Protocol for the economic evaluation of a community-based intervention to improve growth among children under two in rural India (CARING trial).
Undernutrition affects ∼165 million children globally and contributes up to 45% of all child deaths. India has the highest proportion of global undernutrition-related morbidity and mortality. This protocol describes the planned economic evaluation of a community-based intervention to improve growth in children under 2 years of age in two rural districts of eastern India. The intervention is being evaluated through a cluster-randomised controlled trial (cRCT, the CARING trial).



A cost-effectiveness and cost-utility analysis nested within a cRCT will be conducted from a societal perspective, measuring programme, provider, household and societal costs. Programme costs will be collected prospectively from project accounts using a standardised tool. These will be supplemented with time sheets and key informant interviews to inform the allocation of joint costs. Direct and indirect costs incurred by providers will be collected using key informant interviews and time use surveys. Direct and indirect household costs will be collected prospectively, using time use and consumption surveys. Incremental cost-effectiveness ratios (ICERs) will be calculated for the primary outcome measure, that is, cases of stunting prevented, and other outcomes such as cases of wasting prevented, cases of infant mortality averted, life years saved and disability-adjusted life years (DALYs) averted. Sensitivity analyses will be conducted to assess the robustness of results.



There is a shortage of robust evidence regarding the cost-effectiveness of strategies to improve early child growth. As this economic evaluation is nested within a large scale, cRCT, it will contribute to understanding the fiscal space for investment in early child growth, and the relative (in)efficiency of prioritising resources to this intervention over others to prevent stunting in this and other comparable contexts. The protocol has all necessary ethical approvals and the findings will be disseminated within academia and the wider policy sphere.



ISRCTN51505201; pre-results.
University College London, Institute for Global Health, London, UK.
Jolene
0000-0002-8633-0208
J
Skordis-Worrall
Ekjut, Chakradharpur, Jharkhand, India.
Rajesh
R
Sinha
Ekjut, Chakradharpur, Jharkhand, India.
Amit
A
Kumar Ojha
Ekjut, Chakradharpur, Jharkhand, India.
Soumendra
S
Sarangi
Ekjut, Chakradharpur, Jharkhand, India.
Nirmala
N
Nair
Ekjut, Chakradharpur, Jharkhand, India.
Prasanta
P
Tripathy
Sitaram Bhartia Institute of Science and Research, New Delhi, India.
H S
HS
Sachdev
Public Health Foundation of India, New Delhi, India.
Sanghita
S
Bhattacharyya
Ekjut, Chakradharpur, Jharkhand, India.
Rajkumar
R
Gope
Ekjut, Chakradharpur, Jharkhand, India.
Shibanand
S
Rath
Ekjut, Chakradharpur, Jharkhand, India.
Suchitra
S
Rath
Public Health Foundation of India, New Delhi, India.
Aradhana
A
Srivastava
University College London, Institute for Global Health, London, UK.
Neha
0000-0002-8175-8125
N
Batura
University College London, Institute for Global Health, London, UK.|Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Anni-Maria
AM
Pulkki-Brännström
University College London, Institute for Global Health, London, UK.
Anthony
A
Costello
Department of Infection and Population Health, University College London, London, UK.
Andrew
A
Copas
University College London, Institute for Global Health, London, UK.
Naomi
N
Saville
University College London, Institute for Global Health, London, UK.
Audrey
A
Prost
University College London, Institute for Global Health, London, UK.
Hassan
H
Haghparast-Bidgoli
D002657:Child Development; D003362:Cost-Benefit Analysis; D005260:Female; D063105:Food Assistance; D006130:Growth Disorders / Q000517:prevention & control*; D006293:Health Promotion / Q000191:economics / Q000379:methods*; D006801:Humans; D007194:India; D007223:Infant; D007226:Infant Mortality; D008297:Male; D015397:Program Evaluation; D011634:Public Health / Q000191:economics*; D012107:Research Design; D012424:Rural Population; D011795:Surveys and Questionnaires
Cost-effectiveness; India; PUBLIC HEALTH; stunting; undernutrition