title: Cost-Effectiveness of Peer Counselling for the Promotion of Exclusive Breastfeeding in Uganda.
abstract: BACKGROUND
  Community based breastfeeding promotion programmes have been shown to be effective in increasing breastfeeding prevalence. However, there is limited data on the cost-effectiveness of these programmes in sub-Saharan Africa. This paper evaluates the cost-effectiveness of a breastfeeding promotion intervention targeting mothers and their 0 to 6 month old children.
  
  
  METHODS
  Data were obtained from a community randomized trial conducted in Uganda between 2006-2008, and supplemented with evidence from several studies in sub-Saharan Africa. In the trial, peer counselling was offered to women in intervention clusters. In the control and intervention clusters, women could access standard health facility breastfeeding promotion services (HFP). Thus, two methods of breastfeeding promotion were compared: community based peer counselling (in addition to HFP) and standard HFP alone. A Markov model was used to calculate incremental cost-effectiveness ratios between the two strategies. The model estimated changes in breastfeeding prevalence and disability adjusted life years. Costs were estimated from a provider perspective. Uncertainty around the results was characterized using one-way sensitivity analyses and a probabilistic sensitivity analysis.
  
  
  RESULTS
  Peer counselling more than doubled the breastfeeding prevalence as reported by mothers, but there was no observable impact on diarrhoea prevalence. Estimated incremental cost-effectiveness ratios were US$68 per month of exclusive or predominant breastfeeding and U$11,353 per disability adjusted life year (DALY) averted. The findings were robust to parameter variations in the sensitivity analyses.
  
  
  CONCLUSIONS
  Our strategy to promote community based peer counselling is unlikely to be cost-effective in reducing diarrhoea prevalence and mortality in Uganda, because its cost per DALY averted far exceeds the commonly assumed willingness-to-pay threshold of three times Uganda's GDP per capita (US$1653). However, since the intervention significantly increases prevalence of exclusive or predominant breastfeeding, it could be adopted in Uganda if benefits other than reducing the occurrence of diarrhoea are believed to be important.
authors.affiliation: Population Health, Health Systems and Innovation (PHHSI), Human Sciences Research Council, Pretoria, South Africa.|School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Box 7804, N-5020, Bergen, Norway.
authors.forename: Lumbwe
authors.initials: L
authors.lastname: Chola
authors.affiliation: Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Box 7804, N-5020, Bergen, Norway.|Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
authors.forename: Lars T
authors.initials: LT
authors.lastname: Fadnes
authors.affiliation: Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Box 7804, N-5020, Bergen, Norway.|Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
authors.forename: Ingunn M S
authors.initials: IM
authors.lastname: Engebretsen
authors.affiliation: Health Systems and Services Research Unit, Division of Community Health, University of Stellenbosch, Cape Town, South Africa.
authors.forename: Lungiswa
authors.initials: L
authors.lastname: Nkonki
authors.affiliation: Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Box 7804, N-5020, Bergen, Norway.|Department of Paediatrics and Child Health, School of Medicine, Makerere University, Box 7072, Kampala, Uganda.
authors.forename: Victoria
authors.initials: V
authors.lastname: Nankabirwa
authors.affiliation: Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Box 7804, N-5020, Bergen, Norway.|Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Halvor
authors.initials: H
authors.lastname: Sommerfelt
authors.affiliation: Department of Paediatrics and Child Health, School of Medicine, Makerere University, Box 7072, Kampala, Uganda.
authors.forename: James K
authors.initials: JK
authors.lastname: Tumwine
authors.affiliation: Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Box 7804, N-5020, Bergen, Norway.
authors.forename: Thorkild
authors.initials: T
authors.lastname: Tylleskar
authors.affiliation: Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Box 7804, N-5020, 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; D003376:Counseling / Q000191:economics* / Q000379:methods; D003967:Diarrhea / Q000517:prevention & control; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009035:Mothers / Q000193:education; D010379:Peer Group; D014454:Uganda