Management of moderate wasting (MW) is an important component of country-level strategies to address wasting, given high caseloads and susceptibility to illness and death. However, many countries experience challenges in providing targeted supplementary feeding programs with specially-formulated foods (SFF) involved in managing MW. Some implementing agencies have developed a community-based program using locally-available foods (LF) for MW management known as Tom Brown (TB). This study assessed the costs and cost-efficiency of three TB programs (two with 8-weeks supplementation duration, one with 10-weeks duration).

Northeast Nigeria

Program staff

We assessed institutional costs and selected estimates of societal costs to households and community volunteers.

Total cost per child ranged from $155-184 per 8-week program and $493 per 10-week program. Monthly LF supplementation cost per child ranged from $5-21. Unit costs were influenced by implementation duration and variations in program features including storage and transportation models, the inclusion of voucher transfers, and volunteer cadre models. Opportunity costs to beneficiaries and volunteers in preparing recipes were substantial. Cash/voucher components, where used, represented a cost driver for institutional and societal costs.

An updated WHO guideline emphasizes the role of LF for supplementing MW children who lack other risk factors. Given that SFFs are not necessary for all MW children to recover, program approaches using LF are important options for managing MW. This study from Nigeria provides the first cost estimates for using LF to manage MW. Future research is needed on effectiveness and cost-effectiveness of these approaches.