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Pre-Packaged Treatment for Pneumonia

PSI uses easy-to-use pre-packaged treatment kits for pneumonia in children under five. Each treatment kit contains the appropriate dose of oral antibiotic (either pediatric amoxicillin or cotrimoxazole) for a one-course treatment of a pneumonia episode. The antibiotic is packaged in strength and dosage suitable for two age groups of children (2-11 months and 1-5 years) with instructions provided in local languages and reinforced by simple illustrations.

Unit of intervention1 treatment course of antibiotics

FormulaFormulation and dosage dependent on national treatment guidelines and child’s age

Target populationChildren under five with pneumonia

For information about how PSI is increasing access to pre-packaged treatment for pneumonia to improve health and save lives, visit our website at:
http://www.psi.org/health-area/child-health/pneumonia/

Model Overview

PSI’s pre-packaged treatment for pneumonia impact model is based on the Lives Saved Tool (LiST). LiST is used to estimate the number of deaths averted with complete coverage of pre-packaged treatment for pneumonia among children under age five in a country. This number of deaths averted at the population level is translated to deaths averted per pre-packaged treatment course, using parameters such as the number of children under five years old in the target population, under-five mortality rates, and the average number of clinical acute respiratory infection episodes per child per year. Once we have deaths averted per pre-packaged treatment course, we apply data from the 2010 Global Burden of Disease study to estimate the corresponding number of DALYs averted.

Model Outputs (impact metrics)

Estimates of DALYs averted, deaths averted, CYPs provided, and unintended pregnancies averted represent the projected health impact of the intervention. It is projected because it has not been directly measured.

Examples based on distribution of antibiotics in Myanmar in 2015 Statement of modeled results, examples:

In 2015, an estimated 46 deaths and 3,950 DALYs would be averted if 10,000 pre-packaged treatment courses for pneumonia were distributed in Myanmar.

For more details about how PSI models the impact of pre-packaged treatment for pneumonia, see below.

Model Details

Step 1: Running a projection in the Lives Saved Tool (LiST)LiST is a multi-cause mortality model developed by Johns Hopkins Bloomberg School of Public Health that estimates the number of deaths averted (or lives saved) through the scale up of maternal and child health interventions.

PSI begins by running a projection in LiST for a selected country. In this projection, coverage of antibiotic treatment for pneumonia is increased from the current, country-specific baseline to 100% among children under five. LiST then projects the number of deaths averted by this increased level of coverage.

Step 1 Output:
Number of deaths averted (or lives saved) if coverage of antibiotic treatment for pneumonia is increased to 100% among the children under age five years in a given country

Step 2: Estimating deaths averted per pre-packaged treatment courses of antibioticsPSI uses the step 1 output (deaths averted at 100% coverage of antibiotic treatment) to estimate the number of deaths averted by a single pre-packaged treatment course. To do this, we divide the number of deaths averted at 100% coverage by the number of kits needed to reach 100% coverage.

PSI estimates the number of pre-packaged treatment courses needed to reach 100% coverage using a number of parameters, including the number of children under five years old in the target population, under-five mortality rates, and the average number of clinical acute respiratory infection episodes per child per year. Each case of pneumonia is assumed to require one pre-packaged treatment course. We also account for wastage of pre-packaged treatment courses in the supply chain, assumed to be 10%.

Step 2 Output:
Deaths averted coefficient

Step 3: Estimating DALYs averted per pre-packaged antibiotic treatmentA DALY (or disability adjusted life year) includes two components: years of life lost due to premature death (YLL) and years lived with disability (YLD). DALYs averted are in turn comprised of YLLs averted and YLDs averted or, put simply: death and disability that is prevented by PSI interventions.

To estimate YLLs averted per pre-packaged treatment, PSI first estimates the number of years of life lost per pneumonia death among children under five in a selected country. This is equal to the life expectancy at the average age of death from pneumonia. Age specific life expectancy is taken from the 2010 Global Burden of Disease study (GD 2010). The number of years of life lost per episode of lower respiratory infection is then multiplied by the number of deaths averted per pre-packaged treatment (deaths averted coefficient), calculated in step 2 above for a selected country. This gives us the YLLs averted per pre-packaged treatment.

To estimate YLDs averted per pre-packaged treatment course, we use a YLD/YLL ratio, based on GBD 2010. This ratio represents the relative number of years lived with disability for every year lost due to death from lower respiratory infections in a selected country. We apply this ratio to the number of YLLs averted per pre-packaged treatment course to estimate the number of YLDs averted per pre-packaged treatment course. Because pre-package treatment courses treat pneumonia, rather than prevent it, we assume that individuals will still suffer some disability before and during treatment. Therefore, we only include half of the total YLD averted in our estimate. This is a standard assumption in all of our treatment models.

Finally, YLLs averted and YLDs averted are added together to estimate the number of DALYs averted per pre-packaged treatment course.

Step 3 Output:
DALYs averted coefficient