Comparative Impact Assessment of Child Pneumonia interventions/Evaluation Comparative Des Impacts Des Interventions Contre la Pneumonie Chez l'enfant/Evaluacion Comparativa del Impacto De Las Intervenciones Contra la Neumonia En la Ninez
Year: 2009
Type: article
Abstract: Introduction Progress in reducing mortality from pneumonia in children under 5 years of age has been relatively slow in many parts of the developing world, where about 155 million clinical pneumonia episodes and 2 million deaths occur annually. (1,2) Risk factors for pneumonia include stunting and underweight) (1,3,4) suboptimal breastfeeding, (5,6) lack of immunization (7,8) and indoor air pollution from household use of solid fuels. (9-12) There is evidence that effective and appropriate management of clinical cases is possible (13,14) at health-care facilities (15) and in the community, (16) but this level of management is often lacking. Efforts to control pneumonia are needed to meet Millennium Development Goal 4 (MDG 4), to reduce child mortality in the world by two-thirds by 2015. (17) Often, a package of priority interventions is developed to address MDG targets and reduce child mortality. (4,6,18-20) Cost-effectiveness analysis has become vital in deciding what interventions to implement and scale up. (21) Single-candidate interventions to reduce pneumonia have been evaluated in general economic terms, (6,11,18,22-24) but no comprehensive analysis has focused on pneumonia control. Different interventions can affect incidence of case fatality, with differences noted across age groups. Population risk interventions can target specific subpopulations, while immunization is intended for all infants. Preventive interventions of this kind may reduce the incidence of pneumonia, whereas case management influences case fatality after falling ill. Both types of interventions can reduce pneumonia mortality. The aim of this study was to compare the impact of eight preventive and curative interventions at the population level (6,25-27) and to identify the intervention mixes that generate the highest possible level of child health at the lowest cost. Methods To estimate the population health effects and total costs of pneumonia interventions from a health-care perspective, we applied demographic life tables for the 40 countries with the highest mortality (list available at: http://oldwww.bmg.eur.nl/ personal/niessen/Webtable%20Countries%20by%20Region. doc The tables were used to estimate the health effect of risk factors, as well as the reductions in incidence and case fatality in population cohorts, simultaneously and consistently. (6,25-27) Detailed descriptions of concepts, methods, background papers, regional studies and data are available at: WHO-CHOICE (CHOosing Interventions that are Cost Effective) at: www.who.int/choice/en. Box 1 provides an overview of the approach. We considered the epidemiological characteristics and level of health care of each of the 40 countries, as well as the coverage levels of the expanded programme on immunization (EPI) and of facility-based case management. Due to the large uncertainties involved in the epidemiologic, effectiveness and cost estimates, we included a high and a low cost-effectiveness scenario for each mix of interventions. Each country's life table provides summary estimates of how pneumonia affects mortality and morbidity, expressed in terms of disability-adjusted life years (DALYs) lost. The tables also provide estimates of the effect and cost of mixed health interventions, in United States dollars (US$) for the year 2000, with a 3% discount rate according to health economics guidelines. We combined estimated health gains and costs per intervention to identify the sets of health interventions that maximized child health at different budget levels by providing the greatest health yield per dollar spent. The life tables were implemented in C++ (a general programming language) using M language (a language for working with data and building domain models). The script with M-equations is available at: http:// old www.bmg.eur.nl/persona/niessenl GAPP_LOW.MPdf.pdf Epidemiologic and demographic data The life tables used in the model were based on the recently published WHO country data, which draw on reviews of incidence and mortality for childhood and neonatal pneumonia. …
Language: French
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2615826473