The impact of a school-based water supply and treatment, hygiene, and sanitation programme on pupil diarrhoea: a cluster-randomized trial.

The impact of improved water, sanitation, and hygiene (WASH) access on mitigating illness is well documented, although impact of school-based WASH on school-aged children has not been rigorously explored. We conducted a cluster-randomized trial in Nyanza Province, Kenya to assess the impact of a school-based WASH intervention on diarrhoeal disease in primary-school pupils. Two study populations were used: schools with a nearby dry season water source and those without. Pupils attending 'water-available' schools that received hygiene promotion and water treatment (HP&WT) and sanitation improvements showed no difference in period prevalence or duration of illness compared to pupils attending control schools. Those pupils in schools that received only the HP&WT showed similar results. Pupils in 'water-scarce' schools that received a water-supply improvement, HP&WT and sanitation showed a reduction in diarrhoea incidence and days of illness. Our study revealed mixed results on the impact of improvements to school WASH improvements on pupil diarrhoea.

[Economic impact of rotavirus vaccination in Panama]. / Impacto económico de la vacuna antirrotavirus en Panamá

INTRODUCTION: Rotavirus (RV) gastroenteritis (GE) causes a significant health and economic burden in Panama. The main objective of this study is to estimate the healthcare costs and the cost-effectiveness of vaccination in Panama from the societal perspective. METHODS: An economic model was constructed, using published epidemiological data, country-specific cost estimates, and vaccine efficacy data. The main outcome measures were disease burden, economic burden and the incremental cost-effectiveness ratio (US$/DALY and US$/life saved) of vaccination. RESULTS: In Panama, among children during the first five years of life, it is estimated that due to RV GE, 283 per 1,000 have a clinic visit, 24 per 1,000 are hospitalized, and 0.53 per 1,000 die. For every 1,000 children born, RV infection results in US$16,463 in total costs during their first five years of life. An estimated US$862,388 may be spent annually on treatment of outpatient and hospitalized cases in Panama. Vaccination would prevent 65% of the associated deaths, 68% of hospitalizations, 69% of outpatient visits and 65% of associated DALY (Disability Adjusted Life Years). From the societal perspective, RV vaccination produces a cost-effectiveness ratio of US$487 per DALY when the price of the vaccine is US$7.50 per dose. CONCLUSIONS: Vaccination can effectively reduce the disease burden and healthcare costs of RV GE in Panama.

Rotavirus disease in Uzbekistan: cost-effectiveness of a new vaccine.

We evaluated the cost-effectiveness of rotavirus vaccination in Uzbekistan from the healthcare system and societal perspectives. Disease burden was estimated using national statistics on hospitalizations and deaths, and international estimates of under-five mortality. Without vaccination, the risk for rotavirus hospitalization by age 5 is 10 per 1000 children. Rotavirus hospitalizations cost US$ 406,000 annually, of which US$ 360,000 (89%) is for medical expenses and US$ 46,000 (11%) is for non-medical and indirect costs. Rotavirus mortality rate at 0.7 per 1000 derived from national data was three-fold lower than the same rate calculated from international estimates of under-five mortality. Rotavirus vaccination could reduce hospitalizations and deaths by 91% and avert US$ 370,000 in hospitalization costs alone. Vaccination would be cost-effective with vaccine prices in a range of US$ 2-25 per child. However, the cost-effectiveness is greatly influenced by mortality, vaccine price and vaccine efficacy.

Beyond the Millennium Development Goals: public health challenges in water and sanitation.

Over 1 billion people lack access to improved water sources and 2.6 billion lack access to appropriate sanitation, greatly contributing to the global burden of disease. The international community has committed to reducing by half the proportion of the world's population lacking access to water and sanitation as a part of the Millennium Development Goals (MDGs). However, the disease burden due to poor access, is borne primarily by the poorest countries and the poorest people within them. Simply reducing the proportion of people without adequate access will not automatically result in proportional reductions in the related disease burden. The public health challenge inherent in meeting the MDG targets is ensuring that improvements result in access to water and sanitation for the critical at-risk populations. Innovative approaches are required to ensure the availability of low-cost, simple, and locally acceptable water and sanitation interventions and integrating these approaches into existing social institutions, such as schools, markets, and health facilities.

Impacto económico de la vacuna antirrotavirus en Panamá / Economic impact of rotavirus vaccination in Panama

Introducción: La gastroenteritis (GE) por rotavirus (RV) contribuye a una carga significativa de enfermedad y costes en Panamá. El objetivo principal de este estudio fue evaluar la relación coste-efectividad de la vacuna antirrotavirus (anti-RV) en la población panameña menor de 5 años de edad. Material y métodos: Se utilizó un modelo económico que plantea el seguimiento de esta población objeto de estudio, basado en información epidemiológica, de eficacia de la vacuna y de costes. Se estimó el número de casos evitados de hospitalizaciones, consultas médicas y muertes tras la aplicación de la vacuna, al igual que el coste promedio de atención de los casos de GE por RV desde la perspectiva de la sociedad. La relación coste-efectividad de la vacuna anti-RV se evaluó considerando la disminución de años de vida ajustados por discapacidad (AVAD) tras el uso programático de la vacuna. Resultados: Un programa de vacunación anti-RV evitaría anualmente en Panamá alrededor de 24 muertes, 1.140 hospitalizaciones y 13.685 visitas médicas ambulatorias causadas por RV durante los primeros 5 años de vida. En Panamá se estima un gasto total medio de alrededor de 16.463 dólares para cada 1.000 niños que nacen anualmente como consecuencia de esta enfermedad. Un programa de vacunación anti-RV evitaría alrededor del 69 % de estos gastos. Para un precio estimado de vacuna de 7,50 dólares por dosis, se genera una relación coste-efectividad de 487 dólares por AVAD. Conclusiones: Los resultados de este estudio demuestran que la vacuna anti-RV puede ser una estrategia coste-efectiva en la prevención de GE por RV en Panamá (AU)

Introduction: Rotavirus (RV) gastroenteritis (GE) causes a significant health and economic burden in Panama. The main objective of this study is to estimate the healthcare costs and the cost-effectiveness of vaccination in Panama from the societal perspective. Methods: An economic model was constructed, using published epidemiological data, country-specific cost estimates, and vaccine efficacy data. The main outcome measures were disease burden, economic burden and the incremental cost-effectiveness ratio (US$/DALY and US$/life saved) of vaccination. Results: In Panama, among children during the first five years of life, it is estimated that due to RV GE, 283 per 1,000 have a clinic visit, 24 per 1,000 are hospitalized, and 0.53 per 1,000 die. For every 1,000 children born, RV infection results in US$16,463 in total costs during their first five years of life. An estimated US$862,388 may be spent annually on treatment of outpatient and hospitalized cases in Panama. Vaccination would prevent 65 % of the associated deaths, 68 % of hospitalizations, 69 % of outpatient visits and 65 % of associated DALY (Disability Adjusted Life Years). From the societal perspective, RV vaccination produces a cost-effectiveness ratio of US$487 per DALY when the price of the vaccine is US$7.50 per dose. Conclusions: Vaccination can effectively reduce the disease burden and healthcare costs of RV GE in Panama (AU)