Evidence map›Paper›PMID 26619338›Full record

Trial reportPloS one2015

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

Lumbwe Chola, Lars T Fadnes, Ingunn M S Engebretsen, Lungiswa Nkonki, Victoria Nankabirwa, Halvor Sommerfelt, James K Tumwine, Thorkild Tylleskar, Bjarne Robberstad, PROMISE-EBF Study Group

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 8 syntheses or guidelines pooled it.

  1. Support for healthy breastfeeding mothers with healthy term babies.The Cochrane database of systematic reviews · 2022
    Pooled it
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  7. Support for healthy breastfeeding mothers with healthy term babies.The Cochrane database of systematic reviews · 2017
    Pooled it
  8. Interventions for promoting the initiation of breastfeeding.The Cochrane database of systematic reviews · 2016
    Pooled it
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  20. Peer Education and Peer Counselling for Health and Well-Being: A Review of Reviews.International journal of environmental research and public health · 2022
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Lumbwe CholaPopulation Health, Health Systems and Innovation (PHHSI), Human Sciences Research Council, Pretoria, South Africa.
Lars T FadnesCentre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Box 7804, N-5020, Bergen, Norway.
Ingunn M S EngebretsenCentre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Box 7804, N-5020, Bergen, Norway.
Lungiswa NkonkiHealth Systems and Services Research Unit, Division of Community Health, University of Stellenbosch, Cape Town, South Africa.
Victoria NankabirwaCentre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Box 7804, N-5020, Bergen, Norway.
Halvor SommerfeltCentre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Box 7804, N-5020, Bergen, Norway.
James K TumwineDepartment of Paediatrics and Child Health, School of Medicine, Makerere University, Box 7072, Kampala, Uganda.
Thorkild TylleskarCentre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Box 7804, N-5020, Bergen, Norway.
Bjarne RobberstadCentre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Box 7804, N-5020, Bergen, Norway.
PROMISE-EBF Study Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

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 analyses.

conclusionsOur 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.

Indexed as

Cost-Benefit AnalysisAdultBreast FeedingCounselingDiarrheaFemaleHumansInfantInfant, NewbornMaleMothersPeer GroupUganda

Identifiers

PMID26619338
PMCPMC4664391

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.