Hygiene promotion is an important weapon in the fight against childhood diarrhoea. Researchers from the London School of Hygiene and Tropical Medicine and the Burkina Faso Ministry of Health investigated the cost-effectiveness of a hygiene promotion programme in Bobo-Dioulasso, Burkina Faso. The programme could be replicated widely at low cost, they conclude.

Diarrhoeal diseases cause two to three million deaths each year, mainly among children in developing countries. Hygiene promotion has been shown to be effective in preventing diarrhoeal disease yet policy-makers need information as to it's efficiency relative to alternatives when deciding whether this should be a priority for healthcare spending.

A hygiene promotion programme was set up and implemented in Bobo-Dioulasso. The researchers carried out a cost-effectiveness analysis in order to assess the efficiency and affordability of the intervention relative to the status quo. The aim of the intervention was to increase hand washing with soap after handling child stools or using a latrine, and to increase stool disposal in a latrine. Observation of 37 319 mothers showed that it was effective in changing hygiene behaviour. But what were the costs?

The study found that the total provider cost including start-up and three years running costs was US$ 302 507. It also showed that:

• Core programme activities (house-to-house visits, participatory discussions in health centres, hygiene promotion in schools, street theatre and radio broadcasts) accounted for only 31 per cent of the cost, while administration consumed 40 per cent.
• Salaries represented 47 per cent of the total cost, communication 10 per cent, equipment seven per cent and transport seven per cent.
• The total cost to the 7 286 households where behaviour changed during the three years of the programme in terms of soap and water was US$ 160 125 (US$ 7.3 per year per household).
• The programme averted an estimated 8 636 cases of diarrhoea, 864 outpatient consultations, 324 hospital referrals and 105 deaths.
• Savings to the provider from reduced treatment costs were estimated at US$ 10 716 and the corresponding savings to households were US$ 9 136. This gives a total saving to society of US$ 19 852, which rises to US$ 393 967 if indirect savings of caregiver time and lost productivity associated with child death are included.
• The provider cost per case of diarrhoea averted was US$ 33.8. The cost to society was US$ 51.3 falling to US$ 7.9 if indirect savings are included.

The researchers conclude that hygiene promotion reduces childhood diarrhoea in Burkina Faso for less than one per cent of government health spending and less than two per cent of household budgets. They also point out that:

• Replicating the programme elsewhere would involve less research and start up investment, reducing provider costs to US$ 26.9 per case of diarrhoea averted.
• The programme will be more cost-effective in areas with a higher incidence of childhood diarrhoea, which may offset the increased transport and communication costs of the programme in rural areas.
• The acceptability of this cost-effectiveness ratio in other settings will depend on resource constraints and available budget.

Source(s):
‘Is hygiene promotion cost-effective? A case study in Burkina Faso’, Tropical Medicine and International Health, 7 (11): 960-969, by J. Borghi, L. Guinness, J. Ouedrago and V. Curtis, 2002
HINARI subscribers can access the full-text article here. Full document.

Funded by: UNICEF; Ministry of Health, Burkina Faso

id21 Research Highlight: 20 February 2003

Further Information:
Josephine Borghi
Health Policy Unit
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0)207 927 2939
Fax: +44 (0)207 637 5391
Contact the contributor: jo.burghi@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

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'Keeping it clean: women, living spaces and health in urban Mali'

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