title: Highlighting the evidence gap: how cost-effective are interventions to improve early childhood nutrition and development?
abstract: There is growing evidence of the effectiveness of early childhood interventions to improve the growth and development of children. Although, historically, nutrition and stimulation interventions may have been delivered separately, they are increasingly being tested as a package of early childhood interventions that synergistically improve outcomes over the life course. However, implementation at scale is seldom possible without first considering the relative cost and cost-effectiveness of these interventions. An evidence gap in this area may deter large-scale implementation, particularly in low- and middle-income countries. We conduct a literature review to establish what is known about the cost-effectiveness of early childhood nutrition and development interventions. A set of predefined search terms and exclusion criteria standardized the search across five databases. The search identified 15 relevant articles. Of these, nine were from studies set in high-income countries and six in low- and middle-income countries. The articles either calculated the cost-effectiveness of nutrition-specific interventions (n = 8) aimed at improving child growth, or parenting interventions (stimulation) to improve early childhood development (n = 7). No articles estimated the cost-effectiveness of combined interventions. Comparing results within nutrition or stimulation interventions, or between nutrition and stimulation interventions was largely prevented by the variety of outcome measures used in these analyses. This article highlights the need for further evidence relevant to low- and middle-income countries. To facilitate comparison of cost-effectiveness between studies, and between contexts where appropriate, a move towards a common outcome measure such as the cost per disability-adjusted life years averted is advocated. Finally, given the increasing number of combined nutrition and stimulation interventions being tested, there is a significant need for evidence of cost-effectiveness for combined programmes. This too would be facilitated by the use of a common outcome measure able to pool the impact of both nutrition and stimulation activities.
authors: Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa n.batura@ucl.ac.uk.
authors: Neha
authors: N
authors: Batura
authors: Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa.
authors: Zelee
authors: Z
authors: Hill
authors: Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa.
authors: Hassan
authors: H
authors: Haghparast-Bidgoli
authors: Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa.
authors: Raghu
authors: R
authors: Lingam
authors: Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa.
authors: Timothy
authors: T
authors: Colbourn
authors: Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa.
authors: Sungwook
authors: S
authors: Kim
authors: Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa.
authors: Siham
authors: S
authors: Sikander
authors: Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa.
authors: Anni-Maria
authors: AM
authors: Pulkki-Brannstrom
authors: Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa.
authors: Atif
authors: A
authors: Rahman
authors: Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa.
authors: Betty
authors: B
authors: Kirkwood
authors: Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, Unive
authors: Jolene
authors: J
authors: Skordis-Worrall
mesh_terms: D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006293:Health Promotion / Q000191:economics* / Q000379:methods*; D006801:Humans; D009752:Nutritional Status
keywords: Cost-effectiveness analysis; early childhood development; nutrition; review