Abstract

Vaccination is a cost-effective public health intervention, yet evidence abounds that vaccination uptake is still poor in many low- and middle-income countries. Traditional and Religious Leaders play a substantial role in improving the uptake of health services such as immunization. However, there is paucity of evidence on the cost-effectiveness of using such strategies. This study aimed to assess the cost-effectiveness of using a multi-faceted intervention that included traditional and religious leaders for community engagement to improve uptake of routine immunisation services in communities in Cross River State, Southern Nigeria. The target population for the intervention was traditional and religious leaders in randomly selected communities in Cross River State. The impact of the intervention on the uptake of routine vaccination among children 0 to 23 months was assessed using a cluster randomized trials. Outcome assessments were performed at the end of the project (36 months).The cost of the intervention was obtained from the accounting records for expenditures incurred in the course of implementing the intervention. Costs were assessed from the health provider perspective. The cost-effectiveness analysis showed that the incremental cost of the initial implementation of the intervention was US$19,357and that the incremental effect was 323 measles cases averted, resulting in an incremental cost-effectiveness ratio (ICER) of US$60/measles case averted. However, for subsequent scale-up of the interventions to new areas not requiring a repeat expenditure of some of the initial capital expenditure the ICER was estimated to be US$34 per measles case averted. Involving the traditional and religious leaders in vaccination is a cost-effective strategy for improving the uptake of childhood routine vaccinations.

Highlights

  • Vaccination is a cost-effective public health intervention [1, 2]

  • The study perspective was from a healthcare payer system but we considered only the payment from the provider’s angle

  • The estimate cost for averting measles illness was obtained from an earlier study based on the forecasted short-term cost that would be incurred for treatment of measles illness divided by the number of individuals with measles disease who likely sought health-care treatment [19]

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Summary

Introduction

Vaccination is a cost-effective public health intervention [1, 2]. It is estimated to cost less than $100 to $1000 per disability-adjusted life year averted in low-and-middle-income countries [2]. Vaccination uptake remains poor in many low- and middle- income countries [3]. Apart from the weakness of the health system, family characteristics, parental attitudes and behaviours, limitations in immunization-related communication and information have been associated with under-vaccination and non-vaccination of children [3, 5]. A recent systematic review (6) found paucity of evidence on effectiveness of the interventions for improving vaccine coverage among children. Due to the multiplicity of the factors that are associated with under-vaccination and non-vaccination, multi-faceted local interventions may have promising beneficial effects [5]

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