Breastfeeding promotion and priority setting in health
An increase in exclusive breastfeeding prevalence can substantially reduce mortality and morbidity among infants. In this paper, estimates of the costs and impacts of three breastfeeding promotion programmes, implemented through maternity services in Brazil, Honduras and Mexico, are used to develop cost-effectiveness measures and these are compared with other health interventions. The results show that breastfeeding promotion can be one of the most cost-effective health interventions for preventing cases of diarrhoea, preventing deaths from diarrhoea, and gaining disability-adjusted life years (DALYs). The benefits are substantial over a broad range of programme types. Programmes starting with the removal of formula and medications during delivery are likely to derive a high level of impact per unit of net incremental cost. Cost-effectiveness is lower (but still attractive relative to other interventions) if hospitals already have rooming-in and no bottle-feeds; and the cost-effectiveness Improves as programmes become well-established. At an annual cost of about 30 to 40 US cents per birth, programmes starting with formula feeding in nurseries and maternity wards can reduce diarrhoea cases for approximately $0.65 to $1.10 per case prevented, diarrhoea deaths for $100 to $200 per death averted, and reduce the burden of disease for approximately $2 to $4 per DALY. Maternity services that have already eliminated formula can, by investing from $2 to $3 per birth, prevent diarrhoea cases and deaths for $3.50 to $6.75 per case, and $550 to $800 per death respectively, with DALYs gained at $12 to $19 each. During April 1992 to March 1993, in Santos, Brazil, in San Pedro Sula, Honduras, and in Mexico City, Mexico, interviews were conducted with 200-400 women in each of three hospitals and at their homes at 1 month and at 2-4 months postpartum as part of a study of the cost and effectiveness of three breast feeding promotion programs in hospital-based maternity services. The hospital in Mexico and, in the past, the one in Brazil used infant formula, while the hospital in Honduras and the hospital in Brazil removed infant formula. Various nutrition and policy specialists estimated the costs and impacts of these programs to develop cost effectiveness measures and then compared them with other health interventions. At a net incremental cost ranging from about US$0.30 to US$0.40 per birth, infant feeding programs with formula feeding in nurseries and maternity wards can reduce diarrhea cases for about US$0.65 to US$1.10 each, prevent diarrhea-related deaths for US$100 to US$200 each, and reduce the burden of disease for about US$2 to US$4 per disability-adjusted life year (DALY). On the other hand, by investing US$2 to US$3 per birth, maternity services that no longer provide infant formula can prevent diarrhea cases and deaths for US$3.50 to US$6.75 per case and US$550 to US$800 per death, respectively, and gain DALYs at a cost of US$12 to US$19 each. The estimates obtained indicate that breast feeding promotion in hospitals competes very closely with measles and rotavirus vaccination as the most efficient option for diarrheal disease control and is markedly more cost-effective than oral rehydration therapy and cholera immunization even when infant formula is no longer offered. In fact, investments in breast feeding promotion are among the most cost-effective health interventions. The cost effectiveness of breast feeding promotion programs improved as programs became institutionalized. These findings show that such programs are a very efficient way of improving the health status of children.