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Mdege ND, Masuku SD, Musakwa N, Chisala M, Tingum EN, Boachie MK, Shokraneh F. Costs and cost-effectiveness of treatment setting for children with wasting, oedema and growth failure/faltering: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002551. [PMID: 37939029 PMCID: PMC10631642 DOI: 10.1371/journal.pgph.0002551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023]
Abstract
This systematic review aimed to address the existing evidence gaps, and guide policy decisions on the settings within which to treat infants <12 months of age with growth faltering/failure, and infants and children aged <60 months with moderate wasting or severe wasting and/or bilateral pitting oedema. Twelve electronic databases were searched for studies published before 10 December 2021. The searches yielded 16,709 records from which 31 studies were eligible and included in the review. Three studies were judged as low quality, whilst 14 were moderate and the remaining 14 were high quality. We identified very few cost and cost-effectiveness analyses for most of the models of care with the certainty of evidence being judged at very low or low. However, there were 17 cost and 6 cost-effectiveness analyses for the initiation of treatment in outpatient settings for severe wasting and/or bilateral pitting oedema in infants and children <60 months of age. From this evidence, the costs appear lowest for initiating treatment in community settings, followed by initiating treatment in community and transferring to outpatient settings, initiating treatment in outpatients then transferring to community settings, initiating treatment in outpatient settings, and lastly initiating treatment in inpatient settings. In addition, the evidence suggested that initiation of treatment in outpatient settings is highly cost-effective when compared to doing nothing or no programme implementation scenarios, using country-specific WHO GDP per capita thresholds. The incremental cost-effectiveness ratios ranged from $20 to $145 per DALY averted from a provider perspective, and $68 to $161 per DALY averted from a societal perspective. However, the certainty of the evidence was judged as moderate because of comparisons to do nothing/ no programme scenarios which potentially limits the applicability of the evidence in real-world settings. There is therefore a need for evidence that compare the different available alternatives.
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Affiliation(s)
- Noreen Dadirai Mdege
- Department of Health Sciences, University of York, York, United Kingdom
- Centre for Research in Health and Development, York, United Kingdom
| | - Sithabiso D. Masuku
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nozipho Musakwa
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mphatso Chisala
- Department of Population, Policy and Practice, Great Ormond Street Hospital, Institute of Child Health, University College London, London, United Kingdom
| | | | - Micheal Kofi Boachie
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Farhad Shokraneh
- Department of Evidence Synthesis, Systematic Review Consultants LTD, Nottingham, United Kingdom
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Msibi-Afolayan N, Nchinyani M, Nakwa F, Adam Y. Perinatal outcome of maternal deaths at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, January 2014 - June 2019. S Afr Med J 2023; 113:42-47. [PMID: 37882129 DOI: 10.7196/samj.2023.v113i9.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Maternal death is a tragic event. Of maternal deaths worldwide, 99% occur in low- and middle-income countries. Perinatal outcome is related to maternal wellbeing. Maternal death has a negative impact on fetal and neonatal outcome in the short and long term. OBJECTIVES To determine the perinatal outcomes of pregnancies that ended in a maternal death at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, South Africa, over a 5-year period, to describe the causes of maternal death, and to determine the stillbirth rate (SBR) and early neonatal death (ENND) rate in this population. METHODS This was a retrospective cross-sectional study of maternal deaths in women with a viable pregnancy from January 2014 to June 2019 at CHBAH. All maternal deaths with gestation >26 weeks or fetal weight >500 g were included in the study. Information on demographics, booking status, antenatal care, pregnancy outcome, and fetal and neonatal outcome was extracted from maternal and neonatal files. RESULTS Of a total of 183 maternal deaths during the study period, 147 were included in the study. The institutional maternal mortality ratio was 135 deaths per 100 000 live births. Hypertension was the main direct cause of death (36.5%; n=27/74), followed by pregnancy related sepsis (27.4%; n=21/74) and obstetric haemorrhage (20.6%; n=15/74). Non-pregnancy-related infections, of which 91.4% were HIV and HIV-related complications, comprised 47.9% (n=35/73) of indirect causes of death, followed by medical and surgical disorders. Of a total of 151 babies, including two sets of twins and one set of triplets, 137 were delivered and 14 were undelivered at the time of maternal death. Ninety-one babies (61.9%) were born alive and 51 (34.6%) were stillbirths. Of the 91 liveborn infants, 6 (6.5%) had an ENND. Of the 51 stillbirths, 14 (27.5%) were undelivered and 11 (21.6%) were delivered by perimortem caesarean section. The SBR was 347 per 1 000 maternal deaths and the ENND rate 66 per 1 000 live births. The perinatal mortality rate (PMR) was 388 per 1 000 maternal deaths, which is 12 times higher than the PMR per 1 000 live births for the general population. CONCLUSION Women who experience maternal death have babies with very poor perinatal outcomes, with a very high SBR, ENND rate and PMR. The health of the mother has a direct and significant effect on fetal and neonatal outcomes.
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Affiliation(s)
- N Msibi-Afolayan
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - M Nchinyani
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - F Nakwa
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Y Adam
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Li Z, Karlsson O, Kim R, Subramanian SV. Distribution of under-5 deaths in the neonatal, postneonatal, and childhood periods: a multicountry analysis in 64 low- and middle-income countries. Int J Equity Health 2021; 20:109. [PMID: 33902593 PMCID: PMC8077916 DOI: 10.1186/s12939-021-01449-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/13/2021] [Indexed: 12/25/2022] Open
Abstract
Background As under-5 mortality rates declined all over the world, the relative distribution of under-5 deaths during different periods of life changed. To provide information for policymakers to plan for multi-layer health strategies targeting child health, it is essential to quantify the distribution of under-5 deaths by age groups. Methods Using 245 Demographic and Health Surveys from 64 low- and middle-income countries conducted between 1986 and 2018, we compiled a database of 2,437,718 children under-5 years old with 173,493 deaths. We examined the share of deaths that occurred in the neonatal (< 1 month), postneonatal (1 month to 1 year old), and childhood (1 to 5 years old) periods to the total number of under-5 deaths at both aggregate- and country-level. We estimated the annual change in share of deaths to track the changes over time. We also assessed the association between share of deaths and Gross Domestic Product (GDP) per capita. Results Neonatal deaths accounted for 53.1% (95% confidence interval [CI]: 52.7, 53.4) of the total under-5 deaths. The neonatal share of deaths was lower in low-income countries at 44.0% (43.5, 44.5), and higher in lower-middle-income and upper-middle income countries at 57.2% (56.8, 57.6) and 54.7% (53.8, 55.5) respectively. There was substantial heterogeneity in share of deaths across countries; for example, the share of neonatal to total under-5 deaths ranged from 20.9% (14.1, 27.6) in Eswatini to 82.8% (73.0, 92.6) in Dominican Republic. The shares of deaths in all three periods were significantly associated with GDP per capita, but in different directions—as GDP per capita increased by 10%, the neonatal share of deaths would significantly increase by 0.78 percentage points [PPs] (0.43, 1.13), and the postneonatal and childhood shares of deaths would significantly decrease by 0.29 PPs (0.04, 0.54) and 0.49 PPs (0.24, 0.74) respectively. Conclusions Along with the countries’ economic development, an increasing proportion of under-5 deaths occurs in the neonatal period, suggesting a need for multi-layer health strategies with potentially heavier investment in newborn health. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01449-8.
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Affiliation(s)
- Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Omar Karlsson
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.,Department of Economic History, School of Economics and Management, Lund University, P.O. Box 7083, 220 07, Lund, Sweden
| | - Rockli Kim
- Division of Health Policy & Management, College of Health Science, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, South Korea.,Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, 02841, South Korea.,Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA, 02138, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. .,Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA, 02138, USA.
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Agudelo SI, Molina CF, Gamboa ÓA, Suárez JD. Direct costs of neonatal infection acquired in the community in full-term newborns and low risk at birth, Cundinamarca, Colombia. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2021; 41:87-98. [PMID: 33761192 PMCID: PMC8055585 DOI: 10.7705/biomedica.5196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/21/2020] [Indexed: 11/21/2022]
Abstract
Introduction: Half of the episodes of neonatal sepsis are acquired in the community with a high percentage of mortality and complications. Objective: To estimate the direct costs of hospitalizations due to systemic neonatal infection acquired in the community in low-risk newborns. Materials and methods: For the estimation of costs, we used the perspective of the health systems and the microcosting technique and we established the duration of hospitalization as the time horizon. We identified cost-generating events through expert consensus and the quantification was based on the detailed bill of 337 hospitalized newborns diagnosed with neonatal infection. The costs of the medications were calculated based on the drug price information system (SISMED) and the ISS 2001 rate manuals adjusting percentage, and the mandatory insurance rates for traffic accidents (SOAT). We used the bootstrapping method for cost distribution to incorporate data variability in the estimate. Results: We included the medical care invoices for 337 newborns. The average direct cost of care per patient was USD$ 2,773,965 (Standard Deviation, SD=USD$ 198,813.5; 95% CI: $ 2,384,298 - $ 3,163,632). The main cost-generating categories were hospitalization in intensive care units and health technologies. The costs followed a log-normal distribution. Conclusions: The categories generating the greatest impact on the care costs of newborns with infection were hospitalization in neonatal units and health technologies. The costs followed a log-normal distribution.
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Affiliation(s)
- Sergio Iván Agudelo
- Escuela de Graduados, Universidad CES, Medellín, Colombia; Departamento de Pediatría, Clínica Universidad de La Sabana, Universidad de La Sabana, Chía, Colombia.
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Carroll G, Safon C, Buccini G, Vilar-Compte M, Teruel G, Pérez-Escamilla R. A systematic review of costing studies for implementing and scaling-up breastfeeding interventions: what do we know and what are the gaps? Health Policy Plan 2020; 35:461-501. [PMID: 32073628 DOI: 10.1093/heapol/czaa005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2020] [Indexed: 12/17/2022] Open
Abstract
Despite the well-established evidence that breastfeeding improves maternal and child health outcomes, global rates of exclusive breastfeeding remain low. Cost estimates can inform stakeholders about the financial resources needed to scale up interventions to ultimately improve breastfeeding outcomes in low-, middle- and high-income countries. To inform the development of comprehensive costing frameworks, this systematic review aimed to (1) identify costing studies for implementing or scaling-up breastfeeding interventions, (2) assess the quality of identified costing studies and (3) examine the availability of cost data to identify gaps that need to be addressed through future research. Peer-reviewed and grey literature were systematically searched using a combination of index terms and relevant text words related to cost and the following breastfeeding interventions: breastfeeding counselling, maternity leave, the World Health Organization International Code of Marketing of Breastmilk Substitutes, the Baby-Friendly Hospital Initiative, media promotion, workplace support and pro-breastfeeding social policies. Data were extracted after having established inter-rater reliability among the first two authors. The quality of studies was assessed using an eight-item checklist for key costing study attributes. Forty-five studies met the inclusion criteria, with the majority including costs for breastfeeding counselling and paid maternity leave. Most cost analyses included key costing study attributes; however, major weaknesses among the studies were the lack of clarity on costing perspectives and not accounting for the uncertainty of reported cost estimates. Costing methodologies varied substantially, standardized costing frameworks are needed for reliably estimating the costs of implementing and scaling-up breastfeeding interventions at local-, national- or global-levels.
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Affiliation(s)
- Grace Carroll
- Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College St. Suite 200, New Haven, CT 06510, USA
| | - Cara Safon
- Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College St. Suite 200, New Haven, CT 06510, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Talbot Building, 715 Albany Street, Boston, MA 02118, USA
| | - Gabriela Buccini
- Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College St. Suite 200, New Haven, CT 06510, USA
| | - Mireya Vilar-Compte
- EQUIDE Research Institute for Equitable Development, Universidad Iberoamericana, Prolongacion Paseo de la Reforma 880, Santa Fe, Zedec Sta Fé, Álvaro Obregón, 01219 Ciudad de México, CDMX, Mexico
| | - Graciela Teruel
- EQUIDE Research Institute for Equitable Development, Universidad Iberoamericana, Prolongacion Paseo de la Reforma 880, Santa Fe, Zedec Sta Fé, Álvaro Obregón, 01219 Ciudad de México, CDMX, Mexico
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College St. Suite 200, New Haven, CT 06510, USA
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Njuguna RG, Berkley JA, Jemutai J. Cost and cost-effectiveness analysis of treatment for child undernutrition in low- and middle-income countries: A systematic review. Wellcome Open Res 2020; 5:62. [PMID: 33102783 PMCID: PMC7569484 DOI: 10.12688/wellcomeopenres.15781.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Undernutrition remains highly prevalent in low- and middle-income countries, with sub-Saharan Africa and Southern Asia accounting for majority of the cases. Apart from the health and human capacity impacts on children affected by malnutrition, there are significant economic impacts to households and service providers. The aim of this study was to determine the current state of knowledge on costs and cost-effectiveness of child undernutrition treatment to households, health providers, organizations and governments in low and middle-income countries (LMICs). Methods: We conducted a systematic review of peer-reviewed studies in LMICs up to September 2019. We searched online databases including PubMed-Medline, Embase, Popline, Econlit and Web of Science. We identified additional articles through bibliographic citation searches. Only articles including costs of child undernutrition treatment were included. Results: We identified a total of 6436 articles, and only 50 met the eligibility criteria. Most included studies adopted institutional/program (45%) and health provider (38%) perspectives. The studies varied in the interventions studied and costing methods used with treatment costs reported ranging between US$0.44 and US$1344 per child. The main cost drivers were personnel, therapeutic food and productivity loss. We also assessed the cost effectiveness of community-based management of malnutrition programs (CMAM). Cost per disability adjusted life year (DALY) averted for a CMAM program integrated into existing health services in Malawi was $42. Overall, cost per DALY averted for CMAM ranged between US$26 and US$53, which was much lower than facility-based management (US$1344). Conclusion: There is a need to assess the burden of direct and indirect costs of child undernutrition to households and communities in order to plan, identify cost-effective solutions and address issues of cost that may limit delivery, uptake and effectiveness. Standardized methods and reporting in economic evaluations would facilitate interpretation and provide a means for comparing costs and cost-effectiveness of interventions.
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Affiliation(s)
- Rebecca G Njuguna
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Public Health, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
| | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Julie Jemutai
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
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Njuguna RG, Berkley JA, Jemutai J. Cost and cost-effectiveness analysis of treatment for child undernutrition in low- and middle-income countries: A systematic review. Wellcome Open Res 2020; 5:62. [DOI: 10.12688/wellcomeopenres.15781.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Undernutrition remains highly prevalent in low- and middle-income countries, with sub-Saharan Africa and Southern Asia accounting for majority of the cases. Apart from the health and human capacity impacts on children affected by malnutrition, there are significant economic impacts to households and service providers. The aim of this study was to determine the current state of knowledge on costs of child undernutrition treatment to households, health providers, organizations and governments in low and middle-income countries (LMICs). Methods: We conducted a systematic review of peer-reviewed studies in LMICs up to September 2019. We searched online databases including PubMed-Medline, Embase, Popline, Econlit and Web of Science. We identified additional articles through bibliographic citation searches. Only articles including costs of child undernutrition treatment were included. Results: We identified a total of 6436 articles, and only 50 met the eligibility criteria. Most included studies adopted institutional/program (45%) and health provider (38%) perspectives. The studies varied in the interventions studied and costing methods used with treatment costs reported ranging between US$0.44 and US$1344 per child. The main cost drivers were personnel, therapeutic food and productivity loss. Conclusion: There is a need to assess the burden of direct and indirect costs of child undernutrition to households and communities in order to plan, identify cost-effective solutions and address issues of cost that may limit delivery, uptake and effectiveness. Standardized methods and reporting in economic evaluations would facilitate interpretation and provide a means for comparing costs and cost-effectiveness of interventions.
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Hategeka C, Tuyisenge G, Bayingana C, Tuyisenge L. Effects of scaling up various community-level interventions on child mortality in Burundi, Kenya, Rwanda, Uganda and Tanzania: a modeling study. Glob Health Res Policy 2019; 4:1. [PMID: 31168481 PMCID: PMC6545006 DOI: 10.1186/s41256-019-0106-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 05/13/2019] [Indexed: 12/03/2022] Open
Abstract
Background Improving child health remains one of the most significant health challenges in sub-Saharan Africa, a region that accounts for half of the global burden of under-five mortality despite having approximately 13% of the world population and 25% of births globally. Improving access to evidence-based community-level interventions has increasingly been advocated to contribute to reducing child mortality and, thus, help low-and middle-income countries (LMICs) achieve the child health related Sustainable Development Goal (SDG) target. Nevertheless, the coverage of community-level interventions remains suboptimal. In this study, we estimated the potential impact of scaling up various community-level interventions on child mortality in five East African Community (EAC) countries (i.e., Burundi, Kenya, Rwanda, Uganda and the United Republic of Tanzania). Methods We identified ten preventive and curative community-level interventions that have been reported to reduce child mortality: Breastfeeding promotion, complementary feeding, vitamin A supplementation, Zinc for treatment of diarrhea, hand washing with soap, hygienic disposal of children’s stools, oral rehydration solution (ORS), oral antibiotics for treatment of pneumonia, treatment for moderate acute malnutrition (MAM), and prevention of malaria using insecticide-treated nets and indoor residual spraying (ITN/IRS). Using the Lives Saved Tool, we modeled the impact on child mortality of scaling up these 10 interventions from baseline coverage (2016) to ideal coverage (99%) by 2030 (ideal scale-up scenario) relative to business as usual (BAU) scenario (forecasted coverage based on prior coverage trends). Our outcome measures include number of child deaths prevented. Results Compared to BAU scenario, ideal scale-up of the 10 interventions could prevent approximately 74,200 (sensitivity bounds 59,068–88,611) child deaths by 2030 including 10,100 (8210–11,870) deaths in Burundi, 10,300 (7831–12,619) deaths in Kenya, 4350 (3678–4958) deaths in Rwanda, 20,600 (16049–25,162) deaths in Uganda, and 28,900 (23300–34,002) deaths in the United Republic of Tanzania. The top four interventions (oral antibiotics for pneumonia, ORS, hand washing with soap, and treatment for MAM) account for over 75.0% of all deaths prevented in each EAC country: 78.4% in Burundi, 76.0% in Kenya, 81.8% in Rwanda, 91.0% in Uganda and 88.5% in the United Republic of Tanzania. Conclusions Scaling up interventions that can be delivered at community level by community health workers could contribute to substantial reduction of child mortality in EAC and could help the EAC region achieve child health-related SDG target. Our findings suggest that the top four community-level interventions could account for more than three-quarters of all deaths prevented across EAC countries. Going forward, costs of scaling up each intervention will be estimated to guide policy decisions including health resource allocations in EAC countries.
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Affiliation(s)
- Celestin Hategeka
- 1Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada.,2Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC Canada
| | | | - Christian Bayingana
- 4Bloomberg School of Public Health, Johns Hopkins Hospital, Baltimore, MD USA
| | - Lisine Tuyisenge
- 5Department of Paediatrics and Child Health, University Teaching Hospital of Kigali, Kigali, Rwanda
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