Abstract
BackgroundExclusive breastfeeding (EBF) for six months is the mainstay of global child health and the preferred feeding option for HIV-infected mothers for whom replacement feeding is inappropriate. Promotion of community-level EBF requires effective personnel and management to ensure quality counselling and support for women. We present a costing and cost effectiveness analysis of a successful intervention to promote EBF in high HIV prevalence area in South Africa, and implications for scale-up in the province of KwaZulu-Natal.Methods and FindingsThe costing of the intervention as implemented was calculated, in addition to the modelling of the costs and outcomes associated with running the intervention at provincial level under three different scenarios: full intervention (per protocol), simplified version (half the number of visits compared to the full intervention; more clinic compared to home visits) and basic version (one third the number of visits compared to the full intervention; all clinic and no home visits). Implementation of the full scenario costs R95 million ($14 million) per annum; the simplified version R47 million ($7 million) and the basic version R4 million ($2 million). Although the cost of the basic scenario is less than one tenth of the cost of the simplified scenario, modelled effectiveness of the full and simplified versions suggest they would be 10 times more effective compared to the basic intervention. A further analysis modelled the costs per increased month of EBF due to each intervention: R337 ($48), R206 ($29), and R616 ($88) for the full, simplified and basic scenarios respectively. In addition to the average cost effectiveness the incremental cost effectiveness ratios associated with moving from the less effective scenarios to the more effective scenarios were calculated and reported: Nothing – Basic R616 ($88), Basic – Simplified R162 ($23) and Simplified – Full R879 ($126).ConclusionsThe simplified scenario, with a combination of clinic and home visits, is the most efficient in terms of cost per increased month of EBF and has the lowest incremental cost effectiveness ratio.
Highlights
Exclusive breastmilk is endorsed by the World Health Organisation as the ideal food for infants from birth to six months [1], because of its nutritional superiority over commercial formulas [2,3], and the significant protection afforded to the infant against acute [4] and chronic illnesses [5]
Exclusive breastfeeding by HIV-infected women has recently been shown to carry less risk of postnatal HIV transmission compared to mixed feeding, with solid foods [6,7], and has been associated with greater HIV-free survival at 18 months compared to infants fed solely on formula milk [8,9,10]
The Breastfeeding Intervention Pregnant women attending 9 government clinics in rural, periurban and urban KwaZulu- Natal were enrolled into the Vertical Transmission Study (VTS) from August 2001 to September 2004; the last infant was delivered in April 2005 [6]
Summary
Exclusive breastmilk is endorsed by the World Health Organisation as the ideal food for infants from birth to six months [1], because of its nutritional superiority over commercial formulas [2,3], and the significant protection afforded to the infant against acute [4] and chronic illnesses [5]. There is no doubt, that exclusive breastfeeding for the first six months should be promoted globally. Exclusive breastfeeding for six months is feasible and practical, as demonstrated in many settings [11,12,13], including high HIV prevalence areas [6]. Whether exclusive breastfeeding support programmes can be scaled up in operational situations, and what the financial implications of this would be to governments and health services, is questioned. Exclusive breastfeeding (EBF) for six months is the mainstay of global child health and the preferred feeding option for HIV-infected mothers for whom replacement feeding is inappropriate. We present a costing and cost effectiveness analysis of a successful intervention to promote EBF in high HIV prevalence area in South Africa, and implications for scale-up in the province of KwaZulu-Natal
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
