Basbous Maya, Yehya Nadine, Salti Nisreen, Tamim Hani, Nabulsi Mona
The Scholars in HeAlth Research Program, Faculty of Medicine, American University of Beirut, Beirut-Lebanon.
Department of Public Affairs and Marketing, UC Davis, USA.
medRxiv. 2023 Nov 18:2023.11.17.23298704. doi: 10.1101/2023.11.17.23298704.
Studies evaluating breastfeeding promotion and support interventions suggest some economic benefits. This study assessed the direct and indirect costs of a multicomponent breastfeeding promotion and support intervention during the first two years of the infant's life.
This is a cost-benefit analysis of data generated from a randomized controlled trial that aimed at investigating whether provision of a multicomponent breastfeeding promotion and support intervention to Lebanese mothers in the first six months postpartum would improve breastfeeding rates compared to standard obstetric and pediatric care. Data on 339 participants included information on maternal socio-demographics and health, infant nutrition and health, and direct and indirect costs of the intervention. The primary outcome was the benefit-cost ratio (BCR) of the intervention at one, six, 12, and 24 months. Secondary outcomes included the overall costs of infant nutrition and infant-mother dyad health costs during the first two years. Multiple linear regression models investigated the effect of the multicomponent intervention (independent variable) on the overall infant nutrition cost and the overall mother-infant health costs (as dependent variables), adjusting for monthly income and number of children (confounders) at different time points in the first two years. Similar regression models investigated the association between infant nutrition type (exclusive breastfeeding, mixed feeding, artificial milk) and infant nutrition costs and infant-mother health costs. Intention to treat analyses were conducted using SPSS (version 24). Statistical significance was set at a -value below 0.05.
The prevalence of breastfeeding among participants declined from 51.6% in the first month to 6.6% at the end of second year. The multicomponent breastfeeding intervention incurred 485 USD more in costs than the control group during the first six months but was cost-efficient by the end of the first year (incremental net benefits of 374 USD; BCR=2.44), and by the end of the second year (incremental net benefits of 472 USD; BCR=2.82). In adjusted analyses, the intervention was significantly associated with fewer infant illness visits in the first year (=0.045). Stratified analyses by the type of infant nutrition revealed that infants who were on , or had significantly more favorable health outcomes at different time points during the first two years (<0.05) compared to infants receiving only, with health benefits being highest in the breastfeeding group. Moreover, and had significantly lower costs of infant illness visits, hospitalizations, and infant medications during the two years (<0.05), but had additional cost for maternal non-routine doctor visits due to breastfeeding (all values <0.05). Whereas the overall cost (direct and indirect) during the first six months was significantly lower for the breastfeeding infants (=0.001), they were similar in infants on or .
Breastfeeding is associated with significant economic and infant health benefits in the first two years. In the context of the current economic crisis in Lebanon, this study provides further evidence to policymakers on the need to invest in national breastfeeding promotion and support interventions.
评估母乳喂养促进与支持干预措施的研究显示出一些经济效益。本研究评估了婴儿出生后头两年多成分母乳喂养促进与支持干预措施的直接和间接成本。
这是一项对随机对照试验产生的数据进行的成本效益分析，该试验旨在调查与标准产科和儿科护理相比，在产后头六个月为黎巴嫩母亲提供多成分母乳喂养促进与支持干预措施是否会提高母乳喂养率。339名参与者的数据包括产妇社会人口统计学和健康信息、婴儿营养与健康信息以及干预措施的直接和间接成本。主要结果是干预措施在1个月、6个月、12个月和24个月时的效益成本比（BCR）。次要结果包括头两年婴儿营养的总成本以及母婴二元健康成本。多元线性回归模型研究了多成分干预措施（自变量）对婴儿营养总成本和母婴健康总成本（作为因变量）的影响，并在前两年的不同时间点对月收入和子女数量（混杂因素）进行了调整。类似的回归模型研究了婴儿营养类型（纯母乳喂养、混合喂养、人工喂养）与婴儿营养成本和母婴健康成本之间的关联。使用SPSS（版本24）进行意向性分析。统计学显著性设定为p值低于0.05。
参与者中母乳喂养的比例从第一个月的51.6%下降到第二年末的6.6%。多成分母乳喂养干预措施在前六个月的成本比对照组多485美元，但到第一年末具有成本效益（增量净效益为374美元；BCR = 2.44），到第二年末（增量净效益为472美元；BCR = 2.82）。在调整分析中，该干预措施与第一年婴儿看病次数减少显著相关（p = 0.045）。按婴儿营养类型进行的分层分析显示，与仅接受人工喂养的婴儿相比，在前两年的不同时间点，接受纯母乳喂养、混合喂养或人工喂养的婴儿健康结果明显更好（p < 0.05），纯母乳喂养组的健康效益最高。此外，混合喂养和纯母乳喂养的婴儿在两年内看病、住院和药物治疗的成本显著较低（p < 0.05），但由于母乳喂养导致产妇非例行看医生的额外成本（所有p值 < 0.05）。虽然纯母乳喂养婴儿在前六个月的总体成本（直接和间接）显著较低（p = 0.001），但混合喂养或人工喂养婴儿的总体成本相似。
母乳喂养在头两年带来显著的经济和婴儿健康效益。在黎巴嫩当前经济危机的背景下，本研究为政策制定者提供了进一步证据，证明有必要投资于国家母乳喂养促进与支持干预措施。
