Abstract
BackgroundAs new interventions to reduce childhood mortality are identified, careful consideration must be given to identifying populations that could benefit most from them. Promising reductions in childhood mortality reported in a large cluster randomized trial of mass drug administration (MDA) of azithromycin (AZM) prompted the development of visually compelling, easy-to-use tools that synthesize country-specific data on factors that would influence both potential AZM benefit and MDA implementation success.Methodology/Principal FindingsWe assessed the opportunity to reduce mortality and the feasibility of implementing such a program, creating Opportunity and Feasibility Indices, respectively. Countries with high childhood mortality were included. A Country Ranking Index combined key variables from the previous two Indices and applied a scoring system to identify high-priority countries. We compared four scenarios with varying weights given to each variable.Twenty-five countries met inclusion criteria. We created easily visualized tools to display the results of the Opportunity and Feasibility Indices. The Opportunity Index revealed substantial variation in the opportunity for an MDA of AZM program to reduce mortality, even among countries with high overall childhood mortality. The Feasibility Index demonstrated that implementing such a program would be most challenging in the countries that could see greatest benefit. Based on the Country Ranking Index, Equatorial Guinea would benefit the most from the MZA of AZM in three of the four scenarios we tested.Conclusions/SignificanceThese visually accessible tools can be adapted or refined to include other metrics deemed important by stakeholders, and provide a quantitative approach to prioritization for intervention implementation. The need to explicitly state metrics and their weighting encourages thoughtful and transparent decision making. The objective and data-driven approach promoted by the three Indices may foster more efficient use of resources.
Highlights
Global childhood mortality has declined substantially over the previous 20 years, from 11.6 million deaths in 1990 to 7.2 million in 2011 [1], rates remain unacceptably high in many regions
Infectious diseases, including diarrheal disease, pneumonia, and malaria are responsible for approximately 60% of all deaths in children younger than five years of age [2] and largescale interventions that target these diseases may have the potential to dramatically reduce childhood mortality
We assumed that countries with high childhood mortality have the greatest opportunity to benefit from mass drug administration (MDA) of AZM, especially those with a high burden of diseases that are treatable by AZM, such as diarrhea, pneumonia, malaria, and opportunistic infections associated with HIV
Summary
Global childhood mortality has declined substantially over the previous 20 years, from 11.6 million deaths in 1990 to 7.2 million in 2011 [1], rates remain unacceptably high in many regions. Infectious diseases, including diarrheal disease, pneumonia, and malaria are responsible for approximately 60% of all deaths in children younger than five years of age [2] and largescale interventions that target these diseases may have the potential to dramatically reduce childhood mortality. As successful interventions are identified and implemented, systematic approaches for determining which populations would most benefit from these interventions will be essential. Populations or geographic regions may be targeted based on perceived need, political relationships, existing infrastructure, historical success, or other rationales. Promising reductions in childhood mortality reported in a large cluster randomized trial of mass drug administration (MDA) of azithromycin (AZM) prompted the development of visually compelling, easy-to-use tools that synthesize country-specific data on factors that would influence both potential AZM benefit and MDA implementation success
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