Abstract
BackgroundCommunity-based peer support has been shown to be effective in improving exclusive breastfeeding rates in a variety of settings.MethodsWe conducted a cost analysis of a community cluster randomised-controlled trial (Promise-EBF), aimed at promoting exclusive infant feeding in three sites in South Africa. The costs were considered from the perspective of health service providers. Peer supporters in this trial visited women to support exclusive infant feeding, once antenatally and four times postpartum.ResultsThe total economic cost of the Promise-EBF intervention was US$393 656, with average costs per woman and per visit of US$228 and US$52, respectively. The average costs per woman and visit in an operational ‘non research’ scenario were US$137 and US$32 per woman and visit, respectively. Investing in the promotion of exclusive infant feeding requires substantial financial commitment from policy makers. Extending the tasks of multi-skilled community health workers (CHWs) to include promoting exclusive infant feeding is a potential option for reducing these costs. In order to avoid efficiency losses, we recommend that the time requirements for delivering the promotion of exclusive infant feeding are considered when integrating it within the existing activities of CHWs.DiscussionThis paper focuses on interventions for exclusive infant feeding, but its findings more generally illustrate the importance of documenting and quantifying factors that affect the feasibility and sustainability of community-based interventions, which are receiving increased focus in low income settings.
Highlights
Suboptimal breastfeeding has been estimated to be responsible for 1.4 million child deaths worldwide, which represents 12% of deaths in children under 5 years of age and 44 million disability adjusted life years (DALYs) [1]
Evidence from a systematic review suggests that Community health workers (CHW) can be effective in improving exclusive breastfeeding (EBF) rates
PROMISE-EBF a cluster randomised trial implemented in three sites (Kwa-Zulu Natal, Western Cape, and Eastern Cape) was successful in increasing exclusive breastfeeding
Summary
Suboptimal breastfeeding has been estimated to be responsible for 1.4 million child deaths worldwide, which represents 12% of deaths in children under 5 years of age and 44 million disability adjusted life years (DALYs) [1]. Evidence from a systematic review suggests that Community health workers (CHW) can be effective in improving exclusive breastfeeding (EBF) rates. This international experience is confirmed in the South African context. An intervention cohort study from Kwa-Zulu Natal (VTS) reported EBF rates of 76.5% and 66.7% at 5 months for HIV negative and positive women, respectively following intensive home visit support [4]. In PROMISE-EBF women received 5 visits, whereas, in the VTS study the high impact of peer support was achieved with an intensive intervention with as many as 18 visits during the antenatal period until the infant was 6 months old [6]. Community-based peer support has been shown to be effective in improving exclusive breastfeeding rates in a variety of settings
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