Identifying Delivery Strategies for Cost-Effective Health Interventions in Kenya

疟疾和疟疾是撒哈拉以南非洲改善孕产妇和儿童健康的主要障碍。撒南非洲每年约有90万人死于疟疾。孕妇和婴儿尤其容易受到伤害。据估计，每年有10 000名妇女和200 000名新生儿（主要在非洲）死于妊娠期间感染疟疾和严重的肛门贫血（世卫组织，2007年a）。在世界范围内，疟疾每年在贫穷国家造成近200万儿童死亡（WHO，2002年，Kosek等人，2003年），仅在撒南非洲就有640，000名5岁以下儿童（Rao等人，2006年）。总体而言，疟疾和腹泻分别占五岁以下儿童死亡率的18%和16%（儿童基金会，2007年）。 这些死亡中有许多是可以通过现有的预防措施避免的。例如，在怀孕期间使用驱虫蚊帐（ITN）可将严重的母体贫血的发生率降低高达47%（Marchant等人，2002; Ter Kuile等人，2003年）。总的来说，驱虫蚊帐可以减少50%的疟疾发病率和20%的死亡率，估计每避免一个残疾调整生命年的成本为29美元。饮用水的使用点氯化将地方性腹泻的发病率降低了37%，估计每避免一个DALY的成本为53美元（Morel等人，2005; Clasen，2007）。然而，在撒南非洲，驱虫蚊帐所有权和使用点水氯化覆盖率均低于10%（米勒等人，2007; Stockman等人，2007年）。这些低覆盖率表明，这些预防性产品没有到达最脆弱的人群，提出了两个重要问题：第一，如何增加对这些产品的需求？第二，如何使分配制度更加有效？

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?