Cost effectiveness of a latrine revision programme in Kabul, Afghanistan.
BACKGROUND
We assessed a household latrine revision intervention implemented in Kabul, Afghanistan for evidence of a reduction in diarrhoeal disease.


METHODS
A case-control design involving 1238 cases and 625 controls was used. Logistic regression modelling was performed both for children < 5 years and < or = 11 years, and the parameter estimates were later used with results from a stratified cluster sample survey. This survey used a verbal autopsy methodology to enable an estimation of the number of deaths averted over a 1-year period. A cost-effectiveness analysis using direct and indirect costs for the intervention was then conducted and the results compared with primary health care interventions identified from a Medline search.


RESULTS
Conditional logistic regression showed that patients were less likely than controls to live in households with revised latrines (odds ratio (OR) 0.57, 95% confidence interval (CI) = 0.42-0.77 for children < 5 years, and OR 0.53, 95% = CI 0.41-0.67 for children < or = 11 years). The results from the survey of cause-specific mortality by verbal autopsy enabled estimation of the number of deaths averted over a 1-year period due to the intervention; these estimations were 235 (95% CI = 109-360) for children < 5 years and 285 (95% CI = 180-397) for children < or = 11 years. Estimates of cost effectiveness ranged from approximately US dollars 1800 to US dollars 4100 per death averted depending on age and payer perspective.


CONCLUSIONS
These estimates are conservative because only 1 year of effectiveness is considered, yet they compare favourably with a review of other paediatric interventions. These results are important because funding for sanitation interventions is often limited by the belief that the interventions are not cost-effective.
Meddings
D R
DR
Unit of the Chief Medical Officer, International Committee of the Red Cross, Geneva, Switzerland. meddingsd@who.int
Ronald
L A
LA
Marion
S
S
Pinera
J F
JF
Oppliger
A
A
D000346:Afghanistan / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis; D003967:Diarrhea / Q000401:mortality* / Q000517:prevention & control*; D004867:Equipment Design / Q000191:economics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011050:Policy Making; D011322:Primary Prevention / Q000191:economics*; D012499:Sanitation / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D014038:Toilet Facilities / Q000191:economics*