Cost-effectiveness of peer counselling for the promotion of exclusive breastfeeding in Uganda

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dc.contributor.authorChola, Lumbween_ZA
dc.contributor.authorFadnes, Lars T.en_ZA
dc.contributor.authorEngebretsen, Ingunn M. S.en_ZA
dc.contributor.authorNkonki, Lungiswaen_ZA
dc.contributor.authorNankabirwa, Victoriaen_ZA
dc.contributor.authorSommerfelt, Halvoren_ZA
dc.contributor.authorTumwine6, James K.en_ZA
dc.contributor.authorTylleskar, Thorkilden_ZA
dc.contributor.authorRobberstad, Bjarneen_ZA
dc.contributor.authorPROMISE-EBF Study Groupen_ZA
dc.date.accessioned2016-07-08T09:39:54Z
dc.date.available2016-07-08T09:39:54Z
dc.date.issued2015
dc.descriptionCITATION: Chola, L., et al. 2015. Cost-effectiveness of peer counselling for the promotion of exclusive breastfeeding in Uganda. PLoS ONE, 10(11): 1-18, doi: 10.1371/journal.pone.0142718.
dc.descriptionThe original publication is available at http://journals.plos.org/plosone
dc.description.abstractBackground: 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. Findings: 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.en_ZA
dc.description.urihttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0142718
dc.description.versionPublisher's version
dc.format.extent18 pages
dc.identifier.citationChola, L., et al. 2015. Cost-effectiveness of peer counselling for the promotion of exclusive breastfeeding in Uganda. PLoS ONE, 10(11): 1-18, doi: 10.1371/journal.pone.0142718
dc.identifier.issn1932-6203 (online)
dc.identifier.issn1932-6203 (print)
dc.identifier.otherdoi: 10.1371/journal.pone.0142718
dc.identifier.urihttp://hdl.handle.net/10019.1/99117
dc.language.isoen_ZAen_ZA
dc.publisherPublic Library of Science
dc.rights.holderAuthors retain copyright
dc.subjectPeer counseling -- Uganda -- Cost effectivenessen_ZA
dc.subjectBreastfeeding promotion -- Uganda -- Cost effectivenessen_ZA
dc.titleCost-effectiveness of peer counselling for the promotion of exclusive breastfeeding in Ugandaen_ZA
dc.typeArticleen_ZA
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