Background: Low birth weight is a major public health indicator, reflecting maternal health and influencing neonatal survival. Although preventable, it significantly increases the risk of infant mortality. This study aimed to evaluate the cost-effectiveness of an integrated nutritional intervention for high-risk pregnant women, compared to a nutrition education and follow-up program. Methods: This study is based on an observational and comparative analysis that adopts a multisectoral perspective (projects, beneficiaries, and partners). The intervention group received weekly supplementation of fortified flour, protein biscuits, and oranges from the third month of pregnancy until delivery, along with health education and home visits. The control group received the same follow-up, except for the food kits. The economic evaluation incorporated direct costs into the primary ratio calculation, while indirect costs related to participant time were reported separately to ensure analytical consistency. The Incremental Cost-Effectiveness Ratio (ICER) was calculated relative to the WHO threshold after converting avoided low-birth-weight cases into Disability-Adjusted Life Years (DALYs). Finally, the robustness of the results was tested using a univariate sensitivity analysis, with key parameters varied by ±20%. Results: The intervention reduced the incidence of low birth weight from 12.5% to 2.5% (RR = 0.2; 95% CI [0.023 - 0.58]). With a total cost of 3,273,000 FCFA, the incremental cost-effectiveness ratio (ICER) is 245,750 FCFA per additional case of low birth weight averted. When converted, the ICER is 98,300 FCFA per DALY averted—a figure more than eight times lower than the WHO threshold for a “highly cost-effective” intervention (798,974 FCFA). While sensitivity analysis confirms the model’s economic viability, the ICER is sensitive to production costs, causing an ？18.68% variance, with a range of 64,590 to 132,010 FCFA per DALY. Conclusion: In resource-limited settings like Benin, this supplementation strategy shows strong potential to reduce preterm deaths. Its proven perinatal benefits and low cost justify immediate inclusion in national maternal health policies to significantly reduce the incidence of low birth weight.
References
[1]
Ejigu, N., Sarbecha, N., Seyoum, K., Gomora, D., Geta, G., Kene, C., et al. (2025) Prevalence of Low Birth Weight and Associated Factors in Ethiopia: An Umbrella Review of Systematic Review and Meta-Analyses. PLOSGlobalPublicHealth, 5, e0004556. https://doi.org/10.1371/journal.pgph.0004556
[2]
K. C., A., Basel, P.L. and Singh, S. (2020) Low Birth Weight and Its Associated Risk Factors: Health Facility-Based Case-Control Study. PLOSONE, 15, e0234907. https://doi.org/10.1371/journal.pone.0234907
[3]
Atitwa, E.B. (2015) Socio-Economic Determinants of Low Birth Weight in Kenya: An Application of Logistic Regression Model. American Journal of Theoretical and Applied Statistics, 4, 438-445. http://repository.embuni.ac.ke/handle/embuni/3734
[4]
Okwaraji, Y.B., Krasevec, J., Bradley, E., Conkle, J., Stevens, G.A., Gatica-Domínguez, G., et al. (2024) National, Regional, and Global Estimates of Low Birthweight in 2020, with Trends from 2000: A Systematic Analysis. TheLancet, 403, 1071-1080. https://doi.org/10.1016/s0140-6736(23)01198-4
[5]
Gedefaw, G., Alemnew, B. and Demis, A. (2020) Adverse Fetal Outcomes and Its Associated Factors in Ethiopia: A Systematic Review and Meta-Analysis. BMCPediatrics, 20, Article No. 269. https://doi.org/10.1186/s12887-020-02176-9
[6]
Habtegiorgis, S.D., Mitiku, K.W., Tegegne, E., Tesfaye, A., Azmeraw, M., Addis, E.T., et al. (2023) A Systematic Study and Meta-Analysis: The Prevalence of Low Birth Weight and Its Determinants in Ethiopia. https://www.ssrn.com/abstract=4417075
[7]
Ministère de la santé du Bénin (2019) Annuaire des statistiques sanitaires année 2018. 222 p. https://files.aho.afro.who.int/afahobckpcontainer/production/files/Annuaire_2018_MS.pdf
[8]
Ministère de la santé du Bénin (2020) Annuaire des statistiques sanitaires année 2019. 244 p. https://files.aho.afro.who.int/afahobckpcontainer/production/files/Annuaire_Statistique_2019.pdf
[9]
Blencowe, H., Krasevec, J., de Onis, M., Black, R.E., An, X., Stevens, G.A., et al. (2019) National, Regional, and Worldwide Estimates of Low Birthweight in 2015, with Trends from 2000: A Systematic Analysis. TheLancetGlobalHealth, 7, e849-e860. https://doi.org/10.1016/s2214-109x(18)30565-5
[10]
Pusdekar, Y.V., Patel, A.B., Kurhe, K.G., Bhargav, S.R., Thorsten, V., Garces, A., et al. (2020) Rates and Risk Factors for Preterm Birth and Low Birthweight in the Global Network Sites in Six Low-and Low Middle-Income Countries. ReproductiveHealth, 17, Article No. 187. https://doi.org/10.1186/s12978-020-01029-z
[11]
Nga, H.T., Quyen, P.N., Chaffee, B.W., Diep Anh, N.T., Ngu, T. and King, J.C. (2020) Effect of a Nutrient-Rich, Food-Based Supplement Given to Rural Vietnamese Mothers Prior to and/or during Pregnancy on Birth Outcomes: A Randomized Controlled Trial. PLOSONE, 15, e0232197. https://doi.org/10.1371/journal.pone.0232197
[12]
Nyamasege, C.K., Kimani-Murage, E.W., Wanjohi, M., Kaindi, D.W.M., Ma, E., Fukushige, M., et al. (2019) Determinants of Low Birth Weight in the Context of Maternal Nutrition Education in Urban Informal Settlements, Kenya. JournalofDevelopmentalOriginsofHealthandDisease, 10, 237-245. https://doi.org/10.1017/s2040174418000715
[13]
Keats, E.C., Haider, B.A., Tam, E. and Bhutta, Z.A. (2019) Multiple-Micronutrient Supplementation for Women During Pregnancy. CochraneDatabaseofSystematicReviews, 2019, CD004905. https://doi.org/10.1002/14651858.cd004905.pub6
[14]
Houssou, G.R., Azandjeme, C.S., Fanou, N., Metonnou, C.G., Sossa, C.J., Compaoré, E., et al. (2024) Nutritional Profile of Pregnant Women in the Lake Area of Cotonou (Benin Republic). UniversalJournalofPublicHealth, 12, 1131-1139. https://doi.org/10.13189/ujph.2024.120610
[15]
Houssou, G.R., Azandjeme, C.S., Djenontin, O.A., Fanou, N., Metonnou, C.G., Sossa, C.J., et al. (2024) Development of a Score to Predict the Risk of Low Birth Weight in Pregnant Women. Journal of Public Health and Epidemiology, 16, 107-114.
[16]
Djibril, R., Makoutode, C.P., Lamidhi, S. and Mauricette, M. (2026) Analyse co？tefficacité de la chimioprophylaxie du paludisme saisonnier chez les enfants de moins de 5 ans dans le département des Collines au Bénin en 2025. Revue Africaine des Sciences Sociales et de la Santé Publique, 8, 235-244.
[17]
Husereau, D., Drummond, M., Augustovski, F., de Bekker-Grob, E., Briggs, A.H., Carswell, C., et al. (2022) Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: Updated Reporting Guidance for Health Economic Evaluations. BMCMedicine, 20, Article No. 23. https://doi.org/10.1186/s12916-021-02204-0
[18]
Imdad, A., Mayo-Wilson, E., Haykal, M.R., Regan, A., Sidhu, J., Smith, A., et al. (2022) Vitamin A Supplementation for Preventing Morbidity and Mortality in Children from Six Months to Five Years of Age. CochraneDatabaseofSystematicReviews, 2022, CD008524. https://doi.org/10.1002/14651858.cd008524.pub4
[19]
World Health Statistics (2023) Monitoring Health for the SDGs, Sustainable Development Goals. World Health Organization, 1 p.
[20]
Adu-Afarwuah, S., Young, R.R., Lartey, A., Okronipa, H., Ashorn, P., Ashorn, U., et al. (2020) Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Does Not Increase Child Morbidity in a Semiurban Setting in Ghana: A Secondary Outcome Noninferiority Analysis of the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD Randomized Controlled Trial. TheJournalofNutrition, 150, 382-393. https://doi.org/10.1093/jn/nxz243
[21]
Tufa, B., Mengiste, H., Derash, M., Sebsibe, G. and Tesfaye, H. (2024) Cost-Effectiveness of Folic Acid Supplementation Strategies for Preventing Neural Tube Defects in Ethiopia: A Markov Model Analysis. https://doi.org/10.21203/rs.3.rs-5362096/v1
[22]
Drummond, M.F., Sculpher, M.J., Claxton, K., Stoddart, G.L. and Torrance, G.W. (2015) Methods for the Economic Evaluation of Health Care Programmes. Oxford University Press.
