Browsing by Author "Horton, S."

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Evidence From Ghana Indicates That Childhood Cancer Treatment in Sub-Saharan Africa Is Very Cost Effective: A Report From the Childhood Cancer 2030 Network
(Journal of Global Oncology, 2018-04) Renner, L.; Shah, S.; Bhakta, N.; Denburg, A.; Horton, S.; Gupta, S.
Purpose: No published study to date has examined total cost and cost-effectiveness of maintaining a pediatric oncology treatment center in an African setting, thus limiting childhood cancer advocacy and policy efforts. Methods: Within the Korle Bu Teaching Hospital in Accra, Ghana, costing data were gathered for all inputs related to operating a pediatric cancer unit. Cost and volume data for relevant clinical services (eg, laboratory, pathology, medications) were obtained retrospectively or prospectively. Salaries were determined and multiplied by proportion of time dedicated toward pediatric patients with cancer. Costs associated with inpatient bed use, outpatient clinic use, administrative fees, and overhead were estimated. Costs were summed for a total annual operating cost. Cost-effectiveness was calculated based on annual patients with newly diagnosed disease, survival rates, and life expectancy. Results: The Korle Bu Teaching Hospital pediatric cancer unit treats on average 170 new diagnoses annually. Total operating cost was $1.7 million/y. Personnel salaries and operating room costs were the most expensive inputs, contributing 45% and 21% of total costs. Together, medications, imaging, radiation, and pathology services accounted for 7%. The cost per disability-adjusted life-year averted was $1,034, less than the Ghanaian per capita income, and thus considered very cost effective as per WHO-CHOICE methodology. Conclusion: To our knowledge, this study is the first to examine institution-level costs and cost-effectiveness of a childhood cancer program in an African setting, demonstrating that operating such a program in this setting is very cost effective. These results will inform national childhood cancer strategies in Africa and other low- and middle-income country settings.
Evidence-based interventions for improvement of maternal and child nutrition: What can be done and at what cost?
(The Lancet, 2013-08) Bhutta, Z.A.; Das, J.K.; Rizvi, A.; Gaffey, M.F.; Walker, N.; Horton, S.; Webb, P.; Lartey, A.; Black, R.E.
Maternal undernutrition contributes to 800000 neonatal deaths annually through small for gestational age births; stunting, wasting, and micronutrient deficiencies are estimated to underlie nearly 3·1 million child deaths annually. Progress has been made with many interventions implemented at scale and the evidence for effectiveness of nutrition interventions and delivery strategies has grown since The Lancet Series on Maternal and Child Undernutrition in 2008. We did a comprehensive update of interventions to address undernutrition and micronutrient deficiencies in women and children and used standard methods to assess emerging new evidence for delivery platforms. We modelled the effect on lives saved and cost of these interventions in the 34 countries that have 90% of the world's children with stunted growth. We also examined the effect of various delivery platforms and delivery options using community health workers to engage poor populations and promote behaviour change, access and uptake of interventions. Our analysis suggests the current total of deaths in children younger than 5 years can be reduced by 15% if populations can access ten evidence-based nutrition interventions at 90% coverage. Additionally, access to and uptake of iodised salt can alleviate iodine deficiency and improve health outcomes. Accelerated gains are possible and about a fifth of the existing burden of stunting can be averted using these approaches, if access is improved in this way. The estimated total additional annual cost involved for scaling up access to these ten direct nutrition interventions in the 34 focus countries is Int$9·6 billion per year. Continued investments in nutrition-specific interventions to avert maternal and child undernutrition and micronutrient deficiencies through community engagement and delivery strategies that can reach poor segments of the population at greatest risk can make a great difference. If this improved access is linked to nutrition-sensitive approaches - ie, women's empowerment, agriculture, food systems, education, employment, social protection, and safety nets - they can greatly accelerate progress in countries with the highest burden of maternal and child undernutrition and mortality. © 2013 Elsevier Ltd.
Maternal and child nutrition: Building momentum for impact
(The Lancet, 2013-06) Black, R.E.; Alderman, H.; Bhutta, Z.A.; Gillespie, S.; Haddad, L.; Horton, S.; Lartey, A.; Mannar, V.; Ruel, M.; Victora, C.G.; Walker, S.P.; Webb, P.
support for the interventions that can be quickly scaled up or linked to nutrition programmes—such as early child development initiatives. It is equally important to take note of the message of Marie Ruel and colleagues 4 — that in certain sectors, such as agriculture, the evidence of the eff ect of targeted programmes on maternal and child nutrition is largely inconclusive and requires new approaches to fi eld evaluation. Since 2008, there have been only limited increases in donor aid for nutrition. It is true that nutrition is not so readily attractive to politicians as an international development priority. Undernutrition has a complex set of political, social, and economic causes, none of which are amenable to easy solutions that fi t within the timeframe of a single political cycle. For this reason, the outlook today for nutrition is not wholly good. The target endorsed only a year ago at the World Health Assembly—to reduce by 40% the number of children stunted by 2025—is already on course to be missed. As the endpoint of the Millennium Development Goals approaches, countries and the international community may agree that nutrition was one of the great missed opportunities of the past 15 years. But this neglect can be turned around quickly. As sustainable development becomes the dominant idea post-2015, nutrition emerges as the quintessential example of a sustainable development objective. If maternal and child nutrition is optimised, the benefi ts will accrue and extend over several generations. This remarkable opportunity is why Stuart Gillespie and colleagues 5 take a very diff erent approach to implementation than in any previous Lancet Series. Instead of exhorting politicians and policy makers to do something—or worse, simply hoping that political commitment will appear like a rabbit out of a hat—they set out a practical guide about how to seize the agenda for nutrition, how to create political momentum, and how to turn that momentum into results. This is the prize we have to grasp in the next 18 months.