Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries.
OBJECTIVE
To determine the costs and benefits of interventions for maternal and newborn health to assess the appropriateness of current strategies and guide future plans to attain the millennium development goals.


METHODS
Cost effectiveness analysis.


METHODS
Two regions classified by the World Health Organization according to their epidemiological grouping: Afr-E, those countries in sub-Saharan Africa with very high adult and high child mortality, and Sear-D, comprising countries in South East Asia with high adult and high child mortality.


METHODS
Effectiveness data from several sources, including trials, observational studies, and expert opinion. For resource inputs, quantities came from WHO guidelines, literature, and expert opinion, and prices from the WHO choosing interventions that are cost effective database.


METHODS
Cost per disability adjusted life year (DALY) averted in year 2000 international dollars.


RESULTS
The most cost effective mix of interventions was similar in Afr-E and Sear-D. These were the community based newborn care package, followed by antenatal care (tetanus toxoid, screening for pre-eclampsia, screening and treatment of asymptomatic bacteriuria and syphilis); skilled attendance at birth, offering first level maternal and neonatal care around childbirth; and emergency obstetric and neonatal care around and after birth. Screening and treatment of maternal syphilis, community based management of neonatal pneumonia, and steroids given during the antenatal period were relatively less cost effective in Sear-D. Scaling up all of the included interventions to 95% coverage would halve neonatal and maternal deaths.


CONCLUSIONS
Preventive interventions at the community level for newborn babies and at the primary care level for mothers and newborn babies are extremely cost effective, but the millennium development goals for maternal and child health will not be achieved without universal access to clinical services as well.
Adam
Taghreed
T
Health Systems Financing, Evidence and Information for Policy, World Health Organization, Switzerland.
Lim
Stephen S
SS
Mehta
Sumi
S
Bhutta
Zulfiqar A
ZA
Fogstad
Helga
H
Mathai
Matthews
M
Zupan
Jelka
J
Darmstadt
Gary L
GL
D017954:Africa South of the Sahara / Q000453:epidemiology; D001210:Asia, Southeastern / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000191:economics*; D008428:Maternal Mortality; D018743:Perinatal Care / Q000191:economics*; D011247:Pregnancy; D019057:Quality-Adjusted Life Years