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Christian CS, Nkonki L, Desmond C, Hoegfeldt C, Dube S, Rochat T, Stein A. Protocol of a cost-effectiveness analysis of a combined intervention for depression and parenting compared with enhanced standard of care for perinatally depressed, HIV-positive women and their infants in rural South Africa. BMJ Open 2024; 14:e082977. [PMID: 39097310 PMCID: PMC11337707 DOI: 10.1136/bmjopen-2023-082977] [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: 12/11/2023] [Accepted: 07/12/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION Poverty, HIV and perinatal depression represent a triple threat to public health in sub-Saharan Africa because of their combined negative effects on parenting and child development. In the resource-constrained context of low-income and middle-income countries, a lay-counsellor-delivered intervention that combines a psychological and parenting intervention could offer the potential to mitigate the consequences of perinatal depression while also optimising scarce resources for healthcare.Measuring the cost-effectiveness of such a novel intervention will help decision-makers to better understand the relative costs and effects associated with replicating the intervention, thereby supporting evidence-based decision-making. This protocol sets out the methodological framework for analysing the cost-effectiveness of a cluster randomised controlled trial (RCT) that compares a combined intervention to enhanced standard of care when treating depressed, HIV-positive pregnant women and their infants in rural South Africa. METHODS AND ANALYSIS This cost-effectiveness analysis (CEA) protocol complies with the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist. A societal perspective will be chosen.The proposed methods will determine the cost and efficiency of implementing the intervention as per the randomised control trial protocol, as well as the cost of replicating the intervention in a non-research setting. The costs will be calculated using an appropriately adjusted version of the Standardised Early Childhood Development Costing Tool.Primary health outcomes will be used in combination with costs to determine the cost per improvement in maternal perinatal depression at 12 months postnatal and the cost per improvement in child cognitive development at 24 months of age. To facilitate priority setting, the incremental cost-effectiveness ratios for improvements in child cognitive development will be ranked against six other child cognitive-development interventions according to Verguet et al's methodology (2022).A combination of activity-based and ingredient-based costing approaches will be used to identify, measure and value activities and inputs for all alternatives. Outcomes data will be sourced from the RCT team. ETHICS AND DISSEMINATION The University of Oxford is the sponsor of the CEA. Ethics approval has been obtained from the Human Sciences Research Council (HSRC, #REC 5/23/08/17), South Africa and the Oxford Tropical Research Ethics Committee (OxTREC #31-17), UK.Consent for publication is not applicable since no participant data are used in this protocol.We plan to disseminate the CEA results to key policymakers and researchers in the form of a policy brief, meetings and academic papers. TRIAL REGISTRATION DETAILS ISRCTN registry #11 284 870 (14/11/2017) and SANCTR DOH-27-102020-9097 (17/11/2017).
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Affiliation(s)
- Carmen Sue Christian
- Department of Economics, Faculty of Economics and Management Sciences, University of the Western Cape, Bellville, South Africa
| | - Lungiswa Nkonki
- Health Systems and Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Chris Desmond
- School of Economics and Finance, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Tamsen Rochat
- Department of Psychology, Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
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Palmer T, Clare A, Fearon P, Head R, Hill Z, Kagone B, Kirkwood B, Manu A, Skordis J. Cost-effectiveness of a radio intervention to stimulate early childhood development: protocol for an economic evaluation of the SUNRISE trial in Burkina Faso. BMJ Open 2024; 14:e080905. [PMID: 38626956 PMCID: PMC11029498 DOI: 10.1136/bmjopen-2023-080905] [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: 10/20/2023] [Accepted: 03/14/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Approximately 250 million children under 5 years of age are at risk of poor development in low-income and middle-income countries. However, existing early childhood development (ECD) interventions can be expensive, labour intensive and challenging to deliver at scale. Mass media may offer an alternative approach to ECD intervention. This protocol describes the planned economic evaluation of a cluster-randomised controlled trial of a radio campaign promoting responsive caregiving and opportunities for early learning during the first 3 years of life in rural Burkina Faso (SUNRISE trial). METHODS AND ANALYSIS The economic evaluation of the SUNRISE trial will be conducted as a within-trial analysis from the provider's perspective. Incremental costs and health outcomes of the radio campaign will be compared with standard broadcasting (ie, 'do nothing' comparator). All costs associated with creating and broadcasting the radio campaign during intervention start-up and implementation will be captured. The cost per child under 3 years old reached by the intervention will be calculated. Incremental cost-effectiveness ratios will be calculated for the trial's primary outcome (ie, incremental cost per SD of cognitive gain). A cost-consequence analysis will also be presented, whereby all relevant costs and outcomes are tabulated. Finally, an analysis will be conducted to assess the equity impact of the intervention. ETHICS AND DISSEMINATION The SUNRISE trial has ethical approval from the ethics committees of the Ministry of Health, Burkina Faso, University College London and the London School of Hygiene and Tropical Medicine. The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference. TRIAL REGISTRATION NUMBER The SUNRISE trial was registered with ClinicalTrials.gov on 19 April 2019 (identifier: NCT05335395).
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Affiliation(s)
| | | | | | - Roy Head
- Development Media International, London, UK
| | | | | | | | - Alexander Manu
- London School of Hygiene and Tropical Medicine, London, UK, London, UK
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Ahun MN, Ali NB, Hentschel E, Jeong J, Franchett E, Yousafzai AK. A meta-analytic review of the implementation characteristics in parenting interventions to promote early child development. Ann N Y Acad Sci 2024; 1533:99-144. [PMID: 38354095 DOI: 10.1111/nyas.15110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
This review summarizes the implementation characteristics of parenting interventions to promote early child development (ECD) outcomes from birth to 3 years. We included 134 articles representing 123 parenting trials (PROSPERO record CRD42022285998). Studies were conducted across high-income (62%) and low-and-middle-income (38%) countries. The most frequently used interventions were Reach Up and Learn, Nurse Family Partnership, and Head Start. Half of the interventions were delivered as home visits. The other half used mixed settings and modalities (27%), clinic visits (12%), and community-based group sessions (11%). Due to the lack of data, we were only able to test the moderating role of a few implementation characteristics in intervention impacts on parenting and cognitive outcomes (by country income level) in the meta-analysis. None of the implementation characteristics moderated intervention impacts on cognitive or parenting outcomes in low- and middle-income or high-income countries. There is a significant need in the field of parenting interventions for ECD to consistently collect and report data on key implementation characteristics. These data are needed to advance our understanding of how parenting interventions are implemented and how implementation factors impact outcomes to help inform the scale-up of effective interventions to improve child development.
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Affiliation(s)
- Marilyn N Ahun
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nazia Binte Ali
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth Hentschel
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Emily Franchett
- Department of Applied Psychology, New York University Steinhardt School of Culture, Education, and Human Development, New York, New York, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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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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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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Prado EL, Arnold CD, Wessells KR, Stewart CP, Abbeddou S, Adu-Afarwuah S, Arnold BF, Ashorn U, Ashorn P, Becquey E, Brown KH, Chandna J, Christian P, Dentz HN, Dulience SJL, Fernald LC, Galasso E, Hallamaa L, Hess SY, Huybregts L, Iannotti LL, Jimenez EY, Kohl P, Lartey A, Le Port A, Luby SP, Maleta K, Matchado A, Matias SL, Mridha MK, Ntozini R, Null C, Ocansey ME, Parvez SM, Phuka J, Pickering AJ, Prendergast AJ, Shamim AA, Siddiqui Z, Tofail F, Weber AM, Wu L, Dewey KG. Small-quantity lipid-based nutrient supplements for children age 6-24 months: a systematic review and individual participant data meta-analysis of effects on developmental outcomes and effect modifiers. Am J Clin Nutr 2021; 114:43S-67S. [PMID: 34590116 PMCID: PMC8560311 DOI: 10.1093/ajcn/nqab277] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/04/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Small-quantity (SQ) lipid-based nutrient supplements (LNSs) provide many nutrients needed for brain development. OBJECTIVES We aimed to generate pooled estimates of the effect of SQ-LNSs on developmental outcomes (language, social-emotional, motor, and executive function), and to identify study-level and individual-level modifiers of these effects. METHODS We conducted a 2-stage meta-analysis of individual participant data from 14 intervention against control group comparisons in 13 randomized trials of SQ-LNSs provided to children age 6-24 mo (total n = 30,024). RESULTS In 11-13 intervention against control group comparisons (n = 23,588-24,561), SQ-LNSs increased mean language (mean difference: 0.07 SD; 95% CI: 0.04, 0.10 SD), social-emotional (0.08; 0.05, 0.11 SD), and motor scores (0.08; 95% CI: 0.05, 0.11 SD) and reduced the prevalence of children in the lowest decile of these scores by 16% (prevalence ratio: 0.84; 95% CI: 0.76, 0.92), 19% (0.81; 95% CI: 0.74, 0.89), and 16% (0.84; 95% CI: 0.76, 0.92), respectively. SQ-LNSs also increased the prevalence of children walking without support at 12 mo by 9% (1.09; 95% CI: 1.05, 1.14). Effects of SQ-LNSs on language, social-emotional, and motor outcomes were larger among study populations with a higher stunting burden (≥35%) (mean difference: 0.11-0.13 SD; 8-9 comparisons). At the individual level, greater effects of SQ-LNSs were found on language among children who were acutely malnourished (mean difference: 0.31) at baseline; on language (0.12), motor (0.11), and executive function (0.06) among children in households with lower socioeconomic status; and on motor development among later-born children (0.11), children of older mothers (0.10), and children of mothers with lower education (0.11). CONCLUSIONS Child SQ-LNSs can be expected to result in modest developmental gains, which would be analogous to 1-1.5 IQ points on an IQ test, particularly in populations with a high child stunting burden. Certain groups of children who experience higher-risk environments have greater potential to benefit from SQ-LNSs in developmental outcomes.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020159971.
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Affiliation(s)
- Elizabeth L Prado
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Charles D Arnold
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - K Ryan Wessells
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Christine P Stewart
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Kenneth H Brown
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
- Helen Keller International, New York, NY, USA
| | - Jaya Chandna
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Parul Christian
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Holly N Dentz
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | | | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lotta Hallamaa
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sonja Y Hess
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Lora L Iannotti
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Elizabeth Y Jimenez
- Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Patricia Kohl
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | | | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Andrew Matchado
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | | | - Sarker M Parvez
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - John Phuka
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | | | - Abu A Shamim
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Zakia Siddiqui
- Healthy Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Tofail
- Nutrition and Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ann M Weber
- Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | - Lee S F Wu
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn G Dewey
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
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Lopez Garcia I, Saya UY, Luoto JE. Cost-effectiveness and economic returns of group-based parenting interventions to promote early childhood development: Results from a randomized controlled trial in rural Kenya. PLoS Med 2021; 18:e1003746. [PMID: 34582449 PMCID: PMC8478245 DOI: 10.1371/journal.pmed.1003746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early childhood development (ECD) programs can help address disadvantages for the 43% of children under 5 in low- and middle-income countries (LMICs) experiencing compromised development. However, very few studies from LMIC settings include information on their program's cost-effectiveness or potential returns to investment. We estimated the cost-effectiveness, benefit-cost ratios (BCRs), and returns on investment (ROIs) for 2 effective group-based delivery models of an ECD parenting intervention that utilized Kenya's network of local community health volunteers (CHVs). METHODS AND FINDINGS Between October 1 and November 12, 2018, 1,152 mothers with children aged 6 to 24 months were surveyed from 60 villages in rural western Kenya. After baseline, villages were randomly assigned to one of 3 intervention arms: a group-only delivery model with 16 fortnightly sessions, a mixed-delivery model combining 12 group sessions with 4 home visits, and a control group. At endline (August 5 to October 31, 2019), 1,070 children were retained and assessed for primary outcomes including cognitive and receptive language development (with the Bayley Scales of Infant Development, Third Edition) and socioemotional development (with the Wolke scale). Children in the 2 intervention arms showed better developmental outcomes than children in the control arm, although the group-only delivery model generally had larger effects on children. Total program costs included provider's implementation costs collected during the intervention period using financial reports from the local nongovernmental organization (NGO) implementer, as well as societal costs such as opportunity costs to mothers and delivery agents. We combined program impacts with these total costs to estimate incremental cost-effectiveness ratios (ICERs), as well as BCRs and the program's ROI for the government based on predictions of future lifetime wages and societal costs. Total costs per child were US$140 in the group-only arm and US$145 in the mixed-delivery arm. Because of higher intention-to-treat (ITT) impacts at marginally lower costs, the group-only model was the most cost-effective across all child outcomes. Focusing on child cognition in this arm, we estimated an ICER of a 0.37 standard deviation (SD) improvement in cognition per US$100 invested, a BCR of 15.5, and an ROI of 127%. A limitation of our study is that our estimated BCR and ROI necessarily make assumptions about the discount rate, income tax rates, and predictions of intervention impacts on future wages and schooling. We examine the sensitivity of our results to these assumptions. CONCLUSIONS To the best of our knowledge, this study is the first economic evaluation of an effective ECD parenting intervention targeted to young children in sub-Saharan Africa (SSA) and the first to adopt a societal perspective in calculating cost-effectiveness that accounts for opportunity costs to delivery agents and program participants. Our cost-effectiveness and benefit-cost estimates are higher than most of the limited number of prior studies from LMIC settings providing information about costs. Our results represent a strong case for scaling similar interventions in impoverished rural settings, and, under reasonable assumptions about the future, demonstrate that the private and social returns of such investments are likely to largely outweigh their costs. TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov, NCT03548558, June 7, 2018. American Economic Association RCT Registry trial AEARCTR-0002913.
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Affiliation(s)
- Italo Lopez Garcia
- RAND Corporation, Santa Monica, California, United States of America
- Pardee RAND Graduate School, Santa Monica, California, United States of America
| | - Uzaib Y. Saya
- RAND Corporation, Santa Monica, California, United States of America
- Pardee RAND Graduate School, Santa Monica, California, United States of America
| | - Jill E. Luoto
- RAND Corporation, Santa Monica, California, United States of America
- Pardee RAND Graduate School, Santa Monica, California, United States of America
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Carroll G, Safon C, Buccini G, Vilar-Compte M, Teruel G, Pérez-Escamilla R. A systematic review of costing studies for implementing and scaling-up breastfeeding interventions: what do we know and what are the gaps? Health Policy Plan 2020; 35:461-501. [PMID: 32073628 DOI: 10.1093/heapol/czaa005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2020] [Indexed: 12/17/2022] Open
Abstract
Despite the well-established evidence that breastfeeding improves maternal and child health outcomes, global rates of exclusive breastfeeding remain low. Cost estimates can inform stakeholders about the financial resources needed to scale up interventions to ultimately improve breastfeeding outcomes in low-, middle- and high-income countries. To inform the development of comprehensive costing frameworks, this systematic review aimed to (1) identify costing studies for implementing or scaling-up breastfeeding interventions, (2) assess the quality of identified costing studies and (3) examine the availability of cost data to identify gaps that need to be addressed through future research. Peer-reviewed and grey literature were systematically searched using a combination of index terms and relevant text words related to cost and the following breastfeeding interventions: breastfeeding counselling, maternity leave, the World Health Organization International Code of Marketing of Breastmilk Substitutes, the Baby-Friendly Hospital Initiative, media promotion, workplace support and pro-breastfeeding social policies. Data were extracted after having established inter-rater reliability among the first two authors. The quality of studies was assessed using an eight-item checklist for key costing study attributes. Forty-five studies met the inclusion criteria, with the majority including costs for breastfeeding counselling and paid maternity leave. Most cost analyses included key costing study attributes; however, major weaknesses among the studies were the lack of clarity on costing perspectives and not accounting for the uncertainty of reported cost estimates. Costing methodologies varied substantially, standardized costing frameworks are needed for reliably estimating the costs of implementing and scaling-up breastfeeding interventions at local-, national- or global-levels.
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Affiliation(s)
- Grace Carroll
- Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College St. Suite 200, New Haven, CT 06510, USA
| | - Cara Safon
- Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College St. Suite 200, New Haven, CT 06510, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Talbot Building, 715 Albany Street, Boston, MA 02118, USA
| | - Gabriela Buccini
- Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College St. Suite 200, New Haven, CT 06510, USA
| | - Mireya Vilar-Compte
- EQUIDE Research Institute for Equitable Development, Universidad Iberoamericana, Prolongacion Paseo de la Reforma 880, Santa Fe, Zedec Sta Fé, Álvaro Obregón, 01219 Ciudad de México, CDMX, Mexico
| | - Graciela Teruel
- EQUIDE Research Institute for Equitable Development, Universidad Iberoamericana, Prolongacion Paseo de la Reforma 880, Santa Fe, Zedec Sta Fé, Álvaro Obregón, 01219 Ciudad de México, CDMX, Mexico
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College St. Suite 200, New Haven, CT 06510, USA
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Nguyen T, Sweeny K, Tran T, Luchters S, Hipgrave DB, Hanieh S, Tran T, Tran H, Biggs BA, Fisher J. Protocol for an economic evaluation alongside a cluster randomised controlled trial: cost-effectiveness of Learning Clubs, a multicomponent intervention to improve women's health and infant's health and development in Vietnam. BMJ Open 2019; 9:e031721. [PMID: 31843831 PMCID: PMC6924726 DOI: 10.1136/bmjopen-2019-031721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Economic evaluations of complex interventions in early child development are required to guide policy and programme development, but a few are yet available. METHODS AND ANALYSIS Although significant gains have been made in maternal and child health in resource-constrained environments, this has mainly been concentrated on improving physical health. The Learning Clubs programme addresses both physical and mental child and maternal health. This study is an economic evaluation of a cluster randomised controlled trial of the impact of the Learning Clubs programme in Vietnam. It will be conducted from a societal perspective and aims to identify the cost-effectiveness and the economic and social returns of the intervention. A total of 1008 pregnant women recruited from 84 communes in a rural province in Vietnam will be included in the evaluation. Health and cost data will be gathered at three stages of the trial and used to calculate incremental cost-effectiveness ratios per percentage point improvement of infant's development, infant's health and maternal common mental disorders expressed in quality-adjusted life years gained. The return on investment will be calculated based on improvements in productivity, the results being expressed as benefit-cost ratios. ETHICS AND DISSEMINATION The trial was approved by Monash University Human Research Ethics Committee (Certificate Number 2016-0683), Australia, and approval was extended to include the economic evaluation (Amendment Review Number 2018-0683-23806); and the Institutional Review Board of the Hanoi School of Public Health (Certificate Number 017-377IDD- YTCC), Vietnam. Results will be disseminated through academic journals and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12617000442303.
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Affiliation(s)
- Trang Nguyen
- Global and Women's Health, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Research and Training Centre for Community Development, Hanoi, Viet Nam
| | - Kim Sweeny
- VISES, Victoria University, Melbourne, Victoria, Australia
| | - Thach Tran
- Global and Women's Health, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stanley Luchters
- Centre for International Health, Burnet Institute, Melbourne, Victoria, Australia
- Universiteit Gent, Gent, Belgium
| | | | - Sarah Hanieh
- Department of Medicine and Victorian Infectious Diseases Service at the Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Tuan Tran
- Research and Training Centre for Community Development, Hanoi, Viet Nam
| | - Ha Tran
- Research and Training Centre for Community Development, Hanoi, Viet Nam
| | | | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
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Stansbery P. Translation of evidence to practice to promote early childhood development programs. Ann N Y Acad Sci 2019; 1419:23-25. [PMID: 29791731 DOI: 10.1111/nyas.13721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 11/29/2022]
Abstract
The 2018 special issue of Annals of the New York Academy of Sciences on implementation research and practice for early childhood development brings together emerging evidence on implementing effective nurturing care programs, addressing issues of quality and scale. Translating evidence to practice requires addressing the barriers perceived by policy makers, which have been highlighted in the published literature. Here, I describe how UNICEF and other global partners are addressing these barriers.
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Affiliation(s)
- Pablo Stansbery
- Early Childhood Development (ECD), UNICEF East Asia and Pacific Regional Office (EAPRO), Bangkok, Thailand
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11
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Arregoces L, Hughes R, Milner KM, Ponce Hardy V, Tann C, Upadhyay A, Lawn JE. Accountability for funds for Nurturing Care: what can we measure? Arch Dis Child 2019; 104:S34-S42. [PMID: 30885964 PMCID: PMC6557225 DOI: 10.1136/archdischild-2018-315429] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Understanding donor, government and out-of-pocket funding for early child development (ECD) is important for tracking progress. We aimed to estimate a baseline for the WHO, UNICEF and World Bank Nurturing Care Framework (NCF) with a special focus on childhood disability. METHODS To estimate development assistance spending, the Organisation for Economic Cooperation and Development's Creditor Reporting System (OECD-CRS) database was searched for 2007-2016, using key words derived from domains of the NCF (good health, nutrition and growth, responsive caregiving, security and safety, and early learning), plus disability. Associated funds were analysed by domain, donor, recipient and region. Trends of ECD/NCF were compared with reproductive, maternal, newborn and child health (RMNCH) disbursements. To assess domestic or out-of-pocket expenditure for ECD, we searched electronic databases of indexed and grey literature. RESULTS US$79.1 billion of development assistance were disbursed, mostly for health and nutrition (US$61.9 billion, 78% of total) and least for disability (US$0.7 billion, 2% of total). US$2.3 per child per year were disbursed for non-health ECD activities. Total development assistance for ECD increased by 121% between 2007 and 2016, an average increase of 8.3% annually. Per child disbursements increased more in Africa and Asia, while minimally in Latin America and the Caribbean and Oceania. We could not find comparable sources for domestic funding and out-of-pocket expenditure. CONCLUSIONS Estimated international donor disbursements for ECD remain small compared with RMNCH. Limitations include inconsistent donor terminology in OECD data. Increased investment will be required in the poorest countries and for childhood disability to ensure that progress is equitable.
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Affiliation(s)
- Leonardo Arregoces
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK,Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Rob Hughes
- Children’s Investment Fund Foundation, London, UK,Maternal & Child Health Intervention Research Group, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kate M Milner
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK,Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Victoria Ponce Hardy
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Cally Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK,Neonatal Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Arjun Upadhyay
- Results for Development Institute, Washington, District of Columbia, USA
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
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Yousafzai AK, Aboud FE, Nores M, Kaur R. Reporting guidelines for implementation research on nurturing care interventions designed to promote early childhood development. Ann N Y Acad Sci 2018; 1419:26-37. [DOI: 10.1111/nyas.13648] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/25/2018] [Accepted: 02/05/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Aisha K. Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health; Harvard University; Boston Massachusetts
| | - Frances E. Aboud
- Department of Psychology; McGill University; Montreal Quebec Canada
| | - Milagros Nores
- National Institute for Early Education Research; Rutgers University; New Brunswick New Jersey
| | - Raghbir Kaur
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health; Harvard University; Boston Massachusetts
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13
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Britto PR, Singh M, Dua T, Kaur R, Yousafzai AK. What implementation evidence matters: scaling-up nurturing interventions that promote early childhood development. Ann N Y Acad Sci 2018; 1419:5-16. [DOI: 10.1111/nyas.13720] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Pia R. Britto
- Early Childhood Development; UNICEF; New York New York
| | | | - Tarun Dua
- Department of Mental Health and Substance Abuse; World Health Organization; Geneva Switzerland
| | - Raghbir Kaur
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health; Harvard University; Boston Massachusetts
| | - Aisha K. Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health; Harvard University; Boston Massachusetts
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