TITLE:
Cost-Effectiveness of Nutritional Support and Follow-Up Intervention for Pregnant Women in Southern Benin
AUTHORS:
Colette Sylvie Azandjeme, Gbemahon Roger Houssou, Clémence Germaine Metonnou, Nadia Fanou, Charles Jérôme Sossa
KEYWORDS:
Cost-Effectiveness, Pregnant Women, Low Birth Weight, Benin
JOURNAL NAME:
Open Journal of Preventive Medicine,
Vol.16 No.7,
July
17,
2026
ABSTRACT: 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.