1. Presented by: Delaram Ghodsi PhD. in Nutrition (Minor: Economics)
The cost and effect of the food supplement distribution for nourishment of malnourished or growth-retarded children in Iran
Presented by: Delaram Ghodsi
PhD. in Nutrition (Minor: Economics)
Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Science, Tehran, Iran
Colleagues: Dr Hossein Raghfar, Dr. Nasrin Omidvar, Dr. Arash Rashidian, Dr. Hassan Eini-Zinab, Ms. Mitra Babapour 1

2. Introduction
Evidences support that using supplementary foods is good strategy for combating malnutrition in children.
Concrete information on the outcomes and costs of nutrition programs will be crucial for policy makers and in sorting out those programs that have greatest impact on essential nutrition needs, especially in high risk groups at a reasonable cost

3. Introduction
The multidisciplinary program for improvement of children nutritional status developed nationwide to promote child health and nutrition at 2005, in Iran.
It has two sections:
Collaborative (inter-sectoral approach)
Supportive (targeted approach)

4. Introduction In the supportive section:
Monthly food supplement is distributed targeting malnourished/growth retarded children
Each food basket value Rials (18 US$)
There is a clear need to provide credible evidence showing that the program’s cost or its cost-effectiveness

5. Goal
This study aimed to reports impacts and cost results from food distribution program in two provinces of Iran: Semnan and Qazvin.

6. Methods Outcome analysis: Intervention group: Control group:
Samples: 363 children aged 6m to 6y under coverage of supportive section of the program
Sampling methods: stratified random sampling
Control group:
Samples: 409 children aged 6m to 6y under coverage of PHC in Iran
Sampling methods: Convenience sampling

7. Methods Effects were assessed by:
Weight and length/height of the children in both groups were measured
at the beginning of the study (from June to September 2014)
and 6 month thereafter (from November 2014 to March 2015)
Effects were assessed by:
Difference-in-Difference (DID)

8. Methods
Cost analysis
Monthly implementation costs of the program, including:
Food basket
Staff
Training and education material
Transportation
Building and utilities

9. Methods Data were gathered (in 2014) by: Accounting records
Key informant interviews
from 80 health house/centers in rural/urban areas
An activity-based costing (ABC) was applied to calculate monthly program implementation costs per child.

10. Methods
Unit cost were calculated by dividing implementation cost to the number of children under coverage of the program

11. Results

12. Changes in nutritional status of children in intervention and comparison group at the baseline and end of the study, Iran,
Indicators 1
Intervention
(n=362)
Control
(n=409)
DiD
P value§
WAZ
-0.023
0.62
Baseline *
-1.2±1.05
-0.73±1.16
After 6 months‡
-1.2±1.01
-0.59±1.04
Change in Z-score
0.16±0.62
0.13±0.68
HAZ
-0.007
0.91
-0.87±1.23
-0.51±1.5
After 6 months ‡
-0.8±1.26
-0.43±1.3
0.08±0.77
0.07±1.04
WHZ
0.004
0.94
-1.15±1.12
-0.69±1.1
End of the study‡
-0.94±1.05
-0.48±0.96
0.2±0.91
0.2±0.81
1 values are presented as mean ± SD, *Significant difference between two groups at the baseline (p<0.001),
‡Significant difference between two groups at the end of the study (p<0.001), §Pvalue for DiD.
WAZ: Weight-for-Age Z-score, HAZ: Height-for-Age Z-score, WHZ: Weight-to-Height Z-score, DiD: Difference-in-Difference estimator (differences in change from baseline between two groups at the end of the study)

13. Implementation cost of the supportive section of the program in Semnan, 2014

14. Implementation cost of the supportive section of the program in Qazvin (2014)

15. Total implementation cost of the supportive section of the program in two provinces (2014)

16. Implementation cost of the program per cost and ratio of food basket to total cost in two provinces, 2014
Total
Semnan
Qazvin
841
279
562
Number of under coverage children (person)
31.5
32.86
30.82
Monthly Implementation cost per child (US $)
0.59
0.56
Proportion of total cost to food basket

17. Conclusion
The food component is the highest portion of monthly implementation cost.
The cost of implementation of the program per child is partially low due to implementation of the program via PHC.
With careful training and good implementation and administration, food supplementary program delivered via PHC could be efficient and cost-effective.

18. Conclusion
This program could be more efficient if it was implemented properly by using PHC capacity

19. Thank you