Relative cost of counselling compared to supplementary foods for acute malnutrition: a time and motion study in Nairobi Kenya

AimsWe aimed to describe the relative cost of supplying supplementary food, compared to counselling, in children with acute malnutrition managed in one urban area. MethodA cross-sectional costing study was undertaken. Interviews with staff and time-and-motion observations of children with acute malnutrition and their carers attending 6 ambulatory nutrition treatment centres in Nairobi were conducted to assess the time nutritionists spent treating acute malnutrition and managing ready to use food supplies. Kenyan standard pay rates ($) were used to calculate the monthly staff cost of reviewing each child and speaking to their parent. These were compared to the published cost of purchasing daily ready to use food sachets. ResultsConsultations with 32 children were observed, 3-8 per clinic. Staff spent mean (SD) 9.84 (4.9) minutes seeing each child, of which at most only 3.5 (2.0) minutes were spent counselling the family. With an hourly pay rate of $4.87, the median (IQR) contact and dispensing cost per child visit was $0.77 (0.49-1.16). The cost of RUF was estimated to be $7.84 for a months treatment, giving a total treatment cost of $8.61 per child per month. If ready to use food was not prescribed and more staff time purchased instead, this would pay for 1.6 hours staff time per child per month. ConclusionsVery little time was spent speaking to mothers of malnourished children and supplies of ready to use food represented 91% of total treatment costs.