Cost Effectiveness of Paediatric Antiretroviral Therapy in Low Resource Settings: The Zambian Case

This paper presents a cost-effectiveness analysis (CEA) of paediatric ARV administration in Zambia using cotrimoxazole as a comparator. The CEA was facilitated by the paediatric formulations provided by the Indian company Cipla Limited for the CHAPAS (Children with HIV in Africa – Pharmacokinetics and Adherence of Simple Antiretroviral Regimens) randomized controlled trials. The study design for ARVs was an open, randomised and controlled phase I and II trial, in which 220 children were recruited using a set of inclusive and exclusive criteria and randomised on the basis of 1:1 ratio. Two models were used for analysis: Cost-effectiveness analysis and the Markov stochastic model. The integrated results on a number of outcomes such as the CD4 distribution over time, cost estimates, estimates of transition probabilities, estimates of life expectancy, survival curves, incremental cost effectiveness ratios and net health benefits attest the dominance of the ARVs over cotrimoxazole and its high desirability of use as a vital complement to the comparator drug which has its own merit as a low-cost intervention.. Keywords: Paediatric ARV, Incremental Cost Effectiveness Ratio, Markov model, net health benefits, survival analysi

Costing of Paediatric Treatment alongside Clinical Trials under Low Resource Constraint Environments: Cotrimoxazole and Antiretroviral Medications in Children Living with HIV/AIDS

Introduction. Costing evidence is essential for policy makers for priority setting and resource allocation. It is in this context that the clinical trials of ARVs and cotrimoxazole provided a costing component to provide evidence for budgeting and resource needs alongside the clinical efficacy studies. Methods. A micro based costing approach was adopted, using case record forms for maintaining patient records. Costs for fixed assets were allocated based on the paediatric space. Medication and other resource costs were costed using the WHO/MSH Drug Price Indicators as well as procurement data where these were available. Results. The costs for cotrimoxazole and ARVs are significantly different. The average costs for human resources were US$22 and US$71 for physician costs and $1.3 and$16 for nursing costs while in-patient costs were $257 and$15 for the cotrimoxazole and ARV cohorts, respectively. Mean or average costs were $870 for the cotrimoxazole cohort and$218 for the ARV. The causal factors for the significant cost differences are attributable to the higher human resource time, higher infections of opportunistic conditions, and longer and higher frequency of hospitalisations, among others

Determinants of Child Nutritional Status in Zambia: An Analysis of a National Survey

Malnutrition affects many children and is a leading cause of childhood mortality and non-fatal health loss. Zambia has one of the highest rates of malnutrition in the world. About half of the Zambian children are stunted while one in five is underweight. Prevalence of wasting is much lower. This article examines the determinants of nutritional status among children aged below five years in Zambia using data from a national cross-sectional survey conducted in 2006. Multivariate analysis is used to quantify the effects of several household and child-specific socioeconomic and demographic factors on nutritional status, as well as a geographic context (community level) fixed effect. Our analysis indicates that household expenditure is a leading determinant of nutritional status of a child. Further, the positive effect of parental education was observed. Children become more malnourished as they get older than 18 months. Poor nutrition falls disproportionately on rural children, after all other included covariates were controlled for. The significance of the geographic context suggests an underlying ecological pattern to malnutrition besides the individual and households factors. Understanding the determinants of poor nutritional attainment can provide insights in designing interventions for reducing the high levels of child malnutrition in Zambia

Returns to Technical and Vocational Education and Training: Evidence from Zambia

The study seeks to investigate the returns to technical and vocational education and training (TVET) in Zambia using the 2014 Labour Force Survey (LFS). We adopt the modified Mincerian model and the fixed effects approach. We find that individuals who possessed TVET skills with certification, regardless of their gender or their place of residence, significantly earned more than their counterparts in wage employment without any TVET skills. We also find that males with vocational skills with certification significantly earned more than their female counterparts with the same TVET skills with certification, a sign of labour market discriminatory bias by employers. Moreover, we observe that individuals residing in rural areas with TVET skills with certification significantly earned more than their counterparts in urban areas with the same TVET skills with certification because employers may want to lure TVET graduates to relocate from urban areas to rural areas. However, individuals with TVET skills without certification did not significantly earn more than their colleagues in wage employment without TVET skills. In some cases, individuals with TVET training but without certification were observed to be worse off than their counterparts without TVET training in wage employment. Given the above evidence, it is imperative that the Zambian government significantly increases spending towards vocational training as well as invest in TVET infrastructure in order to improve TVET enrollment rates. This will enhance the employability of Zambians across the country and generate substantial returns to TVET skills. However, there is need for a deliberate policy that will ensure that females with the same vocational skills as their male counterparts earn the same returns. There is also need for deliberate awareness campaigns on the benefits of TVET training in order to reduce the stigma around TVET

A cost-effectiveness analysis of artemether lumefantrine for treatment of uncomplicated malaria in Zambia

BACKGROUND: Malaria remains a leading cause of morbidity, mortality and non-fatal disability in Zambia, especially among children, pregnant women and the poor. Data gathered by the National Malaria Control Centre has shown that recently observed widespread treatment failure of SP and chloroquine precipitated a surge in malaria-related morbidity and mortality. As a result, the Government has recently replaced chloroquine and SP with combination therapy as first-line treatment for malaria. Despite the acclaimed therapeutic advantages of ACTs over monotherapies with SP and CQ, the cost of ACTs is much greater, raising concerns about affordability in many poor countries such as Zambia. This study evaluates the cost-effectiveness analysis of artemether-lumefantrine, a version of ACTs adopted in Zambia in mid 2004. METHODS: Using data gathered from patients presenting at public health facilities with suspected malaria, the costs and effects of using ACTs versus SP as first-line treatment for malaria were estimated. The study was conducted in six district sites. Treatment success and reduction in demand for second line treatment constituted the main effectiveness outcomes. The study gathered data on the efficacy of, and compliance to, AL and SP treatment from a random sample of patients. Costs are based on estimated drug, labour, operational and capital inputs. Drug costs were based on dosages and unit prices provided by the Ministry of Health and the manufacturer (Norvatis). FINDINGS: The results suggest that AL produces successful treatment at less cost than SP, implying that AL is more cost-effective. While it is acknowledged that implementing national ACT program will require considerable resources, the study demonstrates that the health gains (treatment success) from every dollar spent are significantly greater if AL is used rather than SP. The incremental cost-effectiveness ratio is estimated to be US$4.10. When the costs of second line treatment are considered the ICER of AL becomes negative, indicating that there are greater resource savings associated with AL in terms of reduction of costs of complicated malaria treatment. CONCLUSION: This study suggests the decision to adopt AL is justifiable on both economic and public health grounds

Social cost of mining-related lead (Pb) pollution in Kabwe, Zambia, and potential remediation measures

Lead (Pb) pollution has been one of the major environmental problems of worldwide significance. It is a latent factor for several fatal illnesses, whereas the exposure to lead in early childhood causes a lifetime IQ loss. The social cost is the concept to aggregate various adverse effects in a single monetary unit, which is useful in describing the pollution problem and provides foundation for the design of interventions. However, the assessment of the social cost is scarce for developing countries. In this study, we focus on the lead pollution problem of a former mining town, Kabwe, Zambia, where mining wastes abandoned near residential areas has caused a critical pollution problem. We first investigated the social cost of lead pollution that future generations born in 2025–2049 would incur in their lifetime. As the channels of the social cost, we considered the lost income from the IQ loss and the lost lives from lead-related mortality. The results showed that the social cost would amount to 224–593 million USD (discounted to the present value). Our results can be considered conservative, lower bound estimates because we focused only on well-identified effects of lead, but the social cost was still substantial. Then we examined several engineering remediation measures. The results showed that the social cost can be reduced (the benefits of remediations) more than the costs of implementing remediation measures. This study is the first to investigate the social cost of mining-related lead pollution problem in developing countries. Our interdisciplinary approach utilises the micro-level economic, health and pollution data and integrates the techniques in economics, toxicology and engineering.publishedVersio

Cómo tomar decisiones justas en el camino hacia la cobertura universal de salud

La cobertura universal de salud está en el centro de la acción actual para fortalecer los sistemas de salud y mejorar el nivel y la distribución de la salud y los servicios de salud. Este documento es el informe fi nal del Grupo Consultivo de la OMS sobre la Equidad y Cobertura Universal de Salud. Aquí se abordan los temas clave de la justicia (fairness) y la equidad que surgen en el camino hacia la cobertura universal de salud. Por lo tanto, el informe es pertinente para cada agente que infl uye en ese camino y en particular para los gobiernos, ya que se encargan de supervisar y guiar el progreso hacia la cobertura universal de salud

Faire Des Choix Justes Pour Une Couverture Sanitaire Universelle

This report from the WHO Consultative Group on Equity and Universal Health Coverage offers advice on how to make progress fairly towards universal health coverage

Costing of Paediatric Treatment alongside Clinical Trials under Low Resource Constraint Environments: Cotrimoxazole and Antiretroviral Medications in Children Living with HIV/AIDS

Introduction. Costing evidence is essential for policy makers for priority setting and resource allocation. It is in this context that the clinical trials of ARVs and cotrimoxazole provided a costing component to provide evidence for budgeting and resource needs alongside the clinical efficacy studies. Methods. A micro based costing approach was adopted, using case record forms for maintaining patient records. Costs for fixed assets were allocated based on the paediatric space. Medication and other resource costs were costed using the WHO/MSH Drug Price Indicators as well as procurement data where these were available. Results. The costs for cotrimoxazole and ARVs are significantly different. The average costs for human resources were US$22 and US$71 for physician costs and $1.3 and$16 for nursing costs while in-patient costs were $257 and$15 for the cotrimoxazole and ARV cohorts, respectively. Mean or average costs were $870 for the cotrimoxazole cohort and$218 for the ARV. The causal factors for the significant cost differences are attributable to the higher human resource time, higher infections of opportunistic conditions, and longer and higher frequency of hospitalisations, among others

Returns to Technical and Vocational Education and Training: Evidence from Zambia

The study seeks to investigate the returns to technical and vocational education and training (TVET) in Zambia using the 2014 Labour Force Survey (LFS). We adopt the modified Mincerian model and the fixed effects approach. We find that individuals who possessed TVET skills with certification, regardless of their gender or their place of residence, significantly earned more than their counterparts in wage employment without any TVET skills. We also find that males with vocational skills with certification significantly earned more than their female counterparts with the same TVET skills with certification, a sign of labour market discriminatory bias by employers. Moreover, we observe that individuals residing in rural areas with TVET skills with certification significantly earned more than their counterparts in urban areas with the same TVET skills with certification because employers may want to lure TVET graduates to relocate from urban areas to rural areas. However, individuals with TVET skills without certification did not significantly earn more than their colleagues in wage employment without TVET skills. In some cases, individuals with TVET training but without certification were observed to be worse off than their counterparts without TVET training in wage employment. Given the above evidence, it is imperative that the Zambian government significantly increases spending towards vocational training as well as invest in TVET infrastructure in order to improve TVET enrollment rates. This will enhance the employability of Zambians across the country and generate substantial returns to TVET skills. However, there is need for a deliberate policy that will ensure that females with the same vocational skills as their male counterparts earn the same returns. There is also need for deliberate awareness campaigns on the benefits of TVET training in order to reduce the stigma around TVET