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Stunting: an overlooked problem in Myanmar – an economic evaluation

Published online by Cambridge University Press:  20 January 2020

San Kyu Kyu Aye Open the ORCID record for San Kyu Kyu Aye [Opens in a new window] ,
Swe Le Mar ,
Nyi Nyi Lwin ,
Zar Lwin Hnin ,
Lwin Mar Hlaing ,
Michael L. Washington  and
Julie R. Harris
San Kyu Kyu Aye*
Affiliation:
Department of Preventive and Social Medicine, University of Medicine Mandalay, Mandalay, Myanmar
Swe Le Mar
Affiliation:
Department of Public Health, National Nutrition Centre, Naypyitaw, Myanmar
Nyi Nyi Lwin
Affiliation:
Department of Public Health, Sagaing Regional Public Health Department, Monywa, Myanmar
Zar Lwin Hnin
Affiliation:
Department of Preventive and Social Medicine, University of Medicine Mandalay, Mandalay, Myanmar
Lwin Mar Hlaing
Affiliation:
Department of Public Health, National Nutrition Centre, Naypyitaw, Myanmar
Michael L. Washington
Affiliation:
US Centers for Disease Control and Prevention, Health Economics and Modeling Unit, Atlanta, GA, USA
Julie R. Harris
Affiliation:
US Centers for Disease Control and Prevention, Workforce and Institute Development Branch, Atlanta, GA, USA
*
Author for Correspondence: San Kyu Kyu Aye, E-mail: sankyukyuaye@gmail.com
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Abstract

Objectives

Stunting increases a child's susceptibility to diseases, increases mortality, and is associated over long term with reduced cognitive abilities, educational achievement, and productivity. We aimed to assess the most effective public health nutritional intervention to reduce stunting in Myanmar.

Methods

We searched the literature and developed a conceptual framework for interventions known to reduce stunting. We focused on the highest impact and most feasible interventions to reduce stunting in Myanmar, described policies to implement them, and compared their costs and projected effect on stunting using data-based decision trees. We estimated costs from the government perspective and calculated total projected cases of stunting prevented and cost per case prevented (cost-effectiveness). All interventions were compared to projected cases of stunting resulting from the current situation (e.g., no additional interventions).

Results

Three new policy options were identified. Operational feasibility for all three options ranged from medium to high. Compared to the current situation, two were similarly cost-effective, at an additional USD 598 and USD 667 per case of stunting averted. The third option was much less cost-effective, at an additional USD 27,741 per case averted. However, if donor agencies were to expand their support in option three to the entire country, the prevalence of 22.5 percent would be reached by 2025 at an additional USD 667 per case averted.

Conclusions

A policy option involving immediate expansion of the current implementation of proven nutrition-specific interventions is feasible. It would have the highest impact on stunting and would approach the WHO 2025 target.

Keywords

StuntingNutritionHealth policyMyanmarEconomic Evaluation
Type
Policy
Information
International Journal of Technology Assessment in Health Care , Volume 36 , Issue 2 , April 2020 , pp. 167 - 172
Copyright
Copyright © Cambridge University Press 2020

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References

Black, RE, Victora, CG, Walker, SP et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382, 427–451.CrossRefGoogle ScholarPubMed
Hoddinott, J, Alderman, H, Behrman, JR, Haddad, L, Horton, S (2013) The economic rationale for investing in stunting reduction. Matern Child Nutr 9, 69–82.CrossRefGoogle ScholarPubMed
Blake, RA, Park, S, Baltazar, P et al. (2016) Lbw and SGA impact longitudinal growth and nutritional status of Filipino infants. PLoS One 11, e0159461.CrossRefGoogle ScholarPubMed
Shekar, M, Dayton Eberwein, J, Kakietek, J (2016) The costs of stunting in South Asia and the benefits of public investments in nutrition. Matern Child Nutr 12, 186–195.CrossRefGoogle ScholarPubMed
Dewey, KG, Begum, K (2011) Long-term consequences of stunting in early life. Matern Child Nutr 7, 5–18.CrossRefGoogle ScholarPubMed
Hawkes, C (2017) Global nutrition report 2017: Nourishing the SDGs. Bristol, UK: Development Initiatives.Google Scholar
Bhutta, ZA, Ahmed, T, Black, RE et al. (2008) What works? Interventions for maternal and child undernutrition and survival. Lancet 371, 417–440.CrossRefGoogle ScholarPubMed
De Onis, M, Dewey, KG, Borghi, E et al. (2013) The World Health Organization's global target for reducing childhood stunting by 2025: Rationale and proposed actions. Matern Child Nutr 9, 6–26.CrossRefGoogle ScholarPubMed
Ministry of Health Sports (2017) Myanmar demographic and health survey 2015–16. Nay Pyi Taw, Myanmar and Rockville, MD, USA: Ministry of Health Sports and ICF.Google Scholar
Mya, KS, Kyaw, AT, Tun, T (2019) Feeding practices and nutritional status of children age 6–23 months in Myanmar: A secondary analysis of the 2015–16 Demographic and Health Survey. PLoS One 14, e0209044.CrossRefGoogle ScholarPubMed
Danaei, G, Andrews, KG, Sudfeld, CR et al. (2016) Risk factors for childhood stunting in 137 developing countries: A comparative risk assessment analysis at global, regional, and country levels. PLoS Med 13, e1002164.CrossRefGoogle ScholarPubMed
Bhutta, ZA, Das, JK, Rizvi, A et al. (2013) Evidence-based interventions for improvement of maternal and child nutrition: What can be done and at what cost? Lancet 382, 452–477.CrossRefGoogle ScholarPubMed
IndexMundi Myanmar. Prevalence of stunting, height for age (% of children under 5) [cited August 2018]. Available at: https://www.indexmundi.com/facts/myanmar/indicator/SH.STA.STNT.ZS.Google Scholar
The Republic of the Union of Myanmar (2017) Thematic Report on Population Projections for the Union of Myanmar, State/Regions, Rural and Urban Areas, 2014–2050. Available at: https://myanmar.unfpa.org/en/publications/thematic-report-population-projections.Google Scholar
Mashreky, SR, Rahman, F, Rahman, A, Talab, A, Rahman, Z (2015) Role of mass media in increasing knowledge and practices of mothers on IYCF: Findings from a community trial in rural Bangladesh. South East Asia J Public Health 5, 18–24.CrossRefGoogle Scholar
Menon, P, Nguyen, PH, Saha, KK et al. (2016) Combining intensive counseling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth: Results of a cluster-randomized program evaluation in Bangladesh. J Nutr 146, 2075–2084.CrossRefGoogle Scholar
Nguyen, PH, Kim, SS, Nguyen, TT et al. (2016) Exposure to mass media and interpersonal counseling has additive effects on exclusive breastfeeding and its psychosocial determinants among Vietnamese mothers. Matern Child Nutr 12, 713–725.CrossRefGoogle ScholarPubMed
Imdad, A, Bhutta, ZA (2011) Effect of balanced protein energy supplementation during pregnancy on birth outcomes. BMC Public Health 11, S17.CrossRefGoogle ScholarPubMed
Stevens, B, Buettner, P, Watt, K et al. (2015) The effect of balanced protein energy supplementation in undernourished pregnant women and child physical growth in low-and middle-income countries: A systematic review and meta-analysis. Matern Child Nutr 11, 415–432.CrossRefGoogle ScholarPubMed
Aguayo, VM, Nair, R, Badgaiyan, N, Krishna, V (2016) Determinants of stunting and poor linear growth in children under 2 years of age in India: An in-depth analysis of Maharashtra's comprehensive nutrition survey. Matern Child Nutr 12, 121–140.CrossRefGoogle ScholarPubMed
Berhanu, G, Mekonnen, S, Sisay, M (2018) Prevalence of stunting and associated factors among preschool children: A community based comparative cross sectional study in Ethiopia. BMC Nutr 4, 28.CrossRefGoogle ScholarPubMed
Ceesay, SM, Prentice, AM, Cole, TJ et al. (1997) Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: 5 year randomised controlled trial. Br Med J 315, 786–790.CrossRefGoogle ScholarPubMed
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