Nandi Arindam, Megiddo Itamar, Ashok Ashvin, Verma Amit, Laxminarayan Ramanan
Center for Disease Dynamics, Economics & Policy, 1400 Eye St NW, Ste 500, Washington DC, 20005, USA; Public Health Foundation of India, Gurgaon, India.
Center for Disease Dynamics, Economics & Policy, 1400 Eye St NW, Ste 500, Washington DC, 20005, USA; Department of Management Science, University of Strathclyde, Glasgow, UK.
Soc Sci Med. 2017 May;180:181-192. doi: 10.1016/j.socscimed.2016.08.049. Epub 2016 Aug 31.
Each year, more than 300,000 children in India under the age of five years die from diarrheal diseases. Clean piped water and improved sanitation are known to be effective in reducing the mortality and morbidity burden of diarrhea but are not yet available to close to half of the Indian population. In this paper, we estimate the health benefits (reduced cases of diarrheal incidence and deaths averted) and economic benefits (measured by out-of-pocket treatment expenditure averted and value of insurance gained) of scaling up the coverage of piped water and improved sanitation among Indian households to a near-universal 95% level. We use IndiaSim, a previously validated, agent-based microsimulation platform to model disease progression and individual demographic and healthcare-seeking behavior in India, and use an iterative, stochastic procedure to simulate health and economic outcomes over time. We find that scaling up access to piped water and improved sanitation could avert 43,352 (95% uncertainty range [UR] 42,201-44,504) diarrheal episodes and 68 (95% UR 62-74) diarrheal deaths per 100,000 under-5 children per year, compared with the baseline. We estimate a saving of (in 2013 US$) $357,788 (95% $345,509-$370,067) in out-of-pocket diarrhea treatment expenditure, and $1646 (95% UR $1603-$1689) in incremental value of insurance per 100,000 under-5 children per year over baseline. The health and financial benefits are highly progressive, i.e. they reach poorer households more. Thus, scaling up access to piped water and improved sanitation can lead to large and equitable reductions in the burden of childhood diarrheal diseases in India.
印度每年有超过30万5岁以下儿童死于腹泻疾病。众所周知，清洁的管道水和改善卫生条件能有效减轻腹泻造成的死亡率和发病率负担，但印度近半数人口仍无法获得这些条件。在本文中，我们估计了将印度家庭管道水覆盖范围和改善卫生条件扩大到接近普遍的95%水平所带来的健康益处（腹泻发病率降低和死亡避免）和经济效益（通过避免的自付治疗费用和获得的保险价值衡量）。我们使用IndiaSim，一个先前经过验证的基于主体的微观模拟平台，来模拟印度的疾病进展以及个体人口统计学和就医行为，并使用迭代随机程序来模拟随时间推移的健康和经济结果。我们发现，与基线相比，扩大管道水供应和改善卫生条件每年每10万名5岁以下儿童可避免43352例（95%不确定范围[UR]42201 - 44504）腹泻发作和68例（95% UR 62 - 74）腹泻死亡。我们估计每年每10万名5岁以下儿童可节省（以2013年美元计）357788美元（95% 345509 - 370067美元）的腹泻自付治疗费用，以及比基线增加1646美元（95% UR 1603 - 1689美元）的保险价值。健康和经济益处具有高度累进性，即它们更多地惠及较贫困家庭。因此，扩大管道水供应和改善卫生条件可大幅且公平地减轻印度儿童腹泻疾病负担。
