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- Verguet, Stéphane, et al.
(författare)
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Impact of supplemental immunisation activity (SIA) campaigns on health systems : findings from South Africa
- 2013
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ Publishing Group. - 0143-005X .- 1470-2738. ; 67:11, s. 947-952
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Tidskriftsartikel (refereegranskat)abstract
- Background Supplemental immunisation activity (SIA) campaigns provide children with an additional dose of measles vaccine and deliver other childhealth interventions including vitamin A supplements, deworming medications and oral polio vaccines. They also require the mobilisation of a large health workforce. We assess the impact of the implementation of SIA campaigns on selected routine child and maternalhealth services in South Africa (SA).Methods We use district-level monthly headcount data for 52 South African districts for the period 2001-2010, sourced from the District Health Information System, SA. The data include 12 child and maternalhealth headcount indicators including routine immunisation, and maternal and reproductivehealth indicators. We analyse the association between the implementation of the 2010 SIA campaign and the change (decrease/increase) in headcounts, using a linear regression model.Results We find a significant decrease for eight indicators. The total number of fully immunised children before age 1 decreased by 29% (95% CI 23% to 35%, p<0.001) during the month of SIA implementation; contraceptive use and antenatal visits decreased by 7-17% (p0.02) and about 10% (p<0.001), respectively.Conclusions SIA campaigns may negatively impact health systems during the period of implementation by disrupting regular functioning and diverting resources from other activities, including routine child and maternal health services. SIA campaigns present multidimensional costs that need to be explicitly considered in benefit-cost assessments.
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| 2. |
- Verguet, Stephane, et al.
(författare)
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Supplementary immunization activities (SIAs) in South Africa : comprehensive economic evaluation of an integrated child health delivery platform
- 2013
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 6, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Supplementary immunization activity (SIA) campaigns provide children with an additional dose of measles vaccine and deliver other interventions, including vitamin A supplements, deworming medications, and oral polio vaccines.Objective: To assess the cost-effectiveness of the full SIA delivery platform in South Africa (SA).Design: We used an epidemiologic cost model to estimate the cost-effectiveness of the 2010 SIA campaign. We used province-level campaign data sourced from the District Health Information System, SA, and from planning records of provincial coordinators of the Expanded Programme on Immunization. The data included the number of children immunized with measles and polio vaccines, the number of children given vitamin A supplements and Albendazole tablets, and costs.Results: The campaign cost $37 million and averted a total of 1,150 deaths (95% uncertainty range: 990-1,360)- This ranged from 380 deaths averted in KwaZulu-Natal to 20 deaths averted in the Northern Cape. Vitamin A supplementation alone averted 820 deaths (95% UR: 670-1,040); measles vaccination alone averted 330 deaths (95% UR: 280-370)- Incremental cost-effectiveness was $27,100 (95% UR: $18, 500-34,400) per death averted nationally, ranging from $11,300 per death averted in the Free State to $91,300 per death averted in the Eastern Cape.Conclusions: Cost-effectiveness of the SIA child health delivery platform varies substantially across SA provinces, and it is substantially more cost-effective when vitamin A supplementation is included in the interventions administered. Cost-effectiveness assessments should consider health system delivery platforms that integrate multiple interventions, and they should be conducted at the sub-national level.
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