Abstract
BackgroundUndernutrition causes around 3.1 million child deaths annually, around 45% of all child deaths. India has one of the highest proportions of maternal and child undernutrition globally. To accelerate reductions in undernutrition, nutrition-specific interventions need to be coupled with nutrition-sensitive programmes that tackle the underlying causes of undernutrition. This paper describes the planned economic evaluation of the UPAVAN trial, a four-arm, cluster randomised controlled trial that tests the nutritional and agricultural impacts of an innovative agriculture extension platform of women’s groups viewing videos on nutrition-sensitive agriculture practices, coupled with a nutrition-specific behaviour-change intervention of videos on nutrition, and a participatory learning and action approach.MethodsThe economic evaluation of the UPAVAN interventions will be conducted from a societal perspective, taking into account all costs incurred by the implementing agency (programme costs), community and health care providers, and participants and their households, and all measurable outcomes associated with the interventions. All direct and indirect costs, including time costs and donated goods, will be estimated. The economic evaluation will take the form of a cost-consequence analysis, comparing incremental costs and incremental changes in the outcomes of the interventions, compared with the status quo. Robustness of the results will be assessed through a series of sensitivity analyses. In addition, an analysis of the equity impact of the interventions will be conducted.DiscussionEvidence on the cost and cost-effectiveness of nutrition-sensitive agriculture interventions is scarce. This limits understanding of the costs of rolling out or scaling up programs. The findings of this economic evaluation will provide useful information for different multisectoral stakeholders involved in the planning and implementation of nutrition-sensitive agriculture programmes.Trial registrationISRCTN65922679. Registered on 21 December 2016
Highlights
Undernutrition causes around 3.1 million child deaths annually, around 45% of all child deaths
Evidence on the cost and cost-effectiveness of nutrition-sensitive agriculture interventions is scarce. This limits understanding of the costs of rolling out or scaling up programs. The findings of this economic evaluation will provide useful information for different multisectoral stakeholders involved in the planning and implementation of nutrition-sensitive agriculture programmes
There is a lack of evidence on the cost and cost-effectiveness of nutrition-sensitive agriculture (NSA) interventions, which limits the assessment of their potential scale-up feasibility
Summary
Undernutrition causes around 3.1 million child deaths annually, around 45% of all child deaths. India has one of the highest proportions of maternal and child undernutrition globally. Maternal and child undernutrition are major global challenges with substantial consequences for health, human development and economic productivity. Undernutrition causes around 3.1 million child deaths annually, approximately 45% of all child deaths [1]. Maternal and child undernutrition have substantial short-term and life-long adverse consequences including adverse pregnancy outcomes, reduced child survival, curtailed cognitive and educational performance, and increased incidence of chronic disease in adulthood [2, 3]. While India has made progress in reducing maternal and child undernutrition, the prevalence of child undernutrition remains extremely high, with 38% of children under 5 years of age being stunted, 21% wasted and 58% anaemic [7]. It is estimated that almost a quarter of women aged 15–49 years in India are underweight and over half are anaemic [9]
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