The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana

To evaluate the cost-effectiveness of a quality improvement intervention aimed at reducing maternal and fetal mortality in Accra, Ghana.Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis.Data were collected on the cost and outcomes of a 5-year Kybele-Ghana Health Service Quality Improvement (QI) intervention conducted at Ridge Regional Hospital, a tertiary referral center in Accra, Ghana, focused on systems, personnel, and communication. Maternal deaths prevented were estimated comparing observed rates with counterfactual projections of maternal mortality and case-fatality rates for hypertensive disorders of pregnancy and obstetric hemorrhage. Stillbirths prevented were estimated based on counterfactual estimates of stillbirth rates. Cost-effectiveness was then calculated using estimated disability-adjusted life years averted and subjected to Monte Carlo and one-way sensitivity analyses to test the importance of assumptions inherent in the calculations.Incremental Cost-effectiveness ratio (ICER), which represents the cost per disability-adjusted life-year (DALY) averted by the intervention compared to a model counterfactual.From 2007-2011, 39,234 deliveries were affected by the QI intervention implemented at Ridge Regional Hospital. The total budget for the program was $2,363,100. Based on program estimates, 236 (±5) maternal deaths and 129 (±13) intrapartum stillbirths were averted (14,876 DALYs), implying an ICER of$158 ($129-$195) USD. This value is well below the highly cost-effective threshold of $1268 USD. Sensitivity analysis considered DALY calculation methods, and yearly prevalence of risk factors and case fatality rates. In each of these analyses, the program remained highly cost-effective with an ICER ranging from$97-$218.QI interventions to reduce maternal and fetal mortality in low resource settings can be highly cost effective. Cost-effectiveness analysis is feasible and should regularly be conducted to encourage fiscal responsibility in the pursuit of improved maternal and child health

Cholera in Oceania

For approximately 200 years, cholera has been feared globally as a disease that can cause rapid-onset epidemics. The causative organisms, Vibrio cholerae O1 and O139 serogroups, are endemic to Southern Asia, but appear to spread globally in waves resulting in seven recognised pandemics to date. The current seventh pandemic has seen the introduction of V. cholerae O1 El Tor into the Oceania region. Since 1962 there have been five large outbreaks at a frequency of approximately one per decade. There have also been regular small outbreaks and clusters of disease throughout the region during the seventh pandemic. The most recent outbreak of cholera in the region occurred in Papua New Guinea in 2009–2011, and this was the largest outbreak to occur in the region to date. In Oceania the majority of people live in high-income settings (Australia and New Zealand) so the risk of cholera transmission is low. Despite this, an estimated 6.5 million people living in the region are at risk of cholera. The most important risk factors are inadequate access to safe water and lack of appropriate sanitation and hygiene measures. However, many other factors may contribute to cholera transmission risk, and people living in Pacific Island countries may be at increased risk in the future due to climate change. Strengthening health delivery services in the region will ensure countries are better equipped to handle future cholera outbreaks; and further understanding the epidemiology of cholera and the causative agent in the region could help prevent future transmission