Child marriage prevention as a preconception health strategy: A modelling-based cost-benefit analysis in Senegal

Objectives: This modelling study evaluates the costs and benefits of implementing community sensitisation interventions to prevent child marriage in Senegal. By focusing specifically on the prevention of neonatal mortality and stillbirths, it offers a new perspective on the broader health implications of such interventions, addressing a critical gap in the economic evaluation of preconception health strategies. Study design: Model-based economic evaluation. Methods: We developed a deterministic, cohort-based simulation model to estimate the economic and societal impacts of community sensitisation to prevent child marriage in rural Senegal. The model compared a status quo and an intervention scenario to measure the interventions's impact in a cohort of adolescent girls over three years. The model's inputs, including intervention costs, effect size, and epidemiological and demographic parameters, were derived from secondary sources. The neonatal deaths and stillbirths prevented were monetised using a value of a statistical life-based approach. Results: The intervention is projected to reduce the prevalence of child marriage by 3.4 % after three years. As a result, we estimated that 2579 adolescent pregnancies, 86 neonatal deaths, and 46 stillbirths would be prevented within the cohort of adolescent girls. The benefit-cost ratio was 4.2:1, indicating a net benefit of US$3.2 for every dollar invested. Conclusions: These findings demonstrate the substantial economic and health benefits of child marriage prevention as a preconception health strategy. The study highlights the importance of addressing upstream determinants of maternal and child health. It also underscores the need for further cost-benefit analyses of preconception interventions in low and middle-income countries.