September 18, 2018

Addressing adverse outcomes following acute illness among children in Sub-Saharan Africa: predicting risks and cost-effectiveness

Doctoral student Rebecca Brander has received F31 funding from the National Institutes of Health for "Addressing adverse outcomes following acute illness among children in Sub-Saharan Africa: predicting risks and cost-effectiveness."


The burden and consequences of infectious diseases are disproportionately high in children under age 5 in Sub-Saharan Africa. Following recovery from acute illness, children remain at high risk for adverse outcomes, including mortality and growth faltering (which can lead to irreversible stunting, which is associated with substantial health and developmental detriments). Targeted antibiotic interventions may be cost-effective strategies to improving long-term outcomes in settings of high infectious disease burden, due to their growth-promoting, anti-inflammatory, immunomodulatory, and/or prophylactic properties. However, identifying children who are most likely to benefit from targeted interventions and assessing cost-effectiveness of such interventions are needed to inform the development and implementation of such interventions. The proposed research will provide tools for predicting which children are at highest risk of adverse outcomes following acute illness, and for evaluating cost-effectiveness of targeted interventions.

First, we will utilize data on a large, multi-site cohort of children with moderate-to severe diarrhea, to predict children at presentation with diarrhea who are at high risk for experiencing growth faltering in the 50-90 days following the acute illness. We will also evaluate whether children whose diarrhea was treated with antibiotics, irrespective of whether a bacterial pathogen was isolated, were less likely to experience growth faltering in the follow up period. This will inform management strategies of children with diarrhea and identify children who may stand to benefit from targeted antibiotics to prevent growth faltering. Next, we will address several research questions necessary for evaluating intervention cost effectiveness. Quality, precise cost inputs are key for cost-effectiveness analyses but are difficult to ascertain in low-resource settings. We will identify optimal methods for ascertaining health outcome costs in resource limited settings by evaluating micro-costing methods in terms of results, reproducibility, and time investment. This will inform approaches to costing, ultimately improving economic evaluations in low-resource settings. Finally, ongoing clinical trials are evaluating targeted approaches to antibiotic administration to prevent child mortality, such as azithromycin given at discharge to recently hospitalized Kenyan children.

Other recent trials have found a mortality benefit of community-wide distribution of antibiotics, but the relative cost-effectiveness of these approaches is unknown. We will build a cost-effectiveness model to evaluate whether targeted antibiotic prophylaxis is more cost-effective than community-based distribution. Inputs in this model can be updated as new efficacy data becomes available.

This comparative cost-effectiveness model will allow for understanding the resource implications of implementing each strategy and therefore be a guide for policy development. Completion of these specific aims will provide tools that will be useful in developing and implementing interventions for improving long term outcomes following acute illness in children in SSA.

Sponsor Award Number: 1F31HD096776-01