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SourceOptimisticBest guessPessimisticNote
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Benefits
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Diarrheal disease. Under-5 deaths per 100,000 per yearGBD 2015, IHME593.5191.418.2
Country with highest diarrheal+pneumonia death rate in SSA (Chad).
Average for SSA
Country with lowest diarrhea+pneumonia burden in SSA (Cape Verde)
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Likelihood of under-5 dying of diarrhea each year0.59%0.19%0.02%
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Reduction in incidence of under-5 diarrhea due to intervention
Ejemot-Nwadiaro et al 2015
34.00%28.00%
“Hand washing promotion (education activities, sometimes with provision of soap) at child day-care facilities or schools prevents around one-third of diarrhoea episodes in high income countries (rate ratio 0.70; 95% CI 0.58 to 0.85; nine trials, 4664 participants, high quality evidence), and may prevent a similar proportion in LMICs but only two trials from urban Egypt and Kenya have evaluated this (rate ratio 0.66, 95% CI 0.43 to 0.99; two trials, 45,380 participants, low quality evidence).” Ejemot-Nwadiaro et al 2015
“Hand washing promotion among communities in LMICs probably prevents around one-quarter of diarrhoea episodes (rate ratio 0.72, 95% CI 0.62 to 0.83; eight trials, 14,726 participants, moderate quality evidence).” Ejemot-Nwadiaro et al 2015
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Internal validity adjustment70.00%
See interim intervention report for overview of considerations
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External validity adjustment90.00%
See interim intervention report for overview of considerations
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Reduction in overall mortality risk from reductions in diarrhea
0.10%0.03%0.00%
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Number of under-5 deaths for pneumonia per 100,000 people per year.
GBD 2015, IHME511.4215.056.2
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Likelihood of under-5 dying of pneumonia each year0.51%0.21%0.06%
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Reduction in incidence of under-5 pneumonia due to intervention
Luby 200550.00%47.50%45.00%
"Children younger than 5 years in households that received plain soap and handwashing promotion had a 50% lower incidence of pneumonia than controls (95% CI –65% to –34%)." Luby 2005, Pg 225
Average of plain and antibacterial soap
"Antibacterial soap. Difference vs control -45% (-64% to -26%)." Table 2, Luby 2005, Pg 228
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Internal validity adjustment80.00%
See interim intervention report for overview of considerations
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External validity adjustment70.00%
See interim intervention report for overview of considerations
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Reduction in overall mortality risk from reductions in pneumonia
0.14%0.06%0.01%
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Number of years the benefits persist for1
"All included trials were relatively small-sized and of short follow-up duration including intensive monitoring and they demonstrated significant reduction in the risk of diarrhoea after hand hygiene intervention. However, in one relatively large trial, Bowen 2004 CHN, and one with longer follow-up, Luby 2006 PAK, there were no apparent benefits as no significant differences between the incidence or longitudinal prevalence of diarrhoea was found. Therefore, we are unclear if the reductions in incidence of diarrhoea would be maintained if these trials had been larger and conducted over a longer time period." Ejemot-Nwadiaro et al 2015
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Deaths averted per child under-5 treated0.002410.000910.00018
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Costs
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Cost per person (1999 USD)
Sijbesma and Christoffers 2009
1.11.31.7"Irrespective of their results, their costs ranged from US$1.05 to 1.74/pp/yr, with an average of US$1.31" Sijbesma and Christoffers 2009, P.426
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Inflation adjustment to March 2017 USDhttps://data.bls.gov/cgi-bin/cpicalc.pl?cost1=1&year1=199906&year2=2017031.5
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Cost per person (March 2017 USD)1.51.92.6
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Proportion of population under the age of 5 (SSA)https://www.populationpyramid.net/sub-saharan-africa/2016/16.20%Assume the population served has the same proportion of people under the age of 5 as Sub Saharan Africa
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Cost per under-5 served101216
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Cost-effectiveness
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Cost per under-5 life saved$3,958$13,069$86,975
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AMF cost per under-5 life saved equivalentGiveWell cost-effectiveness analysis November 2016$3,282
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GiveDirectly cost per under-5 life saved equivalentGiveWell cost-effectiveness analysis November 2016$7,702
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Multiple on GiveDirectly1.90.60.1
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Sources
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GBD 2015, IHME, diarrheal disease and pneumonia
http://ihmeuw.org/435b
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Sijbesma and Christoffers 2009
https://www.ncbi.nlm.nih.gov/pubmed/19703917
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Ejemot-Nwadiaro et al 2015
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004265.pub3/full
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Luby 2005
http://hope-ngo.com/Portals/0/PDF/SoapHealth%20ARI%20Lancet%20Man%20Report%203.pdf
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Notes and Limitations
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Rationale
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Cost per person is based on the cost of handwashing materials, and may not reflect the cost of implementing the program
Depends on specific charity/program
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Incidence of diarrhea and pneumonia will depend on the specific population and could be higher than the most optimistic estimate
Depends on specific charity/program
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Potential impact on worm infections and intensity not included
Lack of evidence
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Reduction in treatment costs not included
Consistency with other CEAs
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Assumes no effect on those over the age of 5
Lack of evidence
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Assumes reduction in mortality is proportional to reduction in incidence
Lack of evidence
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