Optimal Allocation of Antenatal and Young Child Nutrition Interventions: An Individual-Based GBD-Calibrated Microsimulation

Abstract

Background: Undernutrition remains a global crisis and is a focus of Sustain Development Goals. While there are multiple known, effective interventions, complex interactions between prevention and treatment and resource constraints can lead to difficulties in allocating funding. Simulation studies that use in silico computer simulation can help illuminate the interactions between interventions and provide insight into the cost-effectiveness of alternative packages of options. Methods: We developed an individual-based microsimulation model to test a range of antenatal and child nutrition interventions (iron and folic acid, multiple micronutrients, balanced energy protein supplementation, treatment for severe acute malnutrition, treatment for moderate acute malnutrition, and wasting prevention with small-quantity lipid-based nutrient supplements) and an analytic approach to processes the results of the microsimulation and provide the optimal intervention funding allocation for a given budget size. Results: The reallocation of the baseline budget to minimize DALYs resulted in first funding multiple micronutrients to their maximum coverage, and then funding treatment for severe acute malnutrition. Relative to the baseline allocation, the reallocation optimized to minimizing DALYs resulted in 592,000 fewer annual DALYs. For budgets larger than the baseline, our model recommended funding first targeted moderate acute malnutrition treatment, second universal moderate acute malnutrition treatment, third wasting prevention with small-quantity lipid-based nutrient supplements, and fourth balanced energy protein supplementation. Conclusions: Our simulation is a novel model for estimating optimal allocation of spending on antenatal and child health nutrition interventions. We utilized a detailed health model that accounts for the interaction between preventive and therapeutic approaches. Our results show that an optimized reallocation of current spending on multiple micronutrients and treatment for severe acute malnutrition can substantially improve pregnancy-related and child health without additional funding. Additionally, we provide direction for how to best allocate expanded budgets to maximize impact.