{
  "abstract": "IntroductionSmall-quantity lipid-based nutrient supplementation (SQ-LNS) is an intervention that provides supplemental nutrition to young children and has significant impacts on mortality, nutrition, and developmental outcomes. The World Health Organization recommends the use of SQ-LNS in certain targeted contexts, but evidence on the cost-effectiveness of SQ-LNS targeting approaches is limited.\n\nMethodsWe utilized an individual-based simulation model to estimate the cost-effectiveness of SQ-LNS within first-level administrative divisions in Ethiopia, Nigeria, and Pakistan. We estimated the cost-effectiveness of subnational targeting strategies including threshold- and priority-based targeting algorithms with several indicators across child mortality, nutrition, and complementary feeding measures.\n\nResultsSubnational targeting according to wasting, stunting, and anemia thresholds was on average more cost-effective than untargeted strategies for all locations. Incremental cost-effectiveness ratios for these targeted and untargeted strategies respectively were $363 (95% uncertainty interval, UI: 243, 666) per disability-adjusted life year (DALY) averted and $458 (95% UI: 291, 863) in Ethiopia, $135 (95% UI: 74.2, 305) and $227 (95% UI: 124, 513) in Nigeria, and $474 (95% UI: 329, 718) and $544 (95% UI: 366, 878) to in Pakistan. Priority-based targeting using a composite ranking measure across mortality, wasting, and stunting burdens offered the greatest cost-effectiveness of any strategy assessed, achieving 7.0% (UI: 4.4, 12) and 4.6% (UI: 1.4, 7.3) more DALYs averted for the same cost as the threshold-based targeting approach in Nigeria and Ethiopia and equal impact in Pakistan.\n\nConclusionsSubnational targeting of SQ-LNS can significantly improve cost-effectiveness relative to untargeted scale-up strategies. Several targeting strategies and indicators may be used to improve cost-effectiveness, with highest performance seen with a priority-based algorithm using a composite ranking measure across child mortality, wasting, and stunting burdens. Subnational targeting according to such measures should be considered in the implementation of SQ-LNS programs in accordance with existing guidelines.",
  "abstract_shown": true,
  "affiliations": [
    "Institute for Health Metrics and Evaluation, University of Washington, Seattle"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "A. Bowman"
    },
    {
      "name": "S. Lutze"
    },
    {
      "name": "Z. Burke-Conte"
    },
    {
      "name": "N. D. Blair-Stahn"
    },
    {
      "name": "A. Pletcher"
    },
    {
      "name": "H. Jafari"
    },
    {
      "name": "J. R. Albright"
    },
    {
      "name": "R. Mudambi"
    },
    {
      "name": "A. D. Flaxman"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/08f693p5e7nyy.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.03.26362091",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.03.26362091v1.full",
  "id": "08f693p5e7nyy",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.03.26362091v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "public and global health"
    ],
    [
      "openalex",
      "2916|Child Nutrition and Water Access"
    ]
  ],
  "openalex": "W7211954489",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.03.26362091v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-03",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/08f693p5e7nyy.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:54Z",
      "native_id": "10.64898/2026.09.03.26362091",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.03.26362091v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:public and global health",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Cost-effectiveness of subnational targeting of small-quantity lipid-based nutrient supplementation: A simulation model in Nigeria, Ethiopia, and Pakistan",
  "title_text": "Cost-effectiveness of subnational targeting of small-quantity lipid-based nutrient supplementation: A simulation model in Nigeria, Ethiopia, and Pakistan",
  "type": "preprint",
  "updated_at": "2026-10-30T12:17:54Z",
  "url": "https://research.draconitic.com/paper/08f693p5e7nyy",
  "venue": "medRxiv",
  "versions": []
}