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. 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. 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. 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. 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. 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. 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. 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
