A Gelli, Cg Kemp, A Margolies, A Twalibu, M Katundu, C Levin
International Food Policy Research Institute, Washington, D.C. USA.
Department of Global Health, University of Washington, Washington, USA.
Food Secur. 2022;14(1):67-80. doi: 10.1007/s12571-021-01203-6. Epub 2021 Aug 24.
Malnutrition is a leading cause of death and disability among children in low-income countries. Nutrition-sensitive interventions show promise in increasing food access and improving diets. There are possible synergies of integrating these programs with other sectors, improving effectiveness by leveraging resources. However, economic evaluations of these multi-sectoral programs are limited. We aimed to estimate the cost efficiency, cost-effectiveness, benefit-cost ratio, and net benefit of using community-based early childhood development (ECD) centers as platforms for an intervention promoting agricultural production and nutrition among households with young children in Malawi. The intervention was costed using bottom-up micro-costing and top-down expenditure analysis with a societal perspective and a 12-month horizon. Effectiveness estimates were derived from a cluster-randomized control trial. Premature deaths and stunting cases averted were estimated using the Lived Saved Tool. We calculated DALYs averted, and the value of three benefits streams resulting from reductions in premature mortality, increases in lifetime productivity and household agricultural productivity. We transferred the US value of a statistical life (VSL) to Malawi using an income elasticity of 1.5, and a 10% discount rate. Probabilistic sensitivity analysis was conducted using a Monte Carlo model. The intervention cost $197,377, reaching 4,806 beneficiaries at $41 per beneficiary, $595 per case of stunting, $18,310 per death, and $516 per DALY averted. Net benefit estimates ranged from $507,589 to $4,678,258, and benefit-cost ratios from 3.57 to 24.70. Sensitivity analyses confirmed a positive return on investment. Implementing agriculture-nutrition interventions through ECD platforms may be an efficient use of resources in Malawi and similar contexts.
营养不良是低收入国家儿童死亡和残疾的主要原因。营养敏感型干预措施在增加食物获取和改善饮食方面显示出前景。将这些项目与其他部门整合可能会产生协同效应，通过利用资源提高有效性。然而，对这些多部门项目的经济评估有限。我们旨在估计在马拉维，将基于社区的幼儿发展（ECD）中心作为促进有幼儿家庭农业生产和营养的干预平台的成本效率、成本效益、效益成本比和净效益。采用自下而上的微观成本核算和自上而下的支出分析，从社会角度并以12个月为期限对干预措施进行成本核算。有效性估计来自一项整群随机对照试验。使用“挽救生命工具”估计避免的过早死亡和发育迟缓病例数。我们计算了避免的伤残调整生命年（DALYs），以及因过早死亡率降低、终身生产力提高和家庭农业生产力提高而产生的三个效益流的价值。我们使用1.5的收入弹性和10%的贴现率将美国的统计生命价值（VSL）转换为马拉维的价值。使用蒙特卡罗模型进行概率敏感性分析。该干预措施成本为197,377美元，惠及4,806名受益人，每位受益人的成本为41美元，每例发育迟缓的成本为595美元，每例死亡的成本为18,310美元，每避免一个DALY的成本为516美元。净效益估计范围为507,589美元至4,678,258美元，效益成本比为3.57至24.70。敏感性分析证实了投资的正回报。通过ECD平台实施农业-营养干预措施在马拉维和类似背景下可能是一种有效的资源利用方式。
