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Vosti - Nutrition
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Vosti - Wasting

  1. 1. Enhancing and Scaling Up Screening and Treatment of SAM and MAM for Young Children Stephen Vosti -- Department of Agricultural and Resource Economics, UC Davis Katie Adams – Department of Nutrition, UC Davis In-Country Collaborators Haiti Priorities Conference, Port-au-Prince, Haiti, April 28-May 3, 2017
  2. 2. Key Issues • Severe Acute Malnutrition • Definition: Weight-Height Z-score < -3 Median WHO Growth Standard (MUAC < 11cm) • Extent of the problem (2017): 19,409 children, 1.5% of under-5 children • Mortality consequences: 6.5% mortality rate for untreated SAM • Intrinsic value of a life • Moderate Acute Malnutrition • Definition: -3<=Weight-Height Z-score <-2 (11cm<= MUAC <= 12.5cm) • Extent of the problem (2017): – 58,226 children, 4.5% of under-5 children • Mortality consequences: 1.5% mortality rate for untreated SAM • Intrinsic value of a life • Proven Intervention Exists • Ready-to-Use Therapeutic Food (RUTF) • Two versions – Standard Formula and ‘Local’ Formula • Incomplete Programs Are Now in Place in Haiti • Incomplete screening: 70% on average, much less in rural areas • Incomplete treatment: 70% of SAM cases; 25% of MAM cases • Poorly coordinated collection of actors
  3. 3. Proposed Intervention: Increased Screening and Treatment of SAM and MAM Using RUTF • 12-Year Timeframe • 3-year scale-up • Increase Screening from 70% to 95% • Increase Treatment Using RUTF • SAM – 70% to 95% • MAM – 25% to 95%
  4. 4. Cost of Proposed Intervention • Cost Categories • Salaries & logistics for personnel • Screening – health workers • Treatment – nurses • RUTF product • Purchase, storage, transport • Patient transportation costs • Round-trips to clinics for treatment • Capacity building • Coordination Cost per Child Treated Cost per Child Recovered Cost per Life Saved Cost per DALY Averted US$ 53.18 US$ 63.60 US$ 3,239.91 US$ 49.90 Composition of Costs – At-Scale YearComposition of Costs – Scale-Up Year
  5. 5. Benefits of the Proposed Intervention • 5,768 Young Lives Are Saved • 27,372 Fewer Children Living with SAM Disabilities • 374,476 DALYs Averted • Economic Value of Benefits (DALY=3xGDP, 5% discount rate) • $10,846,435,954 (gourdes)
  6. 6. Total Benefits, Costs, and Cost-Benefit Ratio (DALY value = 3XGDP; 5% Discount Rate) Intervention Benefits (gourdes) Costs (gourdes) BCR Treat SAM and MAM with Standard-Formula RUTF $10,846,435,954 1,184,266,481 9.2 Interventions Benefit (gourdes) Cost (gourdes) BCR Treat SAM and MAM with Local-Formula RUTF $10,846,435,954 1,131,759,778 9.6 Standard-Formula RUTF ‘Local’-Formula RUTF Local formula development and switching costs < US$830,000 (3xGDP, 5% discount rate)  worth doing.
  7. 7. Sensitivity Analyses Scenarios Benefit (in gourdes) Cost (in gourdes) BCR Baseline $ 10,846,435,954 $1,184,266,481 9.2 Optimistic $ 19,069,947,797 $ 886,241,696 21.5 Pessimistic $ 6,171,890,014 $1,444,467,207 4.3 Parameter Baseline Optimistic Pessimistic Health Worker Salary – New Hires $175/mo $135/mo $350/mo Nurse Salary – New Hires $450/mo $250/mo $700/mo Health worker recruitment and initial training $2000/worker $1500/worker $4000/worker Nurse recruitment and initial training $4000/nurse $3000/nurse $8000/nurse Transportation Payments to Caregivers $6-$9/visit, scaled up $6/visit $9/visit Treatment visits Every week Every other week Every week Price of RUTF $54.93/carton $51.28/carton $61.20/carton Mortality rate untreated SAM 6.5% 9.9% 3.1% Mortality rate untreated MAM 1.5% 2.2% 0.9% Key Assumptions/Model Parameters (DALY value = 3XGDP; 5% Discount Rate) Model Parameters of Interest • Major drivers of costs and benefits • Broad range of estimates by in- country collaborators Why Bother? • Robustness of b/c estimates to model assumptions • Insights into potential sources of efficiency gains
  8. 8. Background paper: Vosti, Stephen A. and Katherine P. Adams. 2017. Expanding Community-Based Management of Children Suffering from Moderate and Severe Acute Malnutrition Using a Standard and a Local RUTF Formula. Background paper for the Copenhagen Consensus Haiti Priorise Event, Port-au-Prince, Haiti, April 30-May 3, 2017 Key Issue-Specific References: • Prevalence of SAM and MAM in Haiti: UNICEF. 2015. UNICEF Annual Report: Haiti. • Mortality Rates for Cases of SAM and MAM: Olofin et al. 2013 (primary source). • Costs of RUTF Products: UNICEF. 2016a. Ready-to-Use Therapeutic Food Price Data. • Comparison Studies of Cost-Effectiveness of SAM Treatment Programs: Frankel et al. 2015; Puett et al. 2013; Wilford et al. 2011; and Bachmann 2009 Selected References

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