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

Aims We aimed to describe the relative cost of supplying supplementary food, compared to counselling, in children with acute malnutrition managed in one urban area. Method A 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. Results Consultations 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 month’s 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. Conclusions Very little time was spent speaking to mothers of malnourished children and supplies of ready to use food represented 91% of total treatment costs. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NA ### Funding Statement AN was was supported by Scottish Funding Council Global Challenges Research Fund (no grant number) . They played no role play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Permission to conduct the study was obtained from the African Medical and Research Foundation ethics review committee, and the county and sub county health offices. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the manuscript and its Supporting Information files.