Abstract
BackgroundCommunity based breastfeeding promotion programmes have been shown to be effective in increasing breastfeeding prevalence. However, there is limited data on the cost-effectiveness of these programmes in sub-Saharan Africa. This paper evaluates the cost-effectiveness of a breastfeeding promotion intervention targeting mothers and their 0 to 6 month old children.MethodsData were obtained from a community randomized trial conducted in Uganda between 2006–2008, and supplemented with evidence from several studies in sub-Saharan Africa. In the trial, peer counselling was offered to women in intervention clusters. In the control and intervention clusters, women could access standard health facility breastfeeding promotion services (HFP). Thus, two methods of breastfeeding promotion were compared: community based peer counselling (in addition to HFP) and standard HFP alone. A Markov model was used to calculate incremental cost-effectiveness ratios between the two strategies. The model estimated changes in breastfeeding prevalence and disability adjusted life years. Costs were estimated from a provider perspective. Uncertainty around the results was characterized using one-way sensitivity analyses and a probabilistic sensitivity analysis.FindingsPeer counselling more than doubled the breastfeeding prevalence as reported by mothers, but there was no observable impact on diarrhoea prevalence. Estimated incremental cost-effectiveness ratios were US$68 per month of exclusive or predominant breastfeeding and U$11,353 per disability adjusted life year (DALY) averted. The findings were robust to parameter variations in the sensitivity analysesConclusionsOur strategy to promote community based peer counselling is unlikely to be cost-effective in reducing diarrhoea prevalence and mortality in Uganda, because its cost per DALY averted far exceeds the commonly assumed willingness-to-pay threshold of three times Uganda’s GDP per capita (US$1653). However, since the intervention significantly increases prevalence of exclusive or predominant breastfeeding, it could be adopted in Uganda if benefits other than reducing the occurrence of diarrhoea are believed to be important.
Highlights
Breastfeeding is vital to child survival, as it provides protection against diseases, including diarrhoea and acute respiratory infections [1,2,3]
Since the intervention significantly increases prevalence of exclusive or predominant breastfeeding, it could be adopted in Uganda if benefits other than reducing the occurrence of diarrhoea are believed to be important
The expected cumulative period of exclusive breastfeeding (EBF) was longer for mothers receiving peer counselling (3.5 months) than for mothers in the control group who relied on health facility breastfeeding promotion services (HFP) alone (1.5 months) [28]
Summary
Breastfeeding is vital to child survival, as it provides protection against diseases, including diarrhoea and acute respiratory infections [1,2,3]. Breastfeeding promotion is central to infant health promotion in low and middle income countries (LMICS). The World Health Organisation (WHO) recommends exclusive breastfeeding (EBF) for the first six months [4]. Though breastfeeding is widespread in most LMICS, EBF is less common [5]. Early initiation of breastfeeding averages about 43%, and EBF at six months is close to 39%; only a third of African children below six months are exclusively breastfed [6]. Community based breastfeeding promotion programmes have been shown to be effective in increasing breastfeeding prevalence. There is limited data on the cost-effectiveness of these programmes in sub-Saharan Africa. This paper evaluates the cost-effectiveness of a breastfeeding promotion intervention targeting mothers and their 0 to 6 month old children
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