Cost-effectiveness analysis of insecticide-treated net distribution as part of the Togo Integrated Child Health Campaign

BACKGROUND: To evaluate the cost-effectiveness of the first nationwide delivery of long-lasting insecticide-treated nets (LLITNs) as part of the 2004 measles vaccination campaign in Togo to all children between nine months and five years. METHODS: An incremental approach was used to calculate the economic costs and effects from a provider perspective. Effectiveness was estimated in terms of malaria cases averted, deaths averted and Disability-Adjusted Life Years (DALYs) averted. Malaria cases were modelled using regional estimates. Programme and treatment costs were derived through reviews of financial records and interviews with key stakeholders. Uncertain variables were subjected to a univariate sensitivity analysis. RESULTS: Assuming equal attribution of shared costs between the LLITN distribution and the measles vaccination, the net costs per LLITN distributed were 4.41 USD when saved treatment costs were taken into account. Assuming a constant utilization of LLITNs by the target group over three years, 1.2 million cases could be prevented at a net cost per case averted of 3.26 USD. The net costs were 635 USD per death averted and 16.39 USD per DALY averted, respectively. CONCLUSION: The costs per case, death and DALY averted are well within commonly agreed benchmarks set by other malaria prevention studies. Varying transmission levels are shown to have a significant impact on cost-effectiveness ratios. Results also suggest that substantial efficiency gains may be derived from the joint delivery of vaccination campaigns and malaria interventions

Results of the first mapping of soil-transmitted helminths in Benin: Evidence of countrywide hookworm predominance

<div><p>Background</p><p>National mapping of soil-transmitted helminth infections (STH) was conducted for the first time in all of the 77 districts of Benin (West Africa) from 2013 to 2015. This mapping aimed to provide basic epidemiological data essential for the implementation of the national strategy against the neglected tropical diseases (NTDs) in the context of achieving the WHO target of controlling these infections by 2020.</p><p>Methods</p><p>In each district, 5 schools were purposively selected in 5 villages and 50 school-children (25 girls and 25 boys) from ages 8 to 14 years were randomly enrolled in each school. In total, 19,250 stool samples of school children (9,625 girls and 9,625 boys) from 385 schools were examined by Kato-Katz technique.</p><p>Results</p><p>The three major species of STH (hookworm, <i>Ascaris lumbricoides</i> and <i>Trichuris trichiura</i>) were observed with intra- and inter-specific variations in the prevalence and the intensity of these parasites. Hookworm infection was present in all of the surveyed districts with an average prevalence of 17.14% (95% CI 16.6%-17.6%). Among the infected schoolchildren, at national level, 90.82%, 6.73% and 2.45% of infections were of light, moderate and heavy parasite intensities respectively. A. <i>lumbricoides</i> infection, with a national average prevalence of 5.35% (95% CI 5.00%-5.60%),was the second most prevalent STH, and 84.37%, 14.27% and 1.36% of the infections were of light, moderate and heavy parasite intensities, respectively. <i>T</i>. <i>trichiura</i> had a national average prevalence of 1.15% (95% CI 0.90%-1.20%) and 80.45%, 13.18% and 6.36% infections were of light, moderate and heavy parasite intensities, respectively. The national cumulative prevalence of the three STH infections was 22.74% (95% CI 22.15%-23.33%), with58.44% (45/77) of the districts requiring mass treatment according to WHO recommendations. In all of the surveyed districts, multiple infections by STH species were common, and boys seemed more at risk of hookworm and Ascaris infections.</p><p>Conclusions</p><p>This first national mapping provided an overview of the epidemiological pattern of STH infections and was essential for the implementation of a control strategy with an effective preventive chemotherapy treatment (PCT). Results show that while preventive chemotherapy is not indicated for children in 32/77 districts, 43 require annual deworming and two require twice yearly deworming. If no environmental change occurs, and no mass treatment is delivered, prevalence is likely to remain stable for many years owing to poor hygiene and sanitation.</p></div

Prevalence (%) and intensity of hookworm infections.

<p>(n: Infected invidious).</p

Cumulative STH (hookworms, Ascaris and Trichuris) prevalence and PCT strategy (n: Schoolchildren co infected by at least two STH species; schoolchildren coinfected were counted one; n1: Number of schoolchildren infected per department; PCT: Preventive chemotherapy; SAC: School age children).

<p>Cumulative STH (hookworms, Ascaris and Trichuris) prevalence and PCT strategy (n: Schoolchildren co infected by at least two STH species; schoolchildren coinfected were counted one; n1: Number of schoolchildren infected per department; PCT: Preventive chemotherapy; SAC: School age children).</p

Prevalence (%) and intensity of <i>A</i>. <i>lumbricoides</i> infections.

<p>Prevalence (%) and intensity of <i>A</i>. <i>lumbricoides</i> infections.</p