Evaluation of the ICT whole-blood antigen card test to detect infection due to Wuchereria bancrofti in Sri Lanka.

The sensitivity, specificity and cost effectiveness of an immunochromatographic card test (ICT, AMRAD) for the diagnosis of bancroftian filariasis were estimated against 2 standard parasitological techniques: thick blood film (TBF) and Nuclepore membrane filtration (NMF). Individuals were selected from endemic localities in the Western Province (n = 213) and from the non-endemic Central Province (n = 29) of Sri Lanka. Blood was collected between 21:00 and midnight. Sixty microlitre of non-heparinized blood, and 1 mL and 100 microL of heparinized blood were used in TBF, NMF and ICT, respectively. NMF was positive in 31.5% (67/213) of the endemic group, with a mean microfilaria (mf) count of 343/mL (range 8-1782, SD 422). All 67 were positive by ICT (sensitivity 100%), but only 63 by TBF (sensitivity 94%). Among the endemic population there were 12 who were mf negative but antigen positive by ICT. There were, however, no false positives among the non-endemic controls, indicating the possibility that the ICT may in fact be more sensitive and 100% specific. Thus, ICT filariasis test appears to be more effective (both sensitive and specific) than TBF or NMF in diagnosing infection in lymphatic filariasis. The direct unit recurrent costs of the 2 survey tools, TBF and ICT, were US$ 0.30 (Rs. 27/=) and US$ 2.75 (Rs. 248/=), respectively. The high cost of the ICT may be offset by other factors that are difficult to cost.

Cost and cost effectiveness of mass diethylcarbamazine chemotherapy for the control of bancroftian filariasis: comparison of four strategies in Tanzania.

This study examines the costs and cost effectiveness of four different mass diethylcarbamazine (DEC) chemotherapy regimens-standard dose, semi-annual single dose, low monthly dose and DEC-medicated salt-in reducing microfilarial (mf) prevalence at the community level. Costs were estimated for each intervention in relation to both ingredient and activity, by the derivation and use of detailed itemized cost menus. The most expensive and most effective strategy in reducing community mf prevalence over 2 years was DEC salt intervention, followed in order of costs by the standard, low monthly and semi-annual DEC strategies. The most cost effective strategy was the low monthly DEC treatment. Cost and sensitivity analyses, however, suggest that the optimal choice of mass DEC strategy for reducing mf is very sensitive to programme design parameters. In particular, the results demonstrate that if the salt delivery structure is simplified, DEC salt has the potential to be the dominant intervention for filariasis control. The results suggest that economies of scale considerations might militate against the adoption of this intervention for large-scale applications, unless perhaps offset by its potential for cost recovery by direct patient purchase. Further analyses require a more realistic evaluation of filariasis intervention effectiveness by addressing changes in infection intensity and by accounting for the population dynamics of parasite transmission and control.

[Cost-benefit analysis on Malayan filariasis control in Miaoxi Township, Huzhou City, Zhejiang Province during 1964-1987].

The methods adopted in this paper were as follows: (1) The cost of the filariasis control was estimated to be direct cost and indirect cost; (2) Using the reduction rate of acute inflammatory attack as the measurable indicator of control effectiveness; (3) Estimating the case number of acute inflammatory attack occurred after control year by year basing on the goodness by fitting in the reduction trend of acute inflammatory attack with hyperbola formula; (4) Assuming that the case number of acute inflammatory attack would be relatively stable at the same level of pre-control if filariasis control measures were not implemented; (5) The benefit from the filariasis control was estimated by transforming the increasing man-working day and saving the medicine expenses of patients due to the reduction of acute inflammatory attack. By allowing seven percent discount on cost and benefit, the total cost was 21,182 Yuan, the total benefit was 119,859 Yuan, the ratio of cost-benefit was 1:5.7, implying that putting in one Yuan to filariasis control in this township may gain benefit 5.7 Yuan.

Bovine parafilariosis in Southern Africa: a preliminary report.

A total of 32,042 cattle, slaughtered at the Pretoria, Johannesburg and Durban abattoirs, was examined for parafilariosis and as many animals as possible were traced to the farms from which they originated. The disease is most prevalent in the Bushveld areas of the northern Transvaal. The most important factors limiting its distribution are the annual rainfall and the duration of the frost period. Mention is made of some aspects of the economic loss involved. The effect of routine anthelmintic treatment and dipping on the prevalence of the parasite is briefly discussed.