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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

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



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.


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.


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


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.


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.


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.

[Indexed for MEDLINE]

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