Richard Rheingans | Appalachian State University (original) (raw)

Papers by Richard Rheingans

Open Forum Infectious Diseases, Apr 1, 2019

Background. Although there are many overlapping features, pediatric diarrheal diseases can vary i... more Background. Although there are many overlapping features, pediatric diarrheal diseases can vary in severity, duration, clinical manifestations, and sequelae according to the causal pathogen, which in turn can impact the economic burden on patients and their families. We aimed to evaluate the household costs of diarrheal disease by pathogen in 7 countries. Methods. We analyzed data from the Global Enteric Multicenter Study (GEMS), a prospective, age-stratified, matched casecontrol study of moderate to severe diarrheal disease among children aged 0-59 months in 7 low-income countries; 4 in Africa (Kenya, Mali, Mozambique, The Gambia) and 3 in Asia (Bangladesh, India, Pakistan). Demographic, epidemiological, economic, and clinical data were collected, and a stool sample was obtained for microbiological analysis at enrollment. We used a multivariate generalized linear model to assess the effect of rotavirus, Cryptosporidium, heat-stable toxin (ST)-producing enterotoxigenic Escherichia coli (ETEC [ST only or LT plus ST]), Shigella, Campylobacter jejuni, norovirus GII, Vibrio cholerae O1, age, gender, in/ outpatient, and country on total costs to the patient/family. Results. Household out-of-pocket costs were higher in Mali than any other country. Within countries, household cost differences between pathogens were minimal and not statistically significantly different. Conclusions. We found no significant differences in household costs by pathogen. Despite data limitations, understanding pathogen-specific household costs (or lack thereof) is useful, as decision-makers could consider broader illness cost information and its relevance to a particular pathogen's economic burden and contribution to poverty when deciding which pathogens to target for interventions.

Vaccine, Dec 1, 2018

Rotavirus enteritis is responsible for nearly 200,000 child deaths worldwide in 2015. Globally, m... more Rotavirus enteritis is responsible for nearly 200,000 child deaths worldwide in 2015. Globally, many low-and middle-income countries have introduced rotavirus vaccine, resulting in documented reductions in hospitalizations and child mortality. We examined the potential impact and cost-effectiveness of introducing rotavirus vaccination in Lao People's Democratic Republic using an Excel-based spreadsheet model. We estimated mortality risk factors, patterns of care seeking, and vaccination access to predict outcomes for regional, provincial, and socioeconomic subpopulations for one birth cohort through their first five years of life and life course in Disability-Adjusted Life Years estimates. Socioeconomic status was defined by categorizing households into regional wealth quintiles based on a national asset index. We modeled a two-dose ROTARIX vaccine under current Gavi pricing and efficacy estimates from Bangladesh and Vietnam. DPT1 and DPT2 coverages were used to estimate rotavirus vaccination coverage. Probabilistic sensitivity analysis was used to assess the impact of uncertainty on model parameters on predicted incremental cost-effectiveness ratios (ICERs), including scenarios of increases in vaccination coverage. Rotavirus vaccination would prevent 143 child deaths/year, or 28% of annual rotavirus burden. The estimated national level ICER for rotavirus vaccination was 140/DALY,withregionalsocioeconomicsubpopulationestimatesrangingfrom140/DALY, with regional socioeconomic subpopulation estimates ranging from 140/DALY,withregionalsocioeconomicsubpopulationestimatesrangingfrom72/DALY for the poorest in the Central region to $353/DALY for the richest in the North region, indicating high cost-effectiveness. Within regions, ICERs are most favorable for children in the poorer and poorest quintiles. However, the full benefits of rotavirus vaccination will only be realized by reducing disparities in vaccination coverage, access to treatment, and environmental health. Improving vaccination coverage to equitable levels alone would prevent 87 additional child deaths per year.

Vaccine, Apr 1, 2012

Background: Other studies have demonstrated that the impact and cost effectiveness of rotavirus v... more Background: Other studies have demonstrated that the impact and cost effectiveness of rotavirus vaccination differs among countries, with greater mortality reduction benefits and lower costeffectiveness ratios in low-income and high-mortality countries. This analysis combines the results of a country level model of rotavirus vaccination published elsewhere with data from Demographic and Health Surveys on within-country patterns of vaccine coverage and diarrhea mortality risk factors to estimate within-country distributional effects of rotavirus vaccination. The study examined 25 countries eligible for funding through the GAVI Alliance. Methods: For each country we estimate the benefits and cost-effectiveness of vaccination for each wealth quintile assuming current vaccination patterns and for a scenario where vaccine coverage is equalized to the highest quintile's coverage. In the case of India, variations in coverage and risk proxies by state were modeled to estimate geographic distributional effects. Results: In all countries, rates of vaccination were highest and risks of mortality were lowest in the top two wealth quintiles. However countries differ greatly in the relative inequities in these two underlying variables. Similarly, in all countries examined, the cost-effectiveness ratio for vaccination ($/Disability-Adjusted Life Year averted, DALY) is substantially greater in the higher quintiles (ranging from 2-10 times higher). In all countries, the greatest potential benefit of vaccination was in the poorest quintiles. However, due to reduced vaccination coverage, projected benefits for these quintiles were often lower. Equitable coverage was estimated to result in an 89% increase in mortality reduction for the poorest quintile and a 38% increase overall. Conclusions: Rotavirus vaccination is most cost-effective in low-income groups and regions. However in many countries, simply adding new vaccines to existing systems targets investments to higher income children, due to disparities in vaccination coverage. Maximizing health benefits for the poorest children and value for money require increased attention to these distributional effects.

The Lancet Global Health, Mar 1, 2019

Background Enterotoxigenic Escherichia coli (ETEC) and shigella are two major pathogens that caus... more Background Enterotoxigenic Escherichia coli (ETEC) and shigella are two major pathogens that cause moderate-to-severe diarrhoea in children younger than 5 years. Diarrhoea is associated with an increased risk of stunting, which puts children at risk of death due to other infectious diseases. Methods We modelled ETEC-related and shigella-related mortality and the effect of moderate-to-severe diarrhoea episodes to determine the number of children with stunting due to these infections in 79 low-income and lower middle-income countries. We applied population attributable risk for increased number of deaths due to other infectious diseases in children who are stunted. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings In children younger than 5 years, we estimate 196 million (95% UI 135-269) episodes of ETEC and shigella diarrhoea occur annually, resulting in 3•5 million (0•8-5•4) cases of moderate-to-severe stunting and 44 400 (29 400-59 800) total ETEC deaths and 63 100 (44 000-81 900) total shigella deaths in 2015. Additional infectious disease mortality due to stunting resulted in increases of 24% (8-34; for ETEC) and 28% (10-39; for shigella) over direct deaths due to diarrhoeal episodes. The distribution of mortality and morbidity varied geographically, with African Region and Eastern Mediterranean Region countries bearing the greatest burden. Interpretation The expanded effects of non-fatal ETEC and shigella-related diarrhoeal episodes can have lasting consequences. Prevention of these infections could reduce the risk of direct death and stunting and deaths due to other infectious diseases. Understanding the countries and populations with the highest disease risk helps to target interventions for the most vulnerable populations. Funding The Bill & Melinda Gates Foundation.

The Lancet Global Health, 2020

Revista panamericana de salud pública (Impresa), Apr 1, 2007

Methods. An economic model was constructed to estimate the cost-effectiveness of vaccination from... more Methods. An economic model was constructed to estimate the cost-effectiveness of vaccination from the health care system perspective, using national administrative and published epidemiological evidence, country-specific cost estimates, and vaccine efficacy data. The model was applied to the first five years of life for the 2003 birth cohort in each country. The main health outcome was the disability-adjusted life year (DALY), and the main summary measure was the incremental cost per DALY averted. A 3% discount rate was used for all predicted costs and benefits. Sensitivity analyses evaluated the impact of uncertainty regarding key variables on cost-effectiveness estimates. Results. According to the estimates obtained with the economic model, vaccination would prevent more than 65% of the medical visits, deaths, and treatment costs associated with rotavirus gastroenteritis in the eight countries analyzed here.

The Journal of Infectious Diseases, Sep 1, 2005

Background. New rotavirus vaccines may soon be licensed, and decisions regarding implementation o... more Background. New rotavirus vaccines may soon be licensed, and decisions regarding implementation of their use will likely be based on the health and economic benefits of vaccination. Methods. We estimated the benefits and cost-effectiveness of rotavirus vaccination in Asia by using published estimates of rotavirus disease incidence, health care expenditures, vaccine coverage rates, and vaccine efficacy. Results. Without a rotavirus vaccination program, it is estimated that 171,000 Asian children will die of rotavirus diarrhea, 1.9 million will be hospitalized, and 13.5 million will require an outpatient visit by the time the Asian birth cohort reaches 5 years of age. The medical costs associated with these events are approximately $191 million; however, the total burden would be higher with the inclusion of such societal costs as lost productivity. A universal rotavirus vaccination program could avert approximately 109,000 deaths, 1.4 million hospitalizations, and 7.7 million outpatient visits among these children. Conclusions. A rotavirus vaccine could be cost-effective, depending on the income level of the country, the price of the vaccine, and the cost-effectiveness standard that is used. Decisions regarding implementation of vaccine use should be based not only on whether the intervention provides a cost savings but, also, on the value of preventing rotavirus disease-associated morbidity and mortality, particularly in countries with a low income level (according to 2004 World Bank criteria for the classification of countries into income groups on the basis of per capita gross national income) where the disease burden is great. Rotavirus infection is the leading cause of severe acute gastroenteritis among children worldwide. It is estimated that, each year, 440,000 children !5 years of age die of rotavirus gastroenteritis, 2 million are hospitalized, and 25 million require a visit to a clinic (i.e., an "outpatient visit") for complications associated with rotavirus gastroenteritis [1]. This supplement issue of the Journal of Infectious Diseases highlights the importance of rotavirus-associated diarrheal disease in Asia, with the studies showing that rotavirus infection is the cause of 30%-73% of hospitalizations for gastroenteritis among young children [2]. Because of the tremendous health burden associated Financial support: Rotavirus Vaccine Program (RVP) at the Program for Appropriate Technology in Health; Global Alliance for Vaccines and Immunizations (GAVI).

Waterlines, Oct 1, 2010

Despite the known health benefi ts of washing hands with soap, global handwashing rates are low. ... more Despite the known health benefi ts of washing hands with soap, global handwashing rates are low. In Nyanza Province, Kenya, a follow-up of 55 pilot primary schools three years after the implementation of a safe water and hygiene intervention revealed that only 2 per cent (one school) provided soap for handwashing on the day of the assessment. After identifying barriers to soap provision, SWASH+ partners piloted a handwashing intervention using powdered soap mixed with water to create soapy water in place of bar soap in 11 schools. The fi rst six months of unannounced visits showed high uptake (10 schools). A one-year follow-up visit revealed a decrease of soapy water use (four schools). This paper discusses the soapy water intervention, initial and follow-up monitoring fi ndings, potential sustainability drivers of handwashing programmes in rural primary schools and next steps. Richard D. Rheingans, Shadi Saboori And Alex Mwaki (2010) "Is soapy water a viable solution for handwashing in schools?" Waterlines 29(4) pp.

Expert Review of Pharmacoeconomics & Outcomes Research, Oct 1, 2005

Rotaviruses are the commonest cause of severe watery diarrheal disease in infants and young child... more Rotaviruses are the commonest cause of severe watery diarrheal disease in infants and young children, causing an estimated 352,000-592,000 deaths per year, mostly in developing countries. In 1999, the first rotavirus vaccine to be licensed in the USA (RotaShield) was withdrawn . However, before use of the vaccine was suspended, several economic evaluations were performed. Recently, two rotavirus vaccines, Rotarix and RotaTeq, have completed Phase III clinical trials. The first economic evaluations of these new rotavirus vaccines are now appearing. The purpose of this paper is to review the existing cost-effectiveness evidence-base, and to provide methodologic suggestions for future analyses.

Waterlines, Oct 1, 2011

In Nyanza Province, Kenya, a sustainability evaluation of 55 pilot primary schools 2.5 years afte... more In Nyanza Province, Kenya, a sustainability evaluation of 55 pilot primary schools 2.5 years after the implementation of the Safe Water System (SWS) intervention revealed that programme activities were not successfully sustained in any of the schools visited. The most common criterion met was drinking water provision. We identified six enabling environment domains: financial capacity; accountability; technical feasibility and availability; community support; school leadership and management; and student engagement. While these domains pertain to the sustaining of the SWS activities in schools, they are likely to be applicable in creating an enabling environment and serve as proxy indicators for other school water, sanitation, and hygiene initiatives as well.

Clinical Infectious Diseases, Dec 15, 2012

In addition to being a major cause of mortality in South Asia, childhood diarrhea creates economi... more In addition to being a major cause of mortality in South Asia, childhood diarrhea creates economic burden for affected households. We used survey data from sites in Bangladesh, India, and Pakistan to estimate the costs borne by households due to childhood diarrhea, including direct medical costs, direct nonmedical costs, and productivity losses.

Pediatric Infectious Disease Journal, 2006

DOAJ (DOAJ: Directory of Open Access Journals), Jun 1, 2009

To evaluate the cost and benefits of a national rotavirus childhood vaccination program in Mexico... more To evaluate the cost and benefits of a national rotavirus childhood vaccination program in Mexico. A decision-analysis model was designed to take the Mexican health care system's perspective on a comparison of two alternatives: to vaccinate against rotavirus or not. Using published, national data, estimations were calculated for the rotavirus illnesses, deaths, and disability-adjusted life years (DALYs) that would be averted and the incremental cost-effectiveness ratios (US$/DALY) of a hypothetical annual birth cohort of 2 285 000 children, with certain assumptions made for cost, coverage, and efficacy rates. With 93% coverage and a vaccine price of US$ 16 per course (2 doses), a rotavirus vaccination program in Mexico would prevent an estimated 651 deaths (or 0.28 deaths per 1 000 children); 13 833 hospitalizations (6.05 hospitalizations per 1 000 children); and 414 927 outpatient visits (182 outpatient visits per 1 000 children) for rotavirus-related acute gastroenteritis (AGE). Vaccination is likely to reduce the economic burden of rotavirus AGE in Mexico by averting US$ 14 million (71% of the overall health care burden). At a vaccine price of US$ 16 per course, the cost-effectiveness ratio would be US$ 1 139 per DALY averted. A reduction in the price of the rotavirus vaccination program (US$ 8 per course) would yield a lower incremental cost-effectiveness ratio of US$ 303 per DALY averted. A national rotavirus vaccination program in Mexico is projected to reduce childhood incidence and mortality and to be highly cost-effective based on the World Health Organization's thresholds for cost-effective interventions.

International Journal of Environmental Research and Public Health, Sep 17, 2014

The purpose of this study was to quantify how school sanitation conditions are associated with pu... more The purpose of this study was to quantify how school sanitation conditions are associated with pupils' use of sanitation facilities. We conducted a longitudinal assessment in 60 primary schools in Nyanza Province, Kenya, using structured observations to measure facility conditions and pupils' use at specific facilities. We used multivariable mixed regression models to characterize how pupil to toilet ratio was associated with toilet use at the school-level and also how facility conditions were associated with pupils' use at specific facilities. We found a piecewise linear relationship between decreasing pupil to toilet ratio and increasing pupil toilet use (p < 0.01). Our data also revealed significant associations between toilet use and newer facility age (p < 0.01), facility type (p < 0.01), and the number of toilets in a facility (p < 0.01). We found some evidence suggesting

Revista panamericana de salud pública (Impresa), Apr 1, 2007

Objective. To estimate the health and economic burden of rotavirus gastroenteritis in hospital an... more Objective. To estimate the health and economic burden of rotavirus gastroenteritis in hospital and outpatient settings in eight Latin American and Caribbean countries (Argentina,

DOAJ (DOAJ: Directory of Open Access Journals), Apr 1, 2007

Objective. To estimate the health and economic burden of rotavirus gastroenteritis in hospital an... more Objective. To estimate the health and economic burden of rotavirus gastroenteritis in hospital and outpatient settings in eight Latin American and Caribbean countries (Argentina,

International Journal of Educational Development, Sep 1, 2013

This cross-sectional analysis examined the influence of school and household water, sanitation, a... more This cross-sectional analysis examined the influence of school and household water, sanitation, and hygiene (WASH) conditions on recent primary school absence in light of other individual, household, and school characteristics in western Kenya. School latrine cleanliness was the only school WASH factor associated with reduced odds of absence. The marginal effect of household characteristics, such as distance to water source, child involvement in water collection, and presence of a latrine, differed by gender. Demographic features were more important predictors of absence, suggesting that interventions to improve attendance must consider existing differentials attributable to gender, socioeconomic status, and other household characteristics.

Journal of Water and Health, Jul 1, 2006

Open Forum Infectious Diseases, Apr 1, 2019

Background. Although there are many overlapping features, pediatric diarrheal diseases can vary i... more Background. Although there are many overlapping features, pediatric diarrheal diseases can vary in severity, duration, clinical manifestations, and sequelae according to the causal pathogen, which in turn can impact the economic burden on patients and their families. We aimed to evaluate the household costs of diarrheal disease by pathogen in 7 countries. Methods. We analyzed data from the Global Enteric Multicenter Study (GEMS), a prospective, age-stratified, matched casecontrol study of moderate to severe diarrheal disease among children aged 0-59 months in 7 low-income countries; 4 in Africa (Kenya, Mali, Mozambique, The Gambia) and 3 in Asia (Bangladesh, India, Pakistan). Demographic, epidemiological, economic, and clinical data were collected, and a stool sample was obtained for microbiological analysis at enrollment. We used a multivariate generalized linear model to assess the effect of rotavirus, Cryptosporidium, heat-stable toxin (ST)-producing enterotoxigenic Escherichia coli (ETEC [ST only or LT plus ST]), Shigella, Campylobacter jejuni, norovirus GII, Vibrio cholerae O1, age, gender, in/ outpatient, and country on total costs to the patient/family. Results. Household out-of-pocket costs were higher in Mali than any other country. Within countries, household cost differences between pathogens were minimal and not statistically significantly different. Conclusions. We found no significant differences in household costs by pathogen. Despite data limitations, understanding pathogen-specific household costs (or lack thereof) is useful, as decision-makers could consider broader illness cost information and its relevance to a particular pathogen's economic burden and contribution to poverty when deciding which pathogens to target for interventions.

Vaccine, Dec 1, 2018

Rotavirus enteritis is responsible for nearly 200,000 child deaths worldwide in 2015. Globally, m... more Rotavirus enteritis is responsible for nearly 200,000 child deaths worldwide in 2015. Globally, many low-and middle-income countries have introduced rotavirus vaccine, resulting in documented reductions in hospitalizations and child mortality. We examined the potential impact and cost-effectiveness of introducing rotavirus vaccination in Lao People's Democratic Republic using an Excel-based spreadsheet model. We estimated mortality risk factors, patterns of care seeking, and vaccination access to predict outcomes for regional, provincial, and socioeconomic subpopulations for one birth cohort through their first five years of life and life course in Disability-Adjusted Life Years estimates. Socioeconomic status was defined by categorizing households into regional wealth quintiles based on a national asset index. We modeled a two-dose ROTARIX vaccine under current Gavi pricing and efficacy estimates from Bangladesh and Vietnam. DPT1 and DPT2 coverages were used to estimate rotavirus vaccination coverage. Probabilistic sensitivity analysis was used to assess the impact of uncertainty on model parameters on predicted incremental cost-effectiveness ratios (ICERs), including scenarios of increases in vaccination coverage. Rotavirus vaccination would prevent 143 child deaths/year, or 28% of annual rotavirus burden. The estimated national level ICER for rotavirus vaccination was 140/DALY,withregionalsocioeconomicsubpopulationestimatesrangingfrom140/DALY, with regional socioeconomic subpopulation estimates ranging from 140/DALY,withregionalsocioeconomicsubpopulationestimatesrangingfrom72/DALY for the poorest in the Central region to $353/DALY for the richest in the North region, indicating high cost-effectiveness. Within regions, ICERs are most favorable for children in the poorer and poorest quintiles. However, the full benefits of rotavirus vaccination will only be realized by reducing disparities in vaccination coverage, access to treatment, and environmental health. Improving vaccination coverage to equitable levels alone would prevent 87 additional child deaths per year.

Vaccine, Apr 1, 2012

Background: Other studies have demonstrated that the impact and cost effectiveness of rotavirus v... more Background: Other studies have demonstrated that the impact and cost effectiveness of rotavirus vaccination differs among countries, with greater mortality reduction benefits and lower costeffectiveness ratios in low-income and high-mortality countries. This analysis combines the results of a country level model of rotavirus vaccination published elsewhere with data from Demographic and Health Surveys on within-country patterns of vaccine coverage and diarrhea mortality risk factors to estimate within-country distributional effects of rotavirus vaccination. The study examined 25 countries eligible for funding through the GAVI Alliance. Methods: For each country we estimate the benefits and cost-effectiveness of vaccination for each wealth quintile assuming current vaccination patterns and for a scenario where vaccine coverage is equalized to the highest quintile's coverage. In the case of India, variations in coverage and risk proxies by state were modeled to estimate geographic distributional effects. Results: In all countries, rates of vaccination were highest and risks of mortality were lowest in the top two wealth quintiles. However countries differ greatly in the relative inequities in these two underlying variables. Similarly, in all countries examined, the cost-effectiveness ratio for vaccination ($/Disability-Adjusted Life Year averted, DALY) is substantially greater in the higher quintiles (ranging from 2-10 times higher). In all countries, the greatest potential benefit of vaccination was in the poorest quintiles. However, due to reduced vaccination coverage, projected benefits for these quintiles were often lower. Equitable coverage was estimated to result in an 89% increase in mortality reduction for the poorest quintile and a 38% increase overall. Conclusions: Rotavirus vaccination is most cost-effective in low-income groups and regions. However in many countries, simply adding new vaccines to existing systems targets investments to higher income children, due to disparities in vaccination coverage. Maximizing health benefits for the poorest children and value for money require increased attention to these distributional effects.

The Lancet Global Health, Mar 1, 2019

Background Enterotoxigenic Escherichia coli (ETEC) and shigella are two major pathogens that caus... more Background Enterotoxigenic Escherichia coli (ETEC) and shigella are two major pathogens that cause moderate-to-severe diarrhoea in children younger than 5 years. Diarrhoea is associated with an increased risk of stunting, which puts children at risk of death due to other infectious diseases. Methods We modelled ETEC-related and shigella-related mortality and the effect of moderate-to-severe diarrhoea episodes to determine the number of children with stunting due to these infections in 79 low-income and lower middle-income countries. We applied population attributable risk for increased number of deaths due to other infectious diseases in children who are stunted. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings In children younger than 5 years, we estimate 196 million (95% UI 135-269) episodes of ETEC and shigella diarrhoea occur annually, resulting in 3•5 million (0•8-5•4) cases of moderate-to-severe stunting and 44 400 (29 400-59 800) total ETEC deaths and 63 100 (44 000-81 900) total shigella deaths in 2015. Additional infectious disease mortality due to stunting resulted in increases of 24% (8-34; for ETEC) and 28% (10-39; for shigella) over direct deaths due to diarrhoeal episodes. The distribution of mortality and morbidity varied geographically, with African Region and Eastern Mediterranean Region countries bearing the greatest burden. Interpretation The expanded effects of non-fatal ETEC and shigella-related diarrhoeal episodes can have lasting consequences. Prevention of these infections could reduce the risk of direct death and stunting and deaths due to other infectious diseases. Understanding the countries and populations with the highest disease risk helps to target interventions for the most vulnerable populations. Funding The Bill & Melinda Gates Foundation.

The Lancet Global Health, 2020

Revista panamericana de salud pública (Impresa), Apr 1, 2007

Methods. An economic model was constructed to estimate the cost-effectiveness of vaccination from... more Methods. An economic model was constructed to estimate the cost-effectiveness of vaccination from the health care system perspective, using national administrative and published epidemiological evidence, country-specific cost estimates, and vaccine efficacy data. The model was applied to the first five years of life for the 2003 birth cohort in each country. The main health outcome was the disability-adjusted life year (DALY), and the main summary measure was the incremental cost per DALY averted. A 3% discount rate was used for all predicted costs and benefits. Sensitivity analyses evaluated the impact of uncertainty regarding key variables on cost-effectiveness estimates. Results. According to the estimates obtained with the economic model, vaccination would prevent more than 65% of the medical visits, deaths, and treatment costs associated with rotavirus gastroenteritis in the eight countries analyzed here.

The Journal of Infectious Diseases, Sep 1, 2005

Background. New rotavirus vaccines may soon be licensed, and decisions regarding implementation o... more Background. New rotavirus vaccines may soon be licensed, and decisions regarding implementation of their use will likely be based on the health and economic benefits of vaccination. Methods. We estimated the benefits and cost-effectiveness of rotavirus vaccination in Asia by using published estimates of rotavirus disease incidence, health care expenditures, vaccine coverage rates, and vaccine efficacy. Results. Without a rotavirus vaccination program, it is estimated that 171,000 Asian children will die of rotavirus diarrhea, 1.9 million will be hospitalized, and 13.5 million will require an outpatient visit by the time the Asian birth cohort reaches 5 years of age. The medical costs associated with these events are approximately $191 million; however, the total burden would be higher with the inclusion of such societal costs as lost productivity. A universal rotavirus vaccination program could avert approximately 109,000 deaths, 1.4 million hospitalizations, and 7.7 million outpatient visits among these children. Conclusions. A rotavirus vaccine could be cost-effective, depending on the income level of the country, the price of the vaccine, and the cost-effectiveness standard that is used. Decisions regarding implementation of vaccine use should be based not only on whether the intervention provides a cost savings but, also, on the value of preventing rotavirus disease-associated morbidity and mortality, particularly in countries with a low income level (according to 2004 World Bank criteria for the classification of countries into income groups on the basis of per capita gross national income) where the disease burden is great. Rotavirus infection is the leading cause of severe acute gastroenteritis among children worldwide. It is estimated that, each year, 440,000 children !5 years of age die of rotavirus gastroenteritis, 2 million are hospitalized, and 25 million require a visit to a clinic (i.e., an "outpatient visit") for complications associated with rotavirus gastroenteritis [1]. This supplement issue of the Journal of Infectious Diseases highlights the importance of rotavirus-associated diarrheal disease in Asia, with the studies showing that rotavirus infection is the cause of 30%-73% of hospitalizations for gastroenteritis among young children [2]. Because of the tremendous health burden associated Financial support: Rotavirus Vaccine Program (RVP) at the Program for Appropriate Technology in Health; Global Alliance for Vaccines and Immunizations (GAVI).

Waterlines, Oct 1, 2010

Despite the known health benefi ts of washing hands with soap, global handwashing rates are low. ... more Despite the known health benefi ts of washing hands with soap, global handwashing rates are low. In Nyanza Province, Kenya, a follow-up of 55 pilot primary schools three years after the implementation of a safe water and hygiene intervention revealed that only 2 per cent (one school) provided soap for handwashing on the day of the assessment. After identifying barriers to soap provision, SWASH+ partners piloted a handwashing intervention using powdered soap mixed with water to create soapy water in place of bar soap in 11 schools. The fi rst six months of unannounced visits showed high uptake (10 schools). A one-year follow-up visit revealed a decrease of soapy water use (four schools). This paper discusses the soapy water intervention, initial and follow-up monitoring fi ndings, potential sustainability drivers of handwashing programmes in rural primary schools and next steps. Richard D. Rheingans, Shadi Saboori And Alex Mwaki (2010) "Is soapy water a viable solution for handwashing in schools?" Waterlines 29(4) pp.

Expert Review of Pharmacoeconomics & Outcomes Research, Oct 1, 2005

Rotaviruses are the commonest cause of severe watery diarrheal disease in infants and young child... more Rotaviruses are the commonest cause of severe watery diarrheal disease in infants and young children, causing an estimated 352,000-592,000 deaths per year, mostly in developing countries. In 1999, the first rotavirus vaccine to be licensed in the USA (RotaShield) was withdrawn . However, before use of the vaccine was suspended, several economic evaluations were performed. Recently, two rotavirus vaccines, Rotarix and RotaTeq, have completed Phase III clinical trials. The first economic evaluations of these new rotavirus vaccines are now appearing. The purpose of this paper is to review the existing cost-effectiveness evidence-base, and to provide methodologic suggestions for future analyses.

Waterlines, Oct 1, 2011

In Nyanza Province, Kenya, a sustainability evaluation of 55 pilot primary schools 2.5 years afte... more In Nyanza Province, Kenya, a sustainability evaluation of 55 pilot primary schools 2.5 years after the implementation of the Safe Water System (SWS) intervention revealed that programme activities were not successfully sustained in any of the schools visited. The most common criterion met was drinking water provision. We identified six enabling environment domains: financial capacity; accountability; technical feasibility and availability; community support; school leadership and management; and student engagement. While these domains pertain to the sustaining of the SWS activities in schools, they are likely to be applicable in creating an enabling environment and serve as proxy indicators for other school water, sanitation, and hygiene initiatives as well.

Clinical Infectious Diseases, Dec 15, 2012

In addition to being a major cause of mortality in South Asia, childhood diarrhea creates economi... more In addition to being a major cause of mortality in South Asia, childhood diarrhea creates economic burden for affected households. We used survey data from sites in Bangladesh, India, and Pakistan to estimate the costs borne by households due to childhood diarrhea, including direct medical costs, direct nonmedical costs, and productivity losses.

Pediatric Infectious Disease Journal, 2006

DOAJ (DOAJ: Directory of Open Access Journals), Jun 1, 2009

To evaluate the cost and benefits of a national rotavirus childhood vaccination program in Mexico... more To evaluate the cost and benefits of a national rotavirus childhood vaccination program in Mexico. A decision-analysis model was designed to take the Mexican health care system&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s perspective on a comparison of two alternatives: to vaccinate against rotavirus or not. Using published, national data, estimations were calculated for the rotavirus illnesses, deaths, and disability-adjusted life years (DALYs) that would be averted and the incremental cost-effectiveness ratios (US$/DALY) of a hypothetical annual birth cohort of 2 285 000 children, with certain assumptions made for cost, coverage, and efficacy rates. With 93% coverage and a vaccine price of US$ 16 per course (2 doses), a rotavirus vaccination program in Mexico would prevent an estimated 651 deaths (or 0.28 deaths per 1 000 children); 13 833 hospitalizations (6.05 hospitalizations per 1 000 children); and 414 927 outpatient visits (182 outpatient visits per 1 000 children) for rotavirus-related acute gastroenteritis (AGE). Vaccination is likely to reduce the economic burden of rotavirus AGE in Mexico by averting US$ 14 million (71% of the overall health care burden). At a vaccine price of US$ 16 per course, the cost-effectiveness ratio would be US$ 1 139 per DALY averted. A reduction in the price of the rotavirus vaccination program (US$ 8 per course) would yield a lower incremental cost-effectiveness ratio of US$ 303 per DALY averted. A national rotavirus vaccination program in Mexico is projected to reduce childhood incidence and mortality and to be highly cost-effective based on the World Health Organization&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s thresholds for cost-effective interventions.

International Journal of Environmental Research and Public Health, Sep 17, 2014

The purpose of this study was to quantify how school sanitation conditions are associated with pu... more The purpose of this study was to quantify how school sanitation conditions are associated with pupils' use of sanitation facilities. We conducted a longitudinal assessment in 60 primary schools in Nyanza Province, Kenya, using structured observations to measure facility conditions and pupils' use at specific facilities. We used multivariable mixed regression models to characterize how pupil to toilet ratio was associated with toilet use at the school-level and also how facility conditions were associated with pupils' use at specific facilities. We found a piecewise linear relationship between decreasing pupil to toilet ratio and increasing pupil toilet use (p < 0.01). Our data also revealed significant associations between toilet use and newer facility age (p < 0.01), facility type (p < 0.01), and the number of toilets in a facility (p < 0.01). We found some evidence suggesting

Revista panamericana de salud pública (Impresa), Apr 1, 2007

Objective. To estimate the health and economic burden of rotavirus gastroenteritis in hospital an... more Objective. To estimate the health and economic burden of rotavirus gastroenteritis in hospital and outpatient settings in eight Latin American and Caribbean countries (Argentina,

DOAJ (DOAJ: Directory of Open Access Journals), Apr 1, 2007

Objective. To estimate the health and economic burden of rotavirus gastroenteritis in hospital an... more Objective. To estimate the health and economic burden of rotavirus gastroenteritis in hospital and outpatient settings in eight Latin American and Caribbean countries (Argentina,

International Journal of Educational Development, Sep 1, 2013

This cross-sectional analysis examined the influence of school and household water, sanitation, a... more This cross-sectional analysis examined the influence of school and household water, sanitation, and hygiene (WASH) conditions on recent primary school absence in light of other individual, household, and school characteristics in western Kenya. School latrine cleanliness was the only school WASH factor associated with reduced odds of absence. The marginal effect of household characteristics, such as distance to water source, child involvement in water collection, and presence of a latrine, differed by gender. Demographic features were more important predictors of absence, suggesting that interventions to improve attendance must consider existing differentials attributable to gender, socioeconomic status, and other household characteristics.

Journal of Water and Health, Jul 1, 2006