Cost of a community-based nutrition intervention versus ready-to-use supplementary food (RUSF) for moderate acute malnutrition in children aged 6–59 months in Moutse, Limpopo, South Africa
1
Division of Community Paediatrics and Child Health, University of Witwatersrand, Johannesburg, South Africa
2
School of Public Health, Foundation for Professional Development, Pretoria, South Africa
3
Ndlovu Research Department, Ndlovu Care Group, Groblersdal, South Africa
4
School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Moderate acute malnutrition (MAM) is a major public health concern in Southern Africa.1 Standard community-based management of acute malnutrition (CMAM) relies on imported ready-to-use supplementary food (RUSF), which is costly and supply chain-vulnerable.2,3 These limitations highlight the need for context-specific CMAM programmes, yet local South African data on the costs of programmes integrating garden-based food and household-level interventions are limited. This study quantified the direct costs of a CMAM programme and compared them with short-course RUSF interventions.
METHODS:
A retrospective cost-comparison design evaluated three approaches for children aged 6–59 months enrolled between January 2022 and February 2025: (1) a local Nutritional Unit (NU) programme in Limpopo providing longitudinal care (~12 months) with educational, local food and garden support; (2) a modelled six-week RUSF scenario (Model A); and (3) a standard outpatient MAM treatment model (Model B). Costs were calculated from a provider perspective, disaggregating personnel and non-personnel components.
RESULTS:
Seventy-three children with MAM were enrolled (median age 14 months, IQR 11–26), attending a median of 102 visits (IQR 74–142) over 250 days (IQR 203–349). The annual cost per MAM child in the NU programme was ZAR 43931 (ZAR 431 per visit). Model A and Model B costs were ZAR 23382 and ZAR 22100, with per-visit costs of ZAR 454 and ZAR 355, respectively. Personnel comprised 60% of costs. Children had a shorter length of stay if >24 months old (p = 0.01) or if they attended ≥80% of visits (Spearman ρ = −0.35, p = 0.0025).
CONCLUSIONS:
Although the NU programme has higher total per-child direct costs, its competitive per-visit costs support intensive community-level engagement. This study provides a rare evidence base for South African CMAM costing, showing that locally integrated programmes deliver sustainable intersectoral components, including household food security, without increasing per-visit expenditure compared to short-course RUSF interventions.
Moderate acute malnutrition (MAM) is a major public health concern in Southern Africa.1 Standard community-based management of acute malnutrition (CMAM) relies on imported ready-to-use supplementary food (RUSF), which is costly and supply chain-vulnerable.2,3 These limitations highlight the need for context-specific CMAM programmes, yet local South African data on the costs of programmes integrating garden-based food and household-level interventions are limited. This study quantified the direct costs of a CMAM programme and compared them with short-course RUSF interventions.
METHODS:
A retrospective cost-comparison design evaluated three approaches for children aged 6–59 months enrolled between January 2022 and February 2025: (1) a local Nutritional Unit (NU) programme in Limpopo providing longitudinal care (~12 months) with educational, local food and garden support; (2) a modelled six-week RUSF scenario (Model A); and (3) a standard outpatient MAM treatment model (Model B). Costs were calculated from a provider perspective, disaggregating personnel and non-personnel components.
RESULTS:
Seventy-three children with MAM were enrolled (median age 14 months, IQR 11–26), attending a median of 102 visits (IQR 74–142) over 250 days (IQR 203–349). The annual cost per MAM child in the NU programme was ZAR 43931 (ZAR 431 per visit). Model A and Model B costs were ZAR 23382 and ZAR 22100, with per-visit costs of ZAR 454 and ZAR 355, respectively. Personnel comprised 60% of costs. Children had a shorter length of stay if >24 months old (p = 0.01) or if they attended ≥80% of visits (Spearman ρ = −0.35, p = 0.0025).
CONCLUSIONS:
Although the NU programme has higher total per-child direct costs, its competitive per-visit costs support intensive community-level engagement. This study provides a rare evidence base for South African CMAM costing, showing that locally integrated programmes deliver sustainable intersectoral components, including household food security, without increasing per-visit expenditure compared to short-course RUSF interventions.
| eISSN: | 2654-1459 |
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