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Child Health
1. Child immunization and
management of common
childhood illness
Karin Stenberg (stenbergk@who.int), Organisation mondiale de la santé (OMS), Genève, Suisse
Ludovic Queuille (Queuillelm@paho.org), Organisation panaméricaine de de la santé (OPS/OMS), Port-au-Prince, Haïti
Rachel Sanders (RSanders@avenirhealth.org), Avenir Health, Washington DC, EUA
Marcus Cadet (marcuscade87@yahoo.fr), Ministère de la santé publique et le population (MSPP), Port-au-Prince, Haiti
Haiti Priorise conference (http://www.copenhagenconsensus.com/haiti-priorise)
Port-au-Prince - Haïti, du 29 avril au 2 mai 2017
2. Overview
1) Context - Rationale
2) Management of common childhood illness
- Management of diarrhea and acute respiratory illness /pneumonia (P3)
- Estimation of costs
- Estimation of benefits
- Benefit Cost Ratio
3) Child immunization
- Vaccination (P1 et P2)
- Estimation of costs
- Estimation of benefits
- Benefit Cost Ratio
4) Discussion
3. High rates of child mortality
• Progress has been made, but still 49 children under 5 years of age die every
day
• Under five Mortality Ratio (U5MR = deaths per 1000 live births) is 69 (source: UN
estimate)
• These deaths are largely preventable, and a big societal loss
• The intrinsic value of health and survival
• Societal effects
• Pneumonia and Diarrhea main causes of post-neonatal mortality
• Jointly account for 48% of child deaths (source for cause of death: UN)
• When considering death and disability combined, these two conditions are the second
and third largest causes of loss of healthy life in Haiti (IHME, 2016)
5. Management of diarrhea and pneumonia
A package of interventions delivered through primary level health care:
• Oral antibiotics for pneumonia
• Management of diarrhea with Oral Rehydration Solution (ORS) and zinc
• Antibiotics for treatment of dysentery
Demonstrated cost-effectiveness: Edejer et al (2005), DCP2 (2006), DCP3 (2015)
6. Estimating costs
• Inputs-based costing, by year:
• Commodities: drugs, supplies *
• Supply chain costs and commodity waste
• Service delivery (inpatient & outpatient) operational costs*
• Programme support activities
*Cost assumptions based on WHO guidelines (UN-OneHealth Tool)
• Spectrum-GCEA/ UN-OneHealth Tool (LiST)
• Projected number of episodes of illness 2017-2036
• A comprehensive, country-tailored analysis
7. Estimated costs
Average annual additional cost to reach 95% coverage:
• Average annual cost: USD2014 61.5 million = HTG 2,781 million
• Cost per capita: USD2014 5.07 = HTG 229
• Equivalent to 8% of total health expenditure (2012/2013)
8. 0
10
20
30
40
50
60
70
80
U5MR IMR
Baseline (2015)
80% coverage
95% coverage
12%
Estimating benefits
• avert > 3,800 deaths/year (80% coverage)
• avert > 5,000 deaths/year (95% coverage)
• Healthy Life Years (HLYs) gained valued at
1, 3 and 8 x GDP/capita
Predicted reduction in under-five
mortality rate and infant mortality rate
• Interventions act on unique cause of death
10%
Spectrum-GCEA/ UN-OneHealth Tool (LiST)
9. Benefit-Cost Ratios
Benefits valued at 3x GDP
Discount
rate
Benefits
2018-2036
(HTG bn)
Costs
2018-2036
(HTG bn) BCR
Management of
common
childhood illness
(95% coverage)
3% 229.6 22.5 10.2
5% 129.0 18.9 6.8
12% 32.9 11.2 2.9
13. Benefit-Cost Ratios: including vaccines
95% coverage scale-up; Benefits valued at 3x GDP
0
2
4
6
8
10
12
Routine EPI
(P1)
Routine
EPI+PCV13
(P2)
Management
of childhood
illness (P3)
Combination
(P4)
Package Interventions
Routine EPI
(P1)
Vaccines: BCG, Polio, Measles
single dose, DTC/Penta, Rotavirus
Routine EPI +
PCV13 (P2)
Vaccines: BCG, Polio, Measles
single dose, DTC/Penta, Rotavirus
+ PCV13.
Management
of common
childhood
illness (P3)
Oral Rehydration Solution + zinc
Oral antibiotics for pneumonia +
Antibiotics for treatment of
dysentery
Combination
(P4) P2 + P3
10.4
3.7
6.8
4.5
14. Discussion
• High BCRs (very strong quality of evidence) – in particular for current
Immunization Schedule and management of common childhood illness
• Highlights the need for financial analysis concerning the introduction of PCV13
• Reduce direct (out of pocket) payments for common childhood illness
• Effective implementation of the Integrated Mgt of Childhood Illness (IMCI)
strategy
• Prioritization and rationalisation of available resources towards child health and
primary level
• Improve public health financing / address long term sustainability (vaccines)
• Improve health system performance
• Improve Maternal Health and reduce demographic pressure (family planning,
education and socio-economic development)
Editor's Notes
DCP: The most recent cost-effectiveness estimates for the treatment of pneumonia are from the 2nd edition of Disease Control Priorities in Developing Countries (Simoes and others 2006), and suggest that cost- effectiveness is US$516 per DALY averted in LMICs overall (US$342 per DALY averted in South Asia and US$282 per DALY averted in Sub-Saharan Africa). These costs are averaged across nonsevere cases treated in communities or local facilities along with severe and very severe cases treated in hospitals.
The most cost-effective interventions for diarrhea,based on cost per DALY averted, are prophylactic zinc supplementation as an adjunct to ORS (US$10
to US$50 per DALY averted), ORS (US$150 per DALY averted), rotavirus vaccine (US$100 per DALY averted at the Gavi price in LICs), and household-level water treatment in rural areas using chlorination or solar disinfection (US$180 to US$200 per DALY averted) (figure 17.1).
