Full Report - Research for Development - Department for ...

HIV/AIDS and Malaria, as well as non-communicable diseases like diabetes or
cardiovascular disease.
Synthesis results
When assessing whether studies met our inclusion criteria, not only did we want
therefore to identify whether some studies looked at the costs of implementing
interventions, but also whether we could identify any economic evaluations
synthesising cost and effects data. In doing this we were interested not only in
economic evaluations linked to empirical studies, but also those studies that
constructed models drawing on effectiveness and resource use data from many
sources to make a judgement on potential cost-effectiveness. The quality of
evaluations included in our review was assessed using both the Drummond and
Jefferson (1996) and Evers et al. (2005) checklists as recommended in the Cochrane
Handbook for Systematic Reviews of Interventions (Higgins and Green, 2011).
Results
It is important to note that there is an ever-increasing evidence base looking at the
cost-effectiveness of interventions related to maternal and infant health in low
income country contexts (e.g. Jowett, 2000; Rouse, 2003; Adam et al., 2005; Vos et
al., 2006; Darmstadt et al., 2008 (++)/(++); Goldie et al., 2010). For instance, Adam
et al. (2005) drew together a range of data on the effectiveness of interventions to
look at potential cost-effectiveness in sub-Saharan Africa and south-east Asia,
coming to the conclusion that improving access to preventive measures and early
care would all be cost effective in all settings. These would include antenatal care
(tetanus toxoid, screening for pre-eclampsia, screening and treatment of
asymptomatic bacteria and syphilis); skilled attendance at birth, offering first-level
maternal and neonatal care around childbirth; and emergency obstetric and
neonatal care.
Despite this increase in the broad cost-effectiveness evidence base, our analysis
suggests that few economic evaluations that explicitly met our inclusion criteria
have been undertaken. Little work has been undertaken to look at issues of access,
uptake and use of effective interventions in our study population. As part of our
review, 11 potential economic evaluations were identified by the study team.
However after reading the full text, only four met our inclusion criteria (Appendix
4.8). Seven other studies were excluded because they did not have some focus on an
urban poor population, although they did provide some further economic evidence
for interventions to tackle maternal and infant mortality in low income country
settings. For instance, Hounton et al. (2008) reported on the cost-effectiveness of
improving access to skilled birthing care in a rural area of Burkina Faso. Meantime
Hutton et al. (2009) reported that the administration of three sessions of
sulfadoxine-pyrimethamine treatment to prevent malaria in infants up to the age of
nine months in rural Tanzania and Mozambique had a cost per death averted of US
$100 and US $300 respectively. Thus this intervention would be considered cost
effective in these two populations. Tsu et al. (2009) suggested that increased use of
oxytocin during the third stage of labour would be cost effective in reducing the risk
of postpartum haemorrhage in rural Vietnam.
From our original set of studies, we did identify some papers that had some limited
information on the costs of some services, but without any discussion of the
consequences for health services and other resource use going forward. We also
identified several additional economic evaluations at the abstract screening stage
that all focused on rural populations. For example, Rydzak (2008) and colleagues
looked at the economic case for prenatal syphilis screening in sub-Saharan Africa as
a whole, suggesting overall that some screening programmes could not only reduce
stillbirths and infant deaths, but also reduce costs overall. Sutherland et al. (2009
and 2010) modelled the potential cost-effectiveness of prenatal iron
What are the effects of different models of delivery for improving maternal and infant health
outcomes for poor people in urban areas in low income and lower middle income countries? 41