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The cost-effectiveness of a child nutrition education programme in Peru
Hugh R Waters1, Mary E Penny, Hilary M Creed-Kanashiro
1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. hwaters@jhsph.edu
Insights
A nutrition education program in Peru improved service use and child growth, preventing stunting. This intervention demonstrated positive health outcomes and cost-effectiveness in early childhood nutrition.
Area of Science:
- Public Health
- Nutrition Science
- Health Economics
Background:
- Childhood malnutrition remains a significant global health challenge, particularly in low-resource settings.
- Effective nutrition education programs are crucial for improving infant and young child feeding practices.
- Evaluating the impact and cost-effectiveness of such interventions is vital for public health policy.
Purpose of the Study:
- To evaluate the impact and cost-effectiveness of a health facility-based nutrition education program for children under two years in Trujillo, Peru.
- To assess the program's effects on service utilization and child growth outcomes.
- To determine the cost per child reached and per case of stunting prevented.
Main Methods:
- A quasi-experimental design comparing six intervention and six control health facilities.
- Activity-based costing was used to allocate service costs.
- Household surveys followed 338 children from birth to 18 months to measure intervention effects.
Main Results:
- Children in intervention areas had significantly more health facility visits (17.6 vs. 14.1, P < 0.001).
- The program prevented 11.1 cases of stunting per 100 children (OR 0.33, P = 0.002).
- Marginal costs were $6.12 per child reached and $55.16 per case of stunting prevented.
Conclusions:
- The nutrition education program positively impacted service utilization and child growth, including significant reductions in stunting.
- The intervention proved cost-effective, with a low cost per case of stunting prevented.
- Findings support the scalability and implementation of similar community-based nutrition programs.
Abstract:
This article reports impact and cost results from a health facility-based nutrition education programme targeting children less than 2 years of age in Trujillo, Peru. Key elements of the programme included participative complementary feeding demonstrations, growth monitoring sessions and an accreditation process. Data were collected from six intervention and six control health facilities to measure utilization and costs associated with the intervention. To calculate the unit costs of services, these costs are allocated using activity-based costing. To measure the effects of the intervention, 338 children were followed through household surveys at regular intervals from birth until the age of 18 months. The intervention had a clear positive impact both on the use of nutrition-related services and on children's growth outcomes. Children in the intervention areas made 17.6 visits to health facilities in the first 18 months of life, compared with 14.1 visits for children in the control areas (P < 0.001). This pattern holds true for all socioeconomic groups. The intervention prevented 11.1 cases of stunting per 100 children. In multivariate logistic regression analysis, children in the intervention were 0.33 times as likely to be stunted as the controls (P = 0.002). The marginal cost of the intervention - including external costs, training, health education materials and extra travel and equipment - is 6.12 US dollars per child reached and 55.16 US dollars per case of stunting prevented. The estimated marginal cost of the intervention per death averted is 1952 US dollars.
