Economic evaluations of interventions to reduce neonatal morbidity and mortality: a review of the evidence in LMICs and its implications for South Africa.

Mandy Maredza,Lumbwe Chola,Karen Hofman

doi:10.1186/s12962-015-0049-5

Abstract

BackgroundNewborn mortality, comprising a third of all under-5 deaths, has hardly changed in low and middle income countries (LMICs) including South Africa over the past decade. To attain the MDG 4 target, greater emphasis must be placed on wide-scale implementation of proven, cost-effective interventions. This paper reviews economic evidence on effective neonatal health interventions in LMICs from 2000–2013; documents lessons for South African policy on neonatal health; and identifies gaps and areas for future research.MethodsA narrative review was performed in leading public health databases for full economic evaluations conducted between 2000 and 2013. Data extraction from the articles included in the review was guided by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, and the quality of the included economic evaluations was assessed using the Quality of Health Economics Studies Instrument (QHES).ResultsTwenty-seven economic evaluations were identified, from South East Asia and sub-Saharan Africa, with those from sub-Saharan Africa primarily focused on HIV/AIDS. Packages of care to prevent neonatal mortality were more cost-effective than vertical interventions. A wide variability in methodological approaches challenges the comparability of study results between countries. In South Africa, there is limited cost-effectiveness evidence for the interventions proposed by the National Perinatal Morbidity and Mortality Committee.ConclusionsNeonatal strategies have a strong health system focus but this review suggests that strengthening community care could be an additional component for averting neonatal deaths. While some evidence exists, having a more complete understanding of how to most effectively deploy scarce resources for neonatal health in South Africa in the post-2015 era is essential.Electronic supplementary materialThe online version of this article (doi:10.1186/s12962-015-0049-5) contains supplementary material, which is available to authorized users.

Highlights

Newborn mortality, comprising a third of all under-5 deaths, has hardly changed in low and middle income countries (LMICs) including South Africa over the past decade
International child health policy in the last decade has been largely shaped by millennium development goal 4 (MDG 4), to reduce under-5 mortality by two-thirds between 1990 and 2015
In South Africa, under-5 mortality reduced by 40 % from 2006 to 2011 largely due to the successful scale up Maredza et al Cost Eff Resour Alloc (2016) 14:2 of prevention of mother to child transmission (PMTCT) of HIV [4]

Summary

Introduction

Newborn mortality, comprising a third of all under-5 deaths, has hardly changed in low and middle income countries (LMICs) including South Africa over the past decade. International child health policy in the last decade has been largely shaped by millennium development goal 4 (MDG 4), to reduce under-5 mortality by two-thirds between 1990 and 2015. In South Africa, under-5 mortality reduced by 40 % from 2006 to 2011 largely due to the successful scale up Maredza et al Cost Eff Resour Alloc (2016) 14:2 of prevention of mother to child transmission (PMTCT) of HIV [4]. Newborn mortality remains stagnant at a level of 14–20 deaths per 1000 live births [3, 5] This is despite the fact that 80 % of births are in facilities [6], and there is a national policy of free maternal and child healthcare at public facilities (enacted since 1996) [7]. The high neonatal mortality rate is associated with poor quality care, sub-optimal adherence to guidelines, delays in seeking antenatal care, inadequate inter-facility transport for emergency obstetric care and inadequate postnatal care [9]

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Results

Conclusion