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Parameter name
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Intervention parametersUnitSourceNotes
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No. of women of reproductive age reached2240000.000No.
Info from FEM (note that FEM has especially low cost per person): Freedom Radio reaches 5.6 million listeners (based on third party eval, freedom radio says they reach 10 million), 40% of which are women of reproductive age. I used estimates based off of their Kano campaign only.
See FEM eval for general risks and uncertainties
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Effect of radio intervention (percentage point change in women using contraception)5.900Percentage pointsGlennerster et al. 2021
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Effect of radio intervention (% fewer births per year in treatment vs. control)0.075%
This is based on RCT in Burkina Faso, from DMI
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Generalisability discount0.550Proportion
I discounted for generalisability (discount is 45%): I am uncertain about this value. Survey data is from women who live in rural areas, <5km from health facility, in villages without electricty access. I think these factors likely limit generalisability. (Note though that the paper found fairly similar results using admin data, which is more representative)
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Average no. of births per year per woman of repro age in Kano0.190No.DHS Nigeria 2018 data
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Maternal mortality ratio0.010Proportion
From Kano state data, but using time trend from world bank MMR Nigeria (here)
The Kano data is from 2014 (1025 per 100,000), and it seems likely that MMR has decreased since then. In world bank data, it has decreased by 2.75%, so I decreased Kano MMR by this amount
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Fistula prevalence0.002Percentage
https://www.sciencedirect.com/science/article/pii/S2214109X14703481 (see fig 2 for Nigeria; 69/ 33317)
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Mean number of children for someone with fistula3.100No.
https://www.sciencedirect.com/science/article/pii/S2214109X14703481
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Percentage fistulas that are due to pregnancy71.400Percentage
https://www.sciencedirect.com/science/article/pii/S2214109X14703481
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Disability weight fistula0.593No.GBD
This is the average disability weight from rectovaginal fistula and vesicovaginal fistula
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Average length of time using contraception1.960Years
This is quite rough. From paper, most of the women who use contraception at baseline were using implants (~51%), while some were using injectables (~37%) and others were using pills (~9%). I assumed that the average implant lasts around 3 years, and that the women on injectables or pills would use them for around 1 year, then did a weighted average.
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Number of women surveyed in Glennerster paper6728.000Used in table calculations below
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Calculations
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Calculations over full sample
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No. of women newly using mCPR132160.000No.
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Total number fewer births per year31245.895No.
See the 'estimated births/ deaths averted' sheet
sanity check: the Glennerster paper says that births reduced by ~7% (the 10% figure is for one age group only). 2240000 (no of women reached in total) x 0.19 (birth rate of woman in Kano) x 0.07 (effect size Glennerster) = 31792 births avoided.
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Deaths averted, with generalisability discount170.923No.
See the 'estimated births/ deaths averted' sheet (then has generalisability discount)
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Chance of fistula per pregnancy0.000Proportion
Fistula prevalence x percentage of fistulas that are due to pregnancy/ average number of children for a person with a fistula
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Reduction in number of women suffering from fistulas, with discount0.079No.
Chance of fistula per pregnancy x number of averted pregnancies
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Costs
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Total costs400000.000$
From email with Anna Christina. This is their cost from campaign in Kano.
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Negative scenario: FEM's campaign unexpectedly has negative effects for 3 years
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Discount rate0.040rate
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DALYs avoided by averting fistulas-0.207DALYs
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DALY equivalents by averting maternal deaths-33173.787DALY-equivalents
Using 1 maternal life = 41.4 DALY-equivalents
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Total no. WELLBYs-126061.178WELLBYsUsing 1 DALY = 3.8 WELLBY conversion
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$/WELLBY-3.173$/WELLBY
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Years of effectiveness-4.000years
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GD multiples-52.315GDXNote to self: Relink in current gen
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Probability that this occurs0.030probability
I think is is unlikely (but possible) that FEM has unexpected negative effect. This is a subjective estimate.
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Positive scenario 1: effects for one year only
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DALY avoided by averting fistulas0.047DALYS
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DALY equivalents avoided by averting maternal deaths7511.631DALY-equivalents
167 value points for averting 1 > 5 death, 3.8 value points per DALY
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Total no. DALYs avoided (DALY total per year x length of time using contraception)14722.889DALY-equivalents
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Total no. WELLBYs, inc discount55946.980WELLBY-equivalentsUsing 1 DALY = 3.8 WELLBY conversion
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$/ WELLBY7.150$/WELLBY
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GD multiples23.218GDX166/$ WELLBY for GD from current gen
This includes discount for probability that FEM will drop a location, and discount for generalisability from Burkina Faso trial
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Probability that this occurs0.670ProbabilityThis is a subjective estimate.
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Positive scenario 2: strongly diminuishing effects over 4 years
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Discount rate0.600rate
I put the discount rate higher than usual, because i think contraceptive access/ knowledge will increase even without this intervention
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DALYs avoided by averting fistulas0.106DALYs
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DALY equivalents by averting maternal deaths16974.526DALY-equivalents
Using 1 maternal life = 41.4 DALY-equivalents
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Total no. WELLBY equivalents62806.140WELLBY-equivalentsUsing 1 DALY = 3.7 WELLBY conversionUsing 1 DALY = 3.7 WELLBY conversion
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$/WELLBY6.369$/WELLBY
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Years of effectiveness4.000years
I assume that within 10 years time, even without this intervnetion there would be widespread contraceptive knowledge/ access
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GD multiples26.065GDX166/$ WELLBY for GD from current gen
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Probability that this occurs0.250Probability
Subjective estimate. I think it is unlikely, but not very unlikely, that this campaign would have impacts that last for 4 years and asre strongly diminuishing year by year.
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Positive scenario 3: effects over 8 years (if contraceptive accesss/ knowledge became new social norm)
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Discount rate0.080rate
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DALYs avoided by averting fistulas0.291DALYs
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DALY equivalents by averting maternal deaths46619.964DALY-equivalents
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Total no. WELLBYs172494.944WELLBYsUsing 1 DALY = 3.7 WELLBY conversion
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$/WELLBY2.319$/WELLBY
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Years of effectiveness8.000years
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GD multiples71.585GDX166/$ WELLBY for GD from current gen
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Probability that this occurs0.050probability
Note: I think it's unlikely, but not impossibly so, that new contraceptive knowledge/ behavior establishes self as new social norm
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Overall cost-effectiveness24.082GDX
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