Abstract
BACKGROUND: The prevalence of child undernutrition is significantly high in India, prompting a study to evaluate the effectiveness of a crèche combined with community-based nutrition promotion interventions aimed at reducing undernutrition among children aged 6-36 months in two Indian states. This study also assessed the cost-effectiveness of this intervention for optimal resource allocation. METHOD: Using a provider's perspective, the study analyzed project costs associated with the intervention, which was compared to a control group. The effectiveness was measured through the Composite Index of Anthropometric Failure (CIAF), with costs gathered from project accounts and outcomes analyzed through baseline and endline surveys. To assess the cost-effectiveness of the intervention, the incremental cost-effectiveness ratio was calculated, taking the difference in total costs of intervention and control areas against the Disability-Adjusted Life Years (DALYs) averted through the intervention. Costs were adjusted for inflation and converted to 2023 US Dollars. To assess the robustness of the results, sensitivity analyses were conducted. RESULTS: The incremental cost per CIAF case averted was US$2791, while the incremental cost per DALY averted stood at US$514. This cost-effectiveness was aligned with WHO recommendations, considering it below India's GDP per capita threshold of US$2610. CONCLUSION: In conclusion, the study found that integrating a crèche with community nutrition promotion significantly addresses child undernutrition effectively and affordably. Implementing such interventions into the existing health system is vital for reducing the burden of undernutrition in India.