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1.
Vet Parasitol ; 330: 110221, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38878461

RESUMO

This study evaluated the reproductive, productive and financial consequences of chronic Trypanosoma vivax infection in a dairy cattle herd located in a region without the cyclic vector during two years. Animals were categorized as either positive (chronically infected) or negative for T. vivax antibodies using a commercial rapid test. Additionally, serum samples from cows were analyzed for the presence of anti-Neospora caninum antibodies. Pregnancy diagnoses were performed through rectal palpation and ultrasonography after 30, 60 and every 21 days until the 144th day of pregnancy. If an abortion occurred in the final trimester, serology and cPCR were performed on calves for T. vivax and N. caninum. The breeding period, calving interval and pregnancy losses were recorded. The milk production of each animal during the 305 days of lactation was measured, and the annual financial impact of milk production was calculated using a revenue minus feed cost (RMFC) indicator. Out of 177 cows, 71.75 % were chronically infected, and 13.50 % were T. vivax-negative. No correlation (p = 0.8854) of co-infection between T. vivax and N. caninum was observed. Negative cows required fewer (p≤0.05) artificial inseminations than chronically infected ones. T. vivax was not significantly associated (p = 0.7893) with pregnancy loss up to 81 days of pregnancy. Cows chronically infected by T. vivax had 4-fold greater chance (p = 0.0280) of experiencing pregnancy loss between 82 and 144 days of gestation. Eighteen cows aborted, two were positive for T. vivax antibodies, and one for N. caninum antibodies. The calves were negative for T. vivax and N. caninum. Chronically infected cows and negative cows for T. vivax that experienced pregnancy loss (82-144 days of pregnancy) had a longer (p≤0.05) breeding period to become pregnant, and consequently a longer calving interval compared to cows that maintained pregnancy. The difference (p≤0.05) in milk production was evident when pregnancy loss occurred between 82 and 144 days of gestation in cows chronically infected by T. vivax. The RMFC indicated a negative impact of 38.2 % on the farm's annual milk revenue due to the presence of chronically infected cows.


Assuntos
Doenças dos Bovinos , Indústria de Laticínios , Reprodução , Trypanosoma vivax , Animais , Bovinos , Feminino , Gravidez , Doenças dos Bovinos/parasitologia , Doenças dos Bovinos/economia , Indústria de Laticínios/economia , Doença Crônica/veterinária , Tripanossomíase Africana/veterinária , Tripanossomíase Africana/parasitologia , Tripanossomíase Africana/epidemiologia , Anticorpos Antiprotozoários/sangue , Coccidiose/veterinária , Coccidiose/parasitologia , Coccidiose/economia , Aborto Animal/parasitologia , Lactação , Leite , Neospora/imunologia
2.
PLoS Comput Biol ; 20(4): e1011993, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38557869

RESUMO

The intensification of intervention activities against the fatal vector-borne disease gambiense human African trypanosomiasis (gHAT, sleeping sickness) in the last two decades has led to a large decline in the number of annually reported cases. However, while we move closer to achieving the ambitious target of elimination of transmission (EoT) to humans, pockets of infection remain, and it becomes increasingly important to quantitatively assess if different regions are on track for elimination, and where intervention efforts should be focused. We present a previously developed stochastic mathematical model for gHAT in the Democratic Republic of Congo (DRC) and show that this same formulation is able to capture the dynamics of gHAT observed at the health area level (approximately 10,000 people). This analysis was the first time any stochastic gHAT model has been fitted directly to case data and allows us to better quantify the uncertainty in our results. The analysis focuses on utilising a particle filter Markov chain Monte Carlo (MCMC) methodology to fit the model to the data from 16 health areas of Mosango health zone in Kwilu province as a case study. The spatial heterogeneity in cases is reflected in modelling results, where we predict that under the current intervention strategies, the health area of Kinzamba II, which has approximately one third of the health zone's cases, will have the latest expected year for EoT. We find that fitting the analogous deterministic version of the gHAT model using MCMC has substantially faster computation times than fitting the stochastic model using pMCMC, but produces virtually indistinguishable posterior parameterisation. This suggests that expanding health area fitting, to cover more of the DRC, should be done with deterministic fits for efficiency, but with stochastic projections used to capture both the parameter and stochastic variation in case reporting and elimination year estimations.


Assuntos
Tripanossomíase Africana , Animais , Humanos , Tripanossomíase Africana/epidemiologia , República Democrática do Congo/epidemiologia , Modelos Teóricos , Previsões , Cadeias de Markov , Trypanosoma brucei gambiense
3.
PLoS Negl Trop Dis ; 17(7): e0011396, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37498938

RESUMO

Human African trypanosomiasis, caused by the gambiense subspecies of Trypanosoma brucei (gHAT), is a deadly parasitic disease transmitted by tsetse. Partners worldwide have stepped up efforts to eliminate the disease, and the Chadian government has focused on the previously high-prevalence setting of Mandoul. In this study, we evaluate the economic efficiency of the intensified strategy that was put in place in 2014 aimed at interrupting the transmission of gHAT, and we make recommendations on the best way forward based on both epidemiological projections and cost-effectiveness. In our analysis, we use a dynamic transmission model fit to epidemiological data from Mandoul to evaluate the cost-effectiveness of combinations of active screening, improved passive screening (defined as an expansion of the number of health posts capable of screening for gHAT), and vector control activities (the deployment of Tiny Targets to control the tsetse vector). For cost-effectiveness analyses, our primary outcome is disease burden, denominated in disability-adjusted life-years (DALYs), and costs, denominated in 2020 US$. Although active and passive screening have enabled more rapid diagnosis and accessible treatment in Mandoul, the addition of vector control provided good value-for-money (at less than $750/DALY averted) which substantially increased the probability of reaching the 2030 elimination target for gHAT as set by the World Health Organization. Our transmission modelling and economic evaluation suggest that the gains that have been made could be maintained by passive screening. Our analysis speaks to comparative efficiency, and it does not take into account all possible considerations; for instance, any cessation of ongoing active screening should first consider that substantial surveillance activities will be critical to verify the elimination of transmission and to protect against the possible importation of infection from neighbouring endemic foci.


Assuntos
Trypanosoma brucei brucei , Tripanossomíase Africana , Animais , Humanos , Tripanossomíase Africana/diagnóstico , Tripanossomíase Africana/epidemiologia , Tripanossomíase Africana/prevenção & controle , Chade/epidemiologia , Análise Custo-Benefício , Trypanosoma brucei gambiense
4.
PLoS Negl Trop Dis ; 17(4): e0011299, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-37115809

RESUMO

Gambiense human African trypanosomiasis (gHAT) is a deadly vector-borne, neglected tropical disease found in West and Central Africa targeted for elimination of transmission (EoT) by 2030. The recent pandemic has illustrated how it can be important to quantify the impact that unplanned disruption to programme activities may have in achieving EoT. We used a previously developed model of gHAT fitted to data from the Democratic Republic of the Congo, the country with the highest global case burden, to explore how interruptions to intervention activities, due to e.g. COVID-19, Ebola or political instability, could impact progress towards EoT and gHAT burden. We simulated transmission and reporting dynamics in 38 regions within Kwilu, Mai Ndombe and Kwango provinces under six interruption scenarios lasting for nine or twenty-one months. Included in the interruption scenarios are the cessation of active screening in all scenarios and a reduction in passive detection rates and a delay or suspension of vector control deployments in some scenarios. Our results indicate that, even under the most extreme 21-month interruption scenario, EoT is not predicted to be delayed by more than one additional year compared to the length of the interruption. If existing vector control deployments continue, we predict no delay in achieving EoT even when both active and passive screening activities are interrupted. If passive screening remains as functional as in 2019, we expect a marginal negative impact on transmission, however this depends on the strength of passive screening in each health zone. We predict a pronounced increase in additional gHAT disease burden (morbidity and mortality) in many health zones if both active and passive screening were interrupted compared to the interruption of active screening alone. The ability to continue existing vector control during medical activity interruption is also predicted to avert a moderate proportion of disease burden.


Assuntos
COVID-19 , Tripanossomíase Africana , Animais , Humanos , Tripanossomíase Africana/epidemiologia , Tripanossomíase Africana/prevenção & controle , Tripanossomíase Africana/diagnóstico , Trypanosoma brucei gambiense , República Democrática do Congo/epidemiologia
5.
Mol Divers ; 27(3): 1375-1384, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35842884

RESUMO

Human African trypanosomiasis (HAT) or sleeping sickness is a protozoan neglected tropical disease, which is the main health worry in more than 20 countries in Africa. A novel approach is presented to predict the antitrypanosomal activity of sesquiterpene lactones (STLs) in terms of biological activity (pIC50). The largest reported data set of pIC50 for Trypanosoma brucei rhodesiense (Tbr) as one form of HAT are used to derive and test the new model. The new model is based on five additive and two non-additive molecular structural parameters in several frameworks where it can be easily applied through a computer code. It is derived and tested based on 125 and 31 experimental data, respectively, with different types of statistical parameters. The high reliability of the novel model is compared with the best available QSAR models, which use "classical" molecular descriptors, and 3D pharmacophore features. The values of R2 (correlation coefficient), root mean squared error (RMSE), and RMSEP (root mean square error of prediction) of the new model are 0.77, 0.38, and 0.35, respectively. Meanwhile, R2, RMSE, and RMSEP of comparative QSAR models based on complex descriptors are in the ranges 0.71-76, 0.46-0.4, and 0.51-0.44, respectively. The predictive results of the novel approach confirm its high simplicity, reliability, precision, accuracy, and goodness-of-fit.


Assuntos
Sesquiterpenos , Tripanossomíase Africana , Animais , Humanos , Estrutura Molecular , Reprodutibilidade dos Testes , Lactonas/farmacologia , Lactonas/química , Sesquiterpenos/farmacologia , Sesquiterpenos/química , Trypanosoma brucei rhodesiense
6.
PLoS Negl Trop Dis ; 16(8): e0010106, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35994491

RESUMO

BACKGROUND: Animal African Trypanosomosis (AAT) is a parasitic disease of livestock that has a major socio-economic impact in the affected areas. It is caused by several species of uniflagellate extracellular protists of the genus Trypanosoma mainly transmitted by tsetse flies: T. congolense, T. vivax and T. brucei brucei. In Burkina Faso, AAT hampers the proper economic development of the southwestern part of the country, which is yet the best watered area particularly conducive to agriculture and animal production. It was therefore important to investigate the extent of the infection in order to better control the disease. The objective of the present study was to assess the prevalence of trypanosome infections and collect data on the presence of tsetse flies. METHODS: Buffy coat, Trypanosoma species-specific PCR, Indirect ELISA Trypanosoma sp and trypanolysis techniques were used on 1898 samples collected. An entomological survey was also carried out. RESULTS: The parasitological prevalence of AAT was 1.1%, and all observed parasites were T. vivax. In contrast, the molecular prevalence was 23%, of which T. vivax was predominant (89%) followed by T. congolense (12.3%) and T. brucei s.l. (7.3%) with a sizable proportion as mixed infections (9.1%). T. brucei gambiense, responsible of sleeping sickness in humans, was not detected. The serological prevalence reached 49.7%. Once again T. vivax predominated (77.2%), but followed by T. brucei (14.7%) and T. congolense (8.1%). Seven samples, from six cattle and one pig, were found positive by trypanolysis. The density per trap of Glossina tachinoides and G. palpalis gambiensis was 1.2 flies. CONCLUSIONS/SIGNIFICANCE: Overall, our study showed a high prevalence of trypanosome infection in the area, pointing out an ongoing inadequacy of control measures.


Assuntos
Trypanosoma congolense , Trypanosoma , Tripanossomíase Africana , Moscas Tsé-Tsé , Animais , Burkina Faso/epidemiologia , Bovinos , Humanos , Insetos Vetores/parasitologia , Epidemiologia Molecular , Suínos , Trypanosoma/genética , Trypanosoma congolense/genética , Trypanosoma vivax/genética , Tripanossomíase Africana/epidemiologia , Tripanossomíase Africana/parasitologia , Tripanossomíase Africana/veterinária , Moscas Tsé-Tsé/parasitologia
7.
Acta Trop ; 232: 106520, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35588781

RESUMO

To improve understanding of African Animal Trypanosomosis (AAT) and associated host-parasite relationship's challenges on cow and milk, The Gambia was examined given its enzootic status. Based on an integrated assessment framework, semi-structured questionnaires which were pre-tested and then administered in five regions were used. Relationships among the investigated variables were statistically explored with Pearson chi-square test and strength of association quantified with Phi or Cramer's V coefficient. Rough coat, eye and nose discharge, loss of appetite and weight were more consistently observed as signs of AAT in infected lactating cows. Older cows with more than three calving (75.8%) were indicated as the most susceptible and there is no fixed number of times (85.2%) a cow is treated for AAT in a year. The most commonly recognized effect (91.7%) of AAT is milk reduction. Statistically significant positive but moderate relationship exist between milk reduction and late dry season (phi coefficient of 0.221), between milk contamination and early dry season (phi coefficient of 0.226), and also between wateriness and rainy season (phi coefficient of 0.220). Milk discolouration is not statistically related to any season with highest AAT infection rates. The need for integrated assessment of veterinary challenges based on factors such as herd affiliation status, ethnic affiliation, and farmers' objectives before preventive veterinary and production interventions are designed or implemented is implied. Useful information to advance research in this direction are presented.


Assuntos
Tripanossomíase Africana , Tripanossomíase , Animais , Bovinos , Fazendeiros , Feminino , Gâmbia/epidemiologia , Humanos , Lactação , Leite , Estações do Ano
8.
Soc Sci Med ; 299: 114882, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35299059

RESUMO

Human African Trypanosomiasis (HAT), commonly known as sleeping sickness, is closer than ever to being eliminated as a public health problem. The main narratives for the impressive drop in cases allude to drugs discovery and global financing and coordination. They raise questions about the relationship between well-funded international clinical research and much less well-endowed national disease control programmes. They need to be complemented with a solid understanding of how (and why) national programmes that do most of the frontline work are structured and operate. We analyse archives and in-depth interviews with key stakeholders and explore the role the national HAT programme played in the Democratic Republic of the Congo (DRC), a country that consistently accounts for over 60% of HAT cases worldwide. The programme grew strongly between 1996, when it was barely surviving, and 2016. Our political economy lens highlights how the leadership of the programme managed to carve itself substantial autonomy within the health system, forged new international alliances, and used clinical trials and international research to not only improve treatment and diagnosis but also to enhance its under-resourced disease control system. The DRC, a country often described as 'fragile', stands out as having an efficient national HAT programme that made full use of a window of opportunity that arose in the early 2000s when international researchers and donors responded to the ambition to simplify disease control and make HAT treatment more humane. We discuss the sustainability of both the vertical approach embodied in the DRC's national HAT programme and its funding model at a time when the number of HAT cases is at an all-time low and better integration within the health system is urgent. Our study provides insights for collaborations between unevenly-resourced international research efforts and national health programmes.


Assuntos
Tripanossomíase Africana , Ensaios Clínicos como Assunto , República Democrática do Congo/epidemiologia , Humanos , Saúde Pública , Tripanossomíase Africana/epidemiologia , Tripanossomíase Africana/prevenção & controle
9.
Nat Commun ; 13(1): 1051, 2022 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-35217656

RESUMO

Gambiense human African trypanosomiasis (gHAT) is marked for elimination of transmission by 2030, but the disease persists in several low-income countries. We couple transmission and health outcomes models to examine the cost-effectiveness of four gHAT elimination strategies in five settings - spanning low- to high-risk - of the Democratic Republic of Congo. Alongside passive screening in fixed health facilities, the strategies include active screening at average or intensified coverage levels, alone or with vector control with a scale-back algorithm when no cases are reported for three consecutive years. In high or moderate-risk settings, costs of gHAT strategies are primarily driven by active screening and, if used, vector control. Due to the cessation of active screening and vector control, most investments (75-80%) are made by 2030 and vector control might be cost-saving while ensuring elimination of transmission. In low-risk settings, costs are driven by passive screening, and minimum-cost strategies consisting of active screening and passive screening lead to elimination of transmission by 2030 with high probability.


Assuntos
Tripanossomíase Africana , Animais , Análise Custo-Benefício , República Democrática do Congo/epidemiologia , Humanos , Programas de Rastreamento , Trypanosoma brucei gambiense , Tripanossomíase Africana/epidemiologia , Tripanossomíase Africana/prevenção & controle
10.
PLoS Negl Trop Dis ; 16(1): e0010033, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34986176

RESUMO

BACKGROUND: Work to control the gambiense form of human African trypanosomiasis (gHAT), or sleeping sickness, is now directed towards ending transmission of the parasite by 2030. In order to supplement gHAT case-finding and treatment, since 2011 tsetse control has been implemented using Tiny Targets in a number of gHAT foci. As this intervention is extended to new foci, it is vital to understand the costs involved. Costs have already been analysed for the foci of Arua in Uganda and Mandoul in Chad. This paper examines the costs of controlling Glossina palpalis palpalis in the focus of Bonon in Côte d'Ivoire from 2016 to 2017. METHODOLOGY/PRINCIPAL FINDINGS: Some 2000 targets were placed throughout the main gHAT transmission area of 130 km2 at a density of 14.9 per km2. The average annual cost was USD 0.5 per person protected, USD 31.6 per target deployed of which 12% was the cost of the target itself, or USD 471.2 per km2 protected. Broken down by activity, 54% was for deployment and maintenance of targets, 34% for tsetse surveys/monitoring and 12% for sensitising populations. CONCLUSIONS/SIGNIFICANCE: The cost of tsetse control per km2 of the gHAT focus protected in Bonon was more expensive than in Chad or Uganda, while the cost per km2 treated, that is the area where the targets were actually deployed, was cheaper. Per person protected, the Bonon cost fell between the two, with Uganda cheaper and Chad more expensive. In Bonon, targets were deployed throughout the protected area, because G. p. palpalis was present everywhere, whereas in Chad and Uganda G. fuscipes fuscipes was found only the riverine fringing vegetation. Thus, differences between gHAT foci, in terms of tsetse ecology and human geography, impact on the cost-effectiveness of tsetse control. It also demonstrates the need to take into account both the area treated and protected alongside other impact indicators, such as the cost per person protected.


Assuntos
Doenças Endêmicas/prevenção & controle , Controle de Insetos/métodos , Inseticidas/farmacologia , Tripanossomíase Africana/epidemiologia , Tripanossomíase Africana/prevenção & controle , Moscas Tsé-Tsé , Animais , Chade/epidemiologia , Côte d'Ivoire/epidemiologia , Florestas , Humanos , Controle de Insetos/economia , Insetos Vetores , Trypanosoma brucei gambiense , Tripanossomíase Africana/transmissão , Uganda/epidemiologia
11.
J Med Entomol ; 59(2): 598-606, 2022 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-34935041

RESUMO

The effects of tsetse-transmitted trypanosomosis control in high tsetse flies (Glossina spp.) challenge and trypanocidal drug resistance settings remain poorly understood in Togo owing to poor data coverage on the current disease impact. From March 2014 to November 2017, a database of zoo-sanitary surveys integrating the evolution of disease incidence and intervention coverage made it possible to quantify the apparent effects attributable to the control effort, focused on all sedentary cattle breeds in the 1,000 km² area of Mô in Togo. The strategy involved an initial phase with cross-sectional entomological and parasitological. Then, three times a year, 20% of the bovine animals of the study area received α-cypermethrin pour-on, and infected cattle with poor health (798 cattle in 2014 and 358 in 2017) were individually given diminazene aceturate at 7 mg/kg of body weight. The tsetse density in the area decreased significantly, from 1.78 ± 0.37 in March 2014 before the α-cypermethrin application to 0.48 ± 0.07 in February 2017. The α-cypermethrin pour-on application and diminazene aceturate treatment of cattle led to the largest reduction in disease incidence, from 28.1% in 2014 to 7.8% in 2017, an improvement in hematocrit from 24.27 ± 4.9% to 27.5 ± 4.6%, and a reduction in calf mortality from 15.9 ± 11% to 5.9%. Improved access to these interventions for different types of livestock and maintaining their effectiveness, despite high tsetse (Diptera: Glossinidae) challenges, should be the primary focus of control strategies in many areas of Togo.


Assuntos
Doenças dos Bovinos , Heterópteros , Trypanosoma , Tripanossomíase Africana , Moscas Tsé-Tsé , Animais , Bovinos , Doenças dos Bovinos/tratamento farmacológico , Doenças dos Bovinos/epidemiologia , Estudos Transversais , Diminazena/análogos & derivados , Piretrinas , Togo , Tripanossomíase Africana/tratamento farmacológico , Tripanossomíase Africana/epidemiologia , Tripanossomíase Africana/veterinária
12.
Proc Natl Acad Sci U S A ; 118(50)2021 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-34887355

RESUMO

The global health community has earmarked a number of diseases for elimination or eradication, and these goals have often been praised on the premise of long-run cost savings. However, decision makers must contend with a multitude of demands on health budgets in the short or medium term, and costs per case often rise as the burden of a disease falls, rendering such efforts beyond the cost-effective use of scarce resources. In addition, these decisions must be made in the presence of substantial uncertainty regarding the feasibility and costs of elimination or eradication efforts. Therefore, analytical frameworks are necessary to consider the additional effort for reaching global goals, like elimination or eradication, that are beyond the cost-effective use of country resources. We propose a modification to the net-benefit framework to consider the implications of switching from an optimal strategy, in terms of cost-per-burden averted, to a strategy with a higher likelihood of meeting the global target of elimination or eradication. We illustrate the properties of our framework by considering the economic case of efforts to eliminate the transmission of gambiense human African trypanosomiasis (gHAT), a vector-borne, parasitic disease in West and Central Africa, by 2030.


Assuntos
Erradicação de Doenças/economia , Modelos Econômicos , Tripanossomíase Africana/economia , Tripanossomíase Africana/epidemiologia , Humanos , Trypanosoma brucei gambiense , Tripanossomíase Africana/parasitologia
13.
PLoS Negl Trop Dis ; 15(8): e0009663, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34403426

RESUMO

Tsetse-transmitted Animal African Trypanosomosis (AAT) is one of the most important constraints to livestock development in Africa. Use of trypanocides has been the most widespread approach for the management of AAT, despite the associated drug resistance and health concerns associated with drug metabolites in animal products. Alternative control measures that target tsetse fly vectors of AAT, though effective, have been hard to sustain in part because these are public goods applied area-wide. The International Centre of Insect Physiology and Ecology (icipe) and partners have developed and implemented a novel tsetse repellent collar (TRC) applied on animals to limit contact of tsetse flies and livestock, thereby reducing AAT transmission. The TRC has now advanced to commercialization. A household-level survey involving 632 cattle keeping households, was conducted in Shimba Hills region of Kwale County, where field trials of the TRC have been previously conducted to assess farmers' knowledge, perception, and practices towards the management of tsetse flies, their willingness to pay (WTP) for the TRC, and factors affecting the WTP. Almost all the respondents (90%) reported that tsetse flies were the leading cattle infesting pests in the area. About 22% of these correctly identified at least four AAT clinical signs, and even though many (68%) used trypanocidal drugs to manage the disease, 50% did not perceive the drug as being effective in AAT management (50%). Few respondents (8%) were aware of the harmful effects of trypanocidal drugs. About 89% of the respondents were aware of icipe TRC, and 30% of them were using the field trial collars during the survey. Sixty-three (63%) of them were willing to pay for the TRC at the same cost they spend treating an animal for AAT. On average farmers were willing to pay KES 3,352 per animal per year. Male educated household heads are likely to pay more for the TRC. Moreover, perceived high AAT prevalence and severity further increases the WTP. Wider dissemination and commercialization of the herd-level tsetse control approach (TRC) should be encouraged to impede AAT transmission and thus enhance food security and farm incomes among the affected rural communities. Besides the uptake of TRC can be enhanced through training, especially among women farmers.


Assuntos
Fazendeiros/psicologia , Controle de Insetos/métodos , Repelentes de Insetos/farmacologia , Tripanossomicidas/farmacologia , Tripanossomíase Africana/prevenção & controle , Adulto , Idoso , Animais , Resistência a Medicamentos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Controle de Insetos/economia , Quênia , Gado/parasitologia , Masculino , Pessoa de Meia-Idade , Percepção , Prevalência , Tripanossomíase Africana/parasitologia , Moscas Tsé-Tsé/parasitologia
14.
Emerg Infect Dis ; 27(8): 2144-2153, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34287133

RESUMO

We integrated sleeping sickness case detection into the primary healthcare system in 2 health districts in the Democratic Republic of the Congo. We replaced a less field-friendly serologic test with a rapid diagnostic test, which was followed up by human African trypanosomiasis microscopic testing, and used a mixed costing methodology to estimate costs from a healthcare provider perspective. We screened a total of 18,225 persons and identified 27 new cases. Average financial cost (i.e., actual expenditures) was US $6.70/person screened and $4,464/case diagnosed and treated. Average economic cost (i.e., value of resources foregone that could have been used for other purposes) was $9.40/person screened and $6,138/case diagnosed and treated. Our study shows that integrating sleeping sickness surveillance into the primary healthcare system is feasible and highlights challenges in completing the diagnostic referral process and developing a context-adapted diagnostic algorithm for the large-scale implementation of this strategy in a sustainable and low-cost manner.


Assuntos
Testes Diagnósticos de Rotina , Tripanossomíase Africana , Animais , Atenção à Saúde , República Democrática do Congo/epidemiologia , Pessoal de Saúde , Humanos , Tripanossomíase Africana/diagnóstico , Tripanossomíase Africana/epidemiologia
15.
PLoS One ; 16(7): e0254558, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34283848

RESUMO

Trypanosomiasis is a significant productivity-limiting livestock disease in sub-Saharan Africa, contributing to poverty and food insecurity. In this paper, we estimate the potential economic gains from adopting Waterbuck Repellent Blend (WRB). The WRB is a new technology that pushes trypanosomiasis-transmitting tsetse fly away from animals, improving animals' health and increasing meat and milk productivity. We estimate the benefits of WRB on the production of meat and milk using the economic surplus approach. We obtained data from an expert elicitation survey, secondary and experimental sources. Our findings show that the adoption of WRB in 5 to 50% of the animal population would generate an economic surplus of US$ 78-869 million per annum for African 18 countries. The estimated benefit-cost ratio (9:1) further justifies an investment in WRB. The technology's potential benefits are likely to be underestimated since our estimates did not include the indirect benefits of the technology adoption, such as the increase in the quantity and quality of animals' draught power services and human and environmental health effects. These benefits suggest that investing in WRB can contribute to nutrition security and sustainable development goals.


Assuntos
Controle de Insetos/métodos , Repelentes de Insetos/farmacologia , Tripanossomíase Africana/prevenção & controle , Moscas Tsé-Tsé/efeitos dos fármacos , África Subsaariana/epidemiologia , Animais , Bovinos , Análise Custo-Benefício , Humanos , Controle de Insetos/economia , Repelentes de Insetos/economia , Inseticidas/economia , Inseticidas/farmacologia , Gado/parasitologia , Tripanossomíase Africana/economia , Tripanossomíase Africana/transmissão , Tripanossomíase Africana/veterinária , Moscas Tsé-Tsé/patogenicidade
16.
BMC Med ; 19(1): 86, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794881

RESUMO

BACKGROUND: Gambiense human African trypanosomiasis (gHAT) has been brought under control recently with village-based active screening playing a major role in case reduction. In the approach to elimination, we investigate how to optimise active screening in villages in the Democratic Republic of Congo, such that the expenses of screening programmes can be efficiently allocated whilst continuing to avert morbidity and mortality. METHODS: We implement a cost-effectiveness analysis using a stochastic gHAT infection model for a range of active screening strategies and, in conjunction with a cost model, we calculate the net monetary benefit (NMB) of each strategy. We focus on the high-endemicity health zone of Kwamouth in the Democratic Republic of Congo. RESULTS: High-coverage active screening strategies, occurring approximately annually, attain the highest NMB. For realistic screening at 55% coverage, annual screening is cost-effective at very low willingness-to-pay thresholds (20.4 per disability adjusted life year (DALY) averted), only marginally higher than biennial screening (14.6 per DALY averted). We find that, for strategies stopping after 1, 2 or 3 years of zero case reporting, the expected cost-benefits are very similar. CONCLUSIONS: We highlight the current recommended strategy-annual screening with three years of zero case reporting before stopping active screening-is likely cost-effective, in addition to providing valuable information on whether transmission has been interrupted.


Assuntos
Tripanossomíase Africana , Animais , Análise Custo-Benefício , República Democrática do Congo/epidemiologia , Humanos , Programas de Rastreamento , Trypanosoma brucei gambiense , Tripanossomíase Africana/diagnóstico , Tripanossomíase Africana/epidemiologia , Tripanossomíase Africana/prevenção & controle
17.
Trop Anim Health Prod ; 53(1): 159, 2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33569637

RESUMO

INTRODUCTION: Theoretical and modelling approaches were undertaken on Nigerian livestock industry to estimate financial losses due to African animal trypanosomosis. METHODS: Surveys were conducted between March 2018 and February 2019 to include focus group interactions, in-depth household engagements concerning livestock practices in relation to AAT. Financial losses estimation on livestock were targeted to provide ways to regain cost and maximize household livelihoods. Mathematical equation was developed to project the effects of intervention strategies. Important variables such as mean AAT prevalence, incidence rate, birth rate, morbidity and mortality were estimated and inserted in the model. RESULTS: Mean total income per capita was US$ 1.31 / person / day among livestock producers in Nigeria. A total of US$ 518. 9 million were estimated from direct losses, while US$ 58.8 million as indirect losses. Annual estimated losses to AAT from cattle, sheep, goat and pigs in Nigeria is US$ 577.7 million. This is equivalent to 207.98 billion Nigerian naira and represents 6.93% of annual livestock GDP in the country. This could increase to 85% in the next 50 years if there are no proper control interventions. Control efforts could reduce the losses to US$ 16.7 million at the rate of 0.2% during the same period. DISCUSSIONS: AAT has severe socioeconomic impact on producer's livelihood and urgent improved control intervention strategies should be instituted to reduce the losses attributed to the disease.


Assuntos
Doenças dos Bovinos , Doenças dos Ovinos , Doenças dos Suínos , Tripanossomíase Africana , Animais , Bovinos , Doenças dos Bovinos/epidemiologia , Características da Família , Gado , Nigéria/epidemiologia , Prevalência , Ovinos , Doenças dos Ovinos/epidemiologia , Suínos , Tripanossomíase Africana/veterinária
18.
PLoS Negl Trop Dis ; 14(12): e0008832, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33315896

RESUMO

BACKGROUND: Human African trypanosomiases caused by the Trypanosoma brucei gambiense parasite is a lethal disease targeted for eradication. One of the main disease control strategies is active case-finding through outreach campaigns. In 2014, a new method for active screening was developed with mini, motorcycle-based, teams. This study compares the cost of two active case-finding approaches, namely the traditional mobile teams and mini mobile teams, in the two health districts of the Democratic Republic of the Congo. METHODS: The financial and economic costs of both approaches were estimated from a health care provider perspective. Cost and operational data were collected for 12 months for 1 traditional team and 3 mini teams. The cost per person screened and diagnosed was calculated and univariate sensitivity analysis was conducted to identify the main cost drivers. RESULTS: During the study period in total 264,630 people were screened, and 23 HAT cases detected. The cost per person screened was lower for a mini team than for a traditional team in the study setting (US$1.86 versus US$2.08). A comparable result was found in a scenario analysis, assuming both teams would operate in a similar setting, with the cost per person screened by a mini team 15% lower than the cost per person screened by a traditional team (1.86 $ vs 2.14$). The main explanations for this lower cost are that mini teams work with fewer human resources, cheaper means of transportation and do not perform the Capillary Tube Centrifugation test or card agglutination test dilutions. DISCUSSION: Active HAT screening with mini mobile teams has a lower cost and could be a cost-effective alternative for active case-finding. Further research is needed to determine if mini mobile teams have similar or better yields than traditional mobile teams in terms of detections and cases successfully treated.


Assuntos
Atenção à Saúde/métodos , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Tripanossomíase Africana/diagnóstico , Tripanossomíase Africana/epidemiologia , Testes de Aglutinação , Atenção à Saúde/economia , República Democrática do Congo/epidemiologia , Custos de Cuidados de Saúde , Humanos , Sensibilidade e Especificidade , Trypanosoma brucei gambiense
19.
PLoS Negl Trop Dis ; 14(9): e0008588, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32925917

RESUMO

BACKGROUND: Significant efforts to control human African trypanosomiasis (HAT) over the two past decades have resulted in drastic decrease of its prevalence in Côte d'Ivoire. In this context, passive surveillance, integrated in the national health system and based on clinical suspicion, was reinforced. We describe here the health-seeking pathway of a girl who was the first HAT patient diagnosed through this strategy in August 2017. METHODS: After definitive diagnosis of this patient, epidemiological investigations were carried out into the clinical evolution and the health and therapeutic itinerary of the patient before diagnosis. RESULTS: At the time of diagnosis, the patient was positive in both serological and molecular tests and trypanosomes were detected in blood and cerebrospinal fluid. She suffered from important neurological disorders. The first disease symptoms had appeared three years earlier, and the patient had visited several public and private peripheral health care centres and hospitals in different cities. The failure to diagnose HAT for such a long time caused significant health deterioration and was an important financial burden for the family. CONCLUSION: This description illustrates the complexity of detecting the last HAT cases due to complex diagnosis and the progressive disinterest and unawareness by both health professionals and the population. It confirms the need of implementing passive surveillance in combination with continued sensitization and health staff training.


Assuntos
Diagnóstico Tardio/economia , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/tratamento farmacológico , Tripanossomíase Africana/diagnóstico , Tripanossomíase Africana/tratamento farmacológico , Sangue/parasitologia , Líquido Cefalorraquidiano/parasitologia , Criança , Indicadores de Doenças Crônicas , Côte d'Ivoire/epidemiologia , Feminino , Humanos , Doenças Negligenciadas/parasitologia , Administração dos Cuidados ao Paciente/economia , Trypanosoma brucei gambiense/isolamento & purificação , Tripanossomíase Africana/parasitologia
20.
Parasit Vectors ; 13(1): 419, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32795375

RESUMO

BACKGROUND: Since 2012, the World Health Organisation and the countries affected by the Gambian form of human African trypanosomiasis (HAT) have been committed to eliminating the disease, primarily through active case-finding and treatment. To interrupt transmission of Trypanosoma brucei gambiense and move more rapidly towards elimination, it was decided to add vector control using 'tiny targets'. Chad's Mandoul HAT focus extends over 840 km2, with a human population of 39,000 as well as 14,000 cattle and 3000 pigs. Some 2700 tiny targets were deployed annually from 2014 onwards. METHODS: A protocol was developed for the routine collection of tsetse control costs during all field missions. This was implemented throughout 2015 and 2016, and combined with the recorded costs of the preliminary survey and sensitisation activities. The objective was to calculate the full costs at local prices in Chad. Costs were adjusted to remove research components and to ensure that items outside the project budget lines were included, such as administrative overheads and a share of staff salaries. RESULTS: Targets were deployed at about 60 per linear km of riverine tsetse habitat. The average annual cost of the operation was USD 56,113, working out at USD 66.8 per km2 protected and USD 1.4 per person protected. Of this, 12.8% was an annual share of the initial tsetse survey, 40.6% for regular tsetse monitoring undertaken three times a year, 36.8% for target deployment and checking and 9.8% for sensitisation of local populations. Targets accounted for 8.3% of the cost, and the cost of delivering a target was USD 19.0 per target deployed. CONCLUSIONS: This study has confirmed that tiny targets provide a consistently low cost option for controlling tsetse in gambiense HAT foci. Although the study area is remote with a tsetse habitat characterised by wide river marshes, the costs were similar to those of tiny target work in Uganda, with some differences, in particular a higher cost per target delivered. As was the case in Uganda, the cost was between a quarter and a third that of historical target operations using full size targets or traps.


Assuntos
Custos e Análise de Custo , Controle de Insetos , Tripanossomíase Africana , Moscas Tsé-Tsé , Animais , Bovinos , Chade/epidemiologia , Humanos , Controle de Insetos/economia , Controle de Insetos/métodos , Insetos Vetores/parasitologia , Inseticidas/economia , Tripanossomíase Africana/prevenção & controle , Tripanossomíase Africana/transmissão , Moscas Tsé-Tsé/parasitologia
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