Identifying Delivery Strategies for Cost-Effective Health Interventions in Kenya

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Malaria and diarrheal diseases are major barriers to improving maternal and child health in sub-Saharan Africa (SSA). Each year about 900,000 people in SSA die from malaria. Pregnant women and infants are particularly vulnerable. An estimated 10,000 women and 200,000 newborns, mostly in Africa, die each year as a result of malaria infection during pregnancy and severe malanal anemia (WHO, 2007a). Worldwide, diarrheal diseases kill almost two million children in poor countries each year (WHO, 2002, Kosek, et al., 2003), and 640,000 children under the age of five in SSA alone (Rao, et al., 2006). Overall, malaria and diarrhea account for 18 percent and 16 percent of under-five mortality, respectively (UNICEF, 2007). Many of these deaths could have been averted using available preventative measures. For instance, using an insecticide-treated net (ITN) during pregnancy reduces the incidence of severe maternal anemia by up to 47 percent (Marchant, et al., 2002; Ter Kuile, et al., 2003). Overall, ITNs can reduce the incidence of malaria by 50 percent and mortality by 20 percent at an estimated cost of $29 per disability-adjusted life year (DALY) averted. Point-of-use chlorination of drinking water reduces the incidence of endemic diarrhea by 37 percent at an estimated cost of $53 per DALY averted (Morel, et al., 2005; Clasen, 2007). However, ITN ownership and point-of-use water chlorination coverage are both under 10 percent in SSA (Miller, et al., 2007; Stockman et al., 2007). These low coverage rates suggest that these preventative products are not reaching the most vulnerable populations, raising two important questions: First, how can demand for these products be increased? Second, how can distribution systems be made more effective?