abstract

BackgroundDespite growing interest in use of lipid nutrient supplements for preventing child malnutrition and morbidity, there is inconclusive evidence on the effectiveness, and no evidence on the cost-effectiveness of this strategy.MethodsA cost effectiveness analysis was conducted comparing costs and outcomes of two arms of a cluster randomized controlled trial implemented in eastern Chad during the 2010 hunger gap by Action contre la Faim France and Ghent University. This trial assessed the effect on child malnutrition and morbidity of a 5-month general distribution of staple rations, or staple rations plus a ready-to-use supplementary food (RUSF). RUSF was distributed to households with a child aged 6–36 months who was not acutely malnourished (weight-for-height > = 80% of the NCHS reference median, and absence of bilateral pitting edema), to prevent acute malnutrition in these children. While the addition of RUSF to a staple ration did not result in significant reduction in wasting rates, cost-effectiveness was assessed using successful secondary outcomes of cases of diarrhea and anemia (hemoglobin <110 g/L) averted among children receiving RUSF.Total costs of the program and incremental costs of RUSF and related management and logistics were estimated using accounting records and key informant interviews, and include costs to institutions and communities. An activity-based costing methodology was applied and incremental costs were calculated per episode of diarrhea and case of anemia averted.ResultsAdding RUSF to a general food distribution increased total costs by 23%, resulting in an additional cost per child of 374 EUR, and an incremental cost per episode of diarrhea averted of 1,083 EUR and per case of anemia averted of 3,627 EUR.ConclusionsAdding RUSF to a staple ration was less cost-effective than other standard intervention options for averting diarrhea and anemia. This strategy holds potential to address a broad array of health and nutrition outcomes in emergency settings where infrastructure is weak and other intervention options are infeasible in the short-term. However, further research is needed to establish the contexts in which RUSF is most effective and cost-effective in preventing acute malnutrition and morbidity among vulnerable children, compared to other options.

The cost of improving nutritional outcomes through food‐assisted maternal and child health and nutrition programmes in Burundi and Guatemala

“…The activities implemented closely mirror the supply, logistics, and distribution of food commodities and supplements (AB‐CCs 1 and 2) for which we calculated monthly costs of 7.79 USD for PROCOMIDA (FFR + CSB) and 7.41 USD for Tubaramure (T24). A study from Chad found that the cost per beneficiary of delivering a family ration with ready‐to‐use supplementary foods for 6‐ to 36‐month‐olds was 220.40 2010 EUR per month (Puett et al, ). The monthly cost of PROCOMIDA's programme model that provided a full family ration with LNS was considerably less expensive at 37.60 USD.…”

“…We calculated the hypothetical programme activity cost if each treatment arm was implemented at programme scale (i.e., if all programme beneficiaries received that treatment). The detailed programme description was used to identify which activities would have been conducted differently, to adjust the quantity of the inputs needed to implement these activities, and to estimate the cost of programme activities for each treatment arm–based programme models (Puett et al, ). Because the programmes had target beneficiary numbers and monitored enrolment to reach these goals, we assumed for those treatment arms with lower programme uptake that the corresponding treatment arm–based programme model would have expanded services to reach the target number of beneficiaries and adjust inputs accordingly.…”

Impact of stakeholder perspectives on cost-effectiveness estimates of four specialized nutritious foods for preventing stunting and wasting in children 6–23 months in Burkina Faso

“…Using methods common in other cost-effectiveness studies [30,31], the research team obtained incremental cost and effectiveness measures: Incremental cost per enrolled child was then linked with the specified incremental effectiveness (adjusted number of months of wasting measurements per child and adjusted prevalence of stunting at end-line), as depicted in Fig. 2.…”

Comparison of Economic Evaluation Methods Across Low‐income, Middle‐income and High‐income Countries: What are the Differences and Why?

“…DALYs or QALYs), indicating a very small difference across income groups, which was not statistically significant (odds ratio = 1.24, p = 0.304). The outcome measures in natural units included 'diarrhoea case averted' (Puett et al, 2013) and 'detection of individual with high cardiovascular risk' (Selvarajah et al, 2013).…”