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Community-Based Interventions for Newborns in Ethiopia (COMBINE): Cost-effectiveness analysis
Bereket Mathewos1, Helen Owen2, Deborah Sitrin3
1Save the Children, Addis Ababa, Ethiopia.
Health Policy and Planning
|October 6, 2017
Summary
Ethiopia
Area of Science:
- Global Health
- Public Health Policy
- Neonatal Care
Background:
- Ethiopia faces high annual neonatal mortality, with most births occurring at home.
- Existing community-based newborn care (Health Extension Programme) shows high maternal contact rates.
- Health Extension Workers (HEWs) are central to delivering community-based healthcare services.
Purpose of the Study:
- To evaluate the incremental benefits and costs of managing possible serious bacterial infection (PSBI) in newborns at health posts.
- To assess the integration of PSBI management into Ethiopia's Health Extension Programme.
- To determine the cost-effectiveness of community-based neonatal infection management.
Main Methods:
- A cluster randomized trial was conducted in Ethiopia.
- Both arms involved improved Health Extension Programme implementation.
- The intervention arm provided HEWs with additional resources for PSBI identification and treatment.
Main Results:
- The intervention demonstrated an estimated 17% reduction in neonatal mortality after day 1.
- The cost per Disability-Adjusted Life Year (DALY) averted was $223, considered highly cost-effective.
- Financial costs per mother-newborn pair were $34 (intervention) vs. $27 (control).
Conclusions:
- Strengthening the existing HEW package to include PSBI management is a cost-effective intervention.
- Community-level management of neonatal infections reduces mortality and avoids costly facility transfers.
- A platform-wide approach to supervision, including transport budgets, may enhance sustainability.
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