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Gulrez Shah Azhar Yelan Guo Henock Taddese

Cost Effectiveness Analysis (CEA) of a Traditional Birth Attendants (TBA) programme for reducing perinatal mortality. Gulrez Shah Azhar Yelan Guo Henock Taddese. Annually, some 536,000 mothers die during pregnancy, child birth and the post natal period Around 9 million deaths in children

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Gulrez Shah Azhar Yelan Guo Henock Taddese

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  1. Health EconomicsInstitute of Public Health Cost Effectiveness Analysis (CEA) of a Traditional Birth Attendants (TBA) programme for reducing perinatal mortality Gulrez Shah Azhar Yelan Guo Henock Taddese

  2. Health EconomicsInstitute of Public Health Annually, some 536,000 mothers die during pregnancy, child birth and the post natal period Around 9 million deaths in children Some 40 % of children die within the first 28 days Around 85 % of all maternal deaths and 70 % of child deaths occur in Africa and Southern Asia Global Maternal and Child Health Situation

  3. Health EconomicsInstitute of Public Health Maternal Health in India The neonatal period is recognized as a brief, critical time that requires focused interventions to reach the Millennium Development Goal of a two-thirds reduction in child mortality by 2015. One million neonatal deaths in India every year, accounting for approximately a quarter of all global neonatal deaths Neonatal deaths account for about 38% of the annual 10.6 million child deaths recorded worldwide and nearly half of the deaths in children under 5 years in India

  4. Health EconomicsInstitute of Public Health Primary causes of neonatal deaths in developing countries Infections (36%) Complications of preterm birth (28%) Birth asphyxia (23%) with low birth weight as the primary contributory cause

  5. Health EconomicsInstitute of Public Health Intervention at the family and community level It’s been found that high coverage of a few simple and cost-effective interventions would reduce neonatal mortality Interventions at the family and community level can save lives, especially where health systems are weak

  6. Health EconomicsInstitute of Public Health However Population-level data on the impact of family and community-based neonatal care from large-scale programmes is scarce. Lack of cost-effectiveness analysis on interventions that have been carried out as well.

  7. Health EconomicsInstitute of Public Health • A cluster randomised controlled trial in Pakistan concluded that a community based TBA programme reduces perinatal mortality by 30 % • This study models the intervention in a District in India to assess cost effectiveness Intervention

  8. Health EconomicsInstitute of Public Health Setting • Uttar Pradesh: largest state of India, population 160 million • Highest IMR and low child health indicators • Lowest rates of institutional deliveries and delivaries attended by skilled health persons • Poor state of health system • Aligarh: an average district of the state

  9. Health EconomicsInstitute of Public Health Map

  10. Health EconomicsInstitute of Public Health Decision tree Alive after 28 days = 96.3 % Live babies = 95 % Access to trained TBAs Death within 28 days = 3.7 % Still births = 5 % Pregnant women No access to TBAs Alive after 28 days = 94.7 % Live babies = 93 % Still births = 7 % Death within 28 days = 5.3 %

  11. Health EconomicsInstitute of Public Health

  12. Health EconomicsInstitute of Public Health Costs • Total costs 646 542 • Perinatal deaths 942 (est) • Cochrane review, 2009, 30% reduction in perinatal mortality so, 30 % of 942, we have 283 averted deaths • Incremental Cost per averted death 2285 • Incremental Cost per life year saved 39 / life year saved

  13. Health EconomicsInstitute of Public Health Sensitivity analysis

  14. Health EconomicsInstitute of Public Health The inherent limitation of a CEA limits the comparability of the study results. Option: to compare with some reasonable figures, health care expenditure per capita and yearly per capita income of 673 and 6358 DKK, respectively, were used. In light of the above figures an incremental cost per averted death of 2285 seems acceptable. No standard for training and follow up of TBAs. Conclusion

  15. Health EconomicsInstitute of Public Health References United Nations. The Millennium Development Goals Report 2009. United Nations; 2009; Available from: http://www.un.org/millenniumgoals/pdf/MDG_Report_2009_ENG.pdf. WHO. The World Health Report 2005:Make Every Mother and Child Count. WHO; 2005; Available from: http://www.who.int/whr/2005/whr2005_en.pdf. Baqui, A.H. et al. 2008. Impact of integrated nutrition and health programme on neonatal mortality in rural Northern India. Bulletin of the World Health Organization. 86. 796-804. Saroha, E. et al. 2008. Caste and Maternal Health Care Service Use Among Rural Hindu Women in Maitha, Uttar Pradesh, India. Journal of Midwifery and Women’s Health, 53 (5), e41-e47. Jokhio AH, Winter HR, Cheng KK. An Intervention Involving Traditional Birth Attendants and Perinatal and Maternal Mortality in Pakistan. New England Journal of Medicine 2005;352(20):2091-9. International Institute for Population Studies. National Family Health Survey 2005-6 (NFHS -3),2006. Kelly M, McDaid D, Ludbrook A, Powell J. Economic appraisal of public health interventions. NHS Health Development Agency2005:12-04. Borghi J, Thapa B, Osrin D, Jan S, Morrison J, Tamang S, et al. Economic assessment of a women's group intervention to improve birth outcomes in rural Nepal. The Lancet2005;366(9500):1882-4.

  16. Health EconomicsInstitute of Public Health Websites & Further readings • www.Uponline.in/profile/districts/Aligarh.asp • www.mohfw.nic.in/dofw%20website/MATERNAL%20HEALTH%20%20PROGRAMME%20%20.htm • www.mohfw.nic.in/NRHM/State Files/up.htm • Bang A, Bang R, Reddy H. Home-based neonatal care: summary and applications of the field trial in rural Gadchiroli, India (1993 to 2003). Journal of perinatology2005;25:S108-S22. • Griebsch I, Coast J, Brown J. Quality-adjusted life-years lack quality in pediatric care: a critical review of published cost-utility studies in child health. Pediatrics2005;115(5):e600. • Hounton S, Sombié I, Meda N, Bassane B, Byass P, Stanton C, et al. Methods for evaluating effectiveness and cost-effectiveness of skilled care initiative in rural Burkina Faso. Name: Tropical Medicine and International Health2008;13:14-24. • Manandhar D, Osrin D, Shrestha B, Mesko N, Morrison J, Tumbahangphe K, et al. Effect of a participatory intervention with women's groups on birth outcomes in Nepal: cluster-randomised controlled trial. The Lancet2004;364(9438):970-9. • Sibley L, Sipe T, Brown C, Diallo M, McNatt K, Habarta N. Traditional birth attendant training for improving health behaviours and pregnancy outcomes. 2007.

  17. Health EconomicsInstitute of Public Health Tak & Spørgsmål? Picture: our group work.

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