List Analysis Projects
LiST ANALYSIS PROJECT: Interventions to reduce child mortality in Luapula,
Zambia
Question:
To identify the package of interventions that will have the most impact on child mortality reductions in
the Luapula province of Zambia, so that these interventions can be used as incentives to supplement the
introduction of pneumo vaccine in the province.
Packages/Interventions of interest:
 Pilot A
 Pneumo vaccine
 ORS
 Antibiotics for pneumonia
 Breastfeeding
 Handwashing with soap
 Zinc for prevention
 Zinc for treatment
 Pilot B
 Pneumo vaccine
 ORS
 Antibiotics for pneumonia
 Breastfeeding
 Handwashing with soap
 Zinc for prevention
 Zinc for treatment
 Rotavirus vaccine
 Pilot C
 Pneumo vaccine
 ORS
 Antibiotics for pneumonia
 Breastfeeding
 Handwashing with soap
 Zinc for prevention
 Zinc for treatment
 Rotavirus vaccine
Target values:
Time frame: Base year of coverage 2011, Target year of coverage 2014
In Pilot A & B, coverage of pneumo vaccine is scaled up to 90% in 2014, while coverage of possible
interventions used as incentive for vaccination is scaled up to their respective midpoints (between the
coverage value in base year 2011 and 90%) - this is to account for the fact that the uptake of the
intervention will not always be 90%, for example, when soap is given as an intervention to promote
hand washing, not all that were given soap will actually use it.
In Pilot C, coverage of both pneumo vaccine and possible interventions used as incentive for vaccination
are scaled up to 90%
LiST Version Used:
Version 4.23 beta 14
Outputs of Interest:
Deaths in 1-59 months
Deaths averted in 1-59 months
Percent reduction in deaths 1-59 months
Under-5 mortality rate
Baseline Coverage Values:
Population trend is obtained from the The 2008 Revision of the World Population Prospects published by the
Population Division of the United Nations Department of Economic and Social Affairs of the United Nations
Secretariat. http://esa.un.org/unpd/wpp2008/index.htm
For the purpose of this analysis, province level Total Fertility Rate and Contraceptive Prevalence Rate
was used to adjust for an underlying population trend for the Luapula province.
Province level Child mortality estimates are obtained from Zambia’s DHS 2007.
Causes of death in children under 5 are obtained from the following article

Black, Robert E , Simon Cousens, Hope L Johnson, Joy E Lawn, Igor Rudan, Diego G Bassani, Prabhat Jha,
Harry Campbell, Christa Fischer Walker, Richard Cibulskis, Thomas Eisele, Li Liu, Colin Mathers, for the Child
Health Epidemiology Reference Group of WHO and UNICEF (2010). Global, regional, and national causes of
child mortality in 2008: a systematic analysis. Lancet. 375 (9730): 1969 - 1987.
Vaccine coverage estimates are obtained from the WHO-UNICEF estimates of national immunization coverage,
data downloaded in Oct 2010. The estimates from year 2009 were used.
http://apps.who.int/immunization_monitoring/en/globalsummary/timeseries/tswucoveragedtp3.htm
Province level vaccine coverage estimates are obtained from Zambia’s DHS 2007.
Vaccine effectiveness is based on their impact on specific causes of death:
An affected fraction refers to the percent of a specific cause of death which can be averted by an intervention.
This refers to etiology when available.
Standard vaccine effect sizes and affected fraction used in LiST:

Pneumococcal vaccine’s effect on pneumonia
o Pneumococcal vaccine (full coverage) has an effect of 0.26, meaning that full vaccination can
prevent 26% of pneumonia deaths
o The affected fraction for the vaccine is considered to be the entire population of pneumonia
deaths because that is how the reviews were completed. Thus the presented effect sizes are in
essence, combinations of both effectiveness of the vaccines and the affected fraction, or
proportion of pneumonia due to these bacteria.
o
Reference: Theodoratou, Evropi, Sue Johnson, Arnoupe Jhass, Shabir A Madhi, Andrew Clark,
Cynthia Boschi-Pinto, Sunil Bhopal, Igor Rudan, Harry Campbell (2010). The effect of
Haemophilus influenzae type b and pneumococcal conjugate vaccines on childhood pneumonia
incidence, severe morbidity and mortality. Int. J. Epidemiol. 39: i172-i185.
Coverage values for interventions were obtained from Zambia DHS 2007. Whenever possible, province level
coverage data was used.
Interventions
Complementary feeding--education
only
Complementary feeding-supplementation and education
Hand washing with soap
Baseline value
for No Scale
Up scenario
(2011)
Notes
Target value for
Midpoint scale-up
scenario (2014)
Target value for
90% scale up
scenario (2014)
25.4 Provincial
57.7
90
25.4 Provincial
57.7
90
53.5
90
Global average
17 from Cutis et al
Insecticide treated materials or indoor
residual spraying
81.2 Provincial
85.6
90
Vitamin A for prevention
64.5 Provincial
77.25
90
0 Provincial
45
90
Pneumococcal vaccine
ORS
0
47.2 Provincial
45
68.6
90
90
Antibiotics for dysentery
15.2 Provincial
52.6
90
0
45
90
46.6
68.3
90
Breastfeeding promotion
35
62.5
90
0-1 months Exclusive breastfeeding
86
88
90
0-1 months Predominant
breastfeeding
8.7
6
5
0-1 months Partial breastfeeding
5.3
6
5
Zinc for prevention
Zinc for treatment
Case management of pneumonia (oral
antibiotics)
0-1 months Not breastfeeding
0
0
0
1-5 months Exclusive breastfeeding
35
62.5
90
1-5 months Predominant
breastfeeding
8.2
18.2
4.5
55.7
18.2
4.5
1.1
1.1
1.1
1-5 months Partial breastfeeding
1-5 months Not breastfeeding
Results:
The package of interventions that can prevent the most deaths, when coupled with introduction of
pneumo vaccine, is Pilot C (ORS, breastfeeding, handwashing, antibiotics for pneumonia, zinc for
prevention and treatment, and rotavirus vaccine). More than 6300 deaths can be averted from 20112014 (a 14.5% reduction in deaths compared to status quo) if these incentive interventions’ coverages
are scaled up to the target value of 90% in 2014.