Cost-effectiveness of a complex continuum of care intervention targeting women and children: protocol for an economic evaluation of the Bukhali trial in South Africa.

INTRODUCTION: As nearly two-thirds of women presenting at their first antenatal visit are either overweight or obese in urban South Africa, the preconception period is an opportunity to optimise health and offset transgenerational risk of both obesity and non-communicable diseases. This protocol describes the planned economic evaluation of an individually randomised controlled trial of a complex continuum of care intervention targeting women and children in Soweto, South Africa (Bukhali trial). METHODS AND ANALYSIS: The economic evaluation of the Bukhali trial will be conducted as a within-trial analysis from both provider and societal perspectives. Incremental costs and health outcomes of the continuum of care intervention will be compared with standard care. The economic impact on implementing agencies (programme costs), healthcare providers, participants and their households will be estimated. Incremental cost-effectiveness ratios (ICERs) will be calculated in terms of cost per case of child adiposity at age years averted. Additionally, ICERs will also be reported in terms of cost per quality-adjusted life year gained. If Bukhali demonstrates effectiveness, we will employ a decision analytical model to examine the cost-effectiveness of the intervention over a child's lifetime. A Markov model will be used to estimate long-term health benefits, healthcare costs and cost-effectiveness. Probabilistic sensitivity analyses will be conducted to explore uncertainty and ensure robust results. An analysis will be conducted to assess the equity impact of the intervention, by comparing intervention impact within quintiles of socioeconomic status. ETHICS AND DISSEMINATION: The Bukhali trial economic evaluation has ethical approval from the Human Ethics Research Committee of the University of the Witwatersrand, Johannesburg, South Africa (M240162). The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference. TRIAL REGISTRATION NUMBER: Pan African Clinical Trials Registry (PACTR201903750173871; https://pactr.samrc.ac.za).

Factores incidentes en el uso de métodos anticonceptivos en la población adolescente y adulta joven en Costa Rica

OBJETIVO: analizar los factores que inciden en el uso de métodos anticonceptivos de la población adolescente y adulta joven de Costa Rica (entre 15 y 35 años de edad).MÉTODOS: Por medio de los datos de la Encuesta Nacional de Juventud 2007 y la metodología basada en el Modelo Probit binario con corrección de sesgos de selección mediante Heckman, se modela la decisión de uso de anticonceptivos con base en diferentes características personales y socioeconómicas.RESULTADOS:se muestra que la edad de la persona y la de la pareja, la estabilidad de la relación y pertenecer a la zona urbana son factores que disminuyen la probabilidad de uso de anticonceptivos. Por otro lado, ser mujer, tener educación universitaria, haber recibido información sobre anticonceptivos e infecciones de transmisión sexual (ITS), la frecuencia de las relaciones y contar con una relación familiar de apoyo son factores que incrementan la posibilidad de protección mediante el uso de métodos anticonceptivos.CONCLUSIONES: Estos resultados pueden ayudar en el diseño de políticas para prevenir el embarazo adolescente y la transmisión de ITS. Además, se resalta la importancia de brindar educación sexual tanto a los jóvenes como a sus familias más allá de incentivar la abstinencia, de manera que se motive a tener una vida sexual responsable.

OBJECTIVE:to analyze the factors that affect use and nonuse of contraception in adolescent and young adults in Costa Rica (between ages 15 - 35).METHODS:The influence of personal and socioeconomic characteristics in the decision of the use of contraception can be observed through data collected in the survey National Youth Survey 2007 (Encuesta Nacional de Juventud 2007) and the methodology based on the binary Probit Model with selection bias correction through Heckman.RESULTS:it is showed that the age of both the person and the partner, the stability of the relationship, and residency in urban areas are factors related to lower probability of contraception use. On the other hand, being female, having university education, access to information about birth control and STDs (Sexually Transmitted Diseases), frequency in sexual intercourse, and good supportive family relationships are factors related to higher probability of contraception use.CONCLUSIONS:This results could work as a guide to design public policies to prevent teenage pregnancies and STDs. Furthermore, it is important to highlight the significance of sex education for teenagers and their families. This way, education could go beyond encouraging abstinence; it could motivate a responsible sexual life.