Spoločensko – ekonomický význam dojčenia
V porovnaní s dojčenými deťmi bývajú ich rovesníci kŕmení umelými mliekami častejšie chorí, vyžadujú častejšie návštevy u lekára, prípadne hospitalizácie v nemocnici. Umelá výživa má preto za následok nielen zhoršenie stavu populácie ale zároveň aj zvýšenie výdajov na zdravotníctvo. K priamym nákladom na ošetrenie chorľavejších detí je pritom nutné pripočítať aj nepriame ekonomické dopady vyššej chorobnosti detí a perspektívne aj budúcich dospelých (OČR-ky, PN-ky a pod.). Veď na základe viacerých prác možno predpokladať, že spôsob výživy v rannom detstve (t.j. dojčenie versus umelá výživa) – ovplyvňuje zdravotný stav človeka až do dospelosti. Medzičasom je už zrejmé, že investícia do podpory dojčenia, a tým zlepšenia zdravotného stavu populácie sa spoločnosti mnohonásobne vráti.
Zoberúc do úvahy výsledky viacerých prác, podľa ktorých sú dojčené deti inteligentnejšie, rýchlejšie sa vyvíjajú a dosahujú lepšie študijné výsledky, je spoločensko-ekonomický význam podpory dojčenia oveľa väčší. Vyjadriť presne ekonomický prínos zdravších a inteligentnejších generácii je prakticky nemožné, jednoznačný pozitívny dopad na celú spoločnosť je však nepopierateľný.
Pediatrics 1999 Apr;103(4 Pt 2):870-6 |
Health care costs of formula-feeding in the first year of life.
Ball TM, Wright AL
Department of Pediatrics and Steele Memorial Children's Research Center, University of Arizona, Tucson, USA.
OBJECTIVE: To determine the excess cost of health care services for three illnesses in formula-fed infants in the first year of life, after adjusting for potential confounders. METHODS: Frequency of health service utilization for three illnesses (lower respiratory tract illnesses, otitis media, and gastrointestinal illness) in the first year of life was assessed in relation to duration of exclusive breastfeeding in the Tucson Children's Respiratory Study (n = 944) and the Dundee Community Study (Scottish study, n = 644). Infants in both studies were healthy at birth and represented nonselected, population-based samples. Children were classified as never breastfed, partially breastfed, or exclusively breastfed, based on their feeding status during the first 3 months of life. Frequency of office visits and hospitalizations for the three illnesses was adjusted for maternal education and maternal smoking, using analysis of variance. Cost estimates, from the perspective of the health care provider/payer, were based on the direct medical costs during 1995 within a large managed care health care system. RESULTS: In the first year of life, after adjusting for confounders, there were 2033 excess office visits, 212 excess days of hospitalization, and 609 excess prescriptions for these three illnesses per 1000 never-breastfed infants compared with 1000 infants exclusively breastfed for at least 3 months. These additional health care services cost the managed care health system between $331 and $475 per never-breastfed infant during the first year of life. CONCLUSIONS: In addition to having more illnesses, formula-fed infants cost the health care system money. Health care plans will likely realize substantial savings, as well as providing improved care, by supporting and promoting exclusive breastfeeding.
J Hum Lact 1997 Jun;13(2):93-7 |
The cost of not breastfeeding: a commentary.
Riordan JM
School of Nursing, Wichita State University, Kansas, USA.
Breastfeeding, a valuable natural resource, promotes health, helps prevent infant and childhood disease, and saves health care costs. Additional annual national health care costs, incurred for treatment of four medical conditions in infant who were not breastfed were estimated. Infant diarrhea in nonbreastfed infants costs $291.3 million; respiratory syncytial virus, $225 million; insulin-dependent diabetes mellitus, from $9.6 to $124.8 million; and otitis media, $660 million. Thus, these four medical diagnoses alone create just over $1 billion of extra health care costs each year. Breastfeeding may also enhance intellectual development of children according to at least one medical research study. The potential societal benefits of more intelligent children is incalculable even though it cannot be directly measured in terms of dollars. Finally, it was calculated that an additional $2,665,715 in federal funds is needed yearly in order for WIC to provide infant formula to nonbreastfeeding mothers. For the average family, the cost of purchasing formula is twice the cost of supplemental food for the breastfeeding mother.Breastfeeding education and support should be an integral part of health care, especially under managed care which rewards the prevention of health problems and reduced use of health services.
Riordan JM
School of Nursing, Wichita State University, Kansas, USA.
Breastfeeding, a valuable natural resource, promotes health, helps prevent infant and childhood disease, and saves health care costs. Additional annual national health care costs, incurred for treatment of four medical conditions in infant who were not breastfed were estimated. Infant diarrhea in nonbreastfed infants costs $291.3 million; respiratory syncytial virus, $225 million; insulin-dependent diabetes mellitus, from $9.6 to $124.8 million; and otitis media, $660 million. Thus, these four medical diagnoses alone create just over $1 billion of extra health care costs each year. Breastfeeding may also enhance intellectual development of children according to at least one medical research study. The potential societal benefits of more intelligent children is incalculable even though it cannot be directly measured in terms of dollars. Finally, it was calculated that an additional $2,665,715 in federal funds is needed yearly in order for WIC to provide infant formula to nonbreastfeeding mothers. For the average family, the cost of purchasing formula is twice the cost of supplemental food for the breastfeeding mother.Breastfeeding education and support should be an integral part of health care, especially under managed care which rewards the prevention of health problems and reduced use of health services.
Breastfeed Rev 1998 Aug;6(2):5-9 |
The economics of breastfeeding in Singapore.
Fok D, Mong TG, Chua D
Operational Support Services, K.K. Women's and Children's Hospital, Singapore. Dfok@kkh.com.sg
A study of 340 mothers was conducted in Kandang Kerbau Hospital on September 1992 to determine if it were more economical for households to breastfeed or bottle-feed an infant for the first three months. Two economic models, a low cost model and a high cost model, were adopted incorporating a mathematical expression from Almroth's work in 1979. The savings in a mother's gross income for the period ranged from 3% to 9% for the low cost model and from 8% to 21% for the high cost model. From the household perspective, two components contributed to the economic savings of breastfeeding over artificial feeding: the cost of goods consumed and the time taken to feed the baby. It was noted that the time taken to artificially feed is longer than the time taken to breastfeed an infant. The results of this study provided more concrete basis for policy makers and advocates of breastfeeding to promote breastfeeding in Singapore. The amount of savings from breastfeeding could be considered for the health care system from the public perspective.
Fok D, Mong TG, Chua D
Operational Support Services, K.K. Women's and Children's Hospital, Singapore. Dfok@kkh.com.sg
A study of 340 mothers was conducted in Kandang Kerbau Hospital on September 1992 to determine if it were more economical for households to breastfeed or bottle-feed an infant for the first three months. Two economic models, a low cost model and a high cost model, were adopted incorporating a mathematical expression from Almroth's work in 1979. The savings in a mother's gross income for the period ranged from 3% to 9% for the low cost model and from 8% to 21% for the high cost model. From the household perspective, two components contributed to the economic savings of breastfeeding over artificial feeding: the cost of goods consumed and the time taken to feed the baby. It was noted that the time taken to artificially feed is longer than the time taken to breastfeed an infant. The results of this study provided more concrete basis for policy makers and advocates of breastfeeding to promote breastfeeding in Singapore. The amount of savings from breastfeeding could be considered for the health care system from the public perspective.
Am J Manag Care 1997 Jun;3(6):861-5 |
Economic advantages of breast-feeding in an HMO: setting a pilot study.
Hoey C, Ware JL
Kaiser Permanente, Raleigh, NC 27612, USA.
We performed a pilot study on newborns randomly chosen from term singleton deliveries born to mothers in an HMO group between September 1992 and August 1993. Breast-fed infants were breast-feeding at 6 months (n = 41), whereas bottle-fed infants were bottle-fed from birth (n = 107), Medical care and costs for the first 12 months were retrospectively analyzed, including office visits, drug prescriptions, and hospitalizations. Both groups had similar numbers of office visits and pharmacy costs. Breast-fed infants had fewer inpatient admissions (0.13 vs. 0.20 discharges per 1,000 babies), and their average total medical costs were $200 less than those of bottle-fed infants. Extrapolating to the total number of deliveries during this period, an increase in breast-feeding from the current rate (17%) to the Healthy People 2000 goal (50%) could save up to $140,000 annually.
Hoey C, Ware JL
Kaiser Permanente, Raleigh, NC 27612, USA.
We performed a pilot study on newborns randomly chosen from term singleton deliveries born to mothers in an HMO group between September 1992 and August 1993. Breast-fed infants were breast-feeding at 6 months (n = 41), whereas bottle-fed infants were bottle-fed from birth (n = 107), Medical care and costs for the first 12 months were retrospectively analyzed, including office visits, drug prescriptions, and hospitalizations. Both groups had similar numbers of office visits and pharmacy costs. Breast-fed infants had fewer inpatient admissions (0.13 vs. 0.20 discharges per 1,000 babies), and their average total medical costs were $200 less than those of bottle-fed infants. Extrapolating to the total number of deliveries during this period, an increase in breast-feeding from the current rate (17%) to the Healthy People 2000 goal (50%) could save up to $140,000 annually.
Indian J Pediatr 1995 Jul-Aug;62(4):449-53 |
Exclusive breastfeeding: protective efficacy.
Kasla RR, Bavdekar SB, Joshi SY, Hathi GS
Department of Pediatrics, Dr. R.N. Cooper Hospital, Juhu, Bombay.
A longitudinal study of feeding practices of and morbidity in 537 infants was undertaken. Feeding practices were assessed at monthly follow-up visits. All infants were initially exclusively breastfed but their percentage dropped to 59.8% and 35.3% at the end of 3 months and 6 months respectively. Exclusively breastfed babies were three-times less likely to fall sick than artificially fed babies. Exclusive breastfeeding was also associated with significantly lowered rate of serious illnesses as shown by fewer rate of hospitalisation (0.52/100 children months vs 4.5/100 children months). Premature introduction of supplementary feeding diluted the protective effects of breastmilk.
Kasla RR, Bavdekar SB, Joshi SY, Hathi GS
Department of Pediatrics, Dr. R.N. Cooper Hospital, Juhu, Bombay.
A longitudinal study of feeding practices of and morbidity in 537 infants was undertaken. Feeding practices were assessed at monthly follow-up visits. All infants were initially exclusively breastfed but their percentage dropped to 59.8% and 35.3% at the end of 3 months and 6 months respectively. Exclusively breastfed babies were three-times less likely to fall sick than artificially fed babies. Exclusive breastfeeding was also associated with significantly lowered rate of serious illnesses as shown by fewer rate of hospitalisation (0.52/100 children months vs 4.5/100 children months). Premature introduction of supplementary feeding diluted the protective effects of breastmilk.
Indian Pediatr 1996 Aug;33(8):655-8 |
Cost of infant feeding in exclusive and partially breastfed infants.
Bhatnagar S, Jain NP, Tiwari VK
Department of Planning and Evaluation, Biostatistics and Demography, National Institute of Health and Family Welfare, New Delhi.
OBJECTIVE: To compare the costs incurred on infant feeding between the mothers who exclusively breastfed their infants and those who introduced supplements up to 6 months of age. DESIGN: Longitudinal follow up. SETTING: Urban slums of south Delhi. METHODS: One hundred normal mother infant pairs fulfilling the prelaid criteria were recruited at the time of birth and followed up for determining the feeding practices. The cost of feeding was estimated at prevalent market prices in terms of food supplement and medical treatment of infant and additional nutritional intake of mothers. The differences in costs in exclusively and partially breastfed groups were analyzed at 3, 4, 5 and 6 months of age. RESULTS: There was a sharp decline of exclusive breastfeeding from birth to six months. The mean cost of infant feeding was Rs. 204/- per month in partially breastfed as compared to Rs. 106/- in exclusively breastfed at 6 months of age. The increased cost was largely attributable to supplementary food and the cost of feeding bottles. (83% of mothers used bottles). CONCLUSIONS: The mean cost of infant feeding is substantially higher in partially breastfed children (compared to exclusively breastfeed infants, pozn. zostavovateľa).
Bhatnagar S, Jain NP, Tiwari VK
Department of Planning and Evaluation, Biostatistics and Demography, National Institute of Health and Family Welfare, New Delhi.
OBJECTIVE: To compare the costs incurred on infant feeding between the mothers who exclusively breastfed their infants and those who introduced supplements up to 6 months of age. DESIGN: Longitudinal follow up. SETTING: Urban slums of south Delhi. METHODS: One hundred normal mother infant pairs fulfilling the prelaid criteria were recruited at the time of birth and followed up for determining the feeding practices. The cost of feeding was estimated at prevalent market prices in terms of food supplement and medical treatment of infant and additional nutritional intake of mothers. The differences in costs in exclusively and partially breastfed groups were analyzed at 3, 4, 5 and 6 months of age. RESULTS: There was a sharp decline of exclusive breastfeeding from birth to six months. The mean cost of infant feeding was Rs. 204/- per month in partially breastfed as compared to Rs. 106/- in exclusively breastfed at 6 months of age. The increased cost was largely attributable to supplementary food and the cost of feeding bottles. (83% of mothers used bottles). CONCLUSIONS: The mean cost of infant feeding is substantially higher in partially breastfed children (compared to exclusively breastfeed infants, pozn. zostavovateľa).
J Paediatr Child Health 1999 Apr;35(2):145-50 |
Hospital admissions in the first year of life in very preterm infants.
Elder DE, Hagan R, Evans SF, Benninger HR, French NP
Department of Neonatal Paediatrics, University of Western Australia.
OBJECTIVE: To analyse hospital readmissions to 1 year in infants < 33 weeks' gestation. STUDY DESIGN: Cohort of very preterm infants born in Western Australia. METHODS: Parental social class, history of asthma, race, gestational age, birthweight, sex, severity of respiratory disease and oxygen requirement at 28 days chronic lung disease (CLD), 36 weeks and term, maternal smoking, cohabitation with siblings, breast-feeding duration and hospital readmissions were recorded prospectively. RESULTS: Data were available for 538 of 560 (96%) infants discharged. Eight died in the first year. Two hundred and twenty-five infants (42%) had 443 readmissions, of which 370 were medical and 73 surgical. Risk factors for medical readmission were Aboriginal race, male sex and CLD. Breast-feeding was protective. Risk factors for surgical admission were male sex, lower gestation, severe hyaline membrane disease, severe CLD and birthweight < 10th centile. CONCLUSIONS: Readmission is common after very preterm birth. Risk factors for medical and surgical admission differ with CLD being the only perinatal factor associated with both medical and surgical admission.
Ann Trop Paediatr 2000 Mar;20(1):22-6 |
Feasibility, acceptability and cost of kangaroo mother care in Recife, Brazil.
Lima G, Quintero-Romero S, Cattaneo A
Department of Neonatology, Instituto Materno Infantil de Pernambuco, Recife, Brazil.
This descriptive study on kangaroo mother care (KMC) of low-birthweight infants (LBWIs) was carried out in a tertiary care hospital in Recife, Brazil. Of 244 LBWIs weighing less than 1750 g admitted over 14 months, 112 (46%) died before inclusion, 18 (7%) were excluded, and 114 (47%), after stabilization, were cared for by KMC 24 hours a day until discharge. No deaths were recorded in hospital; two twins died of severe pneumonia after discharge and before the age of 3 months. There were no episodes of moderate or severe hypothermia but mild hypothermia (36-36.4 degrees C axillary temperature) occurred at a rate of 30 episodes per 100 infant days, mainly related to occasional separation from the mother. One hundred infants (88%) were discharged on exclusive breastfeeding, eight (7%) were still taking expressed breast-milk from a cup and six (5%) were being fed breast-milk plus formula. The mean daily weight gain during KMC was 15 g. At follow-up, 87% were still exclusively breastfed at 1 month and 63% at 3 months. KMC was acceptable to mothers and staff. An important advantage of KMC over previous conventional care is cost--US$20 vs US$66 per bed/day. This study confirms that KMC for stabilized LBWIs in hospital is feasible, acceptable and cheap and in hospitals with limited resources is an appropriate alternative to conventional incubator care.
Arch Otolaryngol Head Neck Surg 1999 Jan;125(1):12-8 |
Measuring the indirect and direct costs of acute otitis media.
Alsarraf R, Jung CJ, Perkins J, Crowley C, Alsarraf NW, Gates GA
Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine and Virginia Merrill Bloedel Hearing Research Center, Seattle 98195, USA. amro@u.washington.edu
Alsarraf R, Jung CJ, Perkins J, Crowley C, Alsarraf NW, Gates GA
Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine and Virginia Merrill Bloedel Hearing Research Center, Seattle 98195, USA. amro@u.washington.edu
OBJECTIVES: To test a method of measuring the related cost of acute otitis media (AOM) and to provide a preliminary calculation of the indirect and directs costs associated with a single, medically treated episode of AOM. DESIGN: The Otitis Media Diary was used to measure indirect and direct costs associated with AOM in a prospective cohort study. Measured values included the parental time spent in otitis-specific child care and the number and type of medications used. A previously developed economic model was used to calculate the monetary costs associated with the value of caregiver time and the total opportunity cost of AOM. SETTING: The pediatric clinic of Madigan Army Medical Center, Tacoma, Wash. PATIENTS: A cohort of 25 children (12 with AOM and 13 controls) aged 1 to 3 years. MAIN OUTCOME MEASURES: Caregiver time and medication use. RESULTS: The total cost attributable to AOM in the 3-month period following diagnosis was $1330.58 (95% confidence interval, $1008.75-$1652.43), with the majority of that cost stemming from the indirect, rather than direct, costs of illness. After conservative estimates of unmeasured expenses, such as clinic visits and transportation, were accounted for, indirect costs, accrued primarily by parental time, accounted for nearly 90% (95% confidence interval, 87.1%-92.3%) of the total 3-month cost associated with AOM and its medical treatment. The cost items of the Otitis Media Diary were also highly correlated with each other and with other measures of clinical and functional health status. CONCLUSIONS: Otitis Media Diary measures of parental time and medication use appear to provide a more accurate means of calculating the real social costs attributable to the AOM disease process in this cost-effectiveness analysis.
- Kategória: