Abstract:
:Given the demonstrated efficacy of vitamin A supplements in reducing childhood mortality, health officials now have to decide whether it would be efficient to target the supplements to high risk children. Decisions about targeting are complex because they depend on a number of factors; the degree of clustering of preventable deaths, the cost of the intervention, the side-effects of the intervention, the cost of identifying the high risk group, and the accuracy of the 'diagnosis' of risk. A cost-effectiveness analysis was used in the Philippines to examine whether vitamin A supplements should be given universally to all children 6-59 months, targeted broadly to children suffering from mild, moderate, or severe malnutrition, or targeted narrowly to pre-schoolers with moderate and severe malnutrition. The first year average cost of the universal approach was US$67.21 per death averted compared to $144.12 and $257.20 for the broad and narrow targeting approaches respectively. When subjected to sensitivity analysis the conclusion about the most cost-effective strategy was robust to changes in underlying assumptions such as the efficacy of supplements, clustering of deaths, and toxicity. Targeting vitamin A supplements to high risk children is not an efficient use of resources. Based on the results of this cost-effectiveness analysis and a consideration of alternate strategies, it is apparent that vitamin A, like immunization, should be provided to all pre-schoolers in the developing world. Issues about targeting public health interventions can usefully be addressed by cost-effectiveness analysis. :It has been established that vitamin A supplementation can help reduce levels of child mortality. Findings are reported from a cost-effectiveness study in the Philippines undertaken to determine whether vitamin A supplements should be given universally to all children age 6-59 months; targeted broadly to children with mild, moderate, or severe malnutrition; or targeted narrowly to preschoolers with moderate and severe malnutrition. Whether to target supplementation depends upon the degree of clustering of preventable deaths, the cost of the intervention, the side effects of the intervention, the cost of identifying the high risk group, and the accuracy of the diagnosis of risk. The first year average cost of the universal approach would be US$67.21 per death averted, $144.12 for the broad targeting approach, and $257.20 for the narrow approach. Targeting vitamin A supplements to high-risk children is therefore not an efficient use of resources. Vitamin A, like immunization, should be provided to all preschoolers in the developing world.
journal_name
Health Policy Planjournal_title
Health policy and planningauthors
Loevinsohn BP,Sutter RW,Costales MOdoi
10.1093/heapol/12.1.29subject
Has Abstractpub_date
1997-03-01 00:00:00pages
29-37issue
1eissn
0268-1080issn
1460-2237journal_volume
12pub_type
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journal_title:Health policy and planning
pub_type: 历史文章,杂志文章
doi:10.1093/heapol/czq037
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journal_title:Health policy and planning
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journal_title:Health policy and planning
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更新日期:1997-12-01 00:00:00
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更新日期:2007-09-01 00:00:00
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journal_title:Health policy and planning
pub_type: 杂志文章,评审
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更新日期:1994-09-01 00:00:00
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pub_type: 杂志文章
doi:10.1093/heapol/czx152
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pub_type: 杂志文章
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abstract::Measuring and tracking the quality of healthcare is a critical part of improving service delivery, clinic efficiency and health outcomes. However, no standardized or widely accepted tool exists to assess the quality of clinic-based family planning services in low- and middle-income countries. The objective of this lit...
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pub_type: 杂志文章,评审
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更新日期:2017-11-01 00:00:00
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