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Cost of childhood diarrhoea in rural South Africa: exploring cost-effectiveness of universal zinc supplementation

  • Meera K Chhagan (a1), Jan Van den Broeck (a2), Kany-Kany Angelique Luabeya (a3) (a4), Nontobeko Mpontshane (a5) and Michael L Bennish (a6)
  • DOI: http://dx.doi.org/10.1017/S1368980013002152
  • Published online: 12 August 2013
Abstract
AbstractObjective

To describe the cost of diarrhoeal illness in children aged 6–24 months in a rural South African community and to determine the threshold prevalence of stunting at which universal Zn plus vitamin A supplementation (VAZ) would be more cost-effective than vitamin A alone (VA) in preventing diarrhoea.

Design

We conducted a cost analysis using primary and secondary data sources. Using simulations we examined incremental costs of VAZ relative to VA while varying stunting prevalence.

Setting

Data on efficacy and societal costs were largely from a South African trial. Secondary data were from local and international published sources.

Subjects

The trial included children aged 6–24 months. The secondary data sources were a South African health economics survey and the WHO-CHOICE (CHOosing Interventions that are Cost Effective) database.

Results

In the trial, stunted children supplemented with VAZ had 2·04 episodes (95 % CI 1·37, 3·05) of diarrhoea per child-year compared with 3·92 episodes (95 % CI 3·02, 5·09) in the VA arm. Average cost of illness was $Int 7·80 per episode (10th, 90th centile: $Int 0·28, $Int 15·63), assuming a minimum standard of care (oral rehydration and 14 d of therapeutic Zn). In simulation scenarios universal VAZ had low incremental costs or became cost-saving relative to VA when the prevalence of stunting was close to 20 %. Incremental cost-effectiveness ratios were sensitive to the cost of intervention and coverage levels.

Conclusions

This simulation suggests that universal VAZ would be cost-effective at current levels of stunting in parts of South Africa. This requires further validation under actual programmatic conditions.

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Copyright
Corresponding author
*Corresponding author: Email chhagan@ukzn.ac.za
Linked references
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2.B Lorntz , AM Soares , SR Moore et al. (2006) Early childhood diarrhea predicts impaired school performance. Pediatr Infect Dis J 25, 513520.

3.KH Brown , JM Peerson , SK Baker et al. (2009) Preventive zinc supplementation among infants, preschoolers, and older prepubertal children. Food Nutr Bull 30, 1 Suppl., S12S40.

5.TT Edejer , M Aikins , R Black et al. (2005) Cost effectiveness analysis of strategies for child health in developing countries. BMJ 331, 1177.

7.MK Chhagan , J Van den Broeck , KK Luabeya et al. (2009) Effect of micronutrient supplementation on diarrhoeal disease among stunted children in rural South Africa. Eur J Clin Nutr 63, 850857.

8.M Umeta , CE West , J Haidar et al. (2000) Zinc supplementation and stunted infants in Ethiopia: a randomised controlled trial. Lancet 355, 20212026.

10.KK Luabeya , N Mpontshane , M Mackay et al. (2007) Zinc or multiple micronutrient supplementation to reduce diarrhea and respiratory disease in South African children: a randomized controlled trial. PLoS ONE 2, e541.

12.N Veenstra & A Oyier (2006) The burden of HIV-related illness on outpatient health services in KwaZulu-Natal, South Africa. AIDS Care 18, 262268.

13.T Adam , DB Evans & CJ Murray (2003) Econometric estimation of country-specific hospital costs. Cost Eff Resour Alloc 1, 3.

16.DB Evans , TT Edejer , T Adam et al. (2005) Methods to assess the costs and health effects of interventions for improving health in developing countries. BMJ 331, 11371140.

17.JA Olsen & J Richardson (1999) Production gains from health care: what should be included in cost-effectiveness analyses? Soc Sci Med 49, 1726.

19.R Bobat , H Coovadia , C Stephen et al. (2005) Safety and efficacy of zinc supplementation for children with HIV-1 infection in South Africa: a randomised double-blind placebo-controlled trial. Lancet 366, 18621867.

20.TK Fischer , DD Anh , L Antil et al. (2005) Health care costs of diarrheal disease and estimates of the cost-effectiveness of rotavirus vaccination in Vietnam. J Infect Dis 192, 17201726.

23.SY Hess , JM Peerson , JC King et al. (2007) Use of serum zinc concentration as an indicator of population zinc status. Food Nutr Bull 28, 3 Suppl., S403S429.

25.MM Rahman , SH Vermund , MA Wahed et al. (2001) Simultaneous zinc and vitamin A supplementation in Bangladeshi children: randomised double blind controlled trial. BMJ 323, 314318.

27.D Labadarios , NP Steyn , E Maunder et al. (2005) The National Food Consumption Survey (NFCS): South Africa, 1999. Public Health Nutr 8, 533543.

31.MK Chhagan , J Van den Broeck , KK Luabeya et al. (2010) Effect on longitudinal growth and anemia of zinc or multiple micronutrients added to vitamin A: a randomized controlled trial in children aged 6–24 months. BMC Public Health 10, 145.

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Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
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