University College London, Institute for Global Health, London, United Kingdom.
London School of Hygiene & Tropical Medicine, London, United Kingdom.
J Nutr. 2022 Oct 6;152(10):2255-2268. doi: 10.1093/jn/nxac132.
Economic evaluations of nutrition-sensitive agriculture (NSA) interventions are scarce, limiting assessment of their potential affordability and scalability.
We conducted cost-consequence analyses of 3 participatory video-based interventions of fortnightly women's group meetings using the following platforms: 1) NSA videos; 2) NSA and nutrition-specific videos; or 3) NSA videos with a nutrition-specific participatory learning and action (PLA) cycle.
Interventions were tested in a 32-mo, 4-arm cluster-randomized controlled trial, Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN) in the Keonjhar district, Odisha, India. Impacts were evaluated in children aged 0-23 mo and their mothers. We estimated program costs using data collected prospectively from expenditure records of implementing and technical partners and societal costs using expenditure assessment data collected from households with a child aged 0-23 mo and key informant interviews. Costs were adjusted for inflation, discounted, and converted to 2019 US$.
Total program costs of each intervention ranged from US$272,121 to US$386,907. Program costs per pregnant woman or mother of a child aged 0-23 mo were US$62 for NSA videos, US$84 for NSA and nutrition-specific videos, and US$78 for NSA videos with PLA (societal costs: US$125, US$143, and US$122, respectively). Substantial shares of total costs were attributable to development and delivery of the videos and PLA (52-69%) and quality assurance (25-41%). Relative to control, minimum dietary diversity was higher in the children who underwent the interventions incorporating nutrition-specific videos and PLA (adjusted RRs: 1.19 and 1.27; 95% CIs: 1.03-1.37 and 1.11, 1.46, respectively). Relative to control, minimum dietary diversity in mothers was higher in those who underwent NSA video (1.21 [1.01, 1.45]) and NSA with PLA (1.30 [1.10, 1.53]) interventions.
NSA videos with PLA can increase both maternal and child dietary diversity and have the lowest cost per unit increase in diet diversity. Building on investments made in developing UPAVAN, cost-efficiency at scale could be increased with less intensive monitoring, reduced startup costs, and integration within existing government programs. This trial was registered at clinicaltrials.gov as ISRCTN65922679.
针对营养敏感型农业（NSA）干预措施的经济评估很少，这限制了对其潜在负担能力和可扩展性的评估。
我们对参与式视频基础的三种妇女小组会议干预措施进行了成本-效果分析，这些干预措施使用了以下平台：1）NSA 视频；2）NSA 和营养特定视频；或 3）具有营养特定参与式学习和行动（PLA）周期的 NSA 视频。
该干预措施在印度奥里萨邦 Keonjhar 区进行了为期 32 个月的 4 臂集群随机对照试验 Upscaling Participatory Action and Videos for Agriculture and Nutrition（UPAVAN）中进行了测试。以 0-23 月龄儿童及其母亲为对象评估了影响。我们使用实施伙伴和技术伙伴的前瞻性支出记录以及从有 0-23 月龄儿童的家庭收集的支出评估数据来估算方案成本，并使用关键知情人访谈来估算社会成本。对成本进行了通胀调整、贴现，并转换为 2019 年的美元。
每个干预措施的总方案成本范围为 272121 美元至 386907 美元。每位孕妇或 0-23 月龄儿童母亲的方案成本为 NSA 视频 62 美元，NSA 和营养特定视频 84 美元，具有 PLA 的 NSA 视频 78 美元（社会成本：分别为 125 美元、143 美元和 122 美元）。视频和 PLA（52%-69%）和质量保证（25%-41%）的开发和交付占总成本的很大一部分。与对照组相比，纳入营养特定视频和 PLA 的干预措施组儿童的最低饮食多样性更高（校正 RR：1.19 和 1.27；95%CI：1.03-1.37 和 1.11，1.46）。与对照组相比，接受 NSA 视频（1.21[1.01，1.45]）和 NSA 与 PLA（1.30[1.10，1.53]）干预措施的母亲的最低饮食多样性更高。
具有 PLA 的 NSA 视频可以增加母婴饮食多样性，且单位饮食多样性成本增加最低。在 UPAVAN 开发投资的基础上，可以通过减少监测、降低启动成本以及与现有政府计划相结合来提高成本效益。该试验在 clinicaltrials.gov 上注册为 ISRCTN65922679。
