Objective: The main objective of the economic evaluation was to determine the cost-effectiveness of a weaning food safety and hygiene programme in reducing rates of diarrhoea compared with the control in rural Gambia.
Methods: The public health intervention, using critical control points and motivational drivers, was evaluated in a cluster randomised controlled trial at 6- and 32-month follow-up. An economic evaluation was undertaken alongside the RCT with data collected prospectively from a societal perspective. Decision-analytic modelling was used to explore cost-effectiveness over a longer time period (4 years).
Results: Direct out-of-pocket healthcare expenditure for households due to diarrhoea was large. The intervention significantly reduced reported childhood diarrhoeal episodes after 6 months (incident risk ratio = 0.40, 95% CI 0.33, 0.49) and 2 years after the intervention (incident risk ratio = 0.68, 95% CI 0.46, 1.02). The within-trial analysis found that the intervention led to total savings of 8064 dalasi 6 months after the intervention and 4224 dalasi 2 years after the intervention. Based on the model results, if the intervention is successful in maintaining the reduction in the risk of diarrhoea, the ICER is US$ 814 per DALY avoided over 4 years. This is cost-effective.
Conclusions: This study suggests that there are substantial household costs associated with diarrhoeal episodes in children. The within-trial analysis and model results suggest that the community-based approach to improving weaning food hygiene and safety is likely to be cost-effective compared with control.
Bibliographical noteFunding Information:
The first phase of the study was generously funded by Islamic Development Bank PhD scholarship for Buba Manjang by the UK Department for International Development (DFID), through the SHARE Consortium led by the London School of Hygiene and Tropical Medicine, and by UNICEF Gambia. The two‐year follow‐up was funded by the MRC Confidence in Concept scheme with the contribution of the University of Birmingham, College of Medical & Dental Sciences. The funders had no role in the study design, data collection, analysis interpretation or writing of the report.
© 2021 John Wiley & Sons Ltd
- food safety
- hygiene promotion
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
- Infectious Diseases