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Enhancing diarrhea treatment services through community level zinc introduction in India, Mali, and Pakistan: Cost effectiveness and introduction at scale.

机译：通过在印度，马里和巴基斯坦通过社区一级引入锌来增强腹泻治疗服务：成本效益和大规模引入。

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摘要

Background. Diarrhea is the second leading cause of mortality in children under-5 and is responsible for more deaths in children than HIV/AIDS, tuberculosis, or malaria. Research has emerged demonstrating that therapeutic supplementation of zinc in addition to reduced osmolarity ORS significantly reduces morbidity and mortality due to diarrhea in children under 5.Objectives. Project activities sought to determine whether (a) community-based supplementation of zinc in addition to ORS is cost-effective in treating acute diarrhea in children 1-59 months (India and Pakistan) and (b) identify resource implications and activities associated with zinc introduction (Mali).Methods. In all sites, economic costs were collected from 2004-2007 from a societal perspective inclusive of program implementation costs, household out of pocket payments for care, and incremental government costs. Incremental cost-effectiveness between each study arm was calculated per death and DALY averted in India and Pakistan. In Mali resource implications were explored.Results. Findings across study sites affirm current global recommendations that zinc is a cost-effective intervention appropriate and feasible for delivery at scale. However, attention should be paid to factors related to achieving and sustaining product coverage. In Pakistan, despite the low cost of obtaining and delivering zinc and ORS, coverage remained low (30%). As a result a statistically significant impact on diarrhea morbidity or mortality was not achieved. In India coverage reached 60%---a figure projected to rise to >80% following a year of implementation---and was associated with an 11% mortality reduction as well as significant improvements in health outcomes. The cost per DALY averted was USConclusions. Findings support the ascertain made by the Copenhagen Consensus 2008 that therapeutic provision of zinc in addition to ORS is the most cost-effective child health and public health intervention evaluated to date.
机译：背景。腹泻是5岁以下儿童死亡的第二大主要原因，与HIV / AIDS，结核病或疟疾相比，腹泻导致儿童死亡的原因更多。已有研究表明，除了降低渗透压ORS以外，治疗性补充锌还可以显着降低5岁以下儿童腹泻引起的发病率和死亡率。项目活动旨在确定（a）除ORS以外，以社区为基础的锌补充剂在治疗1-59个月儿童（印度和巴基斯坦）的急性腹泻方面是否具有成本效益，以及（b）确定与锌有关的资源影响和活动简介（马里）。方法。在所有场所，从社会角度收集了2004-2007年的经济成本，包括计划实施成本，家庭自付费用，以及政府增加的成本。在印度和巴基斯坦，每位死亡和避免DALY的人计算每个研究部门之间的增量成本效益。在马里探索了资源含义。研究地点的发现证实了当前的全球建议，即锌是一种经济有效的干预措施，适合大规模推广。但是，应注意与实现和维持产品覆盖率有关的因素。在巴基斯坦，尽管获取和运送锌和ORS的成本较低，但覆盖率仍然很低（<30％）。结果，没有达到对腹泻发病率或死亡率的统计学显着影响。在印度，覆盖率达到60％（这一数字预计将在实施一年后增加到80％以上），并且与死亡率降低11％以及健康结果显着改善相关。每个DALY避免的费用为USConclusions。研究结果支持《 2008年哥本哈根共识》的确定，即除ORS外，锌的治疗性提供是迄今为止评估出的最具成本效益的儿童健康和公共卫生干预措施。

著录项

  • 作者

    LeFevre, Amnesty.;

  • 作者单位

    The Johns Hopkins University.;

  • 授予单位 The Johns Hopkins University.;
  • 学科 Health Sciences Public Health.Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2010
  • 页码 180 p.
  • 总页数 180
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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