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Palmer T, Leiva Granados R, Draper C, Norris SA, Batura N. Cost-effectiveness of a complex continuum of care intervention targeting women and children: protocol for an economic evaluation of the Bukhali trial in South Africa. BMJ Open 2024; 14:e080166. [PMID: 38740501 PMCID: PMC11097888 DOI: 10.1136/bmjopen-2023-080166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION As nearly two-thirds of women presenting at their first antenatal visit are either overweight or obese in urban South Africa, the preconception period is an opportunity to optimise health and offset transgenerational risk of both obesity and non-communicable diseases. This protocol describes the planned economic evaluation of an individually randomised controlled trial of a complex continuum of care intervention targeting women and children in Soweto, South Africa (Bukhali trial). METHODS AND ANALYSIS The economic evaluation of the Bukhali trial will be conducted as a within-trial analysis from both provider and societal perspectives. Incremental costs and health outcomes of the continuum of care intervention will be compared with standard care. The economic impact on implementing agencies (programme costs), healthcare providers, participants and their households will be estimated. Incremental cost-effectiveness ratios (ICERs) will be calculated in terms of cost per case of child adiposity at age years averted. Additionally, ICERs will also be reported in terms of cost per quality-adjusted life year gained. If Bukhali demonstrates effectiveness, we will employ a decision analytical model to examine the cost-effectiveness of the intervention over a child's lifetime. A Markov model will be used to estimate long-term health benefits, healthcare costs and cost-effectiveness. Probabilistic sensitivity analyses will be conducted to explore uncertainty and ensure robust results. An analysis will be conducted to assess the equity impact of the intervention, by comparing intervention impact within quintiles of socioeconomic status. ETHICS AND DISSEMINATION The Bukhali trial economic evaluation has ethical approval from the Human Ethics Research Committee of the University of the Witwatersrand, Johannesburg, South Africa (M240162). The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference. TRIAL REGISTRATION NUMBER Pan African Clinical Trials Registry (PACTR201903750173871; https://pactr.samrc.ac.za).
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Affiliation(s)
- Tom Palmer
- Institute for Global Health, University College London, London, UK
| | | | - Catherine Draper
- MRC-Wits DPHRU, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- MRC-Wits DPHRU, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, UK
| | - Neha Batura
- Institute for Global Health, University College London, London, UK
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Martin-Cañavate R, Custodio E, Trigo E, Romay-Barja M, Herrador Z, Aguado I, Ramirez F, Faria LM, Silva-Gerardo A, Lima JC, Iráizoz E, Marques T, Vargas A, Gomez A, Puett C, Molina I. Preventing chronic malnutrition in children under 2 years in rural Angola (MuCCUA trial): protocol for the economic evaluation of a three-arm community cluster randomised controlled trial. BMJ Open 2023; 13:e073349. [PMID: 38110392 DOI: 10.1136/bmjopen-2023-073349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
INTRODUCTION Chronic malnutrition is a serious problem in southern Angola with a prevalence of 49.9% and 37.2% in the provinces of Huila and Cunene, respectively. The MuCCUA (Mother and Child Chronic Undernutrition in Angola) trial is a community-based randomised controlled trial (c-RCT) which aims to evaluate the effectiveness of a nutrition supplementation plus standard of care intervention and a cash transfer plus standard of care intervention in preventing stunting, and to compare them with a standard of care alone intervention in southern Angola. This protocol describes the planned economic evaluation associated with the c-RCT. METHODS AND ANALYSIS We will conduct a cost-efficiency and cost-effectiveness analysis nested within the MuCCUA trial with a societal perspective, measuring programme, provider, participant and household costs. We will collect programme costs prospectively using a combined calculation method including quantitative and qualitative data. Financial costs will be estimated by applying activity-based costing methods to accounting records using time allocation sheets. We will estimate costs not included in accounting records by the ingredients approach, and indirect costs incurred by beneficiaries through interviews, household surveys and focus group discussions. Cost-efficiency will be estimated as cost per output achieved by combining activity-specific cost data with routine data on programme outputs. Cost-effectiveness will be assessed as cost per stunting case prevented. We will calculate incremental cost-effectiveness ratios comparing the additional cost per improved outcome of the different intervention arms and the standard of care. We will perform sensitivity analyses to assess robustness of results. ETHICS AND DISSEMINATION This economic evaluation will provide useful information to the Angolan Government and other policymakers on the most cost-effective intervention to prevent stunting in this and other comparable contexts. The protocol was approved by the República de Angola Ministério da Saúde Comité de Ética (27C.E/MINSA.INIS/2022). The findings of this study will be disseminated within academia and the wider policy sphere. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05571280).
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Affiliation(s)
- Rocio Martin-Cañavate
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Escuela Internacional de Doctorado, Universidad Nacional de Educación a Distancia, Madrid, España
| | - Estefania Custodio
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- CIBER Enfermedades Infecciosas, ISCIII, Madrid, Spain
| | - Elena Trigo
- Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - María Romay-Barja
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- CIBER Enfermedades Infecciosas, ISCIII, Madrid, Spain
| | - Zaida Herrador
- Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain
- CIBER Epidemiología y Salud Publica (CIBERESP), Madrid, Spain
| | - Isabel Aguado
- Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ferran Ramirez
- Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Ana Silva-Gerardo
- Faculdade de Medicina da Universidade Mandume Ya Ndemufayo, Lubango, Huíla, Angola
| | - Jose Carlos Lima
- Faculdade de Medicina da Universidade Mandume Ya Ndemufayo, Lubango, Huíla, Angola
| | | | - Tayná Marques
- Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Chloe Puett
- Stony Brook University Program in Public Health, Stony Brook, New York, USA
| | - Israel Molina
- Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Le Roch K, Trenouth L, Bizouerne C, Salpéteur C. Methodological choices for an economic evaluation of a combined psychosocial and nutrition treatment intervention for children with severe acute malnutrition: The FUSAM trial in Nepal. EVALUATION AND PROGRAM PLANNING 2023; 101:102356. [PMID: 37651776 DOI: 10.1016/j.evalprogplan.2023.102356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023]
Abstract
As a public health burden, severe acute malnutrition (SAM) among children has been increasingly studied to determine the optimal combination of treatment approaches. Among the new approaches is the addition of early childhood development sessions to standard nutrition-based treatment for SAM which can enhance both nutrition and development outcomes among young children. However, few studies demonstrate the relationship between the costs of such combined programs and the benefits accrued to the children and their caregivers. This article describes our experience of designing and conducting an economic evaluation alongside a cluster randomized controlled trial assessing a combined nutrition and psychosocial intervention for the treatment of SAM in children aged 6-24 months in Nepal. We present key lessons learned regarding methodological choices, the challenges of field data collection, as well as study adjustment when data analysis did not unfold as anticipated. With the view to transparency, this manuscript provides some clarifications on the evaluation processes for funders and policy makers on what economic evaluations entail and what information they convey for the purpose of supporting policy decision-making around limited resource allocation.
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Affiliation(s)
- Karine Le Roch
- Action contre la Faim-France, 14-16 boulevard Douaumont, 75017 Paris, France.
| | - Lani Trenouth
- Action Against Hunger-USA, One Whitehall Street 2nd Floor, New York, NY 10004, USA
| | - Cécile Bizouerne
- Action contre la Faim-France, 14-16 boulevard Douaumont, 75017 Paris, France
| | - Cécile Salpéteur
- Action contre la Faim-France, 14-16 boulevard Douaumont, 75017 Paris, France
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Desmond C, Watt KG, Jensen SKG, Simmons E, Murray SM, Farrar J, Placencio-Castro M, Sezibera V, Rawlings LB, Wilson B, Betancourt TS. Measuring the cost-effectiveness of a home-visiting intervention to promote early child development among rural families linked to the Rwandan social protection system. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002473. [PMID: 37874790 PMCID: PMC10597512 DOI: 10.1371/journal.pgph.0002473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/14/2023] [Indexed: 10/26/2023]
Abstract
Early childhood development (ECD) programmes are heralded as a way to improve children's health and educational outcomes. However, few studies in developing countries calculate the effectiveness of quality early childhood interventions. This study estimates the cost and cost-effectiveness of the Sugira Muryango (SM) trial, a home-visiting intervention to improve ECD outcomes through positive parent-child relationships. Cost-effectiveness analysis of ECD interventions is challenging given their potential to have multiple benefits. We propose a cost-effectiveness method using a single outcome, in this case the improvement in cognitive development per home-visit session, as an indication of efficiency comparable across similar interventions. The trial intervention cost US$456 per family. This cost will likely fall below US$200 if the intervention is scaled through government systems. The cost-effectiveness analysis suggests that while SM generated a relatively small impact on markers of early development, it did so efficiently. The observed improvements in cognitive development per home-visit are similar to other home-visiting interventions of longer duration. SM by focusing on the family had benefits beyond ECD, including reductions in violence against children and intermate partner violence, further analysis is needed to include these returns in the economic evaluation.
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Affiliation(s)
- Chris Desmond
- Faculty of Health Sciences, SAMRC/Wits Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Kathryn G. Watt
- Centre for Rural Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Sarah K. G. Jensen
- Boston College, School of Social Work, Chestnut Hill, Massachusetts, United States of America
| | - Erik Simmons
- Boston College, School of Social Work, Chestnut Hill, Massachusetts, United States of America
| | - Shauna M. Murray
- University of Massachusetts Boston, Boston, Massachusetts, United States of America
| | - Jordan Farrar
- Boston College, School of Social Work, Chestnut Hill, Massachusetts, United States of America
| | - Matias Placencio-Castro
- Boston College, Lynch School of Education and Human Development, Chestnut Hill, Massachusetts, United States of America
| | - Vincent Sezibera
- Centre for Mental Health, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | | | - Briana Wilson
- The World Bank, Washington, DC, United States of America
| | - Theresa S. Betancourt
- Boston College, School of Social Work, Chestnut Hill, Massachusetts, United States of America
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Batura N, Roy R, Aziz S, Sharma K, Kumar D, Verma D, Correa Ossa A, Spinola P, Soremekun S, Sikander S, Zafar S, Divan G, Hill Z, Avan BI, Rahman A, Kirkwood B, Skordis J. Maternal time investment in caregiving activities to promote early childhood development: evidence from rural India. Front Pediatr 2023; 11:1120253. [PMID: 37484767 PMCID: PMC10360126 DOI: 10.3389/fped.2023.1120253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Intervention strategies that seek to improve early childhood development outcomes are often targeted at the primary caregivers of children, usually mothers. The interventions require mothers to assimilate new information and then act upon it by allocating sufficient physical resources and time to adopt and perform development promoting behaviours. However, women face many competing demands on their resources and time, returning to familiar habits and behaviours. In this study, we explore mothers' allocation of time for caregiving activities for children under the age of 2, nested within a cluster randomised controlled trial of a nutrition and care for development intervention in rural Haryana, India. Methods We collected quantitative maternal time use data at two time points in rural Haryana, India, using a bespoke survey instrument. Data were collected from 704 mothers when their child was 12 months old, and 603 mothers when their child was 18 months old. We tested for significant differences in time spent by mothers on different activities when children are 12 months of age vs. 18 months of age between arms as well as over time, using linear regression. As these data were collected within a randomised controlled trial, we adjusted for clusters using random effects when testing for significant differences between the two time points. Results At both time points, no statistically significant difference in maternal time use was found between arms. On average, mothers spent most of their waking time on household chores (over 6 h and 30 min) at both time points. When children were aged 12 months, approximately three and a half hours were spent on childcare activities for children under the age of 2 years. When children were 18 months old, mothers spent more time on income generating activities (30 min) than when the children were 12 years old, and on leisure (approximately 4 h and 30 min). When children were 18 months old, less time was spent on feeding/breastfeeding children (30 min less) and playing with children (15 min). However, mothers spent more time talking or reading to children at 18 months than at 12 months. Conclusion We find that within a relatively short period of time in early childhood, maternal (or caregiver) time use can change, with time allocation being diverted away from childcare activities to others. This suggests that changing maternal time allocation in resource poor households may be quite challenging, and not allow the uptake of new and/or optimal behaviours.
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Affiliation(s)
- Neha Batura
- Institute for Global Health, University College London, London, United Kingdom
| | - Reetabrata Roy
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Child Development Group, Sangath, New Delhi, India
| | - Sarmad Aziz
- Department of Anthropology, University College London, United Kingdom
| | | | - Divya Kumar
- Child Development Group, Sangath, New Delhi, India
| | | | - Ana Correa Ossa
- Institute for Global Health, University College London, London, United Kingdom
| | - Paula Spinola
- Institute for Global Health, University College London, London, United Kingdom
| | - Seyi Soremekun
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Siham Sikander
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Shamsa Zafar
- Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Gauri Divan
- Child Development Group, Sangath, New Delhi, India
| | - Zelee Hill
- Institute for Global Health, University College London, London, United Kingdom
| | - Bilal Iqbal Avan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Atif Rahman
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Betty Kirkwood
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jolene Skordis
- Institute for Global Health, University College London, London, United Kingdom
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Murphy P, Hinde S, Fulbright H, Padgett L, Richardson G. Methods of assessing value for money of UK-based early childhood public health interventions: a systematic literature review. Br Med Bull 2022; 145:88-109. [PMID: 36542119 PMCID: PMC10075243 DOI: 10.1093/bmb/ldac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/25/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Economic evaluation has an important role to play in the demonstration of value for money of early childhood public health interventions; however, concerns have been raised regarding their consistent application and relevance to commissioners. This systematic review of the literature therefore aims to collate the breadth of the existing economic evaluation evidence of these interventions and to identify the approaches adopted in the assessment of value. SOURCE OF DATA Recently published literature in Medline, EMBASE, EconLit, Health Management Information Consortium, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Health Technology Assessment, NHS EED and Web of Science. AREAS OF AGREEMENT The importance of the early childhood period on future health and well-being as well as the potential to impact health inequalities making for a strong narrative case for expenditure in early childhood public health. AREAS OF CONTROVERSY The most appropriate approaches to evaluating value for money of such preventative interventions relevant for UK decision-makers given the evident challenges. GROWING POINTS The presented review considered inconsistencies across methodological approaches used to demonstrate value for money. The results showed a mixed picture in terms of demonstrating value for money. AREAS TIMELY FOR DEVELOPING RESEARCH Future resource allocations decisions regarding early childhood public health interventions may benefit from consistency in the evaluative frameworks and health outcomes captured, as well as consistency in approaches to incorporating non-health costs and outcomes, incorporating equity concerns and the use of appropriate time horizons.
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Affiliation(s)
- Peter Murphy
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Sebastian Hinde
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Helen Fulbright
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
| | - Louise Padgett
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, York, YO10 5DD, UK
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Miller EB, Whipps MDM, Bogen DL, Morris PA, Mendelsohn AL, Shaw DS, Gross RS. Collateral benefits from a school-readiness intervention on breastfeeding: A cross-domain impact evaluation. MATERNAL & CHILD NUTRITION 2022; 19:e13446. [PMID: 36218286 PMCID: PMC9749611 DOI: 10.1111/mcn.13446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022]
Abstract
This study evaluated the collateral, or unanticipated, impacts of Smart Beginnings (SB), a two-site, tiered intervention designed to promote responsive parenting and school readiness, on breastfeeding intensity in a low-income sample. Impact analyses for the SB intervention were conducted using an intent-to-treat design leveraging a two-arm random assignment structure. Mothers assigned to the SB intervention group were more than three times more likely to give breastmilk as the only milk source at infant age 6 months than mothers assigned to the control group at one site, an effect not evident at the other study site. As development and growth are the two most salient domains of child health, understanding how interventions impact subsequent parenting practices across both domains is critical to address long-term economic and racial/ethnic disparities. Implications of the findings are discussed for improving the efficacy of interventions based on paediatric primary care.
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Affiliation(s)
- Elizabeth B. Miller
- Department of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
| | | | - Debra L. Bogen
- Department of PediatricsUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Pamela A. Morris
- Department of Applied PsychologyNew York UniversityNew YorkNew YorkUSA
| | - Alan L. Mendelsohn
- Department of PediatricsNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Daniel S. Shaw
- Department of PsychologyUniversity of Pittsburgh, PittsburghPennsylvaniaUSA
| | - Rachel S. Gross
- Department of PediatricsNYU Grossman School of MedicineNew YorkNew YorkUSA
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Verguet S, Bolongaita S, Morgan A, Perumal N, Sudfeld CR, Yousafzai AK, Fink G. Priority setting in early childhood development: an analytical framework for economic evaluation of interventions. BMJ Glob Health 2022; 7:bmjgh-2022-008926. [PMID: 35725241 PMCID: PMC9214350 DOI: 10.1136/bmjgh-2022-008926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022] Open
Abstract
Background Early childhood development (ECD) sets the foundation for healthy and successful lives with important ramifications for education, labour market outcomes and other domains of well-being. Even though a large number of interventions that promote ECD have been implemented and evaluated globally, there is currently no standardised framework that allows a comparison of the relative cost-effectiveness of these interventions. Methods We first reviewed the existing literature to document the main approaches that have been used to assess the relative effectiveness of interventions that promote ECD, including early parenting and at-home psychosocial stimulation interventions. We then present an economic evaluation framework that builds on these reviewed approaches and focuses on the immediate impact of interventions on motor, cognitive, language and socioemotional skills. Last, we apply our framework to compute the relative cost-effectiveness of interventions for which recent effectiveness and costing data were published. For this last part, we relied on a recently published review to obtain effect sizes documented in a consistent manner across interventions. Findings Our framework enables direct value-for-money comparison of interventions across settings. Cost-effectiveness estimates, expressed in $ per units of improvement in ECD outcomes, vary greatly across interventions. Given that estimated costs vary by orders of magnitude across interventions while impacts are relatively similar, cost-effectiveness rankings are dominated by implementation costs and the interventions with higher value for money are generally those with a lower implementation cost (eg, psychosocial interventions involving limited staff). Conclusions With increasing attention and investment into ECD programmes, consistent assessments of the relative cost-effectiveness of available interventions are urgently needed. This paper presents a unified analytical framework to address this need and highlights the rather remarkable range in both costs and cost-effectiveness across currently available intervention strategies.
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Affiliation(s)
- Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarah Bolongaita
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anthony Morgan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nandita Perumal
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Günther Fink
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Allschwil, Switzerland
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Ramponi F, Nkhoma D, Griffin S. Informing decisions with disparate stakeholders: cross-sector evaluation of cash transfers in Malawi. Health Policy Plan 2022; 37:140-151. [PMID: 34791229 PMCID: PMC8757493 DOI: 10.1093/heapol/czab137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 10/13/2021] [Accepted: 11/14/2021] [Indexed: 11/16/2022] Open
Abstract
The Social Cash Transfer Programme (SCTP) in Malawi is a cross-sectoral policy with impacts on health, education, nutrition, agriculture and welfare. Implementation of the SCTP requires collaboration across sectors and across national and international stakeholders. Economic evaluation can inform investment by indicating whether benefits exceed costs, but economic evaluations that provide an overall benefit-cost ratio typically assume a common agreed objective and agreed set of value judgements. In reality, the various stakeholders involved in the delivery of the SCTP may have different remits and objectives and may differ in how they value the impacts of the programme. We use the SCTP as a case study to illustrate a cross-sectoral analytical framework that accounts for these differences. The stakeholders that contribute to the SCTP include the Ministry of Gender, Ministry of Finance, Ministry of Economic Planning and Development and Global Fund. We estimate how the SCTP changes outcomes in education, health, net production and poverty, and distinguish outcomes in three groups: SCTP recipients; population in Malawi not eligible for the SCTP and population in other countries. After estimating the direct effects and opportunity costs from investing in the SCTP, we summarize the results according to different perspectives. The SCTP is estimated to provide benefits in excess of costs from the perspective of national stakeholders. From the perspective of an international donor interested in health outcomes, its health benefits do not outweigh the opportunity costs unless health improvement in SCTP recipients is valued at 18 times that of other potential spending beneficiaries or the donor values broader outcomes than health alone. This work illustrates the potential of a cross-sectoral economic evaluation to guide debate about stakeholder contributions to the SCTP, and the value judgements required to favour the SCTP above other policy options.
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Affiliation(s)
- Francesco Ramponi
- Centre for Health Economics, Alcuin A Block, University of York Heslington, York YO10 5DD, UK
- Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona Carrer Rosselló 132, E-08036 Barcelona, Spain
| | - Dominic Nkhoma
- Health Economics and Policy Unit, College of Medicine, Lilongwe Campus, University of Malawi, P. O. Box 3055, Lilongwe 3, Malawi
| | - Susan Griffin
- Centre for Health Economics, Alcuin A Block, University of York Heslington, York YO10 5DD, UK
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Baek Y, Ademi Z, Paudel S, Fisher J, Tran T, Romero L, Owen A. Economic Evaluations of Child Nutrition Interventions in Low- and Middle-Income Countries: Systematic Review and Quality Appraisal. Adv Nutr 2021; 13:282-317. [PMID: 34510178 PMCID: PMC8803532 DOI: 10.1093/advances/nmab097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/24/2021] [Accepted: 07/27/2021] [Indexed: 11/12/2022] Open
Abstract
Economic evaluation is crucial for cost-effective resource allocation to improve child nutrition in low and middle-income countries (LMICs). However, the quality of published economic evaluations in these settings is not well understood. This systematic review aimed to assess the quality of existing economic evaluations of child nutrition interventions in LMICs and synthesize the study characteristics and economic evidence. We searched 9 electronic databases, including MEDLINE, with the following concepts: economic evaluation, children, nutrition, and LMICs. All types of interventions addressing malnutrition, including stunting, wasting, micronutrient deficiency, and overweight, were identified. We included economic evaluations that examined both costs and effects published in English peer-reviewed journals and used the Drummond checklist for quality appraisal. We present findings through a narrative synthesis. Sixty-nine studies with diverse settings, perspectives, time horizons, and outcome measures were included. Most studies used data from sub-Saharan Africa and South Asia and addressed undernutrition. The mortality rate, intervention effect, intervention coverage, cost, and discount rate were reported as predictors among studies that performed sensitivity analyses. Despite the heterogeneity of included studies and the possibility of publication bias, 81% of included studies concluded that nutrition interventions were cost-effective or cost-beneficial, mostly based on a country's cost-effectiveness thresholds. Regarding quality assessment, the studies published after 2016 met more criteria than studies published before 2016. Most studies had well-stated research questions, forms of economic evaluation, interventions, and conclusions. However, reporting the perspective of the analyses, justification of discount rates, and describing the role of funders and ethics approval were identified as areas needing improvement. The gaps in the quality of reporting could be improved by consolidated guidance on the publication of economic evaluations and the use of appropriate quality appraisal checklists. Strengthening the evidence base for child malnutrition across different regions is necessary to inform cost-effective investment in LMICs. Trial registration: PROSPERO CRD42020194445.
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Affiliation(s)
- Yeji Baek
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susan Paudel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ramponi F, Tafesse W, Griffin S. Economic evaluation of interventions to address undernutrition: a systematic review. Health Policy Plan 2021; 36:533-541. [PMID: 33280036 PMCID: PMC8128006 DOI: 10.1093/heapol/czaa149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 12/28/2022] Open
Abstract
Strategies to address undernutrition in low- and middle-income countries (LMICs) include various interventions implemented through different sectors of the economy. Our aim is to provide an overview of published economic evaluations of such interventions and to compare and contrast evaluations of interventions in different areas. We reviewed economic evaluations of nutrition interventions in LMICs published since 2015 and/or included in the Tufts Global registry or Disease Control Priorities 3rd edition. We categorized the studies by intervention type (preventive; therapeutic; fortification; delivery platforms), nutritional deficiency addressed and characteristics of the economic evaluation (e.g. type of model, costs and outcomes included). Of the 62 economic evaluations identified, 56 (90%) were cost-effectiveness analyses. Twenty-two (36%) evaluations investigated fortification and 23 (37%) preventive interventions. Forty-three percent of the evaluations of preventive interventions did not include a model, whereas most of fortification strategies used the same reference model. We identified different trends in cost categories and inclusion of health and non-health outcomes across evaluations in the four different topic areas. To illustrate the implications of such trends for decision-making, we compared a set of studies evaluating alternative strategies to combat zinc deficiency. We showed that the use of ‘off-the-shelf’ models and tools can potentially conceal what outcomes and costs and value judgements are used. Comparing interventions across different areas is fundamental to assist decision-makers in developing their nutrition strategy. Systematic differences in the economic evaluations of interventions delivered within and outside the health sector can undermine the ability to prioritize alternative nutrition strategies.
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Affiliation(s)
- Francesco Ramponi
- Centre for Health Economics, Alcuin A Block, University of York ,York YO10 5DD, UK
| | - Wiktoria Tafesse
- Centre for Health Economics, Alcuin A Block, University of York ,York YO10 5DD, UK
| | - Susan Griffin
- Centre for Health Economics, Alcuin A Block, University of York ,York YO10 5DD, UK
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Schott W, Richardson B, Baker E, D'Agostino A, Namaste S, Vosti SA. Comparing costs and cost-efficiency of platforms for micronutrient powder (MNP) delivery to children in rural Uganda. Ann N Y Acad Sci 2021; 1502:28-39. [PMID: 34169531 PMCID: PMC8596512 DOI: 10.1111/nyas.14621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
Micronutrient powder (MNP) can reduce iron deficiency in young children, which has been well established in efficacy trials. However, the cost of different delivery platforms has not been determined. We calculated the cost and cost-efficiency of distributed MNP through community-based mechanisms and in health facilities in a primarily rural district in Uganda. An endline survey (n = 1072) identified reach and adherence. During the 9-month pilot, 37,458 (community platform) and 12,390 (facility platform) packets of MNP were distributed. Each packet consisted of 30 MNP sachets. In 2016, total costs were $277,082 (community platform, $0.24/sachet) and $221,568 (facility platform, $0.59/sachet). The cost per child reached was lower in the community platform ($53.24) than the facility platform ($65.97). The cost per child adhering to a protocol was $58.08 (community platform) and $72.69 (facility platform). The estimated cost of scaling up the community platform pilot to the district level over 3 years to cover approximately 17,890 children was $1.23 million (scale-up integrated into a partner agency program) to $1.62 million (government scale-up scenario). Unlike previous estimates, these included opportunity costs. Community-based MNP delivery costs were greater, yet more cost-efficient per child reached and adhering to protocol than facility-based delivery. However, total costs for untargeted MNP delivery under program settings are potentially prohibitive.
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Affiliation(s)
- Whitney Schott
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania.,A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Belinda Richardson
- International Agricultural Development, Department of Plant Sciences, University of California, Davis, Davis, California
| | - Emily Baker
- International Agricultural Development, Department of Plant Sciences, University of California, Davis, Davis, California
| | - Alexis D'Agostino
- County of Santa Clara Public Health Department, San Jose, California
| | | | - Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California-Davis, Davis, California
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Adams KP, Lee JA, Piltch E, Jimenez EY. An Introduction to Economic Analysis of Food Security and Nutrition Interventions. J Acad Nutr Diet 2019; 119:856-864. [PMID: 30691954 DOI: 10.1016/j.jand.2018.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Indexed: 12/25/2022]
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Thow AM, Greenberg S, Hara M, Friel S, duToit A, Sanders D. Improving policy coherence for food security and nutrition in South Africa: a qualitative policy analysis. Food Secur 2018. [DOI: 10.1007/s12571-018-0813-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Menon P, McDonald CM, Chakrabarti S. Estimating the cost of delivering direct nutrition interventions at scale: national and subnational level insights from India. MATERNAL AND CHILD NUTRITION 2017; 12 Suppl 1:169-85. [PMID: 27187914 PMCID: PMC6680110 DOI: 10.1111/mcn.12257] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
India's national nutrition and health programmes are largely designed to provide evidence-based nutrition-specific interventions, but intervention coverage is low due to a combination of implementation challenges, capacity and financing gaps. Global cost estimates for nutrition are available but national and subnational costs are not. We estimated national and subnational costs of delivering recommended nutrition-specific interventions using the Scaling Up Nutrition (SUN) costing approach. We compared costs of delivering the SUN interventions at 100% scale with those of nationally recommended interventions. Target populations (TP) for interventions were estimated using national population and nutrition data. Unit costs (UC) were derived from programmatic data. The cost of delivering an intervention at 100% coverage was calculated as (UC*projected TP). Cost estimates varied; estimates for SUN interventions were lower than estimates for nationally recommended interventions because of differences in choice of intervention, target group or unit cost. US$5.9bn/year are required to deliver a set of nationally recommended nutrition interventions at scale in India, while US$4.2bn are required for the SUN interventions. Cash transfers (49%) and food supplements (40%) contribute most to costs of nationally recommended interventions, while food supplements to prevent and treat malnutrition contribute most to the SUN costs. We conclude that although such costing is useful to generate broad estimates, there is an urgent need for further costing studies on the true unit costs of the delivery of nutrition-specific interventions in different local contexts to be able to project accurate national and subnational budgets for nutrition in India.
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Affiliation(s)
- Purnima Menon
- International Food Policy Research Institute (IFPRI), New Delhi, India
| | - Christine M McDonald
- Famine Early Warning Systems Network (FEWS NET), Washington, District of Columbia, USA
| | - Suman Chakrabarti
- International Food Policy Research Institute (IFPRI), New Delhi, India
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16
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Richter LM, Daelmans B, Lombardi J, Heymann J, Boo FL, Behrman JR, Lu C, Lucas JE, Perez-Escamilla R, Dua T, Bhutta ZA, Stenberg K, Gertler P, Darmstadt GL. Investing in the foundation of sustainable development: pathways to scale up for early childhood development. Lancet 2017; 389:103-118. [PMID: 27717610 PMCID: PMC5880532 DOI: 10.1016/s0140-6736(16)31698-1] [Citation(s) in RCA: 382] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/15/2016] [Accepted: 08/22/2016] [Indexed: 01/21/2023]
Abstract
Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals.
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Affiliation(s)
- Linda M Richter
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa.
| | - Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | | | - Jody Heymann
- UCLA Fielding School of Public Health and WORLD Policy Analysis Center, University of California Los Angeles, CA, USA
| | | | - Jere R Behrman
- Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, PA, USA
| | - Chunling Lu
- Division of Global Health Equity, Brigham & Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Jane E Lucas
- Consultant in International Health and Child Development, New York, NY, USA
| | - Rafael Perez-Escamilla
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada; Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Karin Stenberg
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Paul Gertler
- Haas School of Business and the School of Public Health, University of California Berkeley, CA, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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17
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Skordis-Worrall J, Sinha R, Kumar Ojha A, Sarangi S, Nair N, Tripathy P, Sachdev HS, Bhattacharyya S, Gope R, Rath S, Rath S, Srivastava A, Batura N, Pulkki-Brännström AM, Costello A, Copas A, Saville N, Prost A, Haghparast-Bidgoli H. Protocol for the economic evaluation of a community-based intervention to improve growth among children under two in rural India (CARING trial). BMJ Open 2016; 6:e012046. [PMID: 27807084 PMCID: PMC5128945 DOI: 10.1136/bmjopen-2016-012046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Undernutrition affects ∼165 million children globally and contributes up to 45% of all child deaths. India has the highest proportion of global undernutrition-related morbidity and mortality. This protocol describes the planned economic evaluation of a community-based intervention to improve growth in children under 2 years of age in two rural districts of eastern India. The intervention is being evaluated through a cluster-randomised controlled trial (cRCT, the CARING trial). METHODS AND ANALYSIS A cost-effectiveness and cost-utility analysis nested within a cRCT will be conducted from a societal perspective, measuring programme, provider, household and societal costs. Programme costs will be collected prospectively from project accounts using a standardised tool. These will be supplemented with time sheets and key informant interviews to inform the allocation of joint costs. Direct and indirect costs incurred by providers will be collected using key informant interviews and time use surveys. Direct and indirect household costs will be collected prospectively, using time use and consumption surveys. Incremental cost-effectiveness ratios (ICERs) will be calculated for the primary outcome measure, that is, cases of stunting prevented, and other outcomes such as cases of wasting prevented, cases of infant mortality averted, life years saved and disability-adjusted life years (DALYs) averted. Sensitivity analyses will be conducted to assess the robustness of results. ETHICS AND DISSEMINATION There is a shortage of robust evidence regarding the cost-effectiveness of strategies to improve early child growth. As this economic evaluation is nested within a large scale, cRCT, it will contribute to understanding the fiscal space for investment in early child growth, and the relative (in)efficiency of prioritising resources to this intervention over others to prevent stunting in this and other comparable contexts. The protocol has all necessary ethical approvals and the findings will be disseminated within academia and the wider policy sphere. TRIAL REGISTRATION NUMBER ISRCTN51505201; pre-results.
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Affiliation(s)
| | | | | | | | | | | | - H S Sachdev
- Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | | | | | | | | | | | - Neha Batura
- University College London, Institute for Global Health, London, UK
| | - Anni-Maria Pulkki-Brännström
- University College London, Institute for Global Health, London, UK
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anthony Costello
- University College London, Institute for Global Health, London, UK
| | - Andrew Copas
- Department of Infection and Population Health, University College London, London, UK
| | - Naomi Saville
- University College London, Institute for Global Health, London, UK
| | - Audrey Prost
- University College London, Institute for Global Health, London, UK
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18
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Saville NM, Shrestha BP, Style S, Harris-Fry H, Beard BJ, Sengupta A, Jha S, Rai A, Paudel V, Pulkki-Brannstrom AM, Copas A, Skordis-Worrall J, Bhandari B, Neupane R, Morrison J, Gram L, Sah R, Basnet M, Harthan J, Manandhar DS, Osrin D, Costello A. Protocol of the Low Birth Weight South Asia Trial (LBWSAT), a cluster-randomised controlled trial testing impact on birth weight and infant nutrition of Participatory Learning and Action through women's groups, with and without unconditional transfers of fortified food or cash during pregnancy in Nepal. BMC Pregnancy Childbirth 2016; 16:320. [PMID: 27769191 PMCID: PMC5073870 DOI: 10.1186/s12884-016-1102-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/08/2016] [Indexed: 11/16/2022] Open
Abstract
Background Low birth weight (LBW, < 2500 g) affects one third of newborn infants in rural south Asia and compromises child survival, infant growth, educational performance and economic prospects. We aimed to assess the impact on birth weight and weight-for-age Z-score in children aged 0–16 months of a nutrition Participatory Learning and Action behaviour change strategy (PLA) for pregnant women through women’s groups, with or without unconditional transfers of food or cash to pregnant women in two districts of southern Nepal. Methods The study is a cluster randomised controlled trial (non-blinded). PLA comprises women’s groups that discuss, and form strategies about, nutrition in pregnancy, low birth weight and hygiene. Women receive up to 7 monthly transfers per pregnancy: cash is NPR 750 (~US$7) and food is 10 kg of fortified sweetened wheat-soya Super Cereal per month. The unit of randomisation is a rural village development committee (VDC) cluster (population 4000–9200, mean 6150) in southern Dhanusha or Mahottari districts. 80 VDCs are randomised to four arms using a participatory ‘tombola’ method. Twenty clusters each receive: PLA; PLA plus food; PLA plus cash; and standard care (control). Participants are (mostly Maithili-speaking) pregnant women identified from 8 weeks’ gestation onwards, and their infants (target sample size 8880 birth weights). After pregnancy verification, mothers may be followed up in early and late pregnancy, within 72 h, after 42 days and within 22 months of birth. Outcomes pertain to the individual level. Primary outcomes include birth weight within 72 h of birth and infant weight-for-age Z-score measured cross-sectionally on children born of the study. Secondary outcomes include prevalence of LBW, eating behaviour and weight during pregnancy, maternal and newborn illness, preterm delivery, miscarriage, stillbirth or neonatal mortality, infant Z-scores for length-for-age and weight-for-length, head circumference, and postnatal maternal BMI and mid-upper arm circumference. Exposure to women’s groups, food or cash transfers, home visits, and group interventions are measured. Discussion Determining the relative importance to birth weight and early childhood nutrition of adding food or cash transfers to PLA women’s groups will inform design of nutrition interventions in pregnancy. Trial registration ISRCTN75964374, 12 Jul 2013 Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1102-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Naomi M Saville
- University College London, Institute for Global Health, London, UK.
| | - Bhim P Shrestha
- Mother and Infant Research Activities (MIRA), PO Box 921, Thapathali, Kathmandu, Nepal
| | - Sarah Style
- University College London, Institute for Global Health, London, UK
| | - Helen Harris-Fry
- University College London, Institute for Global Health, London, UK
| | - B James Beard
- University College London, Institute for Global Health, London, UK
| | - Aman Sengupta
- Mother and Infant Research Activities (MIRA), PO Box 921, Thapathali, Kathmandu, Nepal
| | - Sonali Jha
- Mother and Infant Research Activities (MIRA), PO Box 921, Thapathali, Kathmandu, Nepal
| | - Anjana Rai
- Mother and Infant Research Activities (MIRA), PO Box 921, Thapathali, Kathmandu, Nepal
| | - Vikas Paudel
- Mother and Infant Research Activities (MIRA), PO Box 921, Thapathali, Kathmandu, Nepal
| | | | - Andrew Copas
- University College London, Institute for Global Health, London, UK
| | | | - Bishnu Bhandari
- Mother and Infant Research Activities (MIRA), PO Box 921, Thapathali, Kathmandu, Nepal
| | - Rishi Neupane
- Mother and Infant Research Activities (MIRA), PO Box 921, Thapathali, Kathmandu, Nepal
| | - Joanna Morrison
- University College London, Institute for Global Health, London, UK
| | - Lu Gram
- University College London, Institute for Global Health, London, UK
| | - Raghbendra Sah
- Mother and Infant Research Activities (MIRA), PO Box 921, Thapathali, Kathmandu, Nepal
| | - Machhindra Basnet
- Mother and Infant Research Activities (MIRA), PO Box 921, Thapathali, Kathmandu, Nepal
| | - Jayne Harthan
- University College London, Institute for Global Health, London, UK
| | - Dharma S Manandhar
- Mother and Infant Research Activities (MIRA), PO Box 921, Thapathali, Kathmandu, Nepal
| | - David Osrin
- University College London, Institute for Global Health, London, UK
| | - Anthony Costello
- University College London, Institute for Global Health, London, UK
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Feldman I, Eurenius E, Häggström J, Sampaio F, Lindkvist M, Pulkki-Brännström AM, Ivarsson A. Effectiveness and cost-effectiveness of the Salut Programme: a universal health promotion intervention for parents and children-protocol of a register-based retrospective observational study. BMJ Open 2016; 6:e011202. [PMID: 27491668 PMCID: PMC4985974 DOI: 10.1136/bmjopen-2016-011202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/10/2016] [Accepted: 07/14/2016] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION There is inadequate evidence for the effectiveness and cost-effectiveness of health promotion interventions. The Salut Programme aims to reach all parents and children in the Västerbotten County of Sweden with a combination of health promotion interventions initiated during pregnancy and continued over the childhood period. This study protocol describes an effectiveness study and an economic evaluation study, where the ongoing Salut Programme is compared to care-as-usual over the periods of pregnancy, delivery and the child's first 2 years of life. METHODS A register-based retrospective observational study design will be used with existing data sources with respect to exposures and outcomes. Outcomes of interest are clustered at 3 points: around the child's birth, 1 month after the child's birth and 2 years after the child's birth. We will simulate an experiment by retrospectively identifying and comparing children and their parents in the geographical areas where the Salut Programme was implemented since 2006 and onwards, and the areas where the Programme was not implemented before 2009. Outcomes will be analysed and compared for the premeasure period, and the postmeasure period for both groups. Our analysis combines difference-in-difference estimation with matching. A complementary analysis will be carried out on the longitudinal subsample of mothers who gave birth at least once during each of the time periods. The economic evaluation aims to capture the wider societal costs and benefits of the Salut Programme for the first 2 years of the children's lives. Incremental costs will be compared with incremental health gains and the results will be presented as a cost-consequence analysis. ETHICS AND DISSEMINATION The Regional Ethical Review Board in Umeå has given clearance for the Salut Programme research (2010-63-31M). No individual's identity will be revealed when presenting results. This study will provide information that can guide decision-makers to allocate resources optimally.
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Affiliation(s)
- Inna Feldman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Eva Eurenius
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Jenny Häggström
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - Filipa Sampaio
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - Anni-Maria Pulkki-Brännström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, Arora M, Azzopardi P, Baldwin W, Bonell C, Kakuma R, Kennedy E, Mahon J, McGovern T, Mokdad AH, Patel V, Petroni S, Reavley N, Taiwo K, Waldfogel J, Wickremarathne D, Barroso C, Bhutta Z, Fatusi AO, Mattoo A, Diers J, Fang J, Ferguson J, Ssewamala F, Viner RM. Our future: a Lancet commission on adolescent health and wellbeing. Lancet 2016; 387:2423-78. [PMID: 27174304 PMCID: PMC5832967 DOI: 10.1016/s0140-6736(16)00579-1] [Citation(s) in RCA: 1719] [Impact Index Per Article: 214.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- George C Patton
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia.
| | - Susan M Sawyer
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia; Murdoch Childrens Research Institute, Columbia University, New York, NY, USA
| | - John S Santelli
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David A Ross
- World Health Organization, Geneva, Switzerland; London School of Hygiene & Tropical Medicine, London, UK
| | - Rima Afifi
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | - Nicholas B Allen
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; University of Oregon, Eugene, OR, USA
| | - Monika Arora
- Public Health Foundation of India, New Delhi, India
| | - Peter Azzopardi
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia
| | | | | | - Ritsuko Kakuma
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Terry McGovern
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ali H Mokdad
- Institute of Health Metrics and Evaluation, University of Washinton, Seattle, WA, USA
| | - Vikram Patel
- London School of Hygiene & Tropical Medicine, London, UK; Public Health Foundation of India, New Delhi, India
| | - Suzanne Petroni
- International Centre for Research on Women, Washington, DC, USA
| | - Nicola Reavley
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Jane Waldfogel
- School of Social Work, Columbia University, New York, NY, USA
| | | | | | - Zulfiqar Bhutta
- University of Toronto, Toronto, ON, Canada; Aga Khan University, Karachi, Pakistan
| | | | - Amitabh Mattoo
- Australia India Centre, University of Melbourne, Melbourne, VIC, Australia; Jawaharlal Nehru University, New Delhi, India
| | | | - Jing Fang
- Kunming Medical University, Kunming, China
| | - Jane Ferguson
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Russell M Viner
- Institute of Child Health, University College London, London, UK
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