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Public Health Nutr. 2014 Sep;17(9):2138-45. doi: 10.1017/S1368980013002152. Epub 2013 Aug 12.

Cost of childhood diarrhoea in rural South Africa: exploring cost-effectiveness of universal zinc supplementation.

Author information

1
1Division of Maternal and Child Health,Department of Paediatrics,University of KwaZulu-Natal,Durban,P/Bag 7,Congella 4013,South Africa.
2
2Center for International Health,University of Bergen,Bergen,Norway.
3
3South African TB Vaccine Initiative,Institute of Infectious Disease and Molecular Medicine,University of Cape Town,Cape Town,South Africa.
4
5i3 Research,Maidenhead,UK.
5
6Mpilonhle,Mtubatuba,South Africa.

Abstract

OBJECTIVE:

To describe the cost of diarrhoeal illness in children aged 6-24 months in a rural South African community and to determine the threshold prevalence of stunting at which universal Zn plus vitamin A supplementation (VAZ) would be more cost-effective than vitamin A alone (VA) in preventing diarrhoea.

DESIGN:

We conducted a cost analysis using primary and secondary data sources. Using simulations we examined incremental costs of VAZ relative to VA while varying stunting prevalence.

SETTING:

Data on efficacy and societal costs were largely from a South African trial. Secondary data were from local and international published sources.

SUBJECTS:

The trial included children aged 6-24 months. The secondary data sources were a South African health economics survey and the WHO-CHOICE (CHOosing Interventions that are Cost Effective) database.

RESULTS:

In the trial, stunted children supplemented with VAZ had 2·04 episodes (95 % CI 1·37, 3·05) of diarrhoea per child-year compared with 3·92 episodes (95 % CI 3·02, 5·09) in the VA arm. Average cost of illness was $Int 7·80 per episode (10th, 90th centile: $Int 0·28, $Int 15·63), assuming a minimum standard of care (oral rehydration and 14 d of therapeutic Zn). In simulation scenarios universal VAZ had low incremental costs or became cost-saving relative to VA when the prevalence of stunting was close to 20 %. Incremental cost-effectiveness ratios were sensitive to the cost of intervention and coverage levels.

CONCLUSIONS:

This simulation suggests that universal VAZ would be cost-effective at current levels of stunting in parts of South Africa. This requires further validation under actual programmatic conditions.

PMID:
23930984
DOI:
10.1017/S1368980013002152
[Indexed for MEDLINE]

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