Assessing health and economic outcomes of interventions to reduce pregnancy-related mortality in Nigeria

BMC Public Health

Research Article

Stephen C Resch¹  Sue J Goldie²  Daniel O Erim³ 

[1] Center for Health Decision Science, Harvard School of Public Health, 718 Huntington Avenue, 2nd floor, 02115, Boston, MA, USA;Center for Health Decision Science, Harvard School of Public Health, 718 Huntington Avenue, 2nd floor, 02115, Boston, MA, USA;Harvard Global Health Institute, Harvard University, Cambridge, MA, USA;Center for Health Decision Science, Harvard School of Public Health, 718 Huntington Avenue, 2nd floor, 02115, Boston, MA, USA;Harvard University Center for Geographic Analysis, Cambridge, MA, USA;

关键词: Maternal Death;    Maternal Mortality Ratio;    Skilled Birth Attendant;    Modern Contraceptive;    Safe Abortion;   

DOI  :  10.1186/1471-2458-12-786

 received in 2012-03-19, accepted in 2012-09-07,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundWomen in Nigeria face some of the highest maternal mortality risks in the world. We explore the benefits and cost-effectiveness of individual and integrated packages of interventions to prevent pregnancy-related deaths.MethodsWe adapt a previously validated maternal mortality model to Nigeria. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to Southwest and Northeast zones using survey-based data. Strategies consisted of improving coverage of effective interventions, and could include improved logistics.ResultsIncreasing family planning was the most effective individual intervention to reduce pregnancy-related mortality, was cost saving in the Southwest zone and cost-effective elsewhere, and prevented nearly 1 in 5 abortion-related deaths. However, with a singular focus on family planning and safe abortion, mortality reduction would plateau below MDG 5. Strategies that could prevent 4 out of 5 maternal deaths included an integrated and stepwise approach that includes increased skilled deliveries, facility births, access to antenatal/postpartum care, improved recognition of referral need, transport, and availability quality of EmOC in addition to family planning and safe abortion. The economic benefits of these strategies ranged from being cost-saving to having incremental cost-effectiveness ratios less than $500 per YLS, well below Nigeria’s per capita GDP.ConclusionsEarly intensive efforts to improve family planning and control of fertility choices, accompanied by a stepwise effort to scale-up capacity for integrated maternal health services over several years, will save lives and provide equal or greater value than many public health interventions we consider among the most cost-effective (e.g., childhood immunization).

【 授权许可】

CC BY   
© Erim et al.; licensee BioMed Central Ltd. 2012