Save the Children US 75 countdown countries analysis

Question:

Impact of scaling up a group of child health interventions as a combinationon U5 deaths averted, and U5 deaths averted due to coverage scale up of each interventionin 75 countdown countries

Packages/Interventions of interest:

Package of interventions listed below:

Tetanus Toxoid
IPTp
PMTCT
Antenatal corticosteroids
Antibiotics for pPRoM
Neonatal resuscitation
Clean birth practices
Breastfeeding promotion
Thermal care (component of preventive postnatal care)
Complementary feeding (education only)
Vitamin A (supplementation)
Improved water source
Handwashing with soap
Hygienic disposal of children's stools
ITNs
DTP vaccine
Hib vaccine
Pneumococcal vaccine
Rotavirus vaccine
Measles vaccine
Oral and injectable antibiotics
ORS
Antibiotics for dysentery
Zinc (treatment)
Oral antibiotics for pneumonia
Vitamin A (treatment)
Antimalarials
Therapeutic feeding

Scenarios of interest:

  1. Scaling up coverage of above interventions from their current coverage in 2010 to their respective targets by year 2020.

Note that when any interventions’ base year coverage exceeds their respective caps, the coverage of that intervention stays constant between 2010 to 2020.

The target value in 2020 for each intervention was based on a pre-set annual rate of coverage increase for that intervention. An analysis was done on a group of countries looking at their historical DHS and MICS, to try to find out what is possible in terms of the annual rate of coverage increase. For most interventions, Cambodia has the biggest annual rate of coverage increase, so we took these numbers and applied them to all countries to produce moderately ambitious targets.

Baseline Values:

Population trendis obtained from the The2010 Revisionof theWorld Population Prospects published by the Population Division of the United Nations Department of Economic and Social Affairs of the United Nations Secretariat.

Child mortality estimates are obtained from The estimates from year 2010.5 were used.

Causes of death in children under 5 are obtained from the following article

  • Black, Robert E , Simon Cousens, Hope L Johnson, Joy E Lawn, Igor Rudan, Diego G Bassani, PrabhatJha, Harry Campbell, Christa Fischer Walker, Richard Cibulskis, Thomas Eisele, Li Liu, Colin Mathers, for the Child Health Epidemiology Reference Group of WHO and UNICEF (2010).Global, regional, and national causes of child mortality in 2008: a systematic analysis.Lancet. 375 (9730): 1969 - 1987.

Vaccine coverage estimates

Vaccine coverage values used is from WHO/UNICEF estimates, last updated Aug 3, 2011

Vaccine effectiveness is based on their impact on specific causes of death:

An affected fraction refers to the percent of a specific cause of death which can be averted by an intervention. This refers to etiology when available.

Standard vaccine effect sizes and affected fraction used in LiST:

  • DPT vaccine’s effect on pertussis.
  • DPT vaccine (3 doses) has an effect of 0.85, meaning that full vaccination can prevent 85% of pertussis deaths.
  • It is assumed that all (100%) pertussis deaths can benefit by full coverage of the vaccine.
  • The effect size is based on expert opinion
  • Measles vaccine’s effect on measles.
  • Measles vaccine (1 dose) has an effect of 0.85, meaning that full vaccination can prevent 85% of measles deaths.
  • It is assumed that all (100%) measles deaths can benefit by full coverage of the vaccine.
  • Pneumococcal and Hib vaccine’s effect on pneumonia and meningitis
  • Pneumococcal vaccine (full coverage) has an effect of 0.26, meaning that full vaccination can prevent 26% of pneumonia deaths, and since the review is not yet finished, we are assuming the same effect (26%) on meningitis deaths.
  • Hib vaccine (full coverage) has an effect of 0.18. This means that full vaccination can prevent 18% of pneumonia deaths and, since the review is not yet finished, we are also assuming the same effect (18%) on meningitis deaths.
  • The affected fraction for each of these vaccines is considered to be the entire population of pneumonia deaths because that is how the reviews were completed. Thus the presented effect sizes are in essence, combinations of both effectiveness of the vaccines and the affected fraction, or proportion of pneumonia due to these bacteria.
  • Reference: Theodoratou, Evropi, Sue Johnson, ArnoupeJhass, Shabir A Madhi, Andrew Clark, Cynthia Boschi-Pinto, Sunil Bhopal, Igor Rudan, Harry Campbell (2010).The effect of Haemophilusinfluenzae type b and pneumococcal conjugate vaccines on childhood pneumonia incidence, severe morbidity and mortality.Int. J. Epidemiol. 39: i172-i185.
  • Rotavirus vaccine’s effect on diarrhea
  • 39% of diarrhea deaths can benefit by full coverage of the vaccine.
  • 5 different Rota vaccine effect sizes were used. Countries were categorized as 'Africa', 'Low mortality Asia', 'High mortality Asia', 'Latin America', and 'Developed', and their effect sizes as follow
  • Africa: 49.7%
  • Low mortality Asia: 87.9%
  • High mortality Asia: 42.7%
  • Latin America: 81%
  • Developed: 90.6%
  • Reference: Fischer Walker CL, Black RE. Rotavirus vaccine and diarrhea mortality: quantifying regional variation in effect size. BMC Public Health 2011;11Suppl 3:S16.

Time frame of interest:

Baseline year: 2010

Target year: 2020

LiST Version Used:

Spectrum 4.48 Beta 19

Outputs of Interest:

•Yearly U5 deaths (and deaths averted) by country between 2010-2020, total U5 deaths (and deaths averted) by countryin 2010-2020

•Yearly U5 deaths averted by each intervention by country between 2010-2020, total U5 deaths averted by each interventionin 2010-2020 for the three scenarios