Cost Analysis of Community-Based Daily and Weekly Programs for Treatment of Moderate and Mild Wasting among Children on Nias Island, Indonesia

Purwestri, Ratna Chrismiari; Scherbaum, Veronika; Inayati, Dyah Ayu; Wirawan, Nia Novita; Suryantan, Julia; Bloem, Maurice Alexander; Pangaribuan, Rosnani Verba; Hoffmann, Volker H.; Biesalski, Hans Konrad; Qaim, Matin; Bellows, Anne C.

doi:10.1177/156482651203300306

Cited by 9 publications

(23 citation statements)

References 10 publications

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“…Personnel cost, to an extent, contributed to the rise in the recurrent cost from 95% of the overall financial cost to 96% of the overall economic cost. These figures correspond with the findings of a study conducted in the Nias Island of Indonesia [12] which reported recurrent costs to constitute 93% of programme cost. Another study in Ethiopia [9] also reported 86% as the proportion of programme cost attributable to recurrent costs.…”

Section: Discussionsupporting

confidence: 89%

“…The 23% recorded for personnel cost was expected because of the high number of CHNs directly or indirectly involved in the CMAM programme as against the relatively small number of cases recorded in the year of the evaluation (2012). This evidence has again been corroborated by an Indonesian study [12], which reported staff salaries (for weekly programmes) as the highest expense (85%) of recurrent costs to the programme managers. Another study in Bangladesh [16] shows that staff salaries constitutes 35% of the total 86% 6% 8% Programme Cost…”

Section: Discussionmentioning

confidence: 59%

“…The cost of all activities or proportion of activities (societal perspective) that were specifically relevant to the objectives of this study was considered. Programme cost of CMAM included the cost incurred by all the organisations involved in the programme, while the caregiver/household cost were the expenses borne by the community as a result of their participation in the programme [12]. Details of all capital and recurrent costs of CMAM are shown in Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…Several countries like Ethiopia [7], Malawi [9], Zambia [10], Bangladesh [11] and Indonesia [12] have also adopted this program to manage and control malnutrition problems in their respective countries. Under the CMAM programme, malnourished children are mostly treated as outpatients while a few cases with complications are admitted and treated at the inpatient care.…”

Section: Introductionmentioning

confidence: 99%

“…The findings of a comparative study by Ashworth and Khanum [16] on three delivery systems on the management of severely malnourished children: inpatient care, day care and domiciliary rehabilitation care, reveal the most cost effective intervention to be domiciliary rehabilitation care ($38.8). The average cost of CMAM as presented by Puett [11] is $165 and that of Tekeste [7] and Purwestri [12] are $134.9 and $331.8 respectively. Though these studies considered costs from the societal perspective, they employed different CMAM delivery models and therefore there is the need to better understand these costs [11].…”

Section: Introductionmentioning

confidence: 99%

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Economic Cost of Community-Based Management of Severe Acute Malnutrition in a Rural District in Ghana

Abdul-Latif¹,

Nonvignon²

2014

Health

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Background: The community based management of severe acute malnutrition (CMAM) was introduced in Ghana in 2008 to manage cases of severe acute malnutrition (SAM) recorded at the community level. This study estimated the economic cost of the CMAM programme for children under-five in the Agona west municipality of Ghana. Methods: A retrospective cross sectional study that used a cost analysis design was employed to estimate the economic cost of the programme from the societal perspective. Household cost data from caregivers were obtained using a semi-structured questionnaire. That of programme cost data was obtained from document reviews as well as the use of semi-structured questionnaires and subsequent discussions with key personnel of the Ghana Health Service, Food and Nutrition Technical Assistance and UNICEF. One and multi-way sensitivity analyses were conducted to test how sensitive the cost estimates are to certain variations in the cost profiles. Results: The economic household cost of CMAM was estimated as $1905.32 ($47.63 per household) of which 79% was attributed to direct cost while the remaining 21% made up indirect cost. Programme economic cost of CMAM was estimated as $27633.5 (96% recurrent and 4% capital), with refresher training constituting majority of the cost (34%). The constituents of the total economic cost of the programme, estimated as $32214.56 are programme cost (86%), household costs (6%) and community volunteer cost (8%). Therefore, the economic cost of treating one SAM case using the CMAM protocol was estimated as $805.36. Conclusion: Although CMAM has proven to be an effective tool for the management of SAM, its associated costs are quite enormous when coverage levels (geographic) are high yet small number of cases are detected and treated. Therefore, it is prudent to implement several cost saving strategies such as a reduction in the number of days spent on trainings in order to reduce these costs.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Economic Cost of Community-Based Management of Severe Acute Malnutrition in a Rural District in Ghana

Abdul-Latif¹,

Nonvignon²

2014

Health

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Severe Acute Malnutrition: The Potential of Non-Peanut, Non-Milk Ready-to-Use Therapeutic Foods

Akinmoladun,

Bamidele,

Jideani

et al. 2023

Curr Nutr Rep

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Purpose of Review This review provides information on the prospect and effectiveness of ready-to-use therapeutic foods (RUTFs) produced locally without the addition of milk and peanut. Recent Findings The foods used in fighting malnutrition in the past decades contributed little to the success of the alleviation program due to their non-effectiveness. Hence, RUTFs are introduced to fight malnutrition. The peanut allergies, the high cost of milk, and the high production cost of peanut RUTF have made its distribution, treatment spread, and accessibility very slow, especially in areas where it is highly needed. There is a need, therefore, for a low-cost RUTF that is acceptable and effective in treating severe acute malnutrition among under-5 children. Summary This review shows both the success and failure of reported studies on the use of non-peanut and non-milk RUTF, including their cost of production as compared to the standard milk and peanut-based RUTF. It was hypothesised that replacing the milk ingredient component with legumes like soybeans can reduce the cost of production of RUTFs while also delivering an effective product in managing and treating severe acute malnutrition (SAM). Consumers generally accept them better because of their familiarity with the raw materials.

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Milk products in the dietary management of childhood undernutrition – a historical review

Scherbaum

Srour²

2017

Nutr. Res. Rev.

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The present narrative review outlines the use of milk products in infant and young child feeding from early history until today and illustrates how research findings and technical innovations contributed to the evolution of milk-based strategies to combat undernutrition in children below the age of 5 years. From the onset of social welfare initiatives, dairy products were provided by maternal and child health services to improve nutrition. During the last century, a number of aetiological theories on oedematous forms of undernutrition were developed and until the 1970s the dogma of protein deficiency was dominant. Thereafter, a multifactorial concept gained acceptance and protein quality was emphasised. During the last decades, research findings demonstrated that the inclusion of dairy products in the management of severe acute malnutrition is most effective. For children suffering from moderate acute malnutrition the evidence for the superiority of milk-based diets is less clear. There is an unmet need for evaluating locally produced milk-free alternatives at lower cost, especially in countries that rely on imported dairy products. New strategies for the dietary management of childhood undernutrition need to be developed on the basis of research findings, current child feeding practices, socio-cultural conditions and local resources. Exclusive and continued breast-feeding supported by community-based nutrition programmes using optimal combinations of locally available complementary foods should be compared with milk product-based interventions.

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Cost Analysis of Community-Based Daily and Weekly Programs for Treatment of Moderate and Mild Wasting among Children on Nias Island, Indonesia

Cited by 9 publications

References 10 publications

Economic Cost of Community-Based Management of Severe Acute Malnutrition in a Rural District in Ghana

Economic Cost of Community-Based Management of Severe Acute Malnutrition in a Rural District in Ghana

Severe Acute Malnutrition: The Potential of Non-Peanut, Non-Milk Ready-to-Use Therapeutic Foods

Milk products in the dietary management of childhood undernutrition – a historical review

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