Cost-Effectiveness of Peer Counselling for the Promotion of Exclusive Breastfeeding in Uganda

Abstract

BackgroundCommunity based breastfeeding promotion programmes have been shown to be effective in increasing breastfeeding prevalence. However, there is limited data on the cost-effectiveness of these programmes in sub-Saharan Africa. This paper evaluates the cost-effectiveness of a breastfeeding promotion intervention targeting mothers and their 0 to 6 month old children.MethodsData were obtained from a community randomized trial conducted in Uganda between 2006–2008, and supplemented with evidence from several studies in sub-Saharan Africa. In the trial, peer counselling was offered to women in intervention clusters. In the control and intervention clusters, women could access standard health facility breastfeeding promotion services (HFP). Thus, two methods of breastfeeding promotion were compared: community based peer counselling (in addition to HFP) and standard HFP alone. A Markov model was used to calculate incremental cost-effectiveness ratios between the two strategies. The model estimated changes in breastfeeding prevalence and disability adjusted life years. Costs were estimated from a provider perspective. Uncertainty around the results was characterized using one-way sensitivity analyses and a probabilistic sensitivity analysis.FindingsPeer counselling more than doubled the breastfeeding prevalence as reported by mothers, but there was no observable impact on diarrhoea prevalence. Estimated incremental cost-effectiveness ratios were US$68 per month of exclusive or predominant breastfeeding and U$11,353 per disability adjusted life year (DALY) averted. The findings were robust to parameter variations in the sensitivity analysesConclusionsOur strategy to promote community based peer counselling is unlikely to be cost-effective in reducing diarrhoea prevalence and mortality in Uganda, because its cost per DALY averted far exceeds the commonly assumed willingness-to-pay threshold of three times Uganda’s GDP per capita (US$1653). However, since the intervention significantly increases prevalence of exclusive or predominant breastfeeding, it could be adopted in Uganda if benefits other than reducing the occurrence of diarrhoea are believed to be important.

Higher likelihood of 6-months exclusive breastfeeding among HIV infected than uninfected mothers: a household survey in Kenya

“…Breastfeeding counseling during pregnancy, immediately after childbirth and at key moments in the postnatal period have been associated significantly with EBF practices [ 2 , 16 , 17 ]. Using peer counselors is one effective way to offer breastfeeding counseling [ 18 ] and has been associated with less prelacteal feeding [ 19 ]. A recent clinic-level study to investigate the impact of a counseling intervention on EBF among mothers with HIV in Nairobi found no significant difference in EBF prevalence between the cases and controls, however, the EBF prevalence was found to be high in the non-intervention arm of this study, making it difficult to evaluate the impact of counseling [ 20 ].…”

Health Care Costs Associated to Type of Feeding in the First Year of Life

“…The benefits of breastfeeding on maternal and neonatal health result in lower demand for health services in both primary and specialized care, decreasing the number of hospital admissions and drug treatments [12][13][14][15][16][17]. Regarding infectious diseases, breastfeeding has been associated with lower risk of, especially, diarrhea and pneumonia, but also bronchiolitis and otitis, although this association is less consistent in high-income countries [18].…”

Exclusive breastfeeding promotion and neuropsychological outcomes in 5-8 year old children from Uganda and Burkina Faso: Results from the PROMISE EBF cluster randomized trial

“…This included common health information the women were given at antenatal clinics, during birth and at follow-up visits. We have reported details of the feeding intervention, results [ 16 , 17 ] and follow-up outcomes such as cost-effectiveness [ 18 ], diarrhoea [ 12 ], growth [ 19 , 20 ] and mortality [ 21 , 22 ] up to 24 weeks; and oral health [ 23 ], growth and mortality [ 24 , 25 ] up to 5 years from the PROMISE EBF. At the time of the intervention, the standard-of-care was limited HIV prevention-of-mother-to child care services where very few were tested, got a result and individually targeted infant feeding advice.…”