Abstract
Background
Undernutrition significantly contributes to infant mortality and underlies approximately 45% of global deaths in children under five, 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 is an early-stage cost and implementation feasibility study defining unit costs for the PROSYNK trial and estimating programmatic cost and feasibility of delivering the intervention to infants 0-5 months in rural Kenya.
Methods
This provider perspective costing study used a combination of 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, semi-structured 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 $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 infant’s mouths. Incremental economic costs to the MoH of delivering the pro/synbiotic programmatically were estimated to be $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 information to inform effective programmatic implementation in Kenya and similar settings.
Undernutrition significantly contributes to infant mortality and underlies approximately 45% of global deaths in children under five, 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 is an early-stage cost and implementation feasibility study defining unit costs for the PROSYNK trial and estimating programmatic cost and feasibility of delivering the intervention to infants 0-5 months in rural Kenya.
Methods
This provider perspective costing study used a combination of 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, semi-structured 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 $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 infant’s mouths. Incremental economic costs to the MoH of delivering the pro/synbiotic programmatically were estimated to be $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 information to inform effective programmatic implementation in Kenya and similar settings.
| Original language | English |
|---|---|
| Article number | e003635 |
| Journal | BMJ Paediatrics Open |
| Volume | 9 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 25 Nov 2025 |
Keywords
- Cost-analysis
- Costing
- growth
- implementation
- probiotic
- programme delivery
- stunting
- synbiotic
- undernutrition
- Low and Middle Income Countries
- Developing Countries
- Health Policy
