Costo Efectividad del Gas Natural Domiciliario como Tecnología Sanitaria en Localidades Rurales del Caribe Colombiano

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Abstract

Objetivo Valorar el impacto económico del Gas Natural Domiciliario -GND- como tecnología sanitaria sobre la enfermedad respiratoria asociada al humo de biomasa en localidades del caribe colombiano. Métodos Tres estudios combinados: a) carga de enfermedad respiratoria asociada al uso de combustibles de biomasa; b) costos de la enfermedad (Infección Respiratoria Aguda -IRA- y Enfermedad Pulmonar Obstructiva Crónica-EPOC); y c) análisis de costo efectividad del GND para reducir morbilidad por enfermedades respiratorias. Resultados En las localidades se esperarían anualmente 498 (477-560) casos de IRA que generaría 149 (119-196) hospitalizaciones, 6 (4-10) muertes y 7 291 (5 746 -9 696) AVAD. También se esperarían 459 (372-684) casos de EPOC, 138 (93- 239) hospitalizaciones, 11 (5-26) muertes y 1 500 (973-2 711) AVAD. Los costos de esta carga de enfermedad en ausencia del GND son anualmente de 5,2 (3,8-8,3) millones de dólares. De éstos, la mayoría son costos de EPOC (cerca del 85 %). Los costos por IRA y EPOC, luego de instalado el GND, ascienden a 3,5 (2,5-5,7) millones de dólares. Los costos evitados serían 1,6 (1,2-2,6) millones de dólares, (30 % de los costos de la carga). El costo efectividad incremental de introducir el GND sería un poco más de 56 (22-74) mil dólares por muerte evitada y entre 43 y 66 dólares evitar un AVAD. Conclusiones Frente a la no intervención, la instalación del GND resulta ser una tecnología costo efectiva para la reducción de las enfermedades respiratorias asociadas al consumo de combustibles de biomasa.

Translated abstract

Objective Evaluating the economic impact of natural gas as a sanitary technology regarding respiratory disease associated with indoor air pollution in rural localities on the Colombian Caribbean coast. Methods Three studies were carried out: the burden of respiratory disease was evaluated (acute lower respiratory infection-ALRI and chronic obstructive pulmonary disease - COPD), disease costs were studied and the cost effectiveness of natural gas was analysed in terms of reducing indoor air pollution. Results Without natural gas in these localities, it would be expected that 498 (477-560) cases of ALRI per year would lead to 149 (119-196) hospitalisations, 6 (4-10) deaths and 7 291 (5,746-9,696) disability adjusted life years (DALY) annually. Furthermore, it is expected that 459 (372-684) cases of COPD per year would lead to 138 (93-239), hospitalisations, 11 deaths (5-26) and 1 500 (973-2 711) DALY annually. Annual disease burden cost was 5,2 (3,8-8,3) million dollars before installing domiciliary natural gas (DNG); most of such cost arose from COPD (around 85 %). ARI and COPD costs after installing DNG would rise to 3,5 (2,5-5,7) million dollars; avoided costs would be 1,6 (1,2-2,6) million dollars, (30 % of disease burden cost without DNG). The incremental cost-effectiveness (ICER) of installing DNG would be 56 (22-74) thousand dollars per life saved and ICER per DALY saved would be 43-66 dollars. Conclusion DNG is a sanitary technology which reduces the burden of indoor air pollution-associated respiratory diseases arising from burning biomass fuel in rural localities in a cost-effective way.

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Most cited references 18

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Evidence-Based Health Policy---Lessons from the Global Burden of Disease Study

C J L Murray, A. Lopez (1996)

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Indoor air pollution in developing countries: a major environmental and public health challenge

Nigel Bruce, Rogelio Perez-Padilla, Rachel Albalak (2000)

Around 50% of people, almost all in developing countries, rely on coal and biomass in the form of wood, dung and crop residues for domestic energy. These materials are typically burnt in simple stoves with very incomplete combustion. Consequently, women and young children are exposed to high levels of indoor air pollution every day. There is consistent evidence that indoor air pollution increases the risk of chronic obstructive pulmonary disease and of acute respiratory infections in childhood, the most important cause of death among children under 5 years of age in developing countries. Evidence also exists of associations with low birth weight, increased infant and perinatal mortality, pulmonary tuberculosis, nasopharyngeal and laryngeal cancer, cataract, and, specifically in respect of the use of coal, with lung cancer. Conflicting evidence exists with regard to asthma. All studies are observational and very few have measured exposure directly, while a substantial proportion have not dealt with confounding. As a result, risk estimates are poorly quantified and may be biased. Exposure to indoor air pollution may be responsible for nearly 2 million excess deaths in developing countries and for some 4% of the global burden of disease. Indoor air pollution is a major global public health threat requiring greatly increased efforts in the areas of research and policy-making. Research on its health effects should be strengthened, particularly in relation to tuberculosis and acute lower respiratory infections. A more systematic approach to the development and evaluation of interventions is desirable, with clearer recognition of the interrelationships between poverty and dependence on polluting fuels.

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Does biofuel smoke contribute to anaemia and stunting in early childhood?

Vinod Mishra, R D Retherford (2007)

Reliance on biomass fuels for cooking and heating exposes many women and young children in developing countries to high levels of air pollution indoors. Exposure to biomass smoke has been linked to reduced birth weight, acute respiratory infections, and childhood mortality. This study examines the association between household use of biofuels (wood, dung, and crop residues) for cooking and heating and prevalence of anaemia and stunting in children. Data are from a 1998-99 national family health survey in India, which measured height, weight, and blood haemoglobin of 29 768 children aged 0-35 months in 92 486 households. Multinomial logistic regression is used to estimate the effects of biofuel use on prevalence of anaemia and stunting, controlling for exposure to tobacco smoke, recent episodes of illness, maternal education and nutrition, and other potentially confounding factors. Analysis shows that prevalence of moderate-to-severe anaemia was significantly higher among children in households using biofuels than among children in households using cleaner fuels (RRR = 1.58; 95% CI: 1.28, 1.94), independent of other factors. Prevalence of severe stunting was also significantly higher among children in biofuel-using households (RRR = 1.84; 95% CI: 1.44, 2.36). Thirty-one per cent of moderate-to-severe anaemia and 37% of severe stunting among children aged 6-35 months in India may be attributable to exposure to biofuel smoke. Effects on mild anaemia and moderate stunting were smaller, but positive and statistically significant. Effects of exposure to tobacco smoke on anaemia and stunting were small and not significant. The study provides a first evidence of the strong association between biofuel use and risks of anaemia and stunting in children, suggesting that exposure to biofuel smoke may contribute to chronic nutritional deficiencies in young children.

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Author and article information

Journal

Journal ID (publisher-id): rsap

Title: Revista de Salud Pública

Abbreviated Title: Rev. salud pública

Publisher: Instituto de Salud Publica, Facultad de Medicina - Universidad Nacional de Colombia (Bogotá, DF, Colombia )

ISSN (Print): 0124-0064

Publication date (Print and electronic): October 2008

Volume: 10

Issue: 4

Pages: 537-549

Affiliations

[01] orgnameUniversidad de Cartagena orgdiv1Facultad de Ciencias Económicas orgdiv2Departamento de Investigaciones Económicas y Sociales -DIES

Article

Publisher ID: S0124-00642008000400004 Publisher ID: S0124-0064(08)01000404

DOI: 10.1590/s0124-00642008000400004

SO-VID: 43773ca8-f45b-47a7-b298-f4be5577a360

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This work is licensed under a Creative Commons Attribution 4.0 International License.

History

Date accepted : 26 August 2008

Date received : 06 December 2007

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Figures: 0, Tables: 0, Equations: 0, References: 31, Pages: 13

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SciELO Public Health

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Costo Efectividad del Gas Natural Domiciliario como Tecnología Sanitaria en Localidades Rurales del Caribe Colombiano Translated title: The cost-effectiveness of installing natural gas as a sanitary alternative for rural communities on the Colombian Caribbean coast burning biomass fuels

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