Cost-Effectiveness of Home-Based Chlorination and Safe Water Storage in Reducing Diarrhea Among Hiv-Affected Households in Rural Uganda

Abstract

Safe water systems (SWSs) have been shown to reduce diarrhea and death. We examined the cost-effectiveness of SWS for HIV-affected households using health outcomes and costs from a randomized controlled trial in Tororo, Uganda. SWS was part of a home-based health care package that included rapid diarrhea diagnosis and treatment of 196 households with relatively good water and sanitation coverage. SWS use averted 37 diarrhea episodes and 310 diarrhea-days, representing 0.155 disability-adjusted life year (DALY) gained per 100 person-years, but did not alter mortality. Net program costs were 5.21 dollars/episode averted, 0.62 dollars/diarrhea-day averted, and 1,252 dollars/DALY gained. If mortality reduction had equaled another SWS trial in Kenya, the cost would have been 11 dollars/DALY gained. The high SWS cost per DALY gained was probably caused by a lack of mortality benefit in a trial designed to rapidly treat diarrhea. SWS is an effective intervention whose cost-effectiveness is sensitive to diarrhea-related mortality, diarrhea incidence, and effective clinical management.

Improved Health among People Living with HIV/AIDS Who Received Packages of Proven Preventive Health Interventions, Amhara, Ethiopia

“…An evaluation of use of BCP components over time in both the Ethiopian and Ugandan programs is warranted and could help guide programming. In addition, an assessment of the costs and benefits of a program of free resupply of BCP commodities would be useful for guiding policy, [32], [33] particularly in view of evidence that integration of free health interventions into health services can serve as an incentive to increase use of services [34].…”

Cost-effectiveness of water quality interventions for preventing diarrhoeal disease in developing countries

“…Household-based disinfection was also found to be among the most cost-beneficial of the water and sanitation interventions (Hutton & Haller 2004). A recent CEA assessed the cost-effectiveness of home-based chlorination among HIV-affected households in Uganda (Shrestha et al 2006). Our study builds on previous research by (i) using more broad-based estimates of cost and effectiveness of the interventions, (ii) comparing conventional non-reticulated source-and four householdbased interventions to improve water quality, and (iii) employing the generalized CEA methodology developed by WHO-CHOICE to permit a comparison of each of these interventions in the context of other Millennium Development Goal (MDG) health initiatives.…”

Protecting child health and nutrition status with ready-to-use food in addition to food assistance in urban Chad: a cost-effectiveness analysis

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