Most low income countries in Africa, including Kenya, still have an unacceptable number of child deaths arising from treatable and preventable diseases, although effective interventions are already available.
A new study by KEMRI Wellcome Trust Researchers however suggests that the Emergency Triage and Treatment Plus (ETAT +) approach can be a cost effective way of improving the management of serious childhood diseases in Kenya’s hospitals and would help achieve the fourth Millennium Development Goal of reducing the under-five mortality rate by two-thirds by 2015.
The ETAT+ approach originates from an earlier study by KEMRI Wellcome Trust Researchers which showed the development and implementation of evidence-based clinical practice guidelines (CPGs) linked to health worker training, follow-up supervision, performance feedback, and facilitation can substantially improve the quality of care in rural district hospitals.
The study, published in PLoS Medicine, set out to assess the cost effectiveness of the ETAT+ strategy. The study also looked at whether scaling up the ETAT+ strategy would be a good use of limited resources. This was done by a rigorous evaluation of costs and consequences to estimate the costs and effects of scaling up the intervention to reach the populations in
Study results indicated that the absolute costs for scaling up the ETAT+ approach are comparable to or lower than costs of other major child health interventions. More specifically, the researchers found out that the quality of care was 25% higher in intervention hospitals than in control hospitals.
The additional cost per child admission in hospitals receiving the full intervention, including all its development costs, was US$19.64 (Kshs 1,468). The estimated annual cost of scaling up the intervention nationally was US$3.6 million (Kshs 269 million), about 0.6% of the annual child health budget in Kenya.
Commenting on the study results, lead author of the study, Dr Edwine Barasa said: “As the international community is giving an increasing focus to strengthening health systems, these findings provide a strong case for scaling up this intervention, which improves quality of care and service provision for the major causes of child mortality, in rural hospitals throughout Kenya and other district hospitals in sub-Saharan Africa.”
Also commenting on the study, the co-authors said: “This work also highlights the need for methodological developments in the economic analysis of complex, system-level interventions. These results are likely to be most usefully generalized to low-income countries beyond Kenya with similar facilities, burden of child mortality, and comparable or worse quality of paediatric care in hospitals.”