Achieving the millennium development goals for health
Cost effectiveness analysis of strategies for maternal and neo-
natal health in developing countries
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BMJ 2005;331:1107 (12 November), doi:10.1136/bmj.331.7525.1107
http://bmj.bmjjournals.com/cgi/content/full/331/7525/0-a
Taghreed Adam, health economist1, Stephen S Lim, research fel-
low2, Sumi Mehta, staff scientist3, Zulfiqar A Bhutta, professor
of pediatrics and child health4, Helga Fogstad, technical offi-
cer5, Matthews Mathai, medical officer5, Jelka Zupan, coordina-
tor5, Gary L Darmstadt, associate professor6
1 Health Systems Financing, Evidence and Information for Policy,
World Health Organization, Switzerland, 2 School of Population
Health, University of Queensland, Australia, 3 Health Effects
Institute, Boston, USA, 4 Aga Khan University, Karachi, Paki-
stan, 5 Department of Making Pregnancy Safer, World Health Or-
ganization, 6 Department of International Health, Bloomberg
School of Public Health, Johns Hopkins University, Baltimore,
MD, USA
Correspondence to: S S Lim <s.lim@sph.uq.edu.au>
Abstract
Objective
To determine the costs and benefits of interventions for mater-
nal and newborn health to assess the appropriateness of current
strategies and guide future plans to attain the millennium de-
velopment goals.
Design
Cost effectiveness analysis.
Setting
Two regions classified by the World Health Organization accord-
ing to their epidemiological grouping: Afr-E, those countries in
sub-Saharan Africa with very high adult and high child mortal-
ity, and Sear-D, comprising countries in South East Asia with
high adult and high child mortality.
Data sources
Effectiveness data from several sources, including trials, ob-
servational studies, and expert opinion. For resource inputs,
quantities came from WHO guidelines, literature, and expert
opinion, and prices from the WHO choosing interventions that are
cost effective database.
Main outcome measures
Cost per disability adjusted life year (DALY) averted in year
2000 international dollars.
Results
The most cost effective mix of interventions was similar in Afr-
E and Sear-D. These were the community based newborn care pack-
age, followed by antenatal care (tetanus toxoid, screening for
pre-eclampsia, screening and treatment of asymptomatic bacteri-
uria and syphilis); skilled attendance at birth, offering first
level maternal and neonatal care around childbirth; and emer-
gency obstetric and neonatal care around and after birth.
Screening and treatment of maternal syphilis, community based
management of neonatal pneumonia, and steroids given during the
antenatal period were relatively less cost effective in Sear-D.
Scaling up all of the included interventions to 95% coverage
would halve neonatal and maternal deaths.
Conclusion
Preventive interventions at the community level for newborn ba-
bies and at the primary care level for mothers and newborn ba-
bies are extremely cost effective, but the millennium develop-
ment goals for maternal and child health will not be achieved
without universal access to clinical services as well.
--
Rana Jawad Asghar MD, MPH
Coordinator South Asian Public Health Forum
mailto:jawad@alumni.washington.edu
http://www.DrJawad.com
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