Background Despite recent improvements in health service coverage, maternal and neonatal mortality remain major public health concerns in Ethiopia. Evidence regarding cost-effectiveness is crucial for prioritizing interventions within the Essential Health Services Package, particularly in resource-constrained settings. Objective This study aims to systematically review and conduct a meta-analysis on the cost-effectiveness of maternal and neonatal health (MNH) interventions in Ethiopia. Methods We conducted a comprehensive search across multiple databases (PubMed/MEDLINE, Embase, the Cochrane Library, CINAHL, Scopus, Web of Science, African Journals Online; including the Ethiopian Journal of Health Development, Tufts Cost-Effectiveness Analysis Registry, and Google Scholar) from January 2000 to December 2024. A total of twelve studies were included in the qualitative synthesis and meta-analysis. A random-effects meta-analysis was performed for interventions with three or more comparable estimates utilizing the DerSimonian-Laird method. Results The pooled incremental cost-effectiveness ratios (ICERs) showed high cost-effectiveness for key neonatal interventions: US$6.23 per DALY averted (95% CI: 4.22–8.23; I2 = 64.10%; n = 4) for neonatal resuscitation and US$8.78 per DALY averted (95% CI: 3.78–13.77; I2 = 90.98%; n = 3) for neonatal sepsis management. Antenatal care had a pooled ICER of US$91.93 per DALY averted (95% CI: 62.84–121.02; I2 = 79.65%; n = 5). The overall pooled ICER across all 12 studies was US$15.47 per DALY averted (95% CI: 11.07–19.87; I2 = 94.14%), but high heterogeneity (primarily due to intervention diversity) severely limits direct comparability; subgroup analyses provide the most reliable insights. Conclusion Neonatal resuscitation, sepsis management, and antenatal care are cost-effective interventions (all pooled ICERs substantially below commonly referenced Ethiopian contextual benchmarks, such as around 1 × projected 2025 GDP per capita of ≈US$950–1,100 per DALY averted, though we note debates on GDP-based approaches and the importance of opportunity costs and affordability). Community-based scale-up in rural regions can optimize outcomes. Trial registration PROSPERO registration number: CRD420251182108.

Cost-effectiveness of maternal and neonatal health interventions in Ethiopia: a systematic review and meta-analysis

期刊论文
出版模式：

开放获取
发表日期：

2026年5月20日

查看全文

Akalu Duguma Sima,
Endale Tamiru Burayu,
Zelalem Banjaw Zegeye

摘要

Background

Despite recent improvements in health service coverage, maternal and neonatal mortality remain major public health concerns in Ethiopia. Evidence regarding cost-effectiveness is crucial for prioritizing interventions within the Essential Health Services Package, particularly in resource-constrained settings.

Objective

This study aims to systematically review and conduct a meta-analysis on the cost-effectiveness of maternal and neonatal health (MNH) interventions in Ethiopia.

Methods

We conducted a comprehensive search across multiple databases (PubMed/MEDLINE, Embase, the Cochrane Library, CINAHL, Scopus, Web of Science, African Journals Online; including the Ethiopian Journal of Health Development, Tufts Cost-Effectiveness Analysis Registry, and Google Scholar) from January 2000 to December 2024. A total of twelve studies were included in the qualitative synthesis and meta-analysis. A random-effects meta-analysis was performed for interventions with three or more comparable estimates utilizing the DerSimonian-Laird method.

Results

The pooled incremental cost-effectiveness ratios (ICERs) showed high cost-effectiveness for key neonatal interventions: US$6.23 per DALY averted (95% CI: 4.22–8.23; I² = 64.10%; n = 4) for neonatal resuscitation and US$8.78 per DALY averted (95% CI: 3.78–13.77; I² = 90.98%; n = 3) for neonatal sepsis management. Antenatal care had a pooled ICER of US$91.93 per DALY averted (95% CI: 62.84–121.02; I² = 79.65%; n = 5). The overall pooled ICER across all 12 studies was US$15.47 per DALY averted (95% CI: 11.07–19.87; I² = 94.14%), but high heterogeneity (primarily due to intervention diversity) severely limits direct comparability; subgroup analyses provide the most reliable insights.

Conclusion

Neonatal resuscitation, sepsis management, and antenatal care are cost-effective interventions (all pooled ICERs substantially below commonly referenced Ethiopian contextual benchmarks, such as around 1 × projected 2025 GDP per capita of ≈US$950–1,100 per DALY averted, though we note debates on GDP-based approaches and the importance of opportunity costs and affordability). Community-based scale-up in rural regions can optimize outcomes.

Trial registration

PROSPERO registration number: CRD420251182108.