List Analysis Projects
LiST ANALYSIS PROJECT: Packages to affect maternal and under-5 mortality in
Malawi and Bihar
Question:
What would be the impact of scaling up various family health interventions (individually, or in packages)
on mortality in Malawi and Bihar, India?
Packages/Interventions of interest:
Skilled birth attendance
Basic newborn care
Pneumonia
Breastfeeding
PMTCT
Family Planning
Combined limited package
Combined comprehensive package
Target values:
Each package was analyzed at 80 90, 95 and 100 percent coverage. To look at family planning, the goal
was to reduce unmet need by 80, 90, 95 or 100%. Whenever an intervention had already reached the
target value, it was maintained at current value, rather than decreased to a lower value.
LiST Version Used:
Version 4.2 beta 7
Outputs of Interest:
Under-5 mortality rate
Under-5 deaths
Percent decline in under-5 deaths
Maternal mortality ratio
Maternal deaths
Percent decline in maternal deaths
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
Child mortality estimates are obtained from http://www.childmortality.org. The estimates from year 2008.5
were used.
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 2008 were used.
http://apps.who.int/immunization_monitoring/en/globalsummary/timeseries/tswucoveragedtp3.htm
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 and Hib vaccine’s effect on pneumonia and meningitis
o Pneumococcal vaccine (full coverage) has an effect of 0.26, meaning that full vaccination can
prevent 26% of pneumonia deaths, and since the review is not yet finished, we are assuming the
same effect (26%) on meningitis deaths.
o Hib vaccine (full coverage) has an effect of 0.18. This means that full vaccination can prevent
18% of pneumonia deaths and, since the review is not yet finished, we are also assuming the
same effect (18%) on meningitis deaths.
o The affected fraction for each of these vaccines 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.

Rotavirus vaccine’s effect on diarrhea
o Rotavirus vaccine can prevent 74% of diarrhea deaths, and 39% of diarrhea deaths can benefit
by full coverage of the vaccine.

Measles vaccine’s effect on measles
o Measles vaccine can prevent 85% of measles deaths, and 100% of measles deaths can benefit by
full coverage of the vaccine.

DPT vaccine’s effect on pertussis.
o DPT vaccine (3 doses) has an effect of 0.85, meaning that full vaccination can prevent 85% of
pertussis deaths.
o It is assumed that all (100%) pertussis deaths can benefit by full coverage of the vaccine.
Time Period
Periconceptual
Antenatal
Interventions
Folic acid supplementation or
fortification
Antenatal care
Calcium supplementation
Malawi
Bihar
0
57.1
2.9
0
26.4
1.3
Notes
Multiple micronutrient
supplementation
20
Tetanus toxoid
87
Balanced energy
supplementation
Case management of malaria
(hospital)
PMTCT
Antenatal corticosteroids for
preterm labor
Antibiotics for pPRoM
Essential care for all women
and immediate essential
newborn care
Comprehensive emergency
obstetric care
Active management of the 3rd
stage of labour
ChildBirth
MgSO4 management of
eclampsia
<1
month
Breastfeeding
1-5
months
Postnatal Preventive
Vaccines
Postnatal Curative
Neonatal resuscitation
(institutional)
Exclusive breastfeeding
Predominant breastfeeding
Partial breastfeeding
Exclusive breastfeeding
Predominant breastfeeding
Partial breastfeeding
Preventive postnatal care
(healthy practices and illness
detection)
Complementary feeding-supplementation and education
Hand washing with soap
Insecticide treated materials or
indoor residual spraying
Vitamin A for prevention
Zinc for prevention
Rotavirus vaccine
Measles vaccine
Hib vaccine
Pneumococcal vaccine
DPT vaccination
Kangaroo mother care
Injectable antibiotics: case
management of severe
neonatal infection
ORS
9.3
Malawi data from WHO/UNICEF
estimates. Bihar data from
73.2 NFHS/DLHS.
0
0.6
0
0
26.9
40.4
2.8
8.3
Estimated using standard LiST
formulas
13.4
24.9
32.3
2.8
0
0
26.9
82.1
9.2
8.6
11.8
4.1
83.9
This data was not available. We
estimated it to be half of the
1.4 CEmOC coverage.
Estimated using standard LiST
2.8 formulas
50.2
26.9
14.9
7.6
37.7
54.6
17.7
15.9
16.15
56.2
0
37.8
95
0
0
88
91
0
91
20
0
63.1
Data for Bihar taken from
4.2 NFHS3.
42
Not data available for Bihar, so it
0 was assumed to be 0
49.9
0
0
54.2
0 Malawi data from WHO/UNICEF
0 estimates. Bihar data from
54.4 NFHS/DLHS.
0 Malawi KMC estimated.
0
22
Antibiotics for dysentery
Zinc for treatment
Case management of
pneumonia (oral antibiotics)
Vitamin A for measles
treatment
Antimalarials
Therapeutic feeding
Other
Contraceptive Prevalence Rate
29.5
0
23
0
29.5
14.3
95
21.1
0
37
Same as Vitamin A
49.9 supplementation.
3.1
Data for Bihar taken from
4 NFHS3.
32.5
Results:
Universal coverage with a comprehensive package of interventions can reduce both under-5 and
maternal mortality by more than 70% in both settings. 80% coverage of the comprehensive package
could reduce mortality by at least 60% in both settings. However this does not take into consideration
delivery strategies needed to achieve these goals.