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Cost-effectiveness of community-based management of acute malnutrition in Malawi

Robyn Wilford1, Kate Golden, Damian G Walker

  • 1Concern Worldwide, 52-55 Camden Street Lower, Dublin, Ireland.

Health Policy and Planning
|March 8, 2011
PubMed

Insights

Community-based management of acute malnutrition (CMAM) is a cost-effective strategy to prevent child deaths. This intervention offers significant value, even in worst-case scenarios, making it a worthwhile investment for child health programs.

Area of Science:

  • Global Health
  • Public Health Economics
  • Pediatric Nutrition

Background:

  • Severe acute malnutrition (SAM) in children under five remains a critical global health challenge.
  • Existing health services often have limitations in effectively managing SAM, leading to preventable deaths.
  • Community-based management of acute malnutrition (CMAM) has emerged as a promising intervention strategy.

Purpose of the Study:

  • To assess the cost-effectiveness of implementing CMAM alongside existing health services for treating SAM in children under five.
  • To compare the costs and health outcomes (DALYs averted) of SAM treatment with and without CMAM.
  • To provide evidence for decision-making regarding the scale-up of CMAM programs.

Main Methods:

  • A decision tree model was utilized to analyze cost-effectiveness.
  • Data on costs and outcomes were sourced from a CMAM program in Dowa district, Malawi.
  • Key assumptions regarding treatment-seeking behavior and mortality were incorporated into the model.

Main Results:

  • In the base case scenario, CMAM cost US$42 per disability-adjusted life year (DALY) averted (2007 US$).
  • Even under a 'worst-case' scenario, CMAM remained cost-effective, costing US$493 per DALY averted.
  • The cost per DALY averted was well below Malawi's 2007 GNI per capita and comparable to other child health interventions.

Conclusions:

  • The implementation and scale-up of CMAM in Dowa, Malawi, represent a highly cost-effective public health intervention.
  • CMAM is likely to be cost-effective in similar contexts, contributing significantly to reducing child mortality from SAM.
  • Contextual and programmatic factors require careful consideration when generalizing findings to diverse settings.

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