Background: This literature review investigates the economic costs of childhood disability analysing methodologies used and summarizing the burden worldwide comparing developed and developing countries. Methods: Four electronic databases were searched. Studies were categorised according to country, perspective, methods of costing, disability category, and time horizon. Annual costs were converted to 2019 current US dollars then compared to the country’s per capita current health expenditure (CHE) and gross domestic product (GDP). Results: Of 2468 references identified, 20 were included in the review. Annual burden of childhood disability ranged ≈$450–69,500 worldwide. Childhood disability imposes a heavy economic burden on families, health systems, and societies. The reason for the wide range of costs is the variability in perspective, costs included, methods, and disability type. Conclusion: The annual societal costs for one disabled child could be up to the country’s GDP per capita. The burden is heavier on households in developing countries as most of the costs are paid out-of-pocket leading to impoverishment of the whole family. Efforts should be directed to avoid preventable childhood disabilities and to support disabled children and their households to make them more independent and increase their productivity. More studies from developing countries are needed.

Preventing infectious disease has often been the primary rationale for public investment in sanitation. However, broader aspects of sanitation such as privacy and safety are important to users across settings, and have been linked to mental wellbeing. The aim of this study is to investigate what people most value about sanitation in low-income areas of Maputo, Mozambique, to inform a definition and conceptual model of sanitation-related quality of life. Our approach to qualitative research was rooted in economics and applied the capability approach, bringing a focus on what people had reason to value. We undertook 19 in-depth interviews and 8 focus group discussions. After eliciting attributes of "a good life" in general, we used them to structure discussion of what was valuable about sanitation. We applied framework analysis to identify core attributes of sanitation-related quality of life, and used pile-sorting and triad exercises to triangulate findings on attributes' relative importance. The five core attributes identified were health, disgust, shame, safety, and privacy. We present a conceptual model illustrating how sanitation interventions might improve quality of life via changes in these attributes, and how changes are likely to be moderated by conversion factors (e.g. individual and environmental characteristics). The five capability-based attributes are consistent with those identified in studies of sanitation-related insecurity, stress and motives in both rural and urban areas, which is supportive of theoretical generalisability. Since two people might experience the same toilet or level of sanitation service differently, quality of life effects of interventions may be heterogeneous. Future evaluations of sanitation interventions should consider how changes in quality of life might be captured.

Public health programmes tend to be complex and may combine social strategies with aspects of empowerment, capacity building and knowledge across sectors. The nature of the programmes means that some effects are likely to occur outside the healthcare sector; this breadth impacts on the choice of health and non‐health outcomes to measure and value in an economic evaluation.Employing conventional outcome measures in evaluations of public health has been questioned. There are concerns that such measures are too narrow, overlook important dimensions of programme effect and, thus, lead to such interventions being undervalued. This issue is of particular importance for low‐income and middle‐income countries, which face considerable budget constraints, yet deliver a large proportion of health activities within public health programmes.The need to develop outcome measures, which include broader measures of quality of life, has given impetus to the development of a variety of new, holistic approaches, including Sen's capability framework and measures of subjective wellbeing. Despite their promise, these approaches have not yet been widely applied, perhaps because they present significant methodological challenges. This paper outlines the methodological challenges for the identification and measurement of broader outcomes of public health interventions in economic evaluation in low‐income and middle‐income countries.

Background: Menstrual health is an increasingly recognised public health issue, defined as complete physical, mental, and social well-being in relation to the menstrual cycle. The MENISCUS trial aims to assess whether a multi-component intervention addressing physical and emotional aspects of menstrual health improves educational attainment, mental health problems, menstrual management, self-efficacy, and quality of life among girls in secondary school in Uganda. Methods: The study is a parallel-arm cluster-randomised controlled trial with 60 schools (clusters) in Wakiso and Kalungu districts, with a mixed-methods process evaluation to assess intervention fidelity and acceptability and economic and policy analyses. The schools will be randomised 1:1 to immediate intervention or to optimised usual care with delayed intervention delivery. The intervention includes creation of a Menstrual Health Action Group at schools and NGO-led training of trainers on puberty education, development of a drama skit, delivery of a menstrual health kit including reusable pads and menstrual cups, access to pain management strategies including analgesics, and basic improvements to school water, sanitation, and hygiene facilities. Baseline data will be collected from secondary 2 students in 2022 (median age ~15.5 years), with endline after 1 year of intervention delivery (~3600 females and a random sample of ~900 males). The primary outcomes assessed in girls are (i) examination performance based on the Mathematics, English, and Biology curriculum taught during the intervention delivery (independently assessed by the Uganda National Examinations Board) and (ii) mental health problems using the Total Difficulties Scale of the Strengths and Difficulties 25-item questionnaire. Secondary outcomes are menstrual knowledge and attitudes in girls and boys and, in girls only, menstrual practices, self-efficacy in managing menstruation, quality of life and happiness, prevalence of urogenital infections, school and class attendance using a self-completed menstrual daily diary, and confidence in maths and science. Discussion: The trial is innovative in evaluating a multi-component school-based menstrual health intervention addressing both physical and emotional aspects of menstrual health and using a “training of trainers” model designed to be sustainable within schools. If found to be cost-effective and acceptable, the intervention will have the potential for national and regional scale-up. Trial registration: ISRCTN 45461276. Registered on 16 September 2021

We report the results of a series of validity and reliability tests performed during the development of the Women’s Capabilities Index (WCI) in Malawi. The WCI is a multidimensional measure based on Sen’s capability framework for assessing women’s quality of life. Construct validity was assessed by investigating the expected relationships of the dimensions with key socioeconomic characteristics. The majority of hypothesized associations were found to be statistically significant in the expected direction. This provides evidence that the index is measuring quality of life as intended in the conceptual model. Further evidence in support of the index’s validity was given by the high degree of correlation between the WCI and another scale measuring comparable (but not identical) domains of quality of life. The results from the internal consistency and the test–retest repeatability also offered encouraging evidence on the reliability of the instrument. This is the first study to rigorously and comprehensively test for validity and reliability a capabilities index for a low-income setting. The results of the validity and reliability tests provide supportive evidence that a locally developed measure of capabilities can be used as a robust tool for the assessment of women’s quality of life.