Understanding Opportunity Costs of Women Participating in Maternal and Child Nutrition Interventions in Southern Angola: Evidence From the MuCCUA Trial

Stunting remains highly prevalent in Angola. Multisectoral interventions are essential to prevent this public health issue, and while economic evaluations have assessed the costs and consequences of these interventions, they have largely overlooked costs incurred by participants. The MuCCUA trial evaluates the cost-effectiveness of three interventions to prevent stunting during the first 1000 days: standard of care (SOC), SOC plus nutritional supplementation (SOC + NS), and SOC plus cash transfers (SOC + CT). This study aimed to estimate participants' opportunity costs and to explore women's experiences. After 12 months of implementation, data were collected from participant women through focus group discussions, interviews and questionnaires on travel and waiting times, and transport costs for attending health posts and community sessions in the SOC arm, and for quarterly distribution visits in the SOC + NS and SOC + CT arms. Total opportunity costs per participant were estimated by intervention arm and community category (close/far from services and/or distribution points). The total opportunity cost of participants over 1 year were US$9373.91 for SOC, US$16,142.09 for SOC + NS and US$18,231.38 for SOC + CT, corresponding to US$1.69, US$2.80 and US$3.17 per participant per month respectively. Value of travel and waiting times accounted for 75%-85% of opportunity costs, with women in remote villages facing substantially higher burdens. These findings highlight the importance of accounting for opportunity costs, especially time and geographic accessibility, when designing maternal and child health and nutrition interventions. Incorporating a societal perspective in economic evaluations is essential to capture unintended participant burdens and promote equitable, effective participation. Trial Registration: NCT05571280. Registered 7 October 2022.