Abstract
Improving maternal and child nutrition in resource-poor settings requires effective use of limited resources, but priority-setting is constrained by limited information about program costs and impacts, especially for interventions designed to improve diet quality. This study utilized a mixed methods approach to identify, describe and estimate the potential costs and impacts on child dietary intake of 12 nutrition-sensitive programs in Ethiopia, Nigeria and India. These potential interventions included conditional livestock and cash transfers, media and education, complementary food processing and sales, household production and food pricing programs. Components and costs of each program were identified through a novel participatory process of expert regional consultation followed by validation and calibration from literature searches and comparison with actual budgets. Impacts on child diets were determined by estimating of the magnitude of economic mechanisms for dietary change, comprehensive reviews of evaluations and effectiveness for similar programs, and demographic data on each country. Across the 12 programs, total cost per child reached (net present value, purchasing power parity adjusted) ranged very widely: from 0.58 to 2650 USD/year among five programs in Ethiopia; 2.62 to 1919 USD/year among four programs in Nigeria; and 27 to 586 USD/year among three programs in India. When impacts were assessed, the largest dietary improvements were for iron and zinc intakes from a complementary food production program in Ethiopia (increases of 17.7 mg iron/child/day and 7.4 mg zinc/child/day), vitamin A intake from a household animal and horticulture production program in Nigeria (335 RAE/child/day), and animal protein intake from a complementary food processing program in Nigeria (20.0 g/child/day). These results add substantial value to the limited literature on the costs and dietary impacts of nutrition-sensitive interventions targeting children in resource-limited settings, informing policy discussions and serving as critical inputs to future cost-effectiveness analyses focusing on disease outcomes.
Highlights
Background and motivationUndernutrition among children in low-income settings is among the world’s leading causes of death, disability and inequity (Black et al 2008; GBD 2016 Risk Factors Collaborators 2017)
In Ethiopia, these included two conditional transfer programs designed to be nutrition-sensitive extensions of the existing Productive Safety Net Program (PSNP), which focused on providing households with either livestock or poultry conditional on household members meeting specific conditions
Two other programs in Ethiopia focused on nutrition education, and one on assisting women to produce complementary infant foods
Summary
Background and motivationUndernutrition among children in low-income settings is among the world’s leading causes of death, disability and inequity (Black et al 2008; GBD 2016 Risk Factors Collaborators 2017). National governments and international agencies declared a ‘Decade of Action for Nutrition’ starting in 2016 (Food and Agriculture Organization of the United Nations and World Health Organization 2016). To achieve these goals, novel programs are needed that address overall dietary diversity and quality (Haddad et al 2016). Nutrition-sensitive programs frequently involve multiple sectors and more diverse stakeholders than supplementation programs, requiring different kinds of evidence and prioritysetting processes (Development Initiatives 2017) While many such programs are being designed and implemented to improve diet quality in low-income countries (Hoddinott et al 2013), scare empirical evidence exists on their costs and on their impacts on dietary intake
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