BREAST-FEEDING PROMOTION AND PRIORITY SETTING IN HEALTH

An increase in exclusive breastfeeding prevalence can substantially re duce mortality and morbidity among infants. In this paper, estimates o f the casts and impacts of three breastfeeding promotion programmes, i mplemented through maternity services in Brazil, Honduras and Mexico, are used to develop cost-effectiveness measures and these are compared with other health interventions. The results show that breastfeeding promotion can be one of the most: cost-effective health interventions for preventing cases of diarrhoea, preventing deaths from diarrhoea, a nd gaining disability-adjusted life years (DALYs). The benefits are su bstantial over a broad range of programme types. Programmes starting w ith the removal of Formula and medications during delivery are likely to derive a high level of impact per unit of net incremental cost. Cos t-effectiveness is lower (but still attractive relative to other inter ventions) if hospitals already have rooming-in and no bottle-feeds; an d the cost-effectiveness improves as programmes become well-establishe d. At an annual cost of about 30 to 40 US cents per birth, programmes starting with formula feeding in nurseries and maternity wards can red uce diarrhoea cases for approximately $0.65 to $1.10 per case prevente d, diarrhoea deaths for $100 to $200 per death averted, and reduce the burden of disease for approximately $2 to $4 per DALY. Maternity serv ices that have already eliminated formula can, by investing from $2 to $3 per birth, prevent diarrhoea cases and deaths for $3.50 to $6.75 p er case, and $550 to $800 per death respectively, with DALYs gained at $12 to $19 each.