The cost-effectiveness of a cash-based transfer, specialised nutritious food, and social and behaviour change communication intervention package to prevent undernutrition among children 6–23 months in Pakistan

A cluster randomised controlled trial

Bibliographic Data

ID19550439
AuthorsMichael Nnachebe Onah (0000-0002-2874-0743, University of Central Asia), Gul Nawaz Khan (0000-0002-2466-1693, Aga Khan University), Sumra Kureishy (0000-0002-8411-1028, World Food Programme), Jessica Bourdaire (0000-0003-4543-7188, World Food Programme), Saskia de Pee (0000-0002-0138-7118, World Food Programme), Cecilia Garzon (UN World Food Programme), Cecilia Ávila Garzón (World Food Programme), Yasir Ihtesham (World Food Programme), Naveed Akbar (0000-0002-5208-4686, Government of Pakistan), Sajid Soofi (0000-0003-4192-8406, Aga Khan University), Sajid Bashir Soofi
Year2024
Volume14
Pages04186-04186
Publication date2024-11-22
Open AccessYes
TypeARTICLE
VenueJournal of Global Health (JOURNAL)
Journal identifiersISSN: 2047-2978 • E-ISSN: 2047-2986
PublisherInternational Society of Global Health (PUBLISHER • GB)
DOI10.7189/jogh.14.04186
PMID39575728
OpenAlexW4404642841
LanguageEN
References cited35

Background: There is mixed evidence on the cost-effectiveness of cash transfers, along with food supplements and behaviour change communication interventions in improving child nutrition outcomes. To add to existing literature, we examined the cost-effectiveness of medium-quantity lipid-based nutrient supplement (LNS) and social and behaviour change communication (SBCC) messaging, separately and combined, compared to an existing unconditional cash transfers (UCT) programme in children 6-23 months of age in the district Rahim Yar Khan, Pakistan. Methods: This was a four-arm, community-based cluster randomised controlled trial. The UCT provided a quarterly sum of USD 32, the medium-quantity LNS contained a daily ration of 50 g of LNS, and the SBCC included monthly and quarterly messaging on nutrition, health, and hygiene to eligible households. Cost data were collected from a provider perspective through the review of procurement invoices and budgets, as well as interviews with stakeholders. We examined cost-effectiveness via statistically significant differences between the intervention and control arms, and estimated as cost per case of stunting, and disability-adjusted life years (DALYs) averted at six and 18 months of intervention. Results: Costs were higher for SBCC intervention combinations (UCT + SBCC and UCT + LNS + SBCC) due to high training costs for lady health workers. UCT + LNS achieved a reduction in stunting at a per-case cost of USDS 278.74 at six months and USD 897.15 at 18 months. UCT + LNS + SBCC achieved a reduction in stunting at per case cost of USD 846.48 at six months and USD 2324.58 at 18 months. The cost per DALYs averted for preventing stunting was USD 234 to USD 557.42 at six months, and USD 787.73 to USD 1537 at 18 months without discounting and age-weights. Conclusions: Although the affordability of such interventions is arguable, combining UCTs with LNS appears to be very cost-effective for reducing undernutrition and averting DALYs, while combining cash transfers with LNS and SBCC showed limited cost-effectiveness when targeting stunting. Registration: Clinicaltrials.gov: NCT03299218

Behavior change communication · Business · Cash · Cash transfers · Environmental health · Health services · Malnutrition · Psychological intervention · Breastfeeding Practices and Influences · Child Nutrition and Water Access · Computer Science · Global Maternal and Child Health · Medicine · Nursing · Finance

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