BMJ Paediatr Open. 2025 Nov 27;9(1):e003635. doi: 10.1136/bmjpo-2025-003635.
ABSTRACT
BACKGROUND: Undernutrition significantly contributes to infant mortality and underlies approximately 45% of global deaths in children under 5, 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 pro/synbiotic doses daily for the first 10 days and then weekly to age 6 months has a positive impact on gut health and thereby growth and nutrition. This study provides a cost analysis of the PROSYNK trial, estimates the costs of implementing the intervention, and offers feasability insights for delivering it to infants 0-5 months in rural Kenya.
METHODS: This provider perspective costing study used a combination of the 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, semistructured interviews with key informants informed a thematic analysis of implementation feasibility and the development of a theoretical programme structure, which formed the basis for estimating total economic programme costs.
RESULTS: The economic cost of delivering the full pro/synbiotics course under trial conditions was measured as US$701.61 per participant. Experience gained during PROSYNK and discussions with key informants suggest that it could be 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 US$9.14 per infant per full course under the baseline scenario.
CONCLUSION: Pro/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 cost and feasibility insights to inform effective programmatic implementation in Kenya and similar settings.
PMID:41314678 | DOI:10.1136/bmjpo-2025-003635
