Abstract
Ethiopia is one of the sub-Saharan African countries contributing to the highest number of maternal and neonatal deaths. Coverage of maternal and neonatal health (MNH) interventions has remained very low in Ethiopia. We examined the cost-effectiveness of selected MNH interventions in an Ethiopian setting. We analysed 13 case management and preventive MNH interventions. For all interventions, we used an ingredients-based approach for cost estimation. We employed a static life table model to estimate the health impact of a 20% increase in intervention coverage relative to the baseline. We used disability-adjusted life years (DALYs) as the health outcome measure while costs were expressed in 2018 US$. Analyses were based on local epidemiological, demographic and cost data when available. Our finding shows that 12 out of the 13 interventions included in our analysis were highly cost-effective. Interventions targeting newborns such as neonatal resuscitation (institutional), kangaroo mother care and management of newborn sepsis with injectable antibiotics were the most cost-effective interventions with incremental cost-effectiveness ratios of US$7, US$8 and US$17 per DALY averted, respectively. Obstetric interventions (induction of labour, active management of third stage of labour, management of pre-eclampsia/eclampsia and maternal sepsis, syphilis treatment and tetanus toxoid during pregnancy) and safe abortion cost between US$100 and US$300 per DALY averted. Calcium supplementation for pre-eclampsia and eclampsia prevention was the least cost-effective, with a cost per DALY of about US$3100. Many of the MNH interventions analysed were highly cost-effective, and this evidence can inform the ongoing essential health services package revision in Ethiopia. Our analysis also shows that calcium supplementation does not appear to be cost-effective in our setting.
Highlights
With 11 000 women dying during pregnancy or childbirth, Ethiopia is one among the 10 countries that contribute to 60% of the global maternal deaths estimated in 2015 (Trends in maternal mortality: 1990 to 2015, 2015)
Neonatal deaths accounted for 30% and 43% of under-five deaths in the 2000 and 2016 Demographic and Health Surveys (DHS), respectively (Central Statistical Agency (CSA) [Ethiopia] and ICF, 2001, 2016)
For safe abortion services and tetanus toxoid baseline coverage data were extracted from the Health Sector Transformation Plan and the 2016 Ethiopia Health and Demographic Survey, respectively (Federal Democratic Republic of Ethiopia Ministry of Health, 2015; Central Statistical Agency [CSA] [Ethiopia] and ICF, 2016), but for the other interventions, we used baseline coverage rates from the Lives Saved Tool (LiST) (Avenir Health, 2017)
Summary
With 11 000 women dying during pregnancy or childbirth, Ethiopia is one among the 10 countries that contribute to 60% of the global maternal deaths estimated in 2015 (Trends in maternal mortality: 1990 to 2015, 2015). Maternal and neonatal deaths arise from the risks attributable to pregnancy and childbirth as well as from low coverage and poorquality health services (Freedman et al, 2005). Effective interventions during the antenatal period, the time around birth, and the first week of life that can significantly decrease maternal and neonatal deaths are available (Trends in maternal mortality: 1990 to 2015, 2015; Levels and Trends in Child Mortality, 2017), but their coverage levels have remained very low in Ethiopia: coverage of skilled birth attendance and post-natal visits (within 2 days of birth), were in 2015 28% and 13%, respectively (Central Statistical Agency (CSA) [Ethiopia] and ICF, 2016)
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