Cost of childhood diarrhoea in rural South Africa: exploring cost-effectiveness of universal zinc supplementation

Abstract

Objective: To describe the cost of diarrhoeal illness in children aged 6-24 months in a rural South African community and to determine the threshold prevalence of stunting at which universal Zn plus vitamin A supplementation (VAZ) would be more cost-effective than vitamin A alone (VA) in preventing diarrhoea. Design: We conducted a cost analysis using primary and secondary data sources. Using simulations we examined incremental costs of VAZ relative to VA while varying stunting prevalence. Setting: Data on efficacy and societal costs were largely from a South African trial. Secondary data were from local and international published sources. Subjects: The trial included children aged 6-24 months. The secondary data sources were a South African health economics survey and the WHO-CHOICE (CHOosing Interventions that are Cost Effective) database. Results: In the trial, stunted children supplemented with VAZ had 2?04 episodes (95 % CI 1?37, 3?05) of diarrhoea per child-year compared with 3?92 episodes (95 % CI 3?02, 5?09) in the VA arm. Average cost of illness was $Int 7?80 per episode (10th, 90th centile: $Int 0?28, $Int 15?63), assuming a minimum standard of care (oral rehydration and 14 d of therapeutic Zn). In simulation scenarios universal VAZ had low incremental costs or became cost-saving relative to VA when the prevalence of stunting was close to 20 %. Incremental cost-effectiveness ratios were sensitive to the cost of intervention and coverage levels. Conclusions: This simulation suggests that universal VAZ would be cost-effective at current levels of stunting in parts of South Africa. This requires further validation under actual programmatic conditions.

Antibiotic Residue in the Aquatic Environment: Status in Africa

“…These life conditions, in addition to poor nutritional status, enhance the risk for different types of diarrheal infections [67]. Diarrhea can be self-regressive after a few days without treatment [68] among the immune-competent, but may be persistent among the immunocompromised or immunosuppressed individuals. Diarrhea disease are prominent in South Africa among children [67] and it is also closely connected to HIV/AIDS.…”

Cost-effectiveness of zinc supplementation for prevention of childhood diarrhoea in Tanzania

“…While a number of studies have examined the cost-effectiveness for preventing diarrhoea (Robberstad et al, 2004;Mejia et al, 2015;Shillcutt et al, 2017), these studies have been performed in the context of therapeutic zinc supplementation, and the outcomes for prophylactic zinc may differ. In addition, the few cost-effectiveness studies for prophylactic zinc have been conducted among children older than 6 months of age (Brown et al, 2013;Chhagan et al, 2013;Fink and Heitner, 2014) and none have been performed using data from East Africa. This study was therefore conducted to fill the knowledge gap with regards to the cost-effectiveness of prophylactic zinc supplementation in preventing various forms of diarrhoea in children aged between 6 weeks and 18 months in an east African setting.…”