Disease Control Priorities for Child Health in the Tropics

Abstract

Child health is an important indicator in measuring national development. This is particularly true in developing countries with meager resources where children constitute a large percentage of the population. One cannot overemphasize its significance in tropical, developing countries like those in Asia and Africa where childhood morbidity and mortality are highest especially in the under-five age bracket. It is also in these countries where infectious diseases consistently rank as major causes of deaths. Realizing the short-term and long-term devastating effects on the health of individual children of developing nations and the resulting implications on national development, the formulation of strategies to address these problems in the context of economic evaluation has increasingly become a priority for developing countries. Economic evaluation deals with costs and consequences. It is basically determining which of the available interventions will utilize the least amount of resources without sacrificing the effectiveness of such strategies and the benefits that are gained from their implementation.

This paper discusses economic evaluation of strategies to control specific diseases in children in the tropics as published in Disease Control Priorities Project (second edition): diarrhea, respiratory diseases, tuberculosis (TB), malaria, HIV/AIDS and malnutrition. It uses costeffectiveness analysis (CEA) utilizing disability-adjusted life years (DALYs) as the consequence or effect. One DALY represents the loss of one year of equivalent full health. For diarrhea, the most cost-effective strategy is breastfeeding promotion. Improved case management, using the Integrated Management of Childhood Illness (IMCI) approach has resulted in significant reduction in mortality in children with Acute Respiratory Infections below five years old. Direct Observed Therapy Short-course(DOTS) is currently considered the most cost-effective intervention even in the most severe and infectious forms of TB. The use of combination drug treatment is the most cost effective strategy in the treatment of malaria. Interventions directed towards both the host and the vector of malaria are also considered cost-effective. Data on cost-effective strategies in preventing AIDS are lacking and treatment strategies are expensive because of the prohibitive cost of drugs used for treatment. Community-based health programs have been found to be most cost-effective in the battle against malnutrition.

Economic evaluation of interventions and strategies to reduce childhood illness, disability and death has become imperative and is very important in developing countries with limited resources such as those in the tropics.