Moving towards malaria elimination in southern Mozambique: Cost and cost-effectiveness of mass drug administration combined with intensified malaria control.

BACKGROUND: As new combinations of interventions aiming at interrupting malaria transmission are under evaluation, understanding the associated economic costs and benefits is critical for decision-making. This study assessed the economic cost and cost-effectiveness of the Magude project, a malaria elimination initiative implemented in a district in southern Mozambique (i.e. Magude) between August 2015-June 2018. This project piloted a combination of two mass drug administration (MDA) rounds per year for two consecutive years, annual rounds of universal indoor residual spraying (IRS) and a strengthened surveillance and response system on the back of universal long-lasting insecticide treated net (LLIN) coverage and routine case management implemented by the National Malaria Control Program (NMCP). Although local transmission was not interrupted, the project achieved large reductions in the burden of malaria in the target district. METHODS: We collected weekly economic data, estimated costs from the project implementer perspective and assessed the incremental cost-effectiveness ratio (ICER) associated with the Magude project as compared to routine malaria control activities, the counterfactual. We estimated disability-adjusted life years (DALYs) for malaria cases and deaths and assessed the variation of the ICER over time to capture the marginal costs and effectiveness associated with subsequent phases of project implementation. We used deterministic and probabilistic sensitivity analyses to account for uncertainty and built an alternative scenario by assuming the implementation of the interventions from a governmental perspective. Economic costs are provided in constant US$2015. RESULTS: After three years, the Magude project averted a total of 3,171 DALYs at an incremental cost of$2.89 million and an average yearly cost of $20.7 per targeted person. At an average cost of$19.4 per person treated per MDA round, the social mobilization and distribution of door-to-door MDA contributed to 53% of overall resources employed, with personnel and logistics being the main cost drivers. The ICER improved over time as a result of decreasing costs and improved effectiveness. The overall ICER was $987 (CI95$1,404/DALY averted, three times the gross domestic product (GDP) per capita of Mozambique, but above the threshold of interventions considered highly cost-effective (one time the GDP per capita or $468/DALY averted) and above the recently suggested thresholds based on the health opportunity cost ($537 purchasing power parity/ DALY averted). A significantly lower ICER was obtained in the implementation scenario from a governmental perspective ($441/DALY averted). CONCLUSION: Despite the initial high costs and volume of resources associated with its implementation, MDA in combination with other existing malaria control interventions, can be a cost-effective strategy to drastically reduce transmission in areas of low to moderate transmission in sub-Saharan Africa. However, further studies are needed to understand the capacity of the health system and financial affordability to scale up such strategies at regional or national level

Reconciling household goals in southern African woodlands using weighted goal programming

Weighted goal programming (WGP) is employed to reconcile the goals of food security, improved incomes and woodland conservation in households from selected sites in Malawi, Mozambique and Zimbabwe. The three goals are attainable simultaneously, albeit with trade-offs useful in guiding development of rural development policies. The WGP model provides a framework for evaluating impact, on the household goals and woodland condition, of some macroeconomic and sectoral policies and demographic changes. Keywords: goal programming, woodlands, households, simulation, southern Africa

Compactação de um argissolo amarelo distrocoeso submetido a diferentes manejos Compaction of a ultisol submitted to different managements

O objetivo deste trabalho foi de avaliar a susceptibilidade a influência do manejo da cana-de-açúcar sobre a compactação de um Argissolo Amarelo distrocoeso, através da densidade máxima (Dsmax) e umidade crítica (Uc) pelo ensaio de Proctor normal, e o grau de compactação em diferentes manejos e uso. O estudo foi realizado na Usina Triunfo Agroindustrial, Alagoas, em região composta de quatro subáreas, sendo: Área de mata (MA), Área de sequeiro (MSI), Área irrigada (MCI) e Área com vinhaça (MCV). Para a realização dos ensaios foram coletadas amostras indeformadas para densidade do solo e deformadas para matéria orgânica e ensaio de Proctor normal para obtenção da Dsmax e Uc e determinação do grau de compactação (GC) nos locais sorteados, 50 × 50 m, nas quatro áreas de manejo, nas profundidades de 0-20, 20-40 e 40-60 cm, com três repetições. Os dados foram submetidos à análise de variância e as médias comparadas pelo teste de Tukey, a 5% de probabilidade. Os valores das Dsmax do solo obedeceram à seguinte ordem crescente: MSI > MCI > MCV > MA, enquanto a Uc acompanhou a mesma ordem, porém decrescente. Portanto, os manejos MSI e MCI podem provocar degradação do solo, mesmo a Ucs mais baixas. Apenas o manejo MCI apresentou GC superior a 4,3%, valor crítico de referência, na profundidade de 0-20 cm.<br>The objective of this work was to evaluate the susceptibility to compaction of an utisoil under different soil managements and use. Evaluations were based on both maximum density (MD) and critical humidity (CH) through Standard Proctor compaction tests, and the degree of compaction in different soil managements and use. The study was carried out at the Triunfo Mill, State of Alagoas in Brazil. The testing area consisted of four distinct sub-areas: a preserved forest (MA), an area without irrigation (MSI), an irrigated area (MCI), and an area with vinasse (MCV). Undeformed soil samples were collected for soil density and the deformed ones for organic matter and Standard Proctor tests in order to obtain MD, CH and the compaction grade (CG). Plots (50 × 50 m) were randomized within the four areas at depths of 0-20, 20-40 and 40-60 cm, with three replications. Data were submitted to variance analyses, and means compared through the Tukey test at 5% of probability. MD data followed the grade MSI > MCI > MCV > MA, in contrast to CH which presented the inverse sequence. Therefore MSI and MCI can cause soil degradation, even at lower CH. Only MCI presented CG higher than 4.3%, the critical value reference, at 0-20 cm