Reduced burden of childhood diarrheal diseases through increased access to water and sanitation in India: a modeling analysis

Arindam Nandi, Itamar Megiddo, Ashvin Ashok, Amit Verma, Ramanan Laxminarayan

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Each year, more than 300,000 children in India under the age of five years die from diarrheal diseases. Clean piped water and improved sanitation are known to be effective in reducing the mortality and morbidity burden of diarrhea but are not yet available to close to half of the Indian population. In this paper, we estimate the health benefits (reduced cases of diarrheal incidence and deaths averted) and economic benefits (measured by out-of-pocket treatment expenditure averted and value of insurance gained) of scaling up the coverage of piped water and improved sanitation among Indian households to a near-universal 95% level. We use IndiaSim, a previously validated, agent-based microsimulation platform to model disease progression and individual demographic and healthcare-seeking behavior in India, and use an iterative, stochastic procedure to simulate health and economic outcomes over time. We find that scaling up access to piped water and improved sanitation could avert 43,352 (95% uncertainty range [UR] 42,201-44,504) diarrheal episodes and 68 (95% UR 62-74) diarrheal deaths per 100,000 under-5 children per year, compared with the baseline. We estimate a saving of (in 2013 US$) $357,788 (95% $345,509-$370,067) in out-of-pocket diarrhea treatment expenditure, and $1646 (95% UR $1603-$1689) in incremental value of insurance per 100,000 under-5 children per year over baseline. The health and financial benefits are highly progressive, i.e. they reach poorer households more. Thus, scaling up access to piped water and improved sanitation can lead to large and equitable reductions in the burden of childhood diarrheal diseases in India.

LanguageEnglish
Pages181-192
Number of pages12
JournalSocial Science and Medicine
Volume180
Early online date31 Aug 2016
DOIs
Publication statusPublished - 31 May 2017

Fingerprint

Sanitation
India
childhood
scaling
Uncertainty
Disease
water
Water
uncertainty
Insurance Benefits
Health Expenditures
Insurance
insurance
Diarrhea
expenditures
health
Economics
death
morbidity
Disease Progression

Keywords

  • India
  • water
  • sanitation
  • childhood diarrhea
  • agent-based model
  • cost efectiveness
  • financial risk protection

Cite this

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title = "Reduced burden of childhood diarrheal diseases through increased access to water and sanitation in India: a modeling analysis",
abstract = "Each year, more than 300,000 children in India under the age of five years die from diarrheal diseases. Clean piped water and improved sanitation are known to be effective in reducing the mortality and morbidity burden of diarrhea but are not yet available to close to half of the Indian population. In this paper, we estimate the health benefits (reduced cases of diarrheal incidence and deaths averted) and economic benefits (measured by out-of-pocket treatment expenditure averted and value of insurance gained) of scaling up the coverage of piped water and improved sanitation among Indian households to a near-universal 95{\%} level. We use IndiaSim, a previously validated, agent-based microsimulation platform to model disease progression and individual demographic and healthcare-seeking behavior in India, and use an iterative, stochastic procedure to simulate health and economic outcomes over time. We find that scaling up access to piped water and improved sanitation could avert 43,352 (95{\%} uncertainty range [UR] 42,201-44,504) diarrheal episodes and 68 (95{\%} UR 62-74) diarrheal deaths per 100,000 under-5 children per year, compared with the baseline. We estimate a saving of (in 2013 US$) $357,788 (95{\%} $345,509-$370,067) in out-of-pocket diarrhea treatment expenditure, and $1646 (95{\%} UR $1603-$1689) in incremental value of insurance per 100,000 under-5 children per year over baseline. The health and financial benefits are highly progressive, i.e. they reach poorer households more. Thus, scaling up access to piped water and improved sanitation can lead to large and equitable reductions in the burden of childhood diarrheal diseases in India.",
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Reduced burden of childhood diarrheal diseases through increased access to water and sanitation in India : a modeling analysis. / Nandi, Arindam; Megiddo, Itamar; Ashok, Ashvin; Verma, Amit; Laxminarayan, Ramanan.

In: Social Science and Medicine, Vol. 180, 31.05.2017, p. 181-192.

Research output: Contribution to journalArticle

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T1 - Reduced burden of childhood diarrheal diseases through increased access to water and sanitation in India

T2 - Social Science and Medicine

AU - Nandi, Arindam

AU - Megiddo, Itamar

AU - Ashok, Ashvin

AU - Verma, Amit

AU - Laxminarayan, Ramanan

N1 - Copyright © 2016 Elsevier Ltd. All rights reserved.

PY - 2017/5/31

Y1 - 2017/5/31

N2 - Each year, more than 300,000 children in India under the age of five years die from diarrheal diseases. Clean piped water and improved sanitation are known to be effective in reducing the mortality and morbidity burden of diarrhea but are not yet available to close to half of the Indian population. In this paper, we estimate the health benefits (reduced cases of diarrheal incidence and deaths averted) and economic benefits (measured by out-of-pocket treatment expenditure averted and value of insurance gained) of scaling up the coverage of piped water and improved sanitation among Indian households to a near-universal 95% level. We use IndiaSim, a previously validated, agent-based microsimulation platform to model disease progression and individual demographic and healthcare-seeking behavior in India, and use an iterative, stochastic procedure to simulate health and economic outcomes over time. We find that scaling up access to piped water and improved sanitation could avert 43,352 (95% uncertainty range [UR] 42,201-44,504) diarrheal episodes and 68 (95% UR 62-74) diarrheal deaths per 100,000 under-5 children per year, compared with the baseline. We estimate a saving of (in 2013 US$) $357,788 (95% $345,509-$370,067) in out-of-pocket diarrhea treatment expenditure, and $1646 (95% UR $1603-$1689) in incremental value of insurance per 100,000 under-5 children per year over baseline. The health and financial benefits are highly progressive, i.e. they reach poorer households more. Thus, scaling up access to piped water and improved sanitation can lead to large and equitable reductions in the burden of childhood diarrheal diseases in India.

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KW - agent-based model

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KW - financial risk protection

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