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

Abstract 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 US4. 87–11. 43 per pregnant woman and an average additional US9. 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.