TY - JOUR
T1 - Cost-effectiveness of 4 specialized nutritious foods in the prevention of stunting and wasting in children aged 6-23 months in Burkina Faso
T2 - A geographically randomized trial
AU - Cliffer, Ilana R.
AU - Nikiema, Laetitia
AU - Langlois, Breanne K.
AU - Zeba, Augustin N.
AU - Shen, Ye
AU - Lanou, Hermann B.
AU - Suri, Devika J.
AU - Garanet, Franck
AU - Chui, Kenneth
AU - Vosti, Stephen
AU - Walton, Shelley
AU - Rosenberg, Irwin
AU - Webb, Patrick
AU - Rogers, Beatrice L.
N1 - Funding Information:
This work was made possible through support provided by the Office of Food for Peace, Bureau for Democracy, Conflict, and Humanitarian Assistance, US Agency for International Development, under the terms of contract no. AID-OAA-C-16-00020.
Funding Information:
Copyright ©C The Author(s) 2020. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Manuscript received September 12, 2019. Initial review completed December 6, 2019. Revision accepted January 16, 2020. Published online January 23, 2020. This work was made possible through support provided by the Office of Food for Peace, Bureau for Democracy, Conflict, and Humanitarian Assistance, US Agency for International Development, under the terms of contract no. AID-OAA-C-16-00020. Author disclosures: The authors reported no conflicts of interest. The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the US Agency for International Development. Upon publication of this manuscript, the datasets generated and analyzed during the current study will be made available on the Development Data Library of USAID, found at https://data.usaid.gov. The study protocol is available upon request. Address correspondence to IRC (e-mail: ilana.cliffer@tufts.edu). Abbreviations used: CSB+, Corn-Soy Blend Plus; CSWB, Corn-Soy-Whey Blend; DHS, Demographic and Health Surveys; FBF, fortified blended flour; FVO, fortified vegetable oil; IRB, institutional review board; IRR, incidence rate ratio; LAZ, length-for-age z score; LNS, lipid-based nutrient supplement; LNS-SQ, small-quantity lipid-based nutrition supplements; LTFU, lost to follow-up; MAM, moderate acute malnutrition; MUAC, midupper arm circumference; RUSF, ready-to-use supplementary food; RUTF, ready-to-use therapeutic food; SBCC, social behavior change communication; SC+, SuperCereal Plus; SNF, specialized nutritious food; USAID, US Agency for International Development; USD, US dollars; VIM, Victoire sur la Malnutrition; WLZ, weight-for-length z score.
Publisher Copyright:
© 2020 Oxford University Press. All rights reserved.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Background: There is a variety of specialized nutritious foods available for use in programs targeting undernutrition, but evidence supporting the choice of product is limited. Objectives: We compared the cost-effectiveness of 4 specialized nutritious foods to prevent stunting and wasting in children aged 6-23 mo in Burkina Faso. Methods: Four geographic regions were randomly assigned to 1 of 4 intervention arms: Corn-Soy Blend Plus (CSB+) programmed with separate fortified vegetable oil (the reference food), Corn-Soy-Whey Blend (CSWB; a new formulation) with oil, SuperCereal Plus (SC+), and ready-to-use supplementary food (RUSF). We compared the effects of each intervention arm on growth (length-for-age z score (LAZ), weight-for-length z score (WLZ), end-line stunting (LAZ < -2), and total monthly measurements of wasting (WLZ < -2). Rations were ~500 kcal/d, distributed monthly. Children were enrolled in the blanket supplementary feeding program at age ~6 mo and measured monthly for ~18 mo. Average costs per child reached were linked with effectiveness to compare the cost-effectiveness of each arm with CSB+ with oil. Results: In our sample of 6112 children (CSB+, n = 1519; CSWB, n = 1503; SC+, n = 1564; RUSF, n = 1526), none of the foods prevented declines in growth. Children in the SC+ and RUSF arms were not significantly different than those in the CSB+ with oil arm. Children in the CSWB with oil arm experienced higher end-line (measurement at age 22.9-23.9 mo) stunting (OR: 2.07; 95% CI: 1.46, 2.94) and more months of wasting (incidence rate ratio: 1.29; 95% CI: 1.09, 1.51). CSB+ with oil was the least-expensive ration in all costing scenarios ($113-131 2018 US dollars/enrolled child) and similar in effectiveness to SC+ and RUSF, and thus the most cost-effective product for the defined purposes. Conclusions: CSB+ with oil was the most cost-effective ration in the prevention of wasting and stunting in this trial.
AB - Background: There is a variety of specialized nutritious foods available for use in programs targeting undernutrition, but evidence supporting the choice of product is limited. Objectives: We compared the cost-effectiveness of 4 specialized nutritious foods to prevent stunting and wasting in children aged 6-23 mo in Burkina Faso. Methods: Four geographic regions were randomly assigned to 1 of 4 intervention arms: Corn-Soy Blend Plus (CSB+) programmed with separate fortified vegetable oil (the reference food), Corn-Soy-Whey Blend (CSWB; a new formulation) with oil, SuperCereal Plus (SC+), and ready-to-use supplementary food (RUSF). We compared the effects of each intervention arm on growth (length-for-age z score (LAZ), weight-for-length z score (WLZ), end-line stunting (LAZ < -2), and total monthly measurements of wasting (WLZ < -2). Rations were ~500 kcal/d, distributed monthly. Children were enrolled in the blanket supplementary feeding program at age ~6 mo and measured monthly for ~18 mo. Average costs per child reached were linked with effectiveness to compare the cost-effectiveness of each arm with CSB+ with oil. Results: In our sample of 6112 children (CSB+, n = 1519; CSWB, n = 1503; SC+, n = 1564; RUSF, n = 1526), none of the foods prevented declines in growth. Children in the SC+ and RUSF arms were not significantly different than those in the CSB+ with oil arm. Children in the CSWB with oil arm experienced higher end-line (measurement at age 22.9-23.9 mo) stunting (OR: 2.07; 95% CI: 1.46, 2.94) and more months of wasting (incidence rate ratio: 1.29; 95% CI: 1.09, 1.51). CSB+ with oil was the least-expensive ration in all costing scenarios ($113-131 2018 US dollars/enrolled child) and similar in effectiveness to SC+ and RUSF, and thus the most cost-effective product for the defined purposes. Conclusions: CSB+ with oil was the most cost-effective ration in the prevention of wasting and stunting in this trial.
KW - Children
KW - Complementary feeding
KW - Corn-soy blend
KW - Cost-effectiveness
KW - Food aid
KW - Lipid-based nutrient supplements
KW - Low-income countries
KW - Stunting
KW - Supplementary feeding
KW - Wasting
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U2 - 10.1093/cdn/nzaa006
DO - 10.1093/cdn/nzaa006
M3 - Article
C2 - 32072130
AN - SCOPUS:85081278066
SN - 2475-2991
VL - 4
JO - Current Developments in Nutrition
JF - Current Developments in Nutrition
IS - 2
M1 - nzaa006
ER -