Reduced burden of childhood diarrheal diseases through increased access to water and sanitation in India: A modeling analysis
Reduced burden of childhood diarrheal diseases through increased access to water and sanitation in India: A modeling analysis
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DOI：
10.1016/j.socscimed.2016.08.049
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发表时间：
2017-05-01
影响因子：
5.4
通讯作者：
Laxminarayan, Ramanan
中科院分区：
文献类型：
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作者：
Nandi, Arindam;Megiddo, Itamar;Laxminarayan, Ramanan
印度每年有30多万5岁以下儿童死于疟疾。众所周知，清洁的自来水和改善的卫生设施可以有效降低腹泻的死亡率和发病率，但近一半的印度人口还无法获得这些服务。在本文中，我们估计了健康益处（减少腹泻病例！减少的发病率和死亡人数）和经济效益（以避免的自付治疗支出和获得的保险价值衡量），将印度家庭自来水和改善卫生设施的覆盖率扩大到接近普遍的95%。我们使用IndiaSim，一个先前验证的，基于代理的微观模拟平台来模拟印度的疾病进展和个人人口统计和就医行为，并使用迭代的随机过程来模拟随着时间的推移的健康和经济结果。我们发现，与基线相比，扩大自来水供应和改善卫生设施每年可避免每10万名5岁以下儿童中发生43，352起（95%不确定性范围[UR] 42，201 - 44，504）疟疾发作和68起（95% UR 62-74）疟疾死亡。我们估计每100，000名5岁以下儿童每年可节省自付腹泻治疗费用（以2013年美元计）357，788美元（95%为345，509 - 370，067美元），保险价值增加1646美元（95%为1603 - 1689美元）。保健和经济福利的累进性很高，即贫困家庭更多地得到这些福利。因此，扩大自来水供应和改善卫生条件，可以大幅度和公平地减轻印度儿童疟疾的负担。(C)2016爱思唯尔有限公司版权所有
Each year, more than 300,000 children in India under the age of five years die from diarrheal diseases. Clean piped water and improved sanitation are known to be effective in reducing the mortality and morbidity burden of diarrhea but are not yet available to close to half of the Indian population. In this paper, we estimate the health benefits (reduced cases of diarrhea! incidence and deaths averted) and economic benefits (measured by out-of-pocket treatment expenditure averted and value of insurance gained) of scaling up the coverage of piped water and improved sanitation among Indian households to a near-universal 95% level. We use IndiaSim, a previously validated, agent-based microsimulation platform to model disease progression and individual demographic and healthcare-seeking behavior in India, and use an iterative, stochastic procedure to simulate health and economic outcomes over time. We find that scaling up access to piped water and improved sanitation could avert 43,352 (95% uncertainty range [UR] 42,201-44,504) diarrheal episodes and 68 (95% UR 62-74) diarrheal deaths per 100,000 under-5 children per year, compared with the baseline. We estimate a saving of (in 2013 US$) $357,788 (95% $345,509-$370,067) in out-of-pocket diarrhea treatment expenditure, and $1646 (95% UR $1603-$1689) in incremental value of insurance per 100,000 under-5 children per year over baseline. The health and financial benefits are highly progressive, i.e. they reach poorer households more. Thus, scaling up access to piped water and improved sanitation can lead to large and equitable reductions in the burden of childhood diarrheal diseases in India. (C) 2016 Elsevier Ltd. All rights reserved.