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Cost-effective treatment for severely malnourished children: what is the best approach?
1Centre for Human Nutrition, London School of Hygiene & Tropical Medicine, UK.
Insights
Domiciliary care for severe malnutrition in children, preceded by day care, is the most cost-effective treatment. This approach significantly reduces costs compared to inpatient or day care alone.
Area of Science:
- Pediatrics
- Public Health
- Health Economics
Background:
- Severe malnutrition affects numerous children in urban Bangladesh.
- Effective and affordable treatment strategies are crucial for improving child health outcomes.
Purpose of the Study:
- To compare the cost-effectiveness of different treatment modalities for severe malnutrition in children.
- To evaluate inpatient, day care, and domiciliary care models.
Main Methods:
- A study involving 437 children (12-60 months) with severe malnutrition in urban Bangladesh.
- Sequential allocation to inpatient, day care, or domiciliary care (after 1 week of day care).
- Analysis of institutional and parental costs to achieve 80% weight-for-height.
Main Results:
- Average institutional costs: $156 (inpatient), $59 (day care), $29 (domiciliary).
- Staff salaries and laboratory tests were major cost components.
- Domiciliary care was most preferred by parents despite higher parental costs.
Conclusions:
- Domiciliary care, following an initial week of day care, is the most cost-effective treatment for severe malnutrition.
- Careful training and an efficient referral system are essential for successful implementation.
Unlabelled:
In urban Bangladesh, 437 children with severe malnutrition aged 12-60 months were sequentially allocated to treat either as i) inpatients, ii) day care, or iii) domiciliary care after one week of day care. Average institutional cost (US$) to achieve 80% weight-for-height were respectively $156, $59 and $29/child. As a proportion of the overall costs, staff salaries were the largest component, followed by laboratory tests. Parental costs were highest for domiciliary care, as no food supplements were provided. Nevertheless it was the option most preferred by parents and when the institutional and parental costs were combined, domiciliary care was 1.6 times more cost-effective than day care, and 4.1 times more cost-effective than inpatient care.
Conclusion:
With careful training and an efficient referral system, domiciliary care preceded by one week of day care is the most cost-effective treatment option for severe malnutrition in this setting.