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Costing of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition from a randomised trial in India
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  • Published on:
    Costing per sustained recovery is more meaningful for policy
    • H.P.S. Sachdev, Senior Consultant Pediatrics and Clinical Epidemiology Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi 110016
    • Other Contributors:
      • Audrey Prost, Professor
      • Dipa Sinha, Assistant Professor (Economics)
      • Vandana Prasad, National Convenor
      • Arun Gupta, Central Coordinator
      • Umesh Kapil, Professor of Public Health Nutrition

    Garg et al. provide a useful, but somewhat incomplete, economic perspective on Community Management of Acute Malnutrition (CMAM) in India. Potential returns, like cost per recovered child, adjusted for spontaneous improvement under the existing system, are crucial for policy makers. Sixteen weeks after completion of the treatment phase (sustenance phase), only 123/838 children (14.7%) met the definition of recovery.1 For simplicity’s sake, we ignore: (i) anticipated lower recovery rates in public programme settings; and (ii) costs for linkages with the government-run Anganwadi centres for supplementary food during the sustenance phase.1 With these assumptions, our calculation of costs per recovered child are 6.8 (100/14.7) times higher than those of Garg et al.: US$ 1575/- (Rs. 97,650/-) and US$ 381 (Rs. 23,622/-) in research and Government settings, respectively. Further, annual budgetary requirements may be considerably higher due to non-response, relapse, and fresh cases of Severe Acute Malnutrition (SAM). Data from rural Meerut, near Delhi, provides a ballpark estimate of spontaneous recovery rates (27%) within a similar follow-up period.2 Actual costs per child recovered, even unadjusted for potentially equivalent spontaneous healing, are thus much higher than those quoted by Garg et al. However, they offer no cost-effectiveness analysis reporting cost per life saved or Disability-Adjusted Life Year averted to enable robust comparisons with the existing system or oth...

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    Conflict of Interest:
    None declared.
  • Published on:
    Efficacy and cost analysis of three types of therapeutic feeds in children with severe acute malnutrition in trbal villages of Nandurbar,Maharashtra,India. cra, India
    • S Saunik, IAS Principal.Secretary,public health ,Govt. of Maharashtra
    • Other Contributors:
      • M Phadke, Pediatrician
      • R Nair, Nutrition specialist

    We, read with interest the article by Garg et al on costing of therapeutic feeds.
    We report our results on a similar trial conducted on 1092 tribal children of SAM,randomly given 3 therapeutic feeds i.e .C-RUTF(commercially produced ready to use therapeutic food),L-RUTF (locally produced RUTF) and ARF(Amylase rich energy dense food) giving 550,513 and 420 kcals respectively.Pea nut paste,sugar ,milk powder,oil were common ingredients,in identical proportions in C-RUTF and L-RUTF while ARF contained amylase rich flour instead of peanut paste.Micro nutrients were present in all three alike.At the end of 8 weeks of treatment,52.8% recovered in C-RUTF group,43.5% in L-RUTF group and 44.8% recovered in ARF group; the difference being statistically significant.The cost of treatment was 63, 59 and 43 USD approx. in the 3 groups respectively.Thus, though cost of ARF was the least compared to C-RUTF and L-RUTF ,recovery rates in ARF group were also compromised.The logistics of preparing the feeds in tribal village Anganwadis,issues of cleanliness in food preparation,time and labour required were also matters of concern.All these factors will require consideration while scaling up of community management of SAM.
    The clinical trial was registered under clinical trial registry of India,no.CTRI/2014/09/004958 and the data is the property of the Govt. of Maharashtra,India.

    Conflict of Interest:
    None declared.