Trial reportPloS one2012
Costs and cost-effectiveness of training traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival study (LUNESP).
Trial report in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 6 syntheses or guidelines pooled it, 37 citations in OpenAlex.
- Systematic review of methodological approaches in economic evaluations of maternal and neonatal sepsis interventions in low- and middle-income countries.BMC health services research · 2025Pooled it
- Health technology assessment to support health benefits package design: a systematic review of economic evaluation evidence in Zambia.BMC health services research · 2024Pooled it
- Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries.Human resources for health · 2017Pooled it
- Cost and cost-effectiveness of newborn home visits: findings from the Newhints cluster-randomised controlled trial in rural Ghana.The Lancet. Global health · 2016Pooled it
- Costs and cost-effectiveness of community health workers: evidence from a literature review.Human resources for health · 2015Pooled it
- Cost-effectiveness of strategies to improve the utilization and provision of maternal and newborn health care in low-income and lower-middle-income countries: a systematic review.BMC pregnancy and childbirth · 2014Pooled it
- Safe birth in cultural safety in southern Mexico: a pragmatic non-inferiority cluster-randomised controlled trial.BMC pregnancy and childbirth · 2022Trial
- Cost-effectiveness analysis of implementing an integrated neonatal care kit to reduce neonatal infection in rural Pakistan.BMJ open · 2022Trial
- Cost-effectiveness of results-based financing, Zambia: a cluster randomized trial.Bulletin of the World Health Organization · 2018Trial
- Can traditional birth attendants be trained to accurately identify septic infants, initiate antibiotics, and refer in a rural African setting?Global health, science and practice · 2014Trial
- Economic evaluation of neonatal care packages in a cluster-randomized controlled trial in Sylhet, Bangladesh.Bulletin of the World Health Organization · 2013Trial
- Cost of diabetes and hypertension care among patients in rural Bangladesh: a cross-sectional study.BMC public health · 2026Article
- Costs and cost-effectiveness of an infection prevention bundle to reduce neonatal sepsis and mortality in Zambia: The Sepsis Prevention in Neonates in Zambia (SPINZ) trial.PLOS global public health · 2026Article
- Cost-effectiveness of low-dose aspirin for the prevention of preterm birth: a prospective study of the Global Network for Women's and Children's Health Research.The Lancet. Global health · 2023Article
- White Paper on Early Critical Care Services in Low Resource Settings.Annals of global health · 2021Article
- Improving maternal and newborn care: cost-effectiveness of an innovation to rebrand traditional birth attendants in Sierra Leone.International journal of public health · 2020Article
- Replacing iron-folic acid with multiple micronutrient supplements among pregnant women in Bangladesh and Burkina Faso: costs, impacts, and cost-effectiveness.Annals of the New York Academy of Sciences · 2019Article
- The Costs and Cost-Effectiveness of a District-Strengthening Strategy to Mitigate the 3 Delays to Quality Maternal Health Care: Results From Uganda and Zambia.Global health, science and practice · 2019Article
- Mobile Technology for Community Health in Ghana: Is Maternal Messaging and Provider Use of Technology Cost-Effective in Improving Maternal and Child Health Outcomes at Scale?Journal of medical Internet research · 2019Article
- Prioritising allocation of donor human breast milk amongst very low birthweight infants in middle-income countries.Maternal & child nutrition · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundThe Lufwanyama Neonatal Survival Project ("LUNESP") was a cluster randomized, controlled trial that showed that training traditional birth attendants (TBAs) to perform interventions targeting birth asphyxia, hypothermia, and neonatal sepsis reduced all-cause neonatal mortality by 45%. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness, and factors that might improve cost-effectiveness. METHODS AND
findingsWe calculated LUNESP's financial and economic costs and the economic cost of implementation for a forecasted ten-year program (2011-2020). In each case, we calculated the incremental cost per death avoided and disability-adjusted life years (DALYs) averted in real 2011 US dollars. The forecasted 10-year program analysis included a base case as well as 'conservative' and 'optimistic' scenarios. Uncertainty was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. The estimated financial and economic costs of LUNESP were $118,574 and $127,756, respectively, or $49,469 and $53,550 per year. Fixed costs accounted for nearly 90% of total costs. For the 10-year program, discounted total and annual program costs were $256,455 and $26,834 respectively; for the base case, optimistic, and conservative scenarios, the estimated cost per death avoided was $1,866, $591, and $3,024, and cost per DALY averted was $74, $24, and $120, respectively. Outcomes were robust to variations in local costs, but sensitive to variations in intervention effect size, number of births attended by TBAs, and the extent of foreign consultants' participation.
conclusionsBased on established guidelines, the strategy of using trained TBAs to reduce neonatal mortality was 'highly cost effective'. We strongly recommend consideration of this approach for other remote rural populations with limited access to health care.
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Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.