Shillcutt Samuel D, LeFevre Amnesty E, Fischer Walker Christa L, Taneja Sunita, Black Robert E, Mazumder Sarmila
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
Health Policy Plan. 2016 Dec;31(10):1411-1422. doi: 10.1093/heapol/czw083. Epub 2016 Jul 31.
Diarrhoea is a leading cause of mortality among young children in India although few receive the recommended treatment. The diarrhoea alleviation through zinc and oral rehydration salts (ORS) therapy (DAZT) team initiated a programme in Gujarat from 2011 to 2013 to increase coverage of these interventions through public and private providers at scale. This study evaluates the economic impact of diarrhoea to caregivers before and after the introduction of zinc and ORS at scale through the DAZT programme.
The DAZT programme evaluation took a before-and-after study design using a two-stage clustered cross-sectional survey. Factors associated with the odds of caregivers incurring economic costs and their amounts were evaluated in a two-part modelling approach.
The DAZT programme lowered unadjusted economic costs to caregivers of treating a diarrhoeal episode from $4.04 to $2.49 in 2 years. Controlling for covariates, analysis showed no association between the programme and a change in odds of incurring an economic cost but did show an association with a reduction in economic cost of $2.15 (95% confidence interval (CI) $1.20-$3.11) per diarrhoea episode. A more than 4-fold increase in care-seeking from public community health workers, reduction in care-seeking from higher levels of the health system and reduced spending on drugs besides ORS and zinc may explain these results.
This study found an association between zinc introduction and a reduction in economic burden of diarrhoea treatment to caregivers in underserved rural areas of Gujarat through more efficient patterns of care-seeking and content of care.
腹泻是印度幼儿死亡的主要原因之一，尽管很少有患儿接受推荐的治疗。通过锌和口服补液盐（ORS）疗法缓解腹泻（DAZT）团队于2011年至2013年在古吉拉特邦启动了一项计划，以通过公共和私人医疗机构大规模扩大这些干预措施的覆盖范围。本研究评估了通过DAZT计划大规模引入锌和ORS前后腹泻对照料者的经济影响。
DAZT计划评估采用前后对照研究设计，使用两阶段整群横断面调查。采用两部分建模方法评估与照料者产生经济成本的几率及其金额相关的因素。
DAZT计划在两年内将治疗一次腹泻发作对照料者的未经调整的经济成本从4.04美元降至2.49美元。在控制协变量后，分析表明该计划与产生经济成本几率的变化之间没有关联，但确实显示与每例腹泻发作的经济成本降低2.15美元（95%置信区间（CI）1.20 - 3.11美元）有关。向公共社区卫生工作者寻求护理的次数增加了四倍多，从卫生系统更高层级寻求护理的次数减少，以及除ORS和锌之外的药品支出减少，可能解释了这些结果。
本研究发现，通过更有效的寻求护理模式和护理内容，在古吉拉特邦农村贫困地区引入锌与降低腹泻治疗对照料者的经济负担之间存在关联。
