Trial design Three feeding regimens—centrally produced ready-to-use therapeutic food, locally produced ready-to-use therapeutic food, and augmented, energy-dense, home-prepared food—were provided in a community setting for children with severe acute malnutrition (SAM) in the age group of 6–59 months in an individually randomised multicentre trial that enrolled 906 children. Foods, counselling, feeding support and treatment for mild illnesses were provided until recovery or 16 weeks.
Methods Costs were estimated for 371 children enrolled in Delhi in a semiurban location after active survey and identification, enrolment, diagnosis and treatment for mild illnesses, and finally treatment with one of the three regimens, both under the research and government setting. Direct costs were estimated for human resources using a price times quantity approach, based on their salaries and average time taken for each activity. The cost per week per child for food, medicines and other consumables was estimated based on the total expenditure over the period and children covered. Indirect costs for programme management including training, transport, non-consumables, infrastructure and equipment were estimated per week per child based on total expenditures for research study and making suitable adjustments for estimations under government setting.
Results No significant difference in costs was found across the three regimens per covered or per treated child. The average cost per treated child in the government setting was estimated at US$56 (<3500 rupees).
Conclusion Home-based management of SAM with a locally produced ready-to-use therapeutic food is feasible, acceptable, affordable and very cost-effective in terms of the disability-adjusted life years saved and gross national income per capita of the country. The treatment of SAM at home needs serious attention and integration into the existing health system, along with actions to prevent SAM.
Trial registration number NCT01705769; Pre-results.
- severe acute malnutrition (SAM)
- community management
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Handling editor Sanni Yaya
Contributors All authors contributed substantially to the design and undertaking of the study, its analyses and writing of the manuscript. CCG, SM, NB, JM and RB designed the study. CCG and SM coordinated the study and did data management and analysis, with technical support from RB, NB and JM. The following were responsible for the day-to-day implementation: ST, MS and SBM (Delhi); AB and SDI provided detailed inputs for the Vellore and Udaipur sites and made field visits for CCG and MS feasible. The study results were interpreted and presented during a workshop and through earlier drafts and report of the study and has the final approval of all the authors. CCG and SM affirm that the manuscript is an honest, accurate and transparent account of the study.
Funding The trial was funded by the Bill & Melinda Gates Foundation (grant number OPP1033634).
Disclaimer The opinions expressed by the authors of this paper are their own and do not necessarily reflect the policy of the WHO.
Competing interests None declared.
Ethics approval The study was approved by the institutional ethics committees of each participating institution and the WHO Ethics Review Committee (Protocol ID RPC538).6 Written informed consent was obtained from caregivers for each different activity.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The authors have a data sharing agreement between the participating sites, and consent for data sharing was obtained from patients at recruitment.
Collaborators Other members of the Study Group. SAS: Sowmya Prakash, Rimpi Kaushik, Gunjan Aggarwal, Rajkumari Suchitra, Priti Sharma. CMC: Kuryan George, Jasmine Helan Prasad, Venkatesan Sankarapandian, Preethi Ragasudha,Dulari Gupta. ARTH: Anandilal Sharma, Anjana Verma, Ashutosh Sharma, Trupti Patel, Priya Krishnan, Satyanarayan Panchal, Hitesh Rawal. Coordination Unit: Kiran Bhatia, Girish Chand Pant, Medha Shekhar. Dakshu Jindal, who worked as an independent consultant with CCG is currently working at JPAL (Jameel Abdul Poverty Action Lab).
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