title: Forecasting burden of long-term disability from neonatal conditions: results from the Projahnmo I trial, Sylhet, Bangladesh.
abstract: BACKGROUND
  The burden of disease resulting from neonatal conditions is substantial in developing countries. From 2003 to 2005, the Projahnmo I programme delivered community-based interventions for maternal and newborn health in Sylhet, Bangladesh. This analysis quantifies burden of disability and incorporates non-fatal outcomes into cost-effectiveness analysis of interventions delivered in the Projahnmo I programme.
  
  
  METHODS
  A decision tree model was created to predict disability resulting from preterm birth, neonatal meningitis and intrapartum-related hypoxia ('birth asphyxia'). Outcomes were defined as the years lost to disability (YLD) component of disability-adjusted life years (DALYs). Calculations were based on data from the Projahnmo I trial, supplemented with values from published literature and expert opinion where data were absent.
  
  
  RESULTS
  195 YLD per 1000 neonates [95% confidence interval (CI): 157-241] were predicted in the main calculation, sensitive to different DALY assumptions, disability weights and alternative model structures. The Projahnmo I home care intervention may have averted 2.0 (1.3-2.8) YLD per 1000 neonates. Compared with calculations based on reductions in mortality alone, the cost-effectiveness ratio decreased by only 0.6% from $105.23 to $104.62 ($65.15-$266.60) when YLD were included, with 0.6% more DALYs averted [total 338/1000 (95% CI: 131-542)].
  
  
  CONCLUSIONS
  A significant burden of disability results from neonatal conditions in Sylhet, Bangladesh. Adding YLD has very little impact on recommendations based on cost-effectiveness, even at the margin of programme adoption. This model provides guidance for collecting data on disabilities in new settings.
authors.affiliation: Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. sshillcu@gmail.com
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Shillcutt
authors.forename: Amnesty E
authors.initials: AE
authors.lastname: Lefevre
authors.forename: Anne C C
authors.initials: AC
authors.lastname: Lee
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D003153:Community Health Services / Q000191:economics; D016001:Confidence Intervals; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D019988:Children with Disabilities; D004660:Encephalitis / Q000150:complications / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D006699:Home Care Services; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008581:Meningitis / Q000150:complications / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D013997:Time Factors