Economic evaluation of zinc and copper use in treating acute diarrhea in children: A randomized controlled trial

BACKGROUND: The therapeutic effects of zinc and copper in reducing diarrheal morbidity have important cost implications. This health services research study evaluated the cost of treating a child with acute diarrhea in the hospital, the impact of micronutrient supplementation on the mean predicted costs and its cost-effectiveness as compared to using only standard oral rehydration solution (ORS), from the patient's and government's (providers) perspective. METHODS: Children aged 6 months to 59 months with acute diarrhea were randomly assigned to receive either the intervention or control. The intervention was a daily dose of 40 mg of zinc sulfate and 5 mg of copper sulfate powder dissolved in a liter of standard ORS (n = 102). The control was 50 mg of standard ORS powder dissolved in a liter of standard ORS (n = 98). The cost measures were the total mean cost of treating acute diarrhea, which included the direct medical, the direct non-medical and the indirect costs. The effectiveness measures were the probability of diarrhea lasting ≤ 4 days, the disability adjusted life years (DALYs) and mortality. RESULTS: The mean total cost of treating a child with acute diarrhea was US $14 of which the government incurred an expenditure of 66%. The factors that increased the total were the number of stools before admission (p = 0.01), fever (p = 0.01), increasing grade of dehydration (p = 0.00), use of antibiotics (p = 0.00), use of intra-venous fluids (p = 0.00), hours taken to rehydrate a child (p = 0.00), the amount of oral rehydration fluid used (p = 0.00), presence of any complications (p = 0.00) and the hospital stay (p = 0.00). The supplemented group had a 8% lower cost of treating acute diarrhea, their cost per unit health (diarrhea lasting ≤ 4 days) was 24% less and the incremental cost-effectiveness ratio indicated cost savings (in Rupees) with the intervention [-452; 95%CI (-11306, 3410)]. However these differences failed to reach conventional levels of significance. CONCLUSION: An emphasis on the costs and economic benefits of an alternative therapy is an important aspect of health services research. The cost savings and the attractive cost-effectiveness indicates the need to further assess the role of micronutrients such as zinc and copper in the treatment of acute diarrhea in a larger and more varied population

Mid Upper Arm Circumference as the Best Surrogate Marker for Identification of Low Birth Weight in Newborns within the First 24 Hours of Life- A Cross-sectional Study

Introduction: Birth weight is a very important determinant factor regarding perinatal morbidity and mortality. However, in developing countries like India weighing facility may not be available in rural areas where an alternative anthropometric parameter like Mid Upper Arm Circumference (MUAC) may be considered alternative to birth weight. Aim: To determine the accuracy of MUAC by comparing it with different anthropometric parameters for identification of LBW in neonates within the first 24 hours of life. Materials and Methods: The present study was a hospital based cross-sectional study conducted in labour ward, Postnatal Care (PNC) wards and Neonatal Intensive Care Unit (NICU) of Indira Gandhi Medical College, Nagpur. Total 640 babies were enrolled over a period of 2 years from September 2018 to September 2020. Anthropometric parameters like weight, length, head circumference, Chest Circumference (CC), MUAC, ponderal index were taken by a researcher using standard techniques within first 24 hours of life and correlated with birth weight by using Pearson’s correlation coefficient. The comparison of the quantitative and qualitative variables was analysed using independent t-test and chi-square test, respectively. Receiver Operating Characteristic (ROC) curve was used to find out cut- off point of anthropometric parameters for predicting birth weight (<2000 gm, <1500 gm, <1000 gm). DeLong test was used for comparison of area under curve between different anthropometric parameters for predicting birth weight (<2000 gm, <1500 gm, <1000 gm). Univariate linear regression was used to assess the effect of anthropometric parameters on birth weight. The data entry was done in the Microsoft EXCEL spreadsheet and final analysis was done with the use of Statistical Package for Social Sciences (SPSS) software version 21.0. Results: Among 640 newborns, 334 (59.19%) were females and 306 (47.81%) were males. The mean birth weight was 1903.93 grams and MUAC of 8.3cm. All the chosen parameters showed significant correlation with birth weight (p<0.001). However, MUAC showed strongest correlation (r=0.890) with birth weight and easy to measure. Cut-offs of MUAC ≤8.45 cm, ≤7.5 cm, ≤6.8 cm predict birth weight of <2000gm, <1500gm, <1000gm with sensitivity of 91.22%, 92.81%, 100% and specificity of 88.95%, 89.12%, 89.35%, respectively. Conclusion: MUAC is the most simple and best surrogate measure that can be used in domiciliary outreach when it is impossible to record weight of baby at birth

Effectiveness of weekly cell phone counselling calls and daily text messages to improve breastfeeding indicators

Abstract Background Every year, nearly one million deaths occur due to suboptimal breastfeeding. If universally practiced, exclusive breastfeeding alone prevents 11.6% of all under 5 deaths. Among strategies to improve exclusive breastfeeding rates, counselling by peers or health workers, has proven to be highly successful. With growing availability of cell phones in India, they are fast becoming a medium to spread information for promoting healthcare among pregnant women and their families. This study was conducted to assess effectiveness of cell phones for personalized lactation consultation to improve breastfeeding practices. Methods This was a two arm, pilot study in four urban maternity hospitals, retrained in Baby Friendly Hospital Initiative. The enrolled mother-infant pairs resided in slums and received healthcare services at the study sites. The control received routine healthcare services, whereas, the intervention received weekly cell phone counselling and daily text messages, in addition to counselling the routine healthcare services. Results 1036 pregnant women were enrolled (518 - intervention and 518 - control). Rates of timely initiation of breastfeeding were significantly higher in intervention as compared to control (37% v/s 24%, p < 0.001). Pre-lacteal feeding rates were similar and low in both groups (intervention: 19%, control: 18%, p = 0.68). Rate of exclusive breastfeeding was similar between groups at 24 h after delivery, but significantly higher in the intervention at all subsequent visits (control vs. intervention: 24 h: 74% vs 74%, p = 1.0; 6 wk.: 81% vs 97%, 10 wk.: 78% vs 98%, 14 wk.: 71% vs 96%, 6 mo: 49% vs 97%, p < 0.001 for the last 4 visits). Adjusting for covariates, women in intervention were more likely to exclusively breastfeed than those in the control (AOR [95% CI]: 6.3 [4.9–8.0]). Conclusion Using cell phones to provide pre and postnatal breastfeeding counselling to women can substantially augment optimal practices. High rates of exclusive breastfeeding at 6 months were achieved by sustained contact and support using cell phones. This intervention shows immense potential for scale up by incorporation in both, public and private health systems. Trial registration This study was retrospectively registered with Clinical Trial Registry of India (http://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=3060) Trial Number: CTRI/2011/06/001822 on date 20/06/2011

Additional file 1: of A randomized controlled trial of hospital versus home based therapy with oral amoxicillin for severe pneumonia in children aged 3 – 59 months: The IndiaCLEN Severe Pneumonia Oral Therapy (ISPOT) Study

Standard operating procedures that were used to train the physicians in assessing clinical signs. (PDF 240 kb

Additional file 2: of A randomized controlled trial of hospital versus home based therapy with oral amoxicillin for severe pneumonia in children aged 3 – 59 months: The IndiaCLEN Severe Pneumonia Oral Therapy (ISPOT) Study

Details of contributorship of the ISPOT study group. (PDF 288 kb