Identifying Delivery Strategies for Cost-Effective Health Interventions in Kenya

疟疾和腹泻疾病是撒哈拉以南非洲改善孕产妇和儿童健康的主要障碍。SSA每年约有90万人死于疟疾。孕妇和婴儿尤其容易受到伤害。估计每年有1万名妇女和20万名新生儿（多数在非洲）死于怀孕期间感染疟疾和严重马拉肛门性贫血（卫生组织，2007年a）。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），仅在撒哈拉以南非洲就有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）。

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?