Comparative impact assessment of child pneumonia interventions

Louis Niessen, Anne Ten Hove, Henk Hilderink, Martin Weber, Kim Mulholland, Majid Ezzati

Research output: Contribution to journalArticle

Abstract

Objective: To compare the cost-effectiveness of interventions to reduce pneumonia mortality through risk reduction, immunization and case management. Methods: Country-specific pneumonia burden estimates and intervention costs from WHO were used to review estimates of pneumonia risk in children under 5 years of age and the efficacy of interventions (case management, pneumonia-related vaccines, improved nutrition and reduced indoor air pollution from household solid fuels). We calculated health benefits (disability-adjusted life years, DALYs, averted) and intervention costs over a period of 10 years for 40 countries, accounting for 90% of pneumonia child deaths. Findings: Solid fuel use contributes 30% (90% confidence interval: 18-44) to the burden of childhood pneumonia. Efficacious community-based treatment, promotion of exclusive breastfeeding, zinc supplementation and Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae immunization through existing programmes showed cost-effectiveness ratios of 10-60 International dollars (I$) per DALY in low-income countries and less than I$ 120 per DALY in middle-income countries. Low-emission biomass stoves and cleaner fuels may be cost-effective in low-income regions. Facility-based treatment is potentially cost-effective, with ratios of I$ 60-120 per DALY. The cost-effectiveness of community case management depends on home visit cost. Conclusion: Vaccines against Hib and S. pneumoniae, efficacious case management, breastfeeding promotion and zinc supplementation are cost-effective in reducing pneumonia mortality. Environmental and nutritional interventions reduce pneumonia and provide other benefits. These strategies combined may reduce total child mortality by 17%.

Original languageEnglish (US)
Pages (from-to)472-480
Number of pages9
JournalBulletin of the World Health Organization
Volume87
Issue number6
DOIs
StatePublished - Jun 2009

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Pneumonia
Case Management
Costs and Cost Analysis
Cost-Benefit Analysis
Haemophilus influenzae type b
Streptococcus pneumoniae
Breast Feeding
Zinc
Immunization
Vaccines
Indoor Air Pollution
Child Mortality
House Calls
Quality-Adjusted Life Years
Mortality
Risk Management
Insurance Benefits
Risk Reduction Behavior
Biomass
Confidence Intervals

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Comparative impact assessment of child pneumonia interventions. / Niessen, Louis; Ten Hove, Anne; Hilderink, Henk; Weber, Martin; Mulholland, Kim; Ezzati, Majid.

In: Bulletin of the World Health Organization, Vol. 87, No. 6, 06.2009, p. 472-480.

Research output: Contribution to journalArticle

Niessen, L, Ten Hove, A, Hilderink, H, Weber, M, Mulholland, K & Ezzati, M 2009, 'Comparative impact assessment of child pneumonia interventions', Bulletin of the World Health Organization, vol. 87, no. 6, pp. 472-480. https://doi.org/10.2471/BLT.08.050872
Niessen, Louis ; Ten Hove, Anne ; Hilderink, Henk ; Weber, Martin ; Mulholland, Kim ; Ezzati, Majid. / Comparative impact assessment of child pneumonia interventions. In: Bulletin of the World Health Organization. 2009 ; Vol. 87, No. 6. pp. 472-480.
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