Peer-reviewed article
The cost of improving nutritional outcomes through food‐assisted maternal and child health and nutrition programmes in Burundi and Guatemala
Jessica Heckert, Jef L J P Leroy, Deanna Kelly Olney, Susan Richter, Elyse Iruhiriye et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined the cost-effectiveness of food assistance programmes for pregnant women and young children in Burundi and Guatemala. The programmes provided food rations during pregnancy and the first two years of life to improve nutrition and reduce stunting. The research found that full-size rations delivered over the entire 1,000-day period (from pregnancy to age 2) were most cost-effective, while smaller rations or shorter durations reduced costs but failed to prevent stunting effectively.
Key points
- In Guatemala, the most cost-effective model combined full-size family rations with individual rations of corn-soy blend or micronutrient powder
- In Burundi, providing food assistance for the full 1,000 days from pregnancy to age 2 had the lowest cost per percentage point reduction in stunting
- Reducing family ration size or shortening duration lowered per-beneficiary costs but was less effective at reducing stunting
- Extending programmes for 2 years could save 11% per beneficiary in Guatemala and 18% in Burundi by spreading start-up costs
- Nutrition programme costs do not scale linearly; smaller doses may not achieve the necessary biological impact on child outcomes
Limitations
The study measures cost-effectiveness based on stunting alone and does not provide information on long-term follow-up outcomes or implementation fidelity across different contexts. The analysis is limited to two countries and may not be generalizable to other settings with different cost structures or programme delivery systems.
Abstract
Evidence on the cost-effectiveness of multisectoral maternal and child health and nutrition programmes is scarce. We conducted a prospective costing study of two food-assisted maternal and child health and nutrition programmes targeted to pregnant women and children during the first 1,000 days (pregnancy to 2 years). Each was paired with a cluster-randomized controlled trial to evaluate impact and compare the optimal quantity and composition of food rations (Guatemala, five treatment arms) and their optimal timing and duration (Burundi, three treatment arms). We calculated the total and per beneficiary cost, conducted cost consequence analyses, and estimated the cost savings from extending the programme for 2 years. In Guatemala, the programme model with the lowest cost per percentage point reduction in stunting provided the full-size family ration with an individual ration of corn-soy blend or micronutrient powder. Reducing family ration size lowered costs but failed to reduce stunting. In Burundi, providing food assistance for the full 1,000 days led to the lowest cost per percentage point reduction in stunting. Reducing the duration of ration eligibility reduced per beneficiary costs but was less effective. A 2-year extension could have saved 11% per beneficiary in Guatemala and 18% in Burundi. We found that investments in multisectoral nutrition programmes do not scale linearly. Programmes providing smaller rations or rations for shorter durations, although less expensive per beneficiary, may not provide the necessary dose to improve (biological) outcomes. Lastly, delivering effective programmes for longer periods can generate cost savings by dispersing start-up costs and lengthening peak operating capacity.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Food-assisted maternal and child health and nutrition programmes providing food rations to pregnant women and children from pregnancy to 2 years of age, with variations in ration size, composition, timing and duration
- Population
- Pregnant women and children aged 0-2 years in Burundi and Guatemala
Key finding
Full-size family ration plus individual corn-soy blend or micronutrient powder most effective in Guatemala for stunting reduction