Achieving the millennium development goals for health - Cost effectiveness analysis of strategies for. maternal and neonatal health in developing countries
Achieving the millennium development goals for health - Cost effectiveness analysis of strategies for. maternal and neonatal health in developing countries
复制标题
DOI：
10.1136/bmj.331.7525.1107
复制
发表时间：
2005-11-12
影响因子：
105.7
通讯作者：
Darmstadt, GL
中科院分区：
文献类型：
--
作者：
Adam, T;Lim, SS;Darmstadt, GL
目的确定孕产妇和新生儿健康干预措施的成本和效益，以评估当前战略的适当性，并指导未来计划实现千年发展目标。设计成本效益分析。设置世界卫生组织根据流行病学分组划分的两个地区：Afr-E指撒哈拉以南非洲成人和儿童死亡率很高的国家，Sear-D指东南亚成人和儿童死亡率很高的国家。数据来源包括试验、观察性研究和专家意见。对于资源投入，量化来自世界卫生组织的指导方针，文献，和专家意见，和价格从世界卫生组织选择的干预措施，是成本效益database.Main结果measures成本每残疾调整生命年（DALY）避免在2000年国际元。这些是基于社区的新生儿护理包，其次是产前护理（破伤风类毒素、先兆子痫筛查、无症状菌尿和梅毒筛查和治疗）;熟练助产护理，在分娩前后提供初级孕产妇和新生儿护理;以及分娩前后的产科和新生儿急诊护理。在Sear-D中，母体梅毒的筛查和治疗、新生儿肺炎的社区管理以及产前给予类固醇的成本效益相对较低。扩大所有包括的干预措施，以95%的覆盖率将减半新生儿和孕产妇deaths.Conclusion预防干预措施在社区一级的新生儿和初级保健水平的母亲和新生儿是非常具有成本效益的，但千年发展目标的孕产妇和儿童健康将无法实现没有普及临床服务。
Objective To determine the costs and benefits of interventions for maternal and newborn health to assess the appropriateness of current strategies and guide future plans to attain the millennium development goals.Design Cost effectiveness analysis.Setting Two regions classified by the World Health Organization according to their epidemiological grouping: Afr-E, those countries in sub-Saharan Africa with very high adult and high child mortality, and Sear-D, comprising countries in South East Asia with high adult and high child mortality.Data sources Effectiveness data from several sources, including trials, observational studies, and expert opinion. For resource inputs, quantifies came from WHO guidelines, literature, and expert opinion, and prices from the WHO choosing interventions that are cost effective database.Main outcome measures Cost per disability adjusted life year (DALY) averted in year 2000 international dollars.Results The most cost effective mix of interventions was similar in Afr-E and Sear-D. These were the community based newborn care package, followed by antenatal care (tetanus toxoid, screening for pre-eclampsia, screening and treatment of asymptomatic bacteriuria and syphilis); skilled attendance at birth, offering first level maternal and neonatal care around childbirth; and emergency obstetric and neonatal care around and after birth. Screening and treatment of maternal syphilis, community based management of neonatal pneumonia, and steroids given during the antenatal period were relatively less cost effective in Sear-D. Scaling up all of the included interventions to 95% coverage would halve neonatal and maternal deaths.Conclusion Preventive interventions at the community level for newborn babies and at the primary care level for mothers and newborn babies are extremely cost effective, but the millennium development goals for maternal and child health will not be achieved without universal access to clinical services as well.