Alternative Strategies to Reduce Maternal Mortality in India A Cost-Effectiveness Analysis 英文参考文献.docVIP

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Alternative Strategies to Reduce Maternal Mortality in India A Cost-Effectiveness Analysis 英文参考文献.doc

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Alternative Strategies to Reduce Maternal Mortality in India A Cost-Effectiveness Analysis 英文参考文献

AlternativeStrategiestoReduceMaternalMortalityin India:ACost-EffectivenessAnalysis SueJ.Goldie1,3*,SteveSweet1,NatalieCarvalho1,UmaChandraMouliNatchu2,4,DelphineHu1,3 1CenterforHealthDecisionScience,HarvardSchoolofPublicHealth,Boston,Massachusetts,UnitedStatesofAmerica,2DepartmentofNutrition,HarvardSchoolof PublicHealth,Boston,Massachusetts,UnitedStatesofAmerica,3DepartmentofHealthPolicyandManagement,HarvardSchoolofPublicHealth,Boston,Massachusetts, UnitedStatesofAmerica,4PediatricBiologyCentre,TranslationalHealthScienceandTechnologyInstitute,Delhi,India Abstract Background:Approximatelyone-quarterofallpregnancy-anddelivery-relatedmaternaldeathsworldwideoccurinIndia. Takingintoaccountthecosts,feasibility,andoperationalcomplexityofalternativeinterventions,weestimatetheclinical andpopulation-levelbenefitsassociatedwithstrategiestoimprovethesafetyofpregnancyandchildbirthinIndia. MethodsandFindings:Country-andregion-specificdataweresynthesizedusingacomputer-basedmodelthatsimulates thenaturalhistoryofpregnancy(bothplannedandunintended)andpregnancy-andchildbirth-associatedcomplicationsin individualwomen;andconsidersdeliverylocation,attendant,andfacilitylevel.Modeloutcomesincludedclinicalevents, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to urban and rural India using survey-based data (e.g., unmet need for birth spacing/limiting, facility births, skilled birth attendants). Model validation compared projected maternal indicators with empiric data. Strategies consisted of improving coverage of effective interventions that could be provided individually or packaged as integrated services, could reduce the incidence of a complication or its case fatality rate, and could include improved logistics such as reliable transport to an appropriate referralfacilityaswellasrecognitionofreferralneedandqualityofcare.Increasingfamilyplanningwasthemosteffective individualinterventiontoreducepregnancy-relatedmortality.Ifoverthenext5ytheunmetne