Cost Effectiveness and Resource Allocation | |
Cost effectiveness of community-based and in-patient therapeutic feeding programs to treat severe acute malnutrition in Ethiopia | |
Kebede Deribe2  Girma Azene1  Mekitie Wondafrash3  Asayehegn Tekeste4  | |
[1] Jimma University Faculty of Public Health, Department of Health Planning and management, Jimma, Ethiopia;Jimma University Faculty of Public Health, P.O.Box 2082 code 1250 Addis Ababa, Ethiopia;Jimma University Faculty of Public Health, Department of population and family health, Jimma, Ethiopia;Jimma University Faculty of Public Health, Jimma, Ethiopia | |
关键词: Cost-effectiveness; Therapeutic feeding center; Community- based therapeutic care; Severe acute malnutrition; | |
Others : 820415 DOI : 10.1186/1478-7547-10-4 |
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received in 2011-03-21, accepted in 2012-03-19, 发布年份 2012 | |
【 摘 要 】
Background
This study estimated the cost effectiveness of community-based therapeutic care (CTC) for children with severe acute malnutrition (SAM) in Sidama Zone, Ethiopia compared to facility based therapeutic feeding center (TFC).
Methods
A cost effectiveness analysis comparing costs and outcomes of two treatment programmes was conducted. The societal perspective, which considers costs to all sectors of the society, was employed. Outcomes and health service costs of CTC and TFC were obtained from Save the Children USA (SC/USA) CTC and TFC programme, government health services and UNICEF(in kind supplies) cost estimates of unit costs. Parental costs were estimated through interviewing 306 caretakers. Cost categories were compared and a single cost effectiveness ratio of costs to treat a child with SAM in each program (regardless of outcome) was computed and compared.
Results
A total of 328 patient cards/records of children treated in the programs were reviewed; out of which 306 (157 CTC and 149 TFC) were traced back to their households to interview their caretakers. The cure rate in TFC was 95.36% compared to 94.30% in CTC. The death rate in TFC was 0% and in CTC 1.2%. The mean cost per child treated was $284.56 in TFC and $134.88 in CTC. The institutional cost per child treated was $262.62 in TFC and $128.58 in CTC. Out of these institutional costs in TFC 46.6% was personnel cost. In contrast, majority (43.2%) of the institutional costs in CTC went to ready to use therapeutic food (RUTF). The opportunity cost per caretaker in the TFC was $21.01 whereas it was $5.87 in CTC. The result of this study shows that community based CTC was two times more cost effective than TFC.
Conclusion
CTC was found to be relatively more cost effective than TFC in this setting. This indicates that CTC is a viable approach on just economic grounds in addition to other benefits such improved access, sustainability and appropriateness documented elsewhere. If costs of RUTF can be reduced such as through local production the CTC costs per child can be further reduced as RUTF constitutes the highest cost in these study settings.
【 授权许可】
2012 Tekeste et al; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
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20140712042232720.pdf | 249KB | download |
【 参考文献 】
- [1]WHO Multicentre Growth Reference Study Group: WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. [http://www.who.int/childgrowth/standards/technical_report/en/index.html] webciteGeneva, World Health Organization 2006.
- [2]WHO: Child growth standards. [http://www.who.int/childgrowth/standards/ac_for_age/en/index.html] webciteArm circumference for age
- [3]WHO/UNICEF: WHO child growth standards and the identification of severe acute malnutrition in infants and children: A Joint Statement by the World Health Organization and the United Nations Children's Fund. [http:/ / www.who.int/ nutrition/ publications/ severemalnutrition/ 9789241598163_eng.pdf] webciteGeneva, Switzerland and New York, USA 2009.
- [4]Caulfield LE, de Onis M, Blossner M, Black RE: Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr 2004, 80:193-8.
- [5]Mason JB, Musgrove P, Habicht J-P: At least one-third of poor countries' disease burden is due to malnutrition. Disease Control Priorities Project (DCPP) Working Paper No. 1. [http://www.fic.nih.gov/dcpp/wps/wp1.pdf] webciteFogarty International Center of the National Institutes of Health 2003. Accessed 16 May 2006
- [6]Collins S, Sadler K, Dent N, Khara T, Guerrero S, Myatt M, Saboya M, Walsh A: Key issues in the success of community-based management of severe malnutrition. Food Nutr Bull 2006, 27:49-82.
- [7]Collins S: Community -based Therapeutic Care: A new paradigm for selective feeding in nutritional crises. 48: London, Overseas Development Institute. HPN network papers 2004.
- [8]World Health Organization: Management of Severe Malnutrition: a Manual for Physicians and Other Senior Health Workers. Geneva, WHO 1999, 1.
- [9]DPPC-ENCU: Emergency Nutrition Intervention Guideline, Emergency Nutrition Coordination Unit (ENCU), Early Warning Department of DPPC. Addis Ababa 2004.
- [10]Cook R: Is hospital the place for the treatment of malnourished children? J Trop Pediatr Environ Child Health 1971, 17:15-25.
- [11]Jelliffe DB, Jelliffe EF: The children's ward as a lethal factor? J Pediatr 1970, 77:895-9.
- [12]Briend A: Management of severe malnutrition efficacious or effective? J Pediatr Gastroenterol Nutr 2001, 32:521-2.
- [13]Collins S: Changing the way we address severe malnutrition during famine. Lancet 2001, 358(9280):498-501.
- [14]World Health Organization: Management of severe malnutrition: a manual for physicians and other senior health workers. [http:/ / www.who.int/ nutrition/ publications/ en/ manage_severe_malnutrition_eng.pdf] webciteGeneva: WHO 1999. Accessed 28 May 2006
- [15]The United Nations System Standing Committee on Nutrition and the United Nations Children's Fund.d Community-Based Management Of Severe Acute Malnutrition [http:/ / www.who.int/ nutrition/ topics/ Statement_community_based_man_sev_a cute_mal_eng.pdf] webciteA Joint Statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children's Fund 2007.
- [16]Brown KH, Nyirandutiye DH, Jungjohann S: Management of children with acute malnutrition in resource-poor settings. Nat Rev Endocrinol 2009, 5(11):597-603.
- [17]UNICEF: Enhanced outreach strategy for child survival interventions in Ethiopia 2004-2006. Proposal to CIDA Canada. Addis Ababa 2003.
- [18]Humanitarian Appeal for Ethiopia: A Joint Government and Humanitarian Partners' Appeal. Addis Ababa 2003.
- [19]Save the children/USA: Emergency Health and Nutrition Program (EHNP) In Ethiopia. Emergency Health and Nutrition Response to the Drought in High Risk Areas in Ethiopia. USAID-HPN Grant Final Report 2004.
- [20]Deconinck H: Adopting CTC, from Scratch in Ethiopia. In Community-based Therapeutic Care (CTC): (2) Oxford. Edited by Khara T, Collins S. ENN: Emergency nutrition Network. Special Supplement Series; 2004.
- [21]Chaiken MS, Deconinck H, Degefie T: The promise of a community-based approach to managing severe malnutrition: A case study from Ethiopia. Food and Nutrition Bulletin 2006, 27:95-104.
- [22]Collins S: Community -based Therapeutic Care: A new paradigm for selective feeding in nutritional crises. 48: London, Overseas Development Institute. HPN network papers 2004.
- [23]Emergency Nutrition Network: Community Based Approaches to Managing Severe Malnutrition. Emergency Nutrition Network (ENN) report on the proceedings of an inter-agency workshop. Dublin 2003.
- [24]Collins S, CTC approach: Community-based Therapeutic Care (CTC).: (2) Oxford ENN. [http://www.ennonline.net/pool/files/ife/supplement23.pdf] webciteIn Edited by Khara T, Collins S. Emergency nutrition Network. Special Supplement Series; 2004, 6-13. Accessed on 28 February 2012
- [25]Ashworth A, Khanum S: Cost-effective treatment for severely malnourished children: what is the best approach? Health Policy & Planning 1979, 12:115-121.
- [26]Ashworth A: Efficacy and effectiveness of Community-based treatment of severe alnutrition. Technical background paper for informal consultation held in Geneva 2005.
- [27]Ahmed T, Islam MM, Nahar B, Azam MA, Salam MA, Ashworth A, Fuchs GJ: Home-based nutritional rehabilitation of severely-malnourished children recovering from diarrhoea and other acute illnesses. In Paper presented at the 10th Annual Scientific Conference, ICDDRB. Dhaka; 2002.
- [28]Save the children/USA: Emergency Health and Nutrition Program in Ethiopia. Expanded Program for Saving Lives through Rapid Response In Ethiopia. Annual report (October 2004 - September 2005) 2005.
- [29]SC/USA: Emergency Health & Nutrition Program (EHNP). Progress Report May-August. Addis Ababa 2003.
- [30]Grobler-Tanner Caroline, Collins Steve: Community Therapeutic Care (CTC): A new approach to managing acute malnutrition in emergencies and beyond. [http://www.fantaproject.org/downloads/pdfs/TN8_CTC.pdf] webciteWashington, D.C.: Food and Nutrition Technical Assistance Project, Academy for Educational DevelopmentAccessed on 28 February 2012
- [31]World Health Organization: Report of an Informal Consultation on the Community-Based Management of Severe Malnutrition in Children. WHO Informal Consultation. Geneva 2006.
- [32]Grima T, Molgaard C, Michaelsen KF: Appropriate Management of severe malnutrition greatly contributes to reduction of child mortality rate. Journal of pediatric Gastroenterology and nutrition 2006, 43:436-438.
- [33]ENN: Community Based Approaches to Managing Severe Malnutrition, Emergency Nutrition Network (ENN) report on the proceedings of an inter-agency workshop. Dublin 2003.
- [34]Bachmann MO: Cost-effectiveness of community-based treatment of severe acute malnutrition in children. Expert Rev Pharmacoecon Outcomes Res 2010, 10(5):605-12.
- [35]Wilford R, Golden K, Walker DG: Cost-effectiveness of community-based management of acute malnutrition in Malawi. Health Policy Plan 2011, in press.
- [36]Bachmann MO: Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model. Cost Eff Resour Alloc 2009, 15:7-2.