Achieving the millennium development goals for health: Cost effectiveness analysis of strategies for child health in developing countries

Objective: To determine the costs and effectiveness of selected child health interventions-namely, case management of pneumonia, oral rehydration therapy, supplementation and fortification of staple foods with vitamin A and zinc, provision of supplementary food with counselling on nutrition, and immunisation against measles. Design: Cost effectiveness analysis. Data sources: Efficacy data came from published systematic reviews and before and after evaluations of programmes. For resource inputs, quantities came from literature and expert opinion, and prices from the World Health Organization Choosing Interventions that are Cost Effective (WHO-CHOICE) database. Results: Cost effectiveness ratios clustered in three groups, with fortification with zinc and vitamin A as the most cost effective intervention, and provision of supplementary food and counselling on nutrition as the least cost effective. Between these were oral rehydration therapy, case management of pneumonia, vitamin A and zinc supplementation, and measles immunisation. Conclusions: On the grounds of cost effectiveness, micronutrients and measles immunisation should be provided routinely to all children, in addition to oral rehydration therapy and case management of pneumonia for those who are sick. The challenge of malnutrition is not well addressed by existing interventions.