Cognitive development among children in a low-income setting: cost-effectiveness analysis of a maternal nutrition education intervention in rural Uganda

Inadequate nutrition and insufficient stimulation in early childhood can
lead to long-term deficits in cognitive and social development. Evidence
for policy and decision-making regarding the cost of delivering nutrition
education is lacking in low and middle-income countries (LMIC). In rural
Uganda, we conducted a cluster-randomized controlled trial (RCT) examining
the effect of a maternal nutrition education intervention on developmental
outcomes among children aged 6–8 months. This intervention led to
significantly improved cognitive scores when the children reached the age
of 20–24 months. When considering the potential for this intervention’s
future implementation, the desired effects should be weighed against the
increased costs. This study therefore aimed to assess the
cost-effectiveness of this education intervention compared with current
practice. Health outcome data were based on the RCT. Cost data were
collected via interviews with researchers involved in processing the
intervention. This study considered a healthcare provider perspective for
an 18-month time horizon. The control group was considered as the current
practice for the future large-scale implementation of this intervention. A
cost-effectiveness analysis was performed, including calculations of
incremental cost-effectiveness ratios (ICERs). In addition, uncertainty in
the results was characterized using one-way and probabilistic sensitivity
analyses. The ICER for the education intervention compared with current
practice was USD ($) 16.50 per cognitive composite score gained, with an
incremental cost of $265.79 and an incremental cognitive composite score
of 16.11. The sensitivity analyses indicated the robustness of these
results. The ICER was sensitive to changes in cognitive composite score
and the cost of personnel, but the education intervention can be
considered cost-effective compared with the current practice. The outcome
of this study, including the cost analysis, health outcome,
cost-effectiveness, and sensitivity analysis, can be useful to inform
policymakers and stakeholders about effective resource allocation
processes in Uganda and possibly other LMIC.