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. 2025 Oct 13:13:1601990.
doi: 10.3389/fpubh.2025.1601990. eCollection 2025.

Economic evaluation: costing participatory learning and action cycles with women's groups to improve feeding, care and dental hygiene for South Asian infants in London

Yeqing Zhang #  1 , Priyanka Patil #  2   3 , Shweta Chaudhary  3 , Kunal D Kondhare  3 , Darlington David Faijue  3   4 , Monica Lakhanpaul  5   6   7 , Michelle Heys  6   8 , Joanna Drazdzewska  9 , Clare H Llewellyn  10 , Kelley Webb-Martin  11 , Carol Irish  11 , Mfon Archibong  11 , Jenny Gilmour  12 , Phoebe Kalungi  12 , Jolene Skordis  1 , Logan Manikam  2   3 , Neha Batura  13 ; NEON Steering Team
Collaborators, Affiliations

Economic evaluation: costing participatory learning and action cycles with women's groups to improve feeding, care and dental hygiene for South Asian infants in London

Yeqing Zhang et al. Front Public Health. .

Abstract

Background: The Nurture Early for Optimal Nutrition (NEON) programme was designed to promote equitable early childhood development by educating mothers of South Asian origin in two boroughs (Newham and Tower Hamlets) in East London on optimal feeding, care, and dental hygiene practices. The study found that the adapted Participatory Learning and Action (PLA) approach was highly acceptable and well-received by participants, with improvements in maternal confidence, infant feeding practices, and community engagement. However, gaps in specific feeding skills and challenges such as low attendance and retention rates were noted, particularly during the COVID-19 pandemic. This study conducted a cost analysis of the NEON programme and evaluated its financial sustainability.

Methods: We conducted a financial and economic costing from the provider perspective, applying a stepdown procedure to identify costs associated with the development and implementation of the NEON programme. Estimates of total and average costs per mother are presented along with affordability assessments, expressed as a proportion of the borough's annual child development expenditure. All costs were discounted and reported in 2022 pound sterling and in 2022 international dollars.

Results: The total cost of NEON design and delivery was £68,165 ($INT 102,658), and the average cost per mother participating in the programme was £439($INT 661) in the face-to face arm and £407($INT 614) in the online arm. The largest contributor to the total cost was materials (50%), including NEON training manuals and intervention toolkits, vouchers for the community facilitators, and overheads, followed by staff costs (45%) and capital investments (5%). The total cost of intervention delivery in Newham accounted for around 0.047% of the borough's annual child development expenditure, while the total intervention cost in Tower Hamlets was equivalent to 0.003% of its spending on children's development.

Conclusion: The delivery of NEON is largely within local authorities' budget for childhood development. The unit cost is expected to decrease when sharing costs are spread across more participants and implementing systems are validated and well developed.

Keywords: affordability; costs; early childhood development; nutritional intervention; participatory learning and action women’s groups.

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Conflict of interest statement

PP, SC, KK, DF, LM were employed by Aceso Global Health Consultants Pte Limited. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Lu C, Black MM, Richter LM. Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country level. Lancet Glob Health. (2016) 4:e916–22. doi: 10.1016/S2214-109X(16)30266-2, PMID: - DOI - PMC - PubMed
    1. Conteh L, Walker D. Cost and unit cost calculations using step-down accounting. Health Policy Plan. (2004) 19:127–35. doi: 10.1093/heapol/czh015, PMID: - DOI - PubMed
    1. Black MM, Walker SP, Fernald LC, Andersen CT, DiGirolamo AM, Lu C, et al. Early childhood development coming of age: science through the life course. Lancet. (2017) 389:77–90. doi: 10.1016/S0140-6736(16)31389-7, PMID: - DOI - PMC - PubMed
    1. Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B. Developmental potential in the first 5 years for children in developing countries. Lancet. (2007) 369:60–70. doi: 10.1016/S0140-6736(07)60032-4, PMID: - DOI - PMC - PubMed
    1. Black MM, Hurley KM. Investment in early childhood development. Lancet. (2014) 384:1244–5. doi: 10.1016/S0140-6736(14)60607-3, PMID: - DOI - PubMed

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