Health Policy and Planning Advance Access originally published online on May 3, 2006
Health Policy and Planning 2006 21(4):257-264; doi:10.1093/heapol/czl010
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The cost-effectiveness of a child nutrition education programme in Peru
1Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and 2Instituto de Investigación Nutricional, Lima, Peru
Correspondence: Hugh R Waters, MS, PhD, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA. E-mail: hwaters{at}jhsph.edu
This article reports impact and cost results from a health facility-based nutrition education programme targeting children less than 2 years of age in Trujillo, Peru. Key elements of the programme included participative complementary feeding demonstrations, growth monitoring sessions and an accreditation process. Data were collected from six intervention and six control health facilities to measure utilization and costs associated with the intervention. To calculate the unit costs of services, these costs are allocated using activity-based costing. To measure the effects of the intervention, 338 children were followed through household surveys at regular intervals from birth until the age of 18 months.
The intervention had a clear positive impact both on the use of nutrition-related services and on children's growth outcomes. Children in the intervention areas made 17.6 visits to health facilities in the first 18 months of life, compared with 14.1 visits for children in the control areas (P<0.001). This pattern holds true for all socioeconomic groups. The intervention prevented 11.1 cases of stunting per 100 children. In multivariate logistic regression analysis, children in the intervention were 0.33 times as likely to be stunted as the controls (P = 0.002). The marginal cost of the intervention – including external costs, training, health education materials and extra travel and equipment – is US$6.12 per child reached and US$55.16 per case of stunting prevented. The estimated marginal cost of the intervention per death averted is US$1952.
Key Words: nutrition education, behavioural change, cost-effectiveness, economic evaluation, stunting
1This article classifies countries by income level using the following categories from the 2003 World Development Report (World Bank 2005): Low-income – US$745 per capita or less; Lower middle-income – US$746–2975; Upper middle-income – US$2976–9205; High-income – US$9206 or more.
2Three key messages were developed (paraphrased in English): (1) Offer your child a thick purée to eat rather than soup; (2) Add a special ingredient to your child's meal: chicken liver, egg or fish; and (3) Use patience, love and good humour to help your child to learn to eat.
3The visits correspond to the child's age as follows: 1st visit before 1 month of age; 2nd visit at 3 months; 3rd visit at 4 months; 4th visit at 6 months; 5th visit at 8 months; 6th visit at 9 months; 7th visit at 12 months; 8th visit at 15 months; 9th visit at 18 months. All visits except for the 3rd and 5th included the collection of anthropometric data; the 9th visit also included collection of economic data for the household.
4Throughout this document, monetary values have been converted to 2001 US dollars. The exchange rate applied is that which was in effect at the midpoint of the health facility intervention, in April 2001: 3.54 Peruvian Soles to US$1.00.
5From the Peru 2000 Demographic and Health Survey, available at: [http://www.measuredhs.com/countries/country.cfm?ctry_id=33].