Lumbwe Chola

• Mandaliya, Prashant; Orangi, Stacey; Waluke, Isaac; Okech, Franklin; Masiye, Felix & Onwujekwe, Obinna [Vis alle 8 forfattere av denne artikkelen] (2026). Economic burden of typhoid among hospitalised children in Kenya. BMJ Global Health. 11(8). doi: 10.1136/bmjgh-2025-023131. Fulltekst i vitenarkiv Vis sammendrag

  Typhoid remains endemic in many low and middle-income countries, with the highest incidence reported in children under 15 years. No published study has estimated the cost of hospitalised paediatric typhoid cases in Kenya. This analysis estimated the direct medical, direct non-medical and indirect costs from the healthcare provider and societal perspectives and assessed the proportion of households that would experience catastrophic health expenditure (CHE) due to the disease. Patient-level data on hospitalised children with typhoid were drawn from 16 public hospitals that are part of the Clinical Information Network (CIN) in Kenya. A cost-of-illness analysis was conducted. Resource quantities were extracted from CIN data and unit costs were obtained from price lists, surveys and expert interviews. All costs were converted to 2025 KES and USD. A simulation-based CHE analysis was conducted. One-way sensitivity analysis varied hospital bed, staff, non-medical and indirect costs. Median cost per unique admission was US$79.68 from the provider and US$96.95 from the societal perspective. Staff costs accounted for up to 55% of societal costs while hospital-bed costs accounted for up to 15%. Productivity loss represented 12% of societal costs. Staff time was the most influential parameter in the sensitivity analysis, increasing median costs by up to 89% from the provider and 74% from the societal perspective. CHE incidence rose as the share paid out-of-pocket increased and house wealth declined, with rural households in the lowest wealth quintile most affected. At full out-of-pocket payment, up to 23.6% of rural and 26.5% of urban households from the poorest wealth quintile could face CHE. Typhoid imposes a substantial economic burden among hospitalised children in Kenya, driven mainly by staff and hospital-bed costs. The findings of this study can guide policymakers in reducing strain on health services and the financial burden on families.

• Adongo, Awinaba Amoah; Bodpii, Dominic Nabil; Mokulogo, Robert Kuchengye; Chola, Lumbwe & Akazili, James (2026). Healthcare Infrastructure and Resource Barriers to Preventing Mother-to-Child Transmission of HIV in Ghana: Insights from a Qualitative Study. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 23(3). doi: 10.3390/ijerph23030293. Fulltekst i vitenarkiv
• Aduo-Adjei, Kofi; Haaland, Øystein Ariansen; Chola, Lumbwe & Akazili, James (2026). The Impoverishment Effect of Out-of-Pocket Expenditure for Hypertension in Ghana. Value in Health Regional Issues. ISSN 2212-1099. 54. doi: 10.1016/j.vhri.2025.101557. Fulltekst i vitenarkiv Vis sammendrag

  Objectives The rising prevalence of hypertension in Ghana and the associated household expenditures have become major policy concerns. High out-of-pocket (OOP) payments restrict access to care and increase the risk of impoverishment. This study examines the level and effect of household impoverishment due to care-seeking for hypertension in Ghana. Methods We analyzed data from a catastrophic health expenditure survey conducted between December 2023 and February 2024 at 2 primary healthcare facilities: Weija Gbawe Municipal Hospital (WGMH) and Shai Osudoku District Hospital (SODH) in the Greater Accra Region. The analysis involved descriptive statistics and estimation of the impact of OOP payment on impoverishment, including a pen’s parade of household per capita expenditure. Results The findings show that OOP led to an increase in the poverty headcount by 3.14% and 0.26% using US dollars $2.15/per day and $3.65/per day, respectively. At a lower threshold, the household poverty gap increased from $40.10 to $46.57 and widened from $83.86 to $90.79. The normalized poverty gap grew from 62.17% to 72.20% at a lower poverty line and from 76.58% to 82.92% at the higher threshold. It also emerged that the normalized mean poverty also increased from 61.78% to 69.62% at a poverty threshold of $2.15 and from 129.8% to 141.92% at $3.65 of the poverty line. Conclusions Our findings suggest that without financial risk protection, households are likely to be pushed into extreme poverty because of expenditures on hypertension care. Urgent intervention is needed to mitigate the impoverishing effects of noncommunicable diseases in Ghana.

• Owusu, Richmond; Heupink, Lieke Fleur; Gulbi, Godwin; Asare, Brian; Amankwah, Ivy & Abassah-Konadu, Emmanuella [Vis alle 34 forfattere av denne artikkelen] (2025). Achieving universal coverage of childhood cancers in Ghana via the National Health Insurance Scheme: A stakeholder analysis. PLOS Global Public Health. 5(7). doi: 10.1371/journal.pgph.0004871. Fulltekst i vitenarkiv
• Aduo-Adjei, Kofi; Akazili, James; Haaland, Øystein Ariansen & Chola, Lumbwe (2025). Estimating the level and determinants of catastrophic expenditure related to hypertension management in the Greater Accra Region of Ghana. Global health action. ISSN 1654-9716. 18(1). doi: 10.1080/16549716.2025.2602116. Fulltekst i vitenarkiv Vis sammendrag

  Background: Since the establishment of national health insurance in Ghana, the government’s health policy has focused on reducing out-of-pocket expenditure (OOP) to ensure that people do not become poorer while accessing healthcare services. However, studies show that OOP expenditure remains high, and a substantial portion of the population experiences catastrophic health expenditure (CHE). Objective(s): We estimated the level and determinants of catastrophic health expenditures for hypertension management among adults in the Greater Accra Region of Ghana. Methods: We conducted a cross-sectional CHE survey at two randomly selected district primary health facilities in the Greater Accra Region. Data collection took place between December 2023 and February 2024. A questionnaire was used to collect data on direct and indirect medical expenditures related to hypertension care from 382 participants. CHE was defined at thresholds of 10% and 40% of the household’s capacity for direct and indirect medical expenditures, respectively. Multivariate logistic regression was used to assess the determinants of CHE. Results: A total of 382 patients were included in the analysis; the majority were females (76%), and Christians (95%). Based on the 10% and 40% thresholds of household income capacity to pay, 65% and 58% of the total sample experienced CHE, respectively. The regression model revealed that being widowed (OR = 0.32, 95% CI: 0.09–1.10, p = 0.07), unemployed (OR = 0.26, 95% CI: 0.08–0.09, p = 0.03), and having a large household size (OR = 1.32, 95% CI: 0.95–1.84, p = 0.09) correlate with CHE for hypertension management and care. Conclusion: The study demonstrates that hypertension care imposes a considerable financial burden on households.

• Dias, Sinaï Francisco; Asare, Brian & Chola, Lumbwe (2025). Cost-Effectiveness of Hydroxyurea for Treatment of Children With Sickle Cell Anemia in Ghana. Value in Health Regional Issues. ISSN 2212-1099. 55. doi: 10.1016/j.vhri.2025.101586. Fulltekst i vitenarkiv
• Nuwamanya, Elly; Mayito, Jonathan; Okoboi, Stephen; Galiwango, Ronald; Byonanebye, Dathan & Nakasendwa, Suzan [Vis alle 18 forfattere av denne artikkelen] (2025). Societal Economic Burden of Antibiotic Resistance in Uganda: A Cost of Illness Study. PharmacoEconomics - Open. ISSN 2509-4262. doi: 10.1007/s41669-025-00625-8. Fulltekst i vitenarkiv Vis sammendrag

  Background: Antibiotic resistance (ABR), largely owing to inappropriate prescriptions and misuse of antibiotics, threatens the effectiveness of current and future antibiotic treatments, resulting in prolonged hospitalization and premature mortality. We estimated the economic burden of ABR in nine regional referral hospitals (RRHs) in Uganda. Methods: This prevalence-based cost-of-illness study was conducted from the societal perspective. We used a top-down micro-costing approach to identify and measure direct healthcare (capital and recurrent) costs in nine RRHs in Uganda. Patient costs, including informal care (absenteeism, foregone leisure, presenteeism, and out-of-pocket expenses), and lost productivity owing to ABR were estimated using clinical outcomes data and relevant literature. We used the human capital approach to estimate productivity losses due to ABR-related morbidity and premature mortality. A one-way sensitivity analysis was conducted to assess the impact of individual parameters on the economic burden estimates. Results: The annual societal cost of ABR in nine RRHs was estimated at US$1.43 million, representing 0.003% of Uganda’s gross domestic product. Lost productivity costs accounted for 82% of the total, while informal care and direct healthcare costs represented 10% and 8%, respectively. Premature mortality associated with ABR accounted for 62% of the total cost of productivity loss; accommodation, food, and out-of-pocket costs represented 55% of the informal care costs; and recurrent costs accounted for 89% of direct healthcare costs. The overall annual societal, health system, and patient costs per ABR-patient were US$4983, US$423, and US$4560, respectively. ABR health system costs were 3% higher (US$61,293 versus US$59,646) among females than among males. Patient costs associated with ABR were higher among females than males, with informal care costs being 4% higher (US$70,657 versus US$67,886), and lost productivity costs 34% higher (US$622,510 versus US$410,354). Overall, societal total costs and per-patient costs of ABR were 29% (US$754,461 versus US$537,886) and 21% (US$5063 versus US$4014) higher in females than in males, respectively. The one-way sensitivity analysis revealed that the societal economic burden of ABR estimates were most influenced by uncertainties in construction cost per square meter of space utilized by ABR patients, reduced hospital capacity, and the discount rate. Conclusions: ABR poses a substantial societal burden that necessitates urgent and targeted gender-based interventions to prevent its escalation. These estimates may be used for future economic evaluation studies of ABR-mitigating interventions and to inform antimicrobial stewardship policies.

• Akazili, James; Amenah, Michel Adurayi; Chola, Lumbwe; Ayanore, Martin Amogre & Ataguba, John Ele-Ojo (2025). Catastrophic health payments in Ghana post-National Health Insurance Scheme implementation: An analysis of service-specific health expenditures. BMJ Global Health. 10(3). doi: 10.1136/bmjgh-2024-018141. Fulltekst i vitenarkiv Vis sammendrag

  Background: Ghana implemented several health reforms in the 1970s and 1990s. Still, several access barriers persist, including high out-of-pocket (OOP) spending, which led to the implementation of the National Health Insurance Scheme (NHIS) in 2003 to achieve Universal Health Coverage and lower OOP spending. This study evaluates the incidence and intensity of catastrophic health expenditure (CHE) among Ghanaian households post-NHIS, considering OOP health spending on different health services. Methods: Data came from the Ghana Living Standards Surveys rounds 6 (2012/2013) and 7 (2016/2017) and the Annual Household Income and Expenditure Survey 2022/2023. Key variables were OOP spending on three health service categories (medical products, outpatient and inpatient) and total expenditure. The incidence and intensity of CHE for various health service categories were calculated using service-specific thresholds. A household incurs CHE for each service when OOP health spending as a share of total expenditure exceeds the service-specific threshold. Results: Overall, at the 10% threshold, CHE headcount for total OOP health spending increased from 1.26% (95% CI 1.11% to 1.44%) to 11.45% (95% CI 10.86% to 12.07%) between 2012 and 2023. CHE gaps were also substantial for overall and service-specific OOP health spending. Medical supplies account for a large share of total OOP health spending, with CHE headcount rising from 1.34% (95% CI 1.18% to 1.53%) to 12.24% (95% CI 11.64% to 12.89%) between 2012 and 2023 at the 10% original threshold. Although the results were mixed, rural, northern and low-income households experienced substantial financial burdens. At the 20% threshold, the CHE headcount for inpatient services increased from 0.84% (95% CI 0.64% to 1.10%) to 4.38% (95% CI 3.83% to 4.99%) for northern dwellers between 2012 and 2023. Discussion/conclusions: Despite NHIS coverage, high-cost services like medical supplies, hospital stays and frequently used outpatient services substantially drive CHE in Ghana, particularly for underserved populations. Addressing them requires prioritised policy interventions to expand NHIS coverage for essential services and improve financial protection, especially for rural and low-income households.

• Owusu, Richmond; Pritchard, Dakota; Heupink, Lieke Fleur; Gulbi, Godwin; Asare, Brian & Amankwah, Ivy [Vis alle 15 forfattere av denne artikkelen] (2025). Cost-efectiveness and budget impact of covering Burkitt lymphoma in children under Ghana’s National Health Insurance Scheme. Cost Effectiveness and Resource Allocation. 23(1). doi: 10.1186/s12962-025-00603-1. Fulltekst i vitenarkiv Vis sammendrag

  Background Childhood cancer is not a high priority in health care financing for many countries, including in Ghana. Delayed care seeking and treatment abandonment, often due to the financial burden of care seeking to families, are common reasons for a relatively low overall survival (OS) in low-and middle-income countries. In this study, we analyzed the cost-effectiveness of extending health insurance coverage to children with Burkitt lymphoma (BL) in Ghana. Methods We developed a Markov model in Microsoft Excel to estimate the costs and effects of BL treatment when National Health Insurance Scheme (NHIS) was provided compared to the status quo where NHIS does not cover care for childhood cancer. The analysis was undertaken from the societal and health system (payer) perspective. Both costs (measured in $) and effects, measured using disability adjusted life years (DALYs), were discounted at a rate of 3%. The time horizon was a lifetime. Probabilistic sensitivity analysis was done to assess uncertainty in the measurement of the incremental cost-effectiveness ratio (ICER). A budget impact analysis was undertaken from the perspective of the NHIS. Results In the base-case analysis, the intervention (NHIS reimbursed treatment) was less costly than current practice ($8,302 vs $9,558). The intervention was also more effective with less DALYs per patient than the standard of care (17.6 vs 23.33). The ICER was -$219 per DALY averted from societal perspective and $113 per DALY averted from health system perspective. The probabilistic sensitivity analysis showed that the intervention is likely to be both less costly and more effective than current practice in 100% of the 1,000 simulations undertaken. Conclusion Providing health insurance coverage to children with BL is potentially cost-effective. The effectiveness and cost-savings relating to this strategy is driven by its positive impact on treatment initiation and retention. Based on this evidence, there has been a policy change where Ghana’s NHIS has prioritized financing for cancer treatment in children.

• Isbeih, Mervett; Heupink, Lieke-Fleur; Qaddomi, Sharif; Salman, Rand & Chola, Lumbwe (2024). Conducting a health technology assessment in the West Bank, occupied Palestinian territory: lessons from a feasibility project. International Journal of Technology Assessment in Health Care. ISSN 0266-4623. 40(1). doi: 10.1017/S0266462324000084. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To achieve universal health coverage (UHC), countries must make difficult choices to optimize the use of scarce resources. There is a growing interest in using evidence-based priority setting processes, such as Health Technology Assessment (HTA), to inform these decisions. In 2020, the Palestinian Institute of Public Health (PNIPH) and the Norwegian Institute of Public Health (NIPH) initiated a pilot to test the feasibility of coproducing an HTA on breast cancer screening in the West Bank, occupied Palestinian Territory. Additionally, a secondary aim was to test whether using an adaptive HTA (aHTA) approach that searched and transferred published evidence syntheses could increase the speed of HTA production. Methods The applied stepwise approach to the HTA is described in detail and can be summarized as defining a core team, topic selection, and prioritization; undertaking the HTA including adaptation using tools from the European Network for HTA (EUnetHTA) and stakeholder engagement; and concluding with dissemination. Results The aHTA approach was faster but not as quick as anticipated, which is attributed to (i) the lack of availability of local evidence for contextualizing findings and (ii) the necessity to build trust between the team and stakeholders. Some delays followed from the COVID-19 pandemic, which showed the importance of good risk anticipation and mitigation. Lastly, other important lessons included the ability of virtual collaborations, the value of capacity strengthening initiatives within low- and middle-income countries (LMICs), and the need for early stakeholder engagement. Overall, the pilot was successfully completed. Conclusion This was the first HTA of its kind produced in Palestine, and despite the challenges, it shows that HTA analysis is feasible in this setting.

• Njie, Hassan; Ilboudo, Patrick Christian Gueswende; Gopinathan, Unni; Chola, Lumbwe & Wangen, Knut Reidar (2023). Preferences of healthcare workers for provider payment systems in The Gambia’s National Health Insurance Scheme. BMC Health Services Research. 23(853). doi: 10.1186/s12913-023-09885-8. Fulltekst i vitenarkiv Vis sammendrag

  Background The Government of The Gambia introduced a national health insurance scheme (NHIS) in 2021 to promote universal health coverage (UHC). Provider payment systems (PPS) are strategic purchasing arrangements that can enhance provider performance, accountability, and efficiency in the NHIS. This study assessed healthcare workers’ (HCWs’) preferences for PPS across major service areas in the NHIS. Methods A facility-based cross-sectional study was conducted using a probability proportionate to size sampling technique to select an appropriate sample size. Health care workers were presented with options for PPS to choose from across major service areas. Descriptive statistics explored HCW socio-demographic and health service characteristics. Multinomial logistic regressions were used to assess the association between these characteristics and choices of PPS. Results The majority of HCW did not have insurance coverage, but more than 60% of them were willing to join and pay for the NHIS. Gender, professional cadre, facility level, and region influenced HCW’s preference for PPS across the major service areas. The preferred PPS varied among HCW depending on the service area, with capitation being the least preferred PPS across all service areas. Conclusion The National Health Insurance Authority (NHIA) needs to consider HCW’s preference for PPS and factors that influence their preferences when choosing various payment systems. Strategic purchasing decisions should consider the incentives these payment systems may create to align incentives to guide provider behaviour towards UHC. The findings of this study can inform policy and decision-makers on the right mix of PPS to spur provider performance and value for money in The Gambia’s NHIS.

• Baker, Peter; Barasa, Edwine; Chalkidou, Kalipso; Chola, Lumbwe; Culyer, Anthony & Dabak, Saudamini [Vis alle 17 forfattere av denne artikkelen] (2023). International Partnerships to Develop Evidence-informed Priority Setting Institutions: Ten Years of Experience from the International Decision Support Initiative (iDSI). Health Systems & Reform. ISSN 2328-8604. 9(3). doi: 10.1080/23288604.2024.2330112. Fulltekst i vitenarkiv
• Torre, Maria Julia Bidonde; Echavez, Jose Francisco Meneses; Asare, Brian; Chola, Lumbwe; Gad, Mohamed & Heupink, Lieke Fleur [Vis alle 14 forfattere av denne artikkelen] (2022). Developing a tool to assess the skills to perform a health technology assessment. BMC Medical Research Methodology. 22(78). doi: 10.1186/s12874-022-01562-4. Fulltekst i vitenarkiv
• Heupink, Lieke Fleur; Peacocke, Elizabeth; Sæterdal, Ingvil von Mehren; Chola, Lumbwe & Frønsdal, Katrine Bjørnebek (2022). Considerations for transferability of health technology assessments: a scoping review of tools, methods, and practices. International Journal of Technology Assessment in Health Care. ISSN 0266-4623. 38(1). doi: 10.1017/S026646232200321X. Fulltekst i vitenarkiv
• Njie, Hassan; Wangen, Knut Reidar; Chola, Lumbwe; Gopinathan, Unni; Mdala, Ibrahimu & Sundby, Johanne Sommerschild [Vis alle 7 forfattere av denne artikkelen] (2022). Willingness to pay for a national health insurance scheme in The Gambia: A contingent valuation study. Health Policy and Planning. ISSN 0268-1080. 38(1), s. 61–73. doi: 10.1093/heapol/czac089. Fulltekst i vitenarkiv Vis sammendrag

  In pursuit of universal health coverage, many low- and middle-income countries are reforming their health financing systems and introducing health insurance schemes. As part of these reforms, lawmakers in The Gambia enacted ‘The National Health Insurance Bill, 2021’. The Act will establish a National Health Insurance Scheme (NHIS) that pays for the cost of healthcare services for its members. This study assessed Gambians’ willingness to pay (WTP) for a NHIS. Using multistage sampling design with no replacement, head/co-head of households were presented with a hypothetical health insurance scheme from July to August 2020. Their WTP and factors influencing WTP were elicited using a contingent valuation method. Descriptive statistics were used to describe sample characteristics. Lopez-Feldman’s modified ordered probit model and linear regression were applied to estimate respondents’ WTP as well as identify factors that influence their WTP. More than 90% of the respondents—677 (94.4%) were willing to join and pay for the scheme. Half of these respondents—398 (58.8%) agreed to pay the first bid of US dollars (US$) 20.78 or Gambian dalasi (GMD) 1000. The average WTP was estimated at US$23.27 (GMD1119.82), whereas average maximum amount to pay was US$26.01 (GMD1251.16). Results of the two models together showed that gender, level of education and household income were statistically significant, with the latter showing negative influence on WTP. The study found that Gambians were largely receptive to the scheme and have stated their willingness to contribute. Our findings can inform policymakers in The Gambia and other sub-Saharan countries when establishing contribution rates and exemption criteria during social health insurance scheme implementation.

• Brady, Elise; Castelli, Michele; Walker, Richard; Grayling, Michael; Alaba, Olufunke & Chola, Lumbwe (2022). The prevalence and social determinants of multimorbidity in South Africa. World Medical & Health Policy (WMHP). ISSN 2153-2028. doi: 10.1002/wmh3.557. Fulltekst i vitenarkiv
• Teerawattananon, Yot; Painter, Chris; Dabak, Saudamini; Ottersen, Trygve; Gopinathan, Unni & Chola, Lumbwe [Vis alle 8 forfattere av denne artikkelen] (2021). Avoiding health technology assessment: a global survey of reasons for not using health technology assessment in decision making. Cost Effectiveness and Resource Allocation. 19(62). doi: 10.1186/s12962-021-00308-1. Fulltekst i vitenarkiv
• Peacocke, Elizabeth; Heupink, Lieke Fleur; Frønsdal, Katrine Bjørnebek; Dahl, Elin Hoffmann & Chola, Lumbwe (2021). Global access to COVID-19 vaccines: A scoping review of factors that may influence equitable access for low and middle-income countries. BMJ Open. 11:e0495005(9), s. 1–11. doi: 10.1136/bmjopen-2021-049505. Fulltekst i vitenarkiv
• Chola, Lumbwe; Fadnes, Lars T.; Engebretsen, Ingunn Marie S.; Nkonki, Lungiswa; Nankabirwa, Victoria & Sommerfelt, Halvor [Vis alle 9 forfattere av denne artikkelen] (2015). Cost-effectiveness of peer counselling for the promotion of exclusive breastfeeding in Uganda. PLOS ONE. 10(11). doi: 10.1371/journal.pone.0142718. Fulltekst i vitenarkiv Vis sammendrag

  Background: Community based breastfeeding promotion programmes have been shown to be effective in increasing breastfeeding prevalence. However, there is limited data on the cost-effectiveness of these programmes in sub-Saharan Africa. This paper evaluates the cost-effectiveness of a breastfeeding promotion intervention targetingmothers and their 0 to 6 month old children. Methods: Data were obtained from a community randomized trial conducted in Uganda between 2006– 2008, and supplemented with evidence from several studies in sub-Saharan Africa. In the trial, peer counselling was offered to women in intervention clusters. In the control and intervention clusters, women could access standard health facility breastfeeding promotion services (HFP). Thus, twomethods of breastfeeding promotion were compared: community based peer counselling (in addition to HFP) and standard HFP alone. A Markov model was used to calculate incremental cost-effectiveness ratios between the two strategies. The model estimated changes in breastfeeding prevalence and disability adjusted life years. Costs were estimated from a provider perspective. Uncertainty around the results was characterized using one-way sensitivity analyses and a probabilistic sensitivity analysis. Findings: Peer counselling more than doubled the breastfeeding prevalence as reported by mothers, but there was no observable impact on diarrhoea prevalence. Estimated incremental cost-effectiveness ratios were USD 68 per month of exclusive or predominant breastfeeding and USD 11,353 per disability adjusted life year (DALY) averted. The findings were robust to parameter variations in the sensitivity analyses Conclusions: Our strategy to promote community based peer counselling is unlikely to be cost-effective in reducing diarrhoea prevalence and mortality in Uganda, because its cost per DALY averted far exceeds the commonly assumed willingness-to-pay threshold of three times Uganda’s GDP per capita (USD 1653). However, since the intervention significantly increases prevalence of exclusive or predominant breastfeeding, it could be adopted in Uganda if benefits other than reducing the occurrence of diarrhoea are believed to be important.

• Nkonki, Lungiswa Leonora; Daviaud, Emmanuelle; Jackson, Debra; Chola, Lumbwe; Doherty, Tanya & Chopra, Mickey [Vis alle 7 forfattere av denne artikkelen] (2014). Costs of promoting exclusive breastfeeding at community level in three sites in South Africa. PLOS ONE. 9(1:e79784). doi: 10.1371/journal.pone.0079784. Fulltekst i vitenarkiv Vis sammendrag

  Background: Community-based peer support has been shown to be effective in improving exclusive breastfeeding rates in a variety of settings. Methods: We conducted a cost analysis of a community cluster randomised-controlled trial (Promise-EBF), aimed at promoting exclusive infant feeding in three sites in South Africa. The costs were considered from the perspective of health service providers. Peer supporters in this trial visited women to support exclusive infant feeding, once antenatally and four times postpartum. Results: The total economic cost of the Promise-EBF intervention was US$393 656, with average costs per woman and per visit of US$228 and US$52, respectively. The average costs per woman and visit in an operational ‘non research’ scenario were US$137 and US$32 per woman and visit, respectively. Investing in the promotion of exclusive infant feeding requires substantial financial commitment from policy makers. Extending the tasks of multi-skilled community health workers (CHWs) to include promoting exclusive infant feeding is a potential option for reducing these costs. In order to avoid efficiency losses, we recommend that the time requirements for delivering the promotion of exclusive infant feeding are considered when integrating it within the existing activities of CHWs. Discussion: This paper focuses on interventions for exclusive infant feeding, but its findings more generally illustrate the importance of documenting and quantifying factors that affect the feasibility and sustainability of community-based interventions, which are receiving increased focus in low income settings.

• Chola, Lumbwe; Fadnes, Lars T.; Engebretsen, Ingunn Marie S.; Tumwine, James K; Tylleskär, Thorkild & Robberstad, Bjarne (2013). Infant feeding survival and Markov transition probabilities among children under age 6 months in Uganda. American Journal of Epidemiology. ISSN 0002-9262. 177(5), s. 453–462. doi: 10.1093/aje/kws254. Fulltekst i vitenarkiv
• Chola, Lumbwe; Nkonki, Lungiswa Leonora; Kankasa, Chipepo; Tumwine, James; Tylleskar, Thorkild & Robberstad, Bjarne [Vis alle 7 forfattere av denne artikkelen] (2011). Cost of individual peer counselling for the promotion of exclusive breastfeeding in Uganda. Cost Effectiveness and Resource Allocation. 9(11). doi: 10.1186/1478-7547-9-11. Fulltekst i vitenarkiv Vis sammendrag

  Background: Exclusive breastfeeding (EBF) for 6 months is the recommended form of infant feeding. Support of mothers through individual peer counselling has been proved to be effective in increasing exclusive breastfeeding prevalence. We present a costing study of an individual peer support intervention in Uganda, whose objective was to raise exclusive breastfeeding rates at 3 months of age. Methods: We costed the peer support intervention, which was offered to 406 breastfeeding mothers in Uganda. The average number of counselling visits was about 6 per woman. Annual financial and economic costs were collected in 2005-2008. Estimates were made of total project costs, average costs per mother counselled and average costs per peer counselling visit. Alternative intervention packages were explored in the sensitivity analysis. We also estimated the resources required to fund the scale up to district level, of a breastfeeding intervention programme within a public health sector model. Results: Annual project costs were estimated to be US$56,308. The largest cost component was peer supporter supervision, which accounted for over 50% of total project costs. The cost per mother counselled was US$139 and the cost per visit was US$26. The cost per week of EBF was estimated to be US$15 at 12 weeks post partum. We estimated that implementing an alternative package modelled on routine public health sector programmes can potentially reduce costs by over 60%. Based on the calculated average costs and annual births, scaling up modelled costs to district level would cost the public sector an additional US$1,813,000. Conclusion: Exclusive breastfeeding promotion in sub-Saharan Africa is feasible and can be implemented at a sustainable cost. The results of this study can be incorporated in cost effectiveness analyses of exclusive breastfeeding promotion programmes in sub-Saharan Africa.

• Chola, Lumbwe & Robberstad, Bjarne (2009). Estimating average inpatient and outpatient costs and childhood pneumonia and diarrhoea treatment costs in an urban health centre in Zambia. Cost Effectiveness and Resource Allocation. 7(16). doi: 10.1186/1478-7547-7-16. Fulltekst i vitenarkiv Vis sammendrag

  Background: Millions of children die every year in developing countries, from preventable diseases such as pneumonia and diarrhoea, owing to low levels of investment in child health. Investment efforts are hampered by a general lack of adequate information that is necessary for priority setting in this sector. This paper measures the health system costs of providing inpatient and outpatient services, and also the costs associated with treating pneumonia and diarrhoea in under-five children at a health centre in Zambia. Methods: Annual economic and financial cost data were collected in 2005-2006. Data were summarized in a Microsoft excel spreadsheet to obtain total department costs and average disease treatment costs. Results: The total annual cost of operating the health centre was US$1,731,661 of which US$1 284 306 and US$447,355 were patient care and overhead departments costs, respectively. The average cost of providing out-patient services was US$3 per visit, while the cost of in-patient treatment was US$18 per bed day. The cost of providing dental services was highest at US$20 per visit, and the cost of VCT services was lowest, with US$1 per visit. The cost per out-patient visit for under-five pneumonia was US$48, while the cost per bed day was US$215. The cost per outpatient visit attributed to under-five diarrhoea was US$26, and the cost per bed day was US$78. Conclusion: In the face of insufficient data, a cost analysis exercise is a difficult but feasible undertaking. The study findings are useful and applicable in similar settings, and can be used in cost effectiveness analyses of health interventions.

Se alle arbeider i NVA

• Horn, Sindre August; Omar, Omar Mwalim; Kagaigai, Alphoncina; Chola, Lumbwe & Chalise, Gita Dhakal (2026). Overcoming Uncertainty in Priority Setting: Multi-Country Experiences with Evidence-Informed Health Benefit Packages in Low- and Middle-income Countries. Fulltekst i vitenarkiv
• Danforth, Kristen; Botwright, Siobhan; Choudhary, Tarun Shankar; Hangoma, Peter & Chola, Lumbwe (2026). Integrating Systems Thinking into the FairChoices Model - Possibilities and Challenges. Fulltekst i vitenarkiv
• Chola, Lumbwe; Kagaigai, Alphoncina; Johansson, Kjell Arne; Eldesoki, Nouran; Torpey, Kwasi & Omar, Omar Mwalim [Vis alle 7 forfattere av denne artikkelen] (2026). Explicit Priority Setting in Practice: Institutionalising Evidence-Informed and Value-Based Priority Setting for Universal Health Coverage. Fulltekst i vitenarkiv
• Sandøy, Ingvild Fossgard; Moen, Bente Elisabeth; Øverland, Simon Nygaard; Engebretsen, Ingunn Marie Stadskleiv; Chola, Lumbwe & Robberstad, Bjarne [Vis alle 9 forfattere av denne artikkelen] (2024). Forskere føler seg lurt. Khrono.no. ISSN 1894-8995. Fulltekst i vitenarkiv
• Norheim, Ole Frithjof; Aasen, Marianne; sivertsen, lisa; Mofoss, Eirik; Emanuel, Ezekiel J. & Twea, Pakwanja Desiree [Vis alle 9 forfattere av denne artikkelen] (2024). "New biotechnology to end malaria: a priority for Norwegian aid?" - Norwegian Biotechnology Advisory Board and BCEPS Centre of Excellence. Fulltekst i vitenarkiv
• Peacocke, Elizabeth; Frønsdal, Katrine Bjørnebek; Heupink, Lieke Fleur; Chola, Lumbwe; Lauvrak, Vigdis & Torre, Maria Julia Bidonde (2023). Technical guidance for Health Technology Assessment in low-and middle-income countries. Folkehelseinstituttet. Fulltekst i vitenarkiv
• Chola, Lumbwe (2012). The economics of promoting exclusive breastfeeding in sub-Saharan Africa. Universitetet i Bergen. ISSN 9788230820384. Fulltekst i vitenarkiv

Se alle arbeider i NVA