Scaling up evidence-based interventions to reduce maternal and child undernutrition in 125 countries: a cost-benefit analysis

BACKGROUND: The world is not on track to reach the Sustainable Development Goal nutrition targets. We aimed to estimate the cost, impact and benefit-cost ratio from scaling up 15 evidence-based nutrition interventions among 125 countries and seven world regions. METHODS: For each country, the Optima Nutrition model was used to project health outcomes over 2025-2034 for pregnant women (anemia, mortality) and children under five (stunting, wasting, anemia, small for gestational age births, children exclusively breastfed). The 15 interventions were identified through systematic reviews. Country-specific demographic, epidemiological and intervention coverage parameters were extracted from large population surveys, World Bank and Institute of Health Metrics and Evaluation estimates. A baseline scenario with current coverage of interventions maintained was compared to an investment scenario where intervention coverage was increased linearly to 90% over 2025 to 2029 and then maintained from 2030 to 2034. Country-specific intervention unit costs were estimated from a health system perspective and used to calculate 10-year intervention costs for each scenario. Health impacts for the 10-year cohort were converted to societal economic benefits from larger and more productive future workforces. Costs and economic benefits are presented in 2023 US$ with 3% per annum discounting. RESULTS: The current coverage of interventions varied widely across countries but was generally low. Compared to the baseline, the investment scenario cost an average additional US$4.87-11.43 per pregnant woman and an average additional US$9.99-20.14 per child under five per annum, depending on world region. Across regions, this investment could reduce child deaths by 7-13%, maternal deaths by 5-9%, stunted children turning age five by 5-9%, wasting episodes by 2-4%, maternal anemia cases by 36-38%, child anemia cases by 16-23%, small for gestational age births by 46-52%, and could increase the number of infants exclusively breastfed by 10-29%. These improved outcomes translated to benefit-cost ratios of 13-54 across regions. The estimated financial needs, distribution of additional costs across interventions and return-on-investment for each country was dependent on population sizes and country-specific epidemiological and economic indicators. CONCLUSIONS: Scaling up evidence-based nutrition interventions could have substantive health and economic impacts. For every $1 invested there could be between $13 and $54 in economic benefits.