An early-stage cost and implementation feasibility study of the administration of pro/synbiotics to infants 0-5 months in rural Kenya

BackgroundUndernutrition underlies approximately 45% of global deaths among children less than five years old, making it one of the most concerning global child health issues. The PRObiotics and SYNbiotics in infants in Kenya (PROSYNK) trial is assessing whether supervised doses of pro/synbiotics daily for the first 10 days and then weekly to age 6 months (total of 32 doses), has a positive impact on gut health and thereby growth and nutrition. This study is an early-stage cost and implementation feasibility study defining unit costs for the PROSYNK trial and estimating programmatic cost and feasibility of delivering the intervention to infants in rural Kenya. MethodsThis provider perspective costing study uses a combination of ingredients approach, activity-based costing and microcosting. First, an empirical cost analysis of the PROSYNK trial was conducted by review of trial documentation and time and motion observations. Next, semi-structured interviews with key informants informed a thematic analysis of implementation feasibility and the development of a theoretical programme structure which formed the basis for estimation of total economic programme costs. ResultsThe economic cost of delivering the full pro/synbiotics course under trial conditions was measured as $757.32 per participant. Experience gained during PROSYNK and discussions with key informants revealed that it was feasible for the Ministry of Health (MoH) to implement programmatic delivery of the pro/synbiotics, particularly through community-based delivery, without a cold chain and with pro/synbiotic administered directly into infants mouths. Incremental economic costs to the MoH of delivering the pro/synbiotic programmatically were estimated to be $9.15 per infant per full course under the base case scenario. ConclusionPro/synbiotic administration in early life may be feasible and bear similar costs to existing nutrition interventions. This study will provide policy makers and stakeholders with vital cost and feasibility information to inform effective programmatic implementation in Kenya and similar settings.