Cost effectiveness of a latrine revision programme in Kabul, Afghanistan
INTRODUCTION: 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...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
The World Health Organization
2004-01-01
|
| Series: | Bulletin of the World Health Organization |
| Subjects: | |
| Online Access: | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862004000400010 |
| _version_ | 1827333424229122048 |
|---|---|
| author | Meddings D.R. Ronald L.A. Marion S. Pinera J.F. Oppliger A. |
| author_facet | Meddings D.R. Ronald L.A. Marion S. Pinera J.F. Oppliger A. |
| author_sort | Meddings D.R. |
| collection | DOAJ |
| description | INTRODUCTION: 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 <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. FINDINGS: 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 <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 <11 years. Estimates of cost effectiveness ranged from approximately US$ 1800 to US$ 4100 per death averted depending on age and payer perspective. CONCLUSION: 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. |
| first_indexed | 2024-03-07T17:25:12Z |
| format | Article |
| id | doaj.art-5051c25c430540128b18c12dff0e0007 |
| institution | Directory Open Access Journal |
| issn | 0042-9686 |
| language | English |
| last_indexed | 2024-03-07T17:25:12Z |
| publishDate | 2004-01-01 |
| publisher | The World Health Organization |
| record_format | Article |
| series | Bulletin of the World Health Organization |
| spelling | doaj.art-5051c25c430540128b18c12dff0e00072024-03-02T19:19:58ZengThe World Health OrganizationBulletin of the World Health Organization0042-96862004-01-01824281289Cost effectiveness of a latrine revision programme in Kabul, AfghanistanMeddings D.R.Ronald L.A.Marion S.Pinera J.F.Oppliger A.INTRODUCTION: 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 <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. FINDINGS: 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 <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 <11 years. Estimates of cost effectiveness ranged from approximately US$ 1800 to US$ 4100 per death averted depending on age and payer perspective. CONCLUSION: 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.http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862004000400010Toilet facilities/economicsDiarrhea/mortalityDiarrhea/prevention and controlInfant mortalityPrimary health careRed CrossCost-benefit analysisCase-control studiesComparative studyAfghanistan |
| spellingShingle | Meddings D.R. Ronald L.A. Marion S. Pinera J.F. Oppliger A. Cost effectiveness of a latrine revision programme in Kabul, Afghanistan Bulletin of the World Health Organization Toilet facilities/economics Diarrhea/mortality Diarrhea/prevention and control Infant mortality Primary health care Red Cross Cost-benefit analysis Case-control studies Comparative study Afghanistan |
| title | Cost effectiveness of a latrine revision programme in Kabul, Afghanistan |
| title_full | Cost effectiveness of a latrine revision programme in Kabul, Afghanistan |
| title_fullStr | Cost effectiveness of a latrine revision programme in Kabul, Afghanistan |
| title_full_unstemmed | Cost effectiveness of a latrine revision programme in Kabul, Afghanistan |
| title_short | Cost effectiveness of a latrine revision programme in Kabul, Afghanistan |
| title_sort | cost effectiveness of a latrine revision programme in kabul afghanistan |
| topic | Toilet facilities/economics Diarrhea/mortality Diarrhea/prevention and control Infant mortality Primary health care Red Cross Cost-benefit analysis Case-control studies Comparative study Afghanistan |
| url | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862004000400010 |
| work_keys_str_mv | AT meddingsdr costeffectivenessofalatrinerevisionprogrammeinkabulafghanistan AT ronaldla costeffectivenessofalatrinerevisionprogrammeinkabulafghanistan AT marions costeffectivenessofalatrinerevisionprogrammeinkabulafghanistan AT pinerajf costeffectivenessofalatrinerevisionprogrammeinkabulafghanistan AT oppligera costeffectivenessofalatrinerevisionprogrammeinkabulafghanistan |