Directing Diarrhoeal Disease Research towards Disease-burden Reduction.

Despite gains in controlling mortality relating to diarrhoeal disease, the burden of disease remains unacceptably high. To refocus health research to target disease-burden reduction as the goal of research in child health, the Child Health and Nutrition Research Initiative developed a systematic strategy to rank health research options. This priority-setting exercise included listing of 46 competitive research options in diarrhoeal disease and their critical and quantitative appraisal by 10 experts based on five criteria for research that reflect the ability of the research to be translated into interventions and achieved disease-burden reduction. These criteria included the answerability of the research questions; the efficacy and effectiveness of the intervention resulting from the research; the maximal potential for disease-burden reduction of the interventions derived from the research; the affordability, deliverability, and sustainability of the intervention supported by the research; and the overall effect of the research-derived intervention on equity. Experts scored each research option independently to delineate the best investments for diarrhoeal disease control in the developing world to reduce the burden of disease by 2015. Priority scores obtained for health policy and systems research obtained eight of the top 10 rankings in overall scores, indicating that current investments in health research are significantly different from those estimated to be the most effective in reducing the global burden of diarrhoeal disease by 2015.

Introducing hepatitis B virus vaccine into the Expanded Programme on Immunization in Bangladesh: a proposed method to evaluate whether the existing infrastructure has the capacity.

To determine whether the existing Expanded Programme on Immunization (EPI) in Bangladesh has the capacity to introduce the hepatitis B virus (HBV) vaccine, this study was carried out in all the nine health facilities, which maintain a cold-chain, in Chandpur district of Bangladesh. The research, focusing specifically on cold-chain equipment, aimed at developing and applying an indicator of the use of cold-chain equipment. A structured questionnaire, developed and field-tested, was used for collecting information on cold-chain equipment and their use-rate. Data were used for estimating the resources needed to introduce the HBV vaccine and for increasing the coverage of measles and DPT vaccines. The findings of the study showed that the use-rate of cold-chain equipment in this district was low, suggesting that the district has sufficient spare capacity to introduce and sustain the storage of an increased quantity of vaccines. This paper suggests an approach to study capacity in relation to infrastructural facilities. By measuring the capacity of capital equipment, the study has illustrated that the measurement of resource-use rates provides useful information about the burden that a new vaccine places on the EPI.

Cost of delivering child immunization services in urban Bangladesh: a study based on facility-level surveys.

This facility-based study estimated the costs of providing child immunization services in Dhaka, Bangladesh, from the perspective of healthcare providers. About a quarter of all immunization (EPI) delivery sites in Dhaka city were surveyed during 1999. The EPI services in urban Dhaka are delivered through a partnership of the Government of Bangladesh (GoB) and non-governmental organizations (NGOs). About 77% of the EPI delivery sites in Dhaka were under the management of NGOs, and 62% of all vaccinations were provided through these sites. The outreach facilities (both GoB and NGO) provided immunization services at a much lower cost than the permanent static facilities. The average cost per measles-vaccinated child (MVC), an indirect measure of number of children fully immunized (FIC-the number of children immunized by first year of life), was 11.61 U.S. dollars. If all the immunization doses delivered by the facilities were administered to children who were supposed to be immunized (FVC), the cost per child would have been 6.91 U.S. dollars. The wide gap between the cost per MVC and the cost per FVC implies that the cost of immunizing children can be reduced significantly through better targeting of children. The incremental cost of adding new services or interventions with current EPI was quite low, not significantly higher than the actual cost of new vaccines or drugs to be added. NGOs in Dhaka mobilized about 15,000 U.S. dollars from the local community to support the immunization activities. Involving local community with EPI activities not only will improve the sustainability of the programme but will also increase the immunization coverage.