title: Costs of promoting exclusive breastfeeding at community level in three sites in South Africa.
abstract: BACKGROUND
  Community-based peer support has been shown to be effective in improving exclusive breastfeeding rates in a variety of settings.
  
  
  METHODS
  We conducted a cost analysis of a community cluster randomised-controlled trial (Promise-EBF), aimed at promoting exclusive infant feeding in three sites in South Africa. The costs were considered from the perspective of health service providers. Peer supporters in this trial visited women to support exclusive infant feeding, once antenatally and four times postpartum.
  
  
  RESULTS
  The total economic cost of the Promise-EBF intervention was US$393 656, with average costs per woman and per visit of US$228 and US$52, respectively. The average costs per woman and visit in an operational 'non research' scenario were US$137 and US$32 per woman and visit, respectively. Investing in the promotion of exclusive infant feeding requires substantial financial commitment from policy makers. Extending the tasks of multi-skilled community health workers (CHWs) to include promoting exclusive infant feeding is a potential option for reducing these costs. In order to avoid efficiency losses, we recommend that the time requirements for delivering the promotion of exclusive infant feeding are considered when integrating it within the existing activities of CHWs.
  
  
  CONCLUSIONS
  This paper focuses on interventions for exclusive infant feeding, but its findings more generally illustrate the importance of documenting and quantifying factors that affect the feasibility and sustainability of community-based interventions, which are receiving increased focus in low income settings.
authors.affiliation: Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa ; Centre for International Health, University of Bergen, Bergen, Norway ; Division of Community Health, Faculty of Health Sciences, Stellenbosch University, South Africa.
authors.forename: Lungiswa Leonora
authors.initials: LL
authors.lastname: Nkonki
authors.affiliation: Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Daviaud
authors.affiliation: School of Public Health, University of the Western Cape, Bellville, South Africa.
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
authors.affiliation: Division of Community Health, Faculty of Health Sciences, Stellenbosch University, South Africa.
authors.forename: Lumbwe
authors.initials: L
authors.lastname: Chola
authors.affiliation: Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa ; School of Public Health, University of the Western Cape, Bellville, South Africa.
authors.forename: Tanya
authors.initials: T
authors.lastname: Doherty
authors.affiliation: UNICEF, New York, New York, United States of America.
authors.forename: Mickey
authors.initials: M
authors.lastname: Chopra
authors.affiliation: Centre for International Health, University of Bergen, Bergen, Norway.
authors.forename: Bjarne
authors.initials: B
authors.lastname: Robberstad
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D005260:Female; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D007223:Infant; D012931:Social Environment; D013019:South Africa