Table 1 Key model inputs and sources
From: Modeling the economic and health impact of substandard uterotonics in Senegal
Parameter variable | Unit | Value (Uncertainty range) | Source | |
|---|---|---|---|---|
Senegal | ||||
Demographics | ||||
Total population | People | 17,316,449 | UNPD 2022 23 | |
Birth rate | Per 1,000 people | 33 | UNPD 2022 23 | |
Maternal mortality ratio | Per 100,000 live births | 261 | World Bank 2020 3 | |
Life expectancy at birth, female | Years | 69 | UNPD 2022 23 | |
Mean age at maternal death | Years | 29.5 | Assumption Kodio et al. 29 | |
GDP per capita | USD | $1,598.70 | World Bank 2022 28 | |
Mothers’ residence by rurality | ||||
Urban | % | 30 | DHS 2019 24 | |
Rural | % | 70 | ||
Care-seeking locations and birth methods by rurality | ||||
Urban | ||||
Public Hospital and Vaginal birth | % | 10 | DHS 2019 24 | |
Public Hospital and C-section | % | 4 | ||
Public PHC and Vaginal birth | % | 75 | ||
Private Hospital and Vaginal birth | % | 6 | ||
Private Hospital and C-section | % | 1 | ||
Home | % | 5 | ||
Rural | ||||
Public Hospital and Vaginal birth | % | 3 | DHS 2019 24 | |
Public Hospital and C-section | % | 2 | ||
Public PHC and Vaginal birth | % | 62 | ||
Private Hospital and Vaginal birth | % | 1 | ||
Private Hospital and C-section | % | 0 | ||
Home | % | 31 | ||
Proportion of deliveries with PPH | % | 40 | Assumption based on Tort et al. 27 | |
Proportion of referrals among severe PPH from home and PHC | % | 18 | Dieme et al. 26 | |
Utilization of Uterotonics | ||||
Facility | ||||
Oxytocin | % | 34 | Assumption based on KOL | |
Oxytocin and Misoprostol | % | 66 | ||
No uterotonics given | % | 0 | ||
Home | ||||
No uterotonics given | % | 100 | Assumption | |
Proportion of substandard uterotonics | ||||
Oxytocin | Senegal | Côte d’Ivoire | ||
Public sector | % | 5.3 | 54 | Mati et al. 10 |
Private sector | % | 4.2 | ||
Misoprostol | ||||
Public sector | % | 45.5 | 4 | Mati et al. 10 |
Private sector | % | 25 | ||
Home | % | 38 | Assumption based on Mati et al. 10 | |
Risk of health outcomes | ||||
Oxytocin | Vaginal birth | C section | ||
PPH ≥ 500 ml | 0.12 (0.10–0.15) | 0.6 (0.57–0.63) | Gallos et al. 25 | |
PPH ≥ 1000 ml | 0.03 (0.02–0.04) | 0.13 (0.13–0.14) | ||
Oxytocin + Misoprostol | ||||
PPH ≥ 500 ml | 0.09 (0.07–0.11) | 0.42 (0.35–0.52) | ||
PPH ≥ 1000 ml | 0.03 (0.02–0.03) | 0.12 (0.09–0.13) | ||
Misoprostol | ||||
PPH ≥ 500 ml | 0.13 (0.12–0.15) | |||
PPH ≥ 1000 ml | 0.04 (0.03–0.04) | |||
Heat-stable carbetocin | ||||
PPH ≥ 500 ml | 0.09 (0.08–0.10) | 0.44 (0.39–0.48) | ||
PPH ≥ 1000 ml | 0.03 (0.02–0.03) | 0.12 (0.10–0.13) | ||
No prophylactic uterotonics | ||||
PPH ≥ 500 ml | 0.24 (0.19–0.29) | |||
PPH ≥ 1000 ml | 0.05 (0.04–0.06) | |||
Risk of PPH using substandard vs. quality-assured uterotonics | ||||
PPH ≥ 500 ml | Risk Ratio | 1.29 | Gallos et al. 14 | |
PPH ≥ 1000 ml | Risk Ratio | 1.26 | ||
Proportion of women with PPH receiving additional uterotonic treatments | ||||
With quality-assured uterotonics | % | 58 | Assumption based on Gallos et al. 14 | |
With substandard uterotonics | % | 73 | ||
Proportion of women with PPH receiving blood transfusion | ||||
With quality-assured uterotonics | % | 19 | Assumption based on Gallos et al. 14 | |
With substandard uterotonics | % | 38 | ||
Proportion of postpartum surgery among vaginal births with severe PPH | % | 20 | KOL Opinion | |
Costs | ||||
Public hospital | ||||
Vaginal births | Estimation by KOL | |||
No PPH | USD | 20.44 | ||
Mild PPH | USD | 30.97 | ||
Severe PPH without surgery | USD | 43.16 | ||
Severe PPH with surgery | USD | 66.76 | ||
C-sections | ||||
No PPH | USD | 53.84 | ||
Mild PPH | USD | 69.94 | ||
Severe PPH without surgery | USD | 77.06 | ||
Severe PPH with surgery | USD | 100.66 | ||
PHC | ||||
Vaginal births | ||||
No PPH | USD | 20.44 | ||
Mild PPH | USD | 24.97 | ||
Severe PPH without surgery | USD | 31.40 | ||
Private hospital | ||||
Vaginal births | ||||
No PPH | USD | 213.73 | ||
Mild PPH | USD | 224.91 | ||
Severe PPH without surgery | USD | 289.83 | ||
Severe PPH with surgery | USD | 1,065.83 | ||
C-sections | ||||
No PPH | USD | 788.36 | ||
Mild PPH | USD | 806.03 | ||
Severe PPH without surgery | USD | 861.83 | ||
Severe PPH with surgery | USD | 1,605.83 | ||