BMJ  2005;331:1107 (12 November), doi:10.1136/bmj.331.7525.1107

Paper

Achieving the millennium development goals for health

Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries

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, Pakistan, ⁵ Department of Making Pregnancy Safer, World Health Organization, ⁶ Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

Objective To determine the costs and benefits of interventions for maternal and newborn health to assess the appropriateness of current strategies and guide future plans to attain the millennium development goals.

Design Cost effectiveness analysis.

Setting Two regions classified by the World Health Organization according to their epidemiological grouping: Afr-E, those countries in sub-Saharan Africa with very high adult and high child mortality, 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, observational 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 package, followed by antenatal care (tetanus toxoid, screening for pre-eclampsia, screening and treatment of asymptomatic bacteriuria and syphilis); skilled attendance at birth, offering first level maternal and neonatal care around childbirth; and emergency 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 babies and at the primary care level for mothers and newborn babies are extremely cost effective, but the millennium development goals for maternal and child health will not be achieved without universal access to clinical services as well.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

What factors predict differences in infant and perinatal mortality in primary care trusts in England? A prognostic model

Nick Freemantle, J Wood, C Griffin, P Gill, M J Calvert, A Shankar, J Chambers, and C MacArthur
BMJ 2009 339: b2892. [Abstract] [Full Text] [PDF]

Evaluation of current strategies and future priorities for improving health in developing countries

David B Evans, Stephen S Lim, Taghreed Adam, Tessa Tan-Torres Edejer WHO Choosing Interventions that are Cost Effective (CHOICE) Millennium Development Goals Team
BMJ 2005 331: 1457-1461. [Extract] [Full Text] [PDF]

Cost effectiveness analysis of strategies for tuberculosis control in developing countries

Rob Baltussen, Katherine Floyd, and Christopher Dye
BMJ 2005 331: 1364. [Abstract] [Full Text] [PDF]

Maternal and neonatal health: universal access is imperative
BMJ 2005 331: 0. [Full Text]

Nervous laughter

Fiona Godlee
BMJ 2005 331: 0. [Extract] [Full Text] [PDF]

Time to reassess strategies for improving health in developing countries

David B Evans, Taghreed Adam, Tessa Tan-Torres Edejer, Stephen S Lim, Andrew Cassels, Timothy G Evans for the the WHO Choosing Interventions that are Cost Effective (CHOICE) Millennium Development Goals Team
BMJ 2005 331: 1133-1136. [Extract] [Full Text] [PDF]

Methods to assess the costs and health effects of interventions for improving health in developing countries

David B Evans, Tessa Tan-Torres Edejer, Taghreed Adam, Stephen S Lim for the WHO Choosing Interventions that are Cost Effective (CHOICE) Millennium Development Goals Team
BMJ 2005 331: 1137-1140. [Extract] [Full Text] [PDF]

Related external webpages:

Paper plus

This article has been cited by other articles:

• Freemantle, N., Wood, J, Griffin, C, Gill, P, Calvert, M J, Shankar, A, Chambers, J, MacArthur, C (2009). What factors predict differences in infant and perinatal mortality in primary care trusts in England? A prognostic model. BMJ 339: b2892-b2892 [Abstract] [Full text]  
• Dodhia, H., Phillips, K. (2008). Measuring burden of disease in two inner London boroughs using Disability Adjusted Life Years. J Public Health (Oxf) 30: 313-321 [Abstract] [Full text]  
• Baqui, A. H, Rosecrans, A. M, Williams, E. K, Agrawal, P. K, Ahmed, S., Darmstadt, G. L, Kumar, V., Kiran, U., Panwar, D., Ahuja, R. C, Srivastava, V. K, Black, R. E, Santosham, M. (2008). NGO facilitation of a government community-based maternal and neonatal health programme in rural India: improvements in equity. Health Policy Plan 23: 234-243 [Abstract] [Full text]  
• Habbema, J. D. F. (2008). Is affordable and cost-effective assisted reproductive technology in low-income countries possible? What should we know to answer the question?. ESHRE Monogr 2008: 21-24 [Abstract] [Full text]  
• Qian, L., Liu, C., Zhuang, W., Guo, Y., Yu, J., Chen, H., Wang, S., Lin, Z., Xia, S., Ni, L., Liu, X., Chen, C., Sun, B., and the Chinese Collaborative Study Group for Neon, (2008). Neonatal Respiratory Failure: A 12-Month Clinical Epidemiologic Study From 2004 to 2005 in China. Pediatrics 121: e1115-e1124 [Abstract] [Full text]  
• Darmstadt, G. L, Walker, N., Lawn, J. E, Bhutta, Z. A, Haws, R. A, Cousens, S. (2008). Saving newborn lives in Asia and Africa: cost and impact of phased scale-up of interventions within the continuum of care. Health Policy Plan 23: 101-117 [Abstract] [Full text]  
• Haws, R. A, Thomas, A. L, Bhutta, Z. A, Darmstadt, G. L (2007). Impact of packaged interventions on neonatal health: a review of the evidence. Health Policy Plan 22: 193-215 [Abstract] [Full text]  
• Msall, M. E., Hogan, D. P. (2007). Counting Children With Disability in Low-Income Countries: Enhancing Prevention, Promoting Child Development, and Investing in Economic Well-being. Pediatrics 120: 182-185 [Full text]  
• Lawn, J. E, Costello, A., Mwansambo, C., Osrin, D. (2007). Countdown to 2015: will the Millennium Development Goal for child survival be met?. Arch. Dis. Child. 92: 551-556 [Abstract] [Full text]  
• Woo, P. P.S., Kim, J. J., Leung, G. M. (2007). What Is the Most Cost-Effective Population-Based Cancer Screening Program for Chinese Women?. JCO 25: 617-624 [Abstract] [Full text]  
• Evans, D. B, Lim, S. S, Adam, T., Edejer, T. T.-T., WHO Choosing Interventions that are Cost Effective, (2005). Evaluation of current strategies and future priorities for improving health in developing countries. BMJ 331: 1457-1461 [Full text]  
• Baltussen, R., Floyd, K., Dye, C. (2005). Cost effectiveness analysis of strategies for tuberculosis control in developing countries. BMJ 331: 1364- [Abstract] [Full text]  
• Evans, D. B, Adam, T., Edejer, T. T.-T., Lim, S. S, Cassels, A., Evans, T. G, for the the WHO Choosing Interventions that are Co, (2005). Time to reassess strategies for improving health in developing countries. BMJ 331: 1133-1136 [Full text]  
• Evans, D. B, Edejer, T. T.-T., Adam, T., Lim, S. S, for the WHO Choosing Interventions that are Cost E, (2005). Methods to assess the costs and health effects of interventions for improving health in developing countries. BMJ 331: 1137-1140 [Full text]  

Rapid Responses:

Read all Rapid Responses

Will we see MCH Care in Social Security Network

Hanoon P Pokharel, et al.
bmj.com, 13 Nov 2005 [Full text]

Family Planning is Fundamental

Eleanor B Schwarz
bmj.com, 2 Dec 2005 [Full text]

Online poll

Find out more on doc2doc >>