Identifying Delivery Strategies for Cost-Effective Health Interventions in Kenya

疟疾和腹泻病是撒哈拉以南非洲(SSA)改善妇幼保健的主要障碍。每年，南沙地区约有90万人死于疟疾。孕妇和婴儿尤其容易受到感染。据估计，每年有10 000名妇女和200 000名新生儿死于孕期疟疾感染和严重的丙型贫血症(世卫组织，2007a)。在世界范围内，腹泻病每年导致贫穷国家近200万儿童死亡(世卫组织，2002年，Kosek等人，2003年)，仅在南非就有64万名5岁以下儿童死亡(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%(联合国儿童基金会，2007年)。 这些死亡中的许多人本可以使用可用的预防措施来避免。例如，在怀孕期间使用驱虫蚊帐(ITN)可将严重孕产妇贫血的发生率降低高达47%(Marchant等人，2002年；Ter Kuile等人，2003年)。总体而言，ITNS可以将疟疾发病率降低50%，死亡率降低20%，估计每个避免的残疾调整生命年(DALY)的成本为29美元。饮用水的使用点氯化处理将地方性腹泻的发病率降低了37%，估计每避免一次DALY的成本为53美元(Morel等人，2005年；Clasen，2007年)。然而，在SSA中，ITN所有权和使用点水加氯覆盖率都低于10%(Miller等人，2007年；斯托克曼等人，2007年)。这些低覆盖率表明，这些预防性产品没有接触到最脆弱的人群，这引发了两个重要问题：第一，如何才能增加对这些产品的需求？第二，如何提高分配系统的效率？

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?