The Cost of Managing Moderate Wasting Using Local Foods: Evidence from Three Interventions in Northeast Nigeria.

objectiveManagement of moderate wasting (MW) is an important component of country-level strategies to address wasting, given high caseloads and susceptibility to illness and death. However, many countries experience challenges in providing targeted supplementary feeding programmes with specially formulated foods involved in managing MW. Some implementing agencies have developed a community-based programme using locally available foods (LF) for MW management known as Tom Brown. This study assessed the costs and cost-efficiency of three Tom Brown programmes (two with an 8-week supplementation duration, one with a 10-week duration).

designWe assessed institutional costs and selected estimates of societal costs to households and community volunteers.

settingNortheast Nigeria.

participantsProgramme staff.

resultsTotal cost per child ranged from $155 to $184 per 8-week programme and $493 per 10-week programme. Monthly LF supplementation cost per child ranged from $5 to $21. Unit costs were influenced by implementation duration and variations in programme features including storage and transportation models, the inclusion of voucher transfers and volunteer cadre models. Opportunity costs to beneficiaries and volunteers in preparing recipes were substantial. Cash/voucher components, when used, represented a cost driver for institutional and societal costs.

conclusionsAn updated WHO guideline emphasises the role of LF for supplementing MW children who lack other risk factors. Given that specially formulated foods are not necessary for all MW children to recover, programme approaches using LF are important options for managing MW. This study from Nigeria provides the first cost estimates for using LF to manage MW. Future research is needed on the effectiveness and cost-effectiveness of these approaches.