Cost‐Effectiveness Analysis of Zinc Supplementation for Treatment of Acute Diarrhea in Children Younger Than 5 Years in Colombia

Mejía, Ana María; Atehortúa, Sara; Flórez, Iván D.; Sierra, Javier; Mejía, María Eliana Vera; Ramírez, Carolina

doi:10.1097/mpg.0000000000000638

Cited by 14 publications

(14 citation statements)

References 25 publications

(36 reference statements)

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“…With all the above mentioned advantages the simple cost effective method of oral zinc supplementation can be incorporated into diarrhoeal disease control program in developing countries. (11,12) BIBLIOGRAPHY:…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Effectiveness of Zinc Therapy in the Treatment of Acute Diarrhoea Among Children

Nazarullah¹,

Pillai²,

Nair³

2015

jemds

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BACKGROUND: Diarrhoea is one of the leading causes of morbidity and mortality affecting children in developing countries. We studied the efficacy of zinc therapy in reducing the duration of diarrhoea. MATERIALS AND METHODS: A double-blinded randomized control study was done in 100 children between age groups 1 month to 5 years having acute diarrhoea. These children were randomly divided into 2 groups. Group 1 received oral supplementation of 20mg zinc and ORS from day one of treatment while group 2 received only ORS therapy. Children who received zinc or antibiotics prior to the study were excluded. Clinical profile of children like age, gender, nutritional status and dehydration level was have been taken into consideration. The outcome of the study was assessed by comparing the mean number of watery stools of both the groups during the course of therapy. RESULTS: Out of 100 children based in the study 50 children in group 1 who received oral zinc supplementation showed a 36% reduction in duration of diarrhoea (6.22 days vs. 8.26 days). CONCLUSION: Zinc supplementation help reduce the duration of acute diarrhoea. KEYWORDS: Zinc, Diarrhoea. INTRODUCTION:Diarrhoeal disease is a major cause of childhood morbidity and mortality affecting millions of children worldwide. (1,2) It is estimated that more than 3 million deaths in developing countries each year is caused by diarrhoeal disease and contribute substantially to malnutrition in surviving children. (2) In accordance with the recommendations of WHO and UNICEF over the past 3 decades children of all ages including infants with acute diarrhoea of any etiology have been treated with standard oral rehydrating salt (ORS) solution. (3) Due to proven efficacy, safety and low cost, standard ORS has been widely used. Along with continued feeding, ORS has helped to bring about a decline in the fatality rate of acute dehydrating diarrhoea in children in developing countries (3). However with the use of ORS there is no reduction of stool volume, diarrhoeal duration and frequency of loose stools raising a practical problem of its acceptance and compliance. (4) Studies have reported that daily loss of zinc in the intestinal fluid during acute diarrhoea is as high as 159 mic/kg/day compared to 47 mic/kg/day in control. (5) A simple and sensitive measuring tool for zinc status is lacking, It can however be assumed that because of low bioavailability of zinc from cereal based diet (6) subclinical zinc deficiency is common in developing countries. Few children with acute diarrhoea also have lowered immunity as manifested by the absence of a cell mediated response to common antigen applied to skin. Micronutrient deficiency is the most likely explanation for this phenomenon. (7) Zinc is important for growth of intestinal mucosa and improves the transport of water and electrolytes (8) across the intestinal mucosa. Zinc also is essential in growth, protein synthesis, epithelial repair and synthesis of RNA and DNA. (9)

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Section: Discussionmentioning

confidence: 99%

Efficacy and Effectiveness of Zinc Therapy in the Treatment of Acute Diarrhoea Among Children

Nazarullah¹,

Pillai²,

Nair³

2015

jemds

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“…50 In its 2014 survey of coca production, UNODC noted that in addition to simply moving, coca producers have found various means of combating aerial spraying, including interspersing and rotating their coca bushes with other crops to avoid detection, planting in remote areas less likely to be detected, washing the leaves, putting molasses or other substances on the leaves to counter the herbicide, and isolating the leafy part of the plant from the herbicide. 366,374 …”

Section: Drug Crops Drug Policy and Healthmentioning

confidence: 99%

“…As Mejía notes, since contracts in illegal markets are not enforced with the help of the courts or the rule of law, traffickers take it upon themselves to use their own violent means. 374 While in some cases in the Andes drug trafficking organizations provide infrastructure, even schools and health centres, to communities relying on drug crop cultivation for survival, sometimes the interaction with drug traffickers is in the form of death threats and lethal gun battles. 386 …”

Section: Drug Crops Drug Policy and Healthmentioning

confidence: 99%

“…Mejía estimates that eliminating the marginal cost of eliminating the amount of coca needed to produce 1 kg of cocaine is about US $240 000. 374 In announcing the end to US support to poppy eradication in Afghanistan, then US envoy Richard Holbrooke cited an estimate that destroying a hectare of poppies cost US $44 000. 391 Holbrooke noted:

The United States [and its allies] are not going to go around assisting or participating in the destruction of poppy fields anymore.

…”

Section: Drug Crops Drug Policy and Healthmentioning

confidence: 99%

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Public health and international drug policy

et al. 2016

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Executive summary In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms. Health impact of drug policy based on enforcement of prohibition The pursuit of drug prohibition has generated a parallel economy run by criminal networks. Both these networks, which resort to violence to protect their markets, and the police and sometimes military ...

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“…breastfeeding, zinc tablets and retinol in addition to ORS or IVF. They considered zinc alone [ 16 ], ORS alone, ORS plus zinc alone [ 17 ], [ 18 ], or ORS plus rotavirus vaccine alone [ 19 ]. It is necessary to evaluate the holistic effect of these components in a cost-effectiveness analysis.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of diarrhoea management approaches in Nigeria: A decision analytical model

Okafor

Ekwunife

2017

PLoS Negl Trop Dis

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BackgroundDiarrhoea is a leading cause of death in Nigerian children under 5 years. Implementing the most cost-effective approach to diarrhoea management in Nigeria will help optimize health care resources allocation. This study evaluated the cost-effectiveness of various approaches to diarrhoea management namely: the ‘no treatment’ approach (NT); the preventive approach with rotavirus vaccine; the integrated management of childhood illness for diarrhoea approach (IMCI); and rotavirus vaccine plus integrated management of childhood illness for diarrhoea approach (rotavirus vaccine + IMCI).MethodsMarkov cohort model conducted from the payer’s perspective was used to calculate the cost-effectiveness of the four interventions. The markov model simulated a life cycle of 260 weeks for 33 million children under five years at risk of having diarrhoea (well state). Disability adjusted life years (DALYs) averted was used to quantify clinical outcome. Incremental cost-effectiveness ratio (ICER) served as measure of cost-effectiveness.ResultsBased on cost-effectiveness threshold of $2,177.99 (i.e. representing Nigerian GDP/capita), all the approaches were very cost-effective but rotavirus vaccine approach was dominated. While IMCI has the lowest ICER of $4.6/DALY averted, the addition of rotavirus vaccine was cost-effective with an ICER of $80.1/DALY averted. Rotavirus vaccine alone was less efficient in optimizing health care resource allocation.ConclusionRotavirus vaccine + IMCI approach was the most cost-effective approach to childhood diarrhoea management. Its awareness and practice should be promoted in Nigeria. Addition of rotavirus vaccine should be considered for inclusion in the national programme of immunization. Although our findings suggest that addition of rotavirus vaccine to IMCI for diarrhoea is cost-effective, there may be need for further vaccine demonstration studies or real life studies to establish the cost-effectiveness of the vaccine in Nigeria.

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Cost‐Effectiveness Analysis of Zinc Supplementation for Treatment of Acute Diarrhea in Children Younger Than 5 Years in Colombia

Abstract: Zinc for the treatment of AD is a highly cost-effective strategy and is recommended for inclusion in the benefit plan of the Colombian health system. This intervention is more cost-effective in children with a higher risk of persistent diarrhea and hospitalization.

Cited by 14 publications

References 25 publications

Efficacy and Effectiveness of Zinc Therapy in the Treatment of Acute Diarrhoea Among Children

Efficacy and Effectiveness of Zinc Therapy in the Treatment of Acute Diarrhoea Among Children

Public health and international drug policy

Cost-effectiveness analysis of diarrhoea management approaches in Nigeria: A decision analytical model

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