Economic analysis of zoonotic disease control in Uganda and the Lao People’s Democratic Republic
Okello, Walter Otieno
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Background: Despite the acknowledged importance of economic assessments for public health interventions at the human-animal-ecosystem interface, there are currently limited economic methodologies for doing so. In this thesis studies were undertaken to ascertain the economic impact of interventions to control trypanosomiasis and taeniasis/cysticercosis in south-east Uganda and northern Lao PDR respectively. Also, in Uganda studies were done to find out if demand of draft cattle would be an important economic driver for spreading trypanosomiasis due to inter-district trade. Method: In Uganda, a one year recall cross-sectional baseline survey and an 18 month longitudinal survey of 660 households was conducted; to determine the benefits and changes due to restricted application of deltamethrin insecticide to only the legs, belly and ears of cattle. During the 18 month study, the households participating in the study were divided into six regimes depending on the type of intervention done in their cattle and these were; diminazine injection only, deworming only, no treatment and those had 25%, 50% and 75% of the total village cattle sprayed. Thus, the first three regimes were those households that had their cattle not sprayed with insecticide at all as opposed to the last three. Additionally, cattle trade data was collected for network and value chain analysis in all markets in Tororo and Namutamba districts from 199 cattle traders. In northern Lao PDR, stochastic modelling was done to determine the burden of neurocysticercosis associated epilepsy and soil transmitted helminthes. A cross-sectional study was carried out in 49 households, focusing on the prevalence of cysticercosis and soil transmitted helminths before and after a twelve month intervention to control a hyperendemic focus of Taenia solium. The village data was then extrapolated to the wider northern Lao PDR population. Results: The Uganda study indicated that the restricted application of deltamethrin in cattle induced change of USD 31 per head of adult bovine per year; this was the change in income that directly occurred due to restricted spraying of cattle with deltamethrin. During the intervention period, the annual difference in income between those households that had their cattle sprayed using restricted application protocol and those that did not was USD 123; and this was significant (t= 7.18, p= <0.001). Analysis of variance using households that had their cattle receive no treatment as control showed that restricted application of deltamethrin significantly increased household income compared to diminazine aceturate injection and deworming of cattle only. The incremental benefit cost ratio of spraying 0% to 25% of the cattle was found to be the highest (16:1) compared to spraying 25% to 50% (3:1) and 50% to 75% (1:1) of the cattle. Cattle trade network and value chain analysis revealed that the key cattle markets from which trypanosomiasis is likely to spread into Tororo District are Molo, Namutumba and Soroti. Also, it was found that the risk of spread of human African trypanosomiasis from south-east to north-west Uganda is high due to the increased demand for male cattle for draft work. In northern Lao PDR, 5,094 (95% CI: 25.6-28,940) DALYs were estimated to be imposed annually due to Taenia solium associated epilepsy, with 446.4 (95% CI: 2.2- 2,536) DALY imposed per 100,000 person-years. Due to the high benefits to pig production, the net monetary cost per DALY averted for simultaneously controlling T. solium, soil transmitted helminthes and classical swine fever was only USD 14, which fell to USD 11 if the separable cost method were applied. If the intervention did not target pigs, then the cost per DALY averted was USD 44; well below the current standard for ’very cost effective ‘of the 1 year’s per capita GDP. Conclusion: This study provided empirical evidence for evaluating the impact of quantifying the benefits of controlling zoonotic diseases in the livestock sector (Uganda case study) and in both livestock and human health populations (Lao PDR case study); this economic assessment approach can be used for planning future integrated health interventions. The results of this study support the policy of preventing the spread of infection by spraying at least 25% of the cattle using RAP, as well as injecting all cattle in key livestock markets in south east Uganda with diminazine aceturate to prevent HAT. In northern Lao PDR, simultaneous control of T. solium, soil transmitted helminths and classical swine fever is the most cost-effective approach. There are still difficulties in incorporating human and animal parameters into a single analytical framework; consequently there is a need to adapt the approaches undertaken in this study to the analysis of other zoonotic diseases in different settings to improve on their robustness.