Ending malnutrition in all its forms requires scaling up proven nutrition interventions and much more: a 129-country analysis

BMC Medicine

Carol Levin¹  Mike Toole²  Caroline SE Homer²  Shan Huang²  Dominic Delport²  Ruth Pearson²  Samuel Hainsworth²  Christopher Morgan³  Nick Scott⁴  Ellen Piwoz⁵  Jonathan K. Akuoku⁶  Meera Shekar⁶ 

[1] Department of Global Health, University of Washington, Seattle, USA;Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia;Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia;School of Population and Global Health, University of Melbourne, Melbourne, Australia;Jhpiego, Baltimore, MD, USA;Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia;School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia;Nutrition Global Development Program, Bill and Melinda Gates Foundation, Seattle, USA;World Bank Group, Washington DC, USA;

关键词: Economic analysis;    Mathematical model;    Nutrition;    Optima Nutrition;    Sustainable Development Goals;   

DOI  :  10.1186/s12916-020-01786-5

来源: Springer

【 摘 要 】

BackgroundSustainable Development Goal (SDG) 2.2 calls for an end to all forms of malnutrition, with 2025 targets of a 40% reduction in stunting (relative to 2012), for wasting to occur in less than 5% of children, and for a 50% reduction in anaemia in women (15–49 years). We assessed the likelihood of countries reaching these targets by scaling up proven interventions and identified priority interventions, based on cost-effectiveness.MethodsFor 129 countries, the Optima Nutrition model was used to compare 2019–2030 nutrition outcomes between a status quo (maintained intervention coverage) scenario and a scenario where outcome-specific interventions were scaled up to 95% coverage over 5 years. The average cost-effectiveness of each intervention was calculated as it was added to an expanding package of interventions.ResultsOf the 129 countries modelled, 46 (36%), 66 (51%) and 0 (0%) were on track to achieve the stunting, wasting and anaemia targets respectively. Scaling up 18 nutrition interventions increased the number of countries reaching the SDG 2.2 targets to 50 (39%), 83 (64%) and 7 (5%) respectively. Intermittent preventative treatment of malaria during pregnancy (IPTp), infant and young child feeding education, vitamin A supplementation and lipid-based nutrition supplements for children produced 88% of the total impact on stunting, with average costs per case averted of US$103, US$267, US$556 and US$1795 when interventions were consecutively scaled up, respectively. Vitamin A supplementation and cash transfers produced 100% of the total global impact on prevention of wasting, with average costs per case averted of US$1989 and US$19,427, respectively. IPTp, iron and folic acid supplementation for non-pregnant women, and multiple micronutrient supplementation for pregnant women produced 85% of the total impact on anaemia prevalence, with average costs per case averted of US$9, US$35 and US$47, respectively.ConclusionsPrioritising nutrition investment to the most cost-effective interventions within the country context can maximise the impact of funding. A greater focus on complementing nutrition-specific interventions with nutrition-sensitive ones that address the social determinants of health is critical to reach the SDG targets.

【 授权许可】

CC BY