Water Treatment And Child Mortality: A Meta-Analysis And Cost-effectiveness Analysis

Michael Kremer, Stephen P. Luby, Ricardo Maertens, Brandon Tan and Witold Więcek

No 30835, NBER Working Papers from National Bureau of Economic Research, Inc

Abstract: Randomized controlled trials (RCTs) of water treatment are typically powered to detect effects on caregiver-reported diarrhea but not child mortality, as detecting mortality effects requires prohibitively large sample sizes. Consequently, water treatment is seldom included in lists of cost-effective, evidence-backed child health interventions which are prioritized in health funding decisions. To increase statistical power, we conducted a systematic review and meta-analysis. We replicated search and selection criteria from previous meta-analyses of RCTs aimed at improving water quality to prevent diarrhea in low- or middle-income countries which included children under 5 years old. We identified 52 RCTs and then obtained child mortality data from each study for which these data were collected and available, contacting authors of the study where necessary; this resulted in 15 studies.Frequentist and Bayesian methods were used to estimate the effect of water treatment on child mortality among included studies. We estimated a mean cross-study reduction in the odds of all-cause under-5 mortality of about 30% (Peto odds ratio, OR, 0.72; 95% CI 0.55 to 0.92; Bayes OR 0.70; 95% CrI 0.49 to 0.93). The results were qualitatively similar under alternative modeling and data inclusion choices. Taking into account heterogeneity across studies, the expected reduction in a new implementation is 25%. We used the results to examine the cost-effectiveness of investing in water treatment for point-of-collection chlorine dispensers or a large-scale program providing coupons for free chlorine solution. We estimate a cost per expected DALY averted due to water treatment of around USD 40 for both, accounting for delivery costs. This is approximately 45 times lower than the widely used threshold of 1x GDP per capita per DALY averted.

JEL-codes: I1 (search for similar items in EconPapers)
Date: 2023-01
New Economics Papers: this item is included in nep-dev, nep-env, nep-exp and nep-hea
Note: DEV
References: Add references at CitEc
Citations: View citations in EconPapers (1)

Downloads: (external link)
http://www.nber.org/papers/w30835.pdf (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:nbr:nberwo:30835

Ordering information: This working paper can be ordered from
http://www.nber.org/papers/w30835

Access Statistics for this paper

More papers in NBER Working Papers from National Bureau of Economic Research, Inc National Bureau of Economic Research, 1050 Massachusetts Avenue Cambridge, MA 02138, U.S.A.. Contact information at EDIRC.
Bibliographic data for series maintained by ().