Objective

The main objective of the economic evaluation was to determine the cost-effectiveness of a weaning-food safety and hygiene programme in reducing rates of diarrhoea compared to the control in rural Gambia.

Methods

The public health intervention, using critical control points and motivational drivers, was evaluated in a cluster randomised controlled trial at 6- and 32-month follow-up. An economic evaluation was undertaken alongside the RCT with data collected prospectively from a societal perspective. Decision-analytical modelling was used to explore cost-effectiveness over a longer time period (4 years).

Results

Direct out-of-pocket healthcare expenditure for households due to diarrhoea was large. The intervention significantly reduced reported childhood diarrhoeal episodes after six months (incident risk ratio =0.40, 95%CI 0.33, 0.49) and two years after the intervention (incident risk ratio = 0.68, 95%CI 0.46, 1.02). The within-trial analysis found that the intervention led to total savings of 8064 dalasi six months after the intervention, and 4224 dalasi two years after the intervention. Based on the model results, if the intervention is successful in maintaining the reduction in the risk of diarrhea, the ICER is US$ 814 per DALY avoided over 4 years. This is cost effective.

Conclusions

This study suggests that there are substantial household costs associated with diarrhoeal episodes in children. The within-trial analysis and model results suggest that the community-based approach to improving weaning food hygiene and safety is likely to be cost-effective compared to control.