Using li st_to_estimate_impactPresentation Transcript
Lives Saved Analyses for Child Survival Projects: Using LiST to Estimate the Impact of Maternal, Newborn and Child Health Interventions Debra Prosnitz, MPH; Rebecca Levine, MPH; James Ricca MD, MPH; and Ingrid Friberg, PhD
Lives Saved Tool
Beginnings of LiST :
Inspired by the “Bellagio” modeling exercise which served as the basis for the data in the Lancet Child Survival Series
Goal of LiST :
To promote evidence-based decision making for planning the appropriate expansion of maternal, neonatal and child health interventions in low-income countries, and evaluation and estimation of Lives Saved (past and present).
Objectives of LiST :
To estimate additional number of lives saved when scaling up key interventions and to provide a user-friendly tool for child survival planning in developing countries.
The Lives Saved Tool
A multi-cause model of mortality
Predicts changes in
Under 5, infant and neonatal mortality rates and deaths
Maternal mortality ratios and deaths
Causes of death
Country specific health status
Baseline Child Mortality from UNICEF
Child and maternal health intervention coverage levels
i.e. ORS, facility delivery, etc.
Effect sizes of interventions based on the best available evidence
How does LiST work
Built into a demographic package
DemProj in Spectrum
Links to other Spectrum modules
AIM for AIDS
FamPlan for Family Planning
Children cannot die multiple times
Impacts can be lagged to a later age period
Risk factors affect probability of mortality
General Framework of the Model Demographic estimates and projections UN Pop/Spectrum Number of Child and Maternal Deaths Deaths by Cause WHO/UNICEF Country estimates
Malaria Mortality Disease Specific Treatments Disease Specific Preventions Risk factors ITN/IRS Antimalarials Stunting
Stunting Post-Neonatal Diarrheal Mortality Rotavirus vaccine Vitamin A Zinc Water/Sanitation (5) Zinc Antibiotics for dysentery ORS Disease Specific Treatments Disease Specific Preventions Risk factors IUGR Syphilis detection and treatment IPTp Maternal energy and/or micronutrient supplementation Zinc Complementary Feeding Complementary feeding education and/or supplementation Diarrhea incidence Improved H 2 O source within 30 minutes Hand washing with soap Water connection in the home Improved excreta disposal (latrine, toilet) Hygienic disposal of children’s stools Distant Factors Breast Feeding Breast Feeding Promotion
Advanced Topics FamPlan and AIM in LiST
LiST can be linked to AIM (HIV) and FamPlan (Family Planning) Spectrum modules
To examine combined, estimated, impact multiple models must be compared.
Please contact a LiST trainer to assist with any LiST, FamPlan, or AIM integration
What LiST Is, What LiST Isn’t
Multi-cause mortality model
Models coverage impacts
Potential impact assessment
National or sub-national planning tool
Natural history model
Detailed costing or planning tool
Projection of Additional Lives Saved
Projections of additional lives saved are based on the assumption that all other coverage levels remain the same!!!
This is important to keep in mind for mature interventions (i.e. Immunization)
We do not want projections to inadvertently make the case for decreasing funding/coverage for these interventions
If no baseline, can’t evaluate impact accurately
Sensible scale up targets
Feasible, acceptable, funds available
EX: Project presented to MOH a plan to scale up handwashing from 3% to 80%
Interventions included in software
Some Limitations: Maternal Health Intervention Assumptions
Because of the much smaller numbers of maternal deaths & the continuing work to determine the impact that some interventions have on maternal survival, LiST may not be the best tool to weigh the relative value of different investments in maternal survival
MH interventions included in LiST are packages that are only effective in reducing mortality if all services are provided at quality
“ How do you know that this works?”
“ How can it be used in reality?”
Neonatal Package Modeling
Source: Friberg, et al. Comparing modelled predictions of neonatal mortality impacts using LiST with observed results of community-based intervention trials in South Asia. International Journal of Epidemiology 2010; 39: i11-i20
Ghana (1% underestimate) - Good
Mali (10% underestimate) – OK
Predominantly post-neonatal interventions
Data from DHS and other sources
Modeling Mortality Rates and Equity
How Can LiST be Used?
Planning, Evaluation, Advocacy
Which interventions are necessary to reduce mortality? (maternal, neonatal, under-5)
By how much will project targets reduce mortality?
Evaluation and intermediate-term follow-up
What is the impact of observed coverage changes?
Evaluation of historic trends (i.e. multiple DHS/MICS/KPC surveys)
Predict estimated lives saved (past and future)
How many lives were saved, total and by intervention, over the course of your project (in your project area)?
How many deaths remain after intervention scale ups?
How Has LiST Been Used?
Global Action Plan for Pneumonia
‘ Impatient Optimist’ speech by Bill Gates
ASADI, by Saving Newborn Lives
Catalytic initiative: to guide planning and priority setting
Lives Saved by CSHGP projects
Who Uses LiST ?
Save the Children
Doris Duke Foundation
Future Directions for LiST
Add the new CHERG Cause of Death structure - 2008
Birth spacing benefit of family planning
Additional costing tie-ins
Finalization of CHOICE based costing tool
Links to the fiscal and bottleneck portions of MBB
Updated interventions – continuous
Research, Reviews, Model updated
Documentation – to be published in the winter
‘ Research’ version
To predict the impact of future developments
Who Owns LiST ?
US Fund for UNICEF?
LiST Contributors Institute for International Programs