UNICEF ARI-DD Report V2

UNICEF ARI-DD report v2

Question:

Scaling up pneumonia and diarrhea interventions from current national coverage to the richest coverage to see impact on deaths averted and mortality rates in 75 countdown countries

Packages/Interventions of interest:

Baseline Values:

Population trend is 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 http://www.childmortality.org. 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, Prabhat Jha, 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 2004-2011used is from WHO/UNICEF estimates, last updated Aug 3, 2011 http://apps.who.int/immunization_monitoring/en/globalsummary/timeseries/tswucoveragedtp3.htm

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:

·  Pneumococcal and Hib vaccine’s effect on pneumonia and meningitis

o  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.

o  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.

o  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.

o  Reference: Theodoratou, Evropi, Sue Johnson, Arnoupe Jhass, Shabir A Madhi, Andrew Clark, Cynthia Boschi-Pinto, Sunil Bhopal, Igor Rudan, Harry Campbell (2010).The effect of Haemophilus influenzae 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

o  39% of diarrhea deaths can benefit by full coverage of the vaccine.

o  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%

o  Reference: Fischer Walker CL, Black RE. Rotavirus vaccine and diarrhea mortality: quantifying regional variation in effect size. BMC Public Health 2011;11 Suppl 3:S16.

Time frame of interest:

Baseline year: 2012

Target year: 2015

LiST Version Used:

Spectrum 4.48

Outputs of Interest:

•  Yearly and total U5 deaths between 2012-2015

•  Yearly and total U5 pneumonia and diarrhea deaths between 2012-2015

•  Year and total U5 deaths averted by intervention between 2012 -2015

•  U5MR