Comparative impact assessment of child pneumonia interventions.
OBJECTIVE
To compare the cost-effectiveness of interventions to reduce pneumonia mortality through risk reduction, immunization and case management.


METHODS
Country-specific pneumonia burden estimates and intervention costs from WHO were used to review estimates of pneumonia risk in children under 5 years of age and the efficacy of interventions (case management, pneumonia-related vaccines, improved nutrition and reduced indoor air pollution from household solid fuels). We calculated health benefits (disability-adjusted life years, DALYs, averted) and intervention costs over a period of 10 years for 40 countries, accounting for 90% of pneumonia child deaths.


RESULTS
Solid fuel use contributes 30% (90% confidence interval: 18-44) to the burden of childhood pneumonia. Efficacious community-based treatment, promotion of exclusive breastfeeding, zinc supplementation and Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae immunization through existing programmes showed cost-effectiveness ratios of 10-60 International dollars (I$) per DALY in low-income countries and less than I$ 120 per DALY in middle-income countries. Low-emission biomass stoves and cleaner fuels may be cost-effective in low-income regions. Facility-based treatment is potentially cost-effective, with ratios of I$ 60-120 per DALY. The cost-effectiveness of community case management depends on home visit cost.


CONCLUSIONS
Vaccines against Hib and S. pneumoniae, efficacious case management, breastfeeding promotion and zinc supplementation are cost-effective in reducing pneumonia mortality. Environmental and nutritional interventions reduce pneumonia and provide other benefits. These strategies combined may reduce total child mortality by 17%.
Niessen
Louis W
LW
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States of America (USA). lniessen@jhsph.edu
ten Hove
Anne
A
Hilderink
Henk
H
Weber
Martin
M
Mulholland
Kim
K
Ezzati
Majid
M
D002648:Child; D046688:Child Mortality / Q000639:trends; D002675:Child, Preschool; D003906:Developing Countries / Q000706:statistics & numerical data; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D011014:Pneumonia / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors
D022242:Pneumococcal Vaccines