The cost of tsetse control using 'Tiny Targets' in the sleeping sickness endemic forest area of Bonon in Côte d'Ivoire: Implications for comparing costs across different settings.

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.

The potential economic benefits of controlling trypanosomiasis using waterbuck repellent blend in sub-Saharan Africa.

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.

Delivering 'tiny targets' in a remote region of southern Chad: a cost analysis of tsetse control in the Mandoul sleeping sickness focus.

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.

Cost analysis of options for management of African Animal Trypanosomiasis using interventions targeted at cattle in Tororo District; south-eastern Uganda.

BACKGROUND: Tsetse-transmitted African trypanosomes cause both nagana (African animal Trypanosomiasis-AAT) and sleeping sickness (human African Trypanosomiasis - HAT) across Sub-Saharan Africa. Vector control and chemotherapy are the contemporary methods of tsetse and trypanosomiasis control in this region. In most African countries, including Uganda, veterinary services have been decentralised and privatised. As a result, livestock keepers meet the costs of most of these services. To be sustainable, AAT control programs need to tailor tsetse control to the inelastic budgets of resource-poor small scale farmers. To guide the process of tsetse and AAT control toolkit selection, that now, more than ever before, needs to optimise resources, the costs of different tsetse and trypanosomiasis control options need to be determined. METHODS: A detailed costing of the restricted application protocol (RAP) for African trypanosomiasis control in Tororo District was undertaken between June 2012 and December 2013. A full cost calculation approach was used; including all overheads, delivery costs, depreciation and netting out transfer payments to calculate the economic (societal) cost of the intervention. Calculations were undertaken in Microsoft Excel without incorporating probabilistic elements. RESULTS: The cost of delivering RAP to the project was US$ 6.89 per animal per year while that of 4 doses of a curative trypanocide per animal per year was US$ 5.69. However, effective tsetse control does not require the application of RAP to all animals. Protecting cattle from trypanosome infections by spraying 25%, 50% or 75% of all cattle in a village costs US$ 1.72, 3.45 and 5.17 per animal per year respectively. Alternatively, a year of a single dose of curative or prophylactic trypanocide treatment plus 50% RAP would cost US$ 4.87 and US$ 5.23 per animal per year. Pyrethroid insecticides and trypanocides cost 22.4 and 39.1% of the cost of RAP and chemotherapy respectively. CONCLUSIONS: Cost analyses of low cost tsetse control options should include full delivery costs since they constitute 77.6% of all project costs. The relatively low cost of RAP for AAT control and its collateral impact on tick control make it an attractive option for livestock management by smallholder livestock keepers.

Ex-ante benefit-cost analysis of the elimination of a Glossina palpalis gambiensis population in the Niayes of Senegal.

BACKGROUND: In 2005, the Government of Senegal embarked on a campaign to eliminate a Glossina palpalis gambiensis population from the Niayes area (∼ 1000 km(2)) under the umbrella of the Pan African Tsetse and Trypanosomosis Eradication Campaign (PATTEC). The project was considered an ecologically sound approach to intensify cattle production. The elimination strategy includes a suppression phase using insecticide impregnated targets and cattle, and an elimination phase using the sterile insect technique, necessary to eliminate tsetse in this area. METHODOLOGY/PRINCIPAL FINDINGS: Three main cattle farming systems were identified: a traditional system using trypanotolerant cattle and two "improved" systems using more productive cattle breeds focusing on milk and meat production. In improved farming systems herd size was 45% lower and annual cattle sales were €250 (s.d. 513) per head as compared to €74 (s.d. 38) per head in traditional farming systems (p<10-3). Tsetse distribution significantly impacted the occurrence of these farming systems (p = 0.001), with 34% (s.d. 4%) and 6% (s.d. 4%) of improved systems in the tsetse-free and tsetse-infested areas, respectively. We calculated the potential increases of cattle sales as a result of tsetse elimination considering two scenarios, i.e. a conservative scenario with a 2% annual replacement rate from traditional to improved systems after elimination, and a more realistic scenario with an increased replacement rate of 10% five years after elimination. The final annual increase of cattle sales was estimated at ∼ €2800/km(2) for a total cost of the elimination campaign reaching ∼ €6400/km(2). CONCLUSION/SIGNIFICANCE: Despite its high cost, the benefit-cost analysis indicated that the project was highly cost-effective, with Internal Rates of Return (IRR) of 9.8% and 19.1% and payback periods of 18 and 13 years for the two scenarios, respectively. In addition to an increase in farmers' income, the benefits of tsetse elimination include a reduction of grazing pressure on the ecosystems.

Tsetse fly control and trypanosomiasis in Africa, quo vadis?

National and international efforts to eradicate tsetse fly-borne human and animal trypanosomiasis are critically evaluated, and possible reasons for their failure in many cases are discussed. Some formerly performed campaigns in specific areas with positive results cannot be taken as examples to solve the main problems. In future, a significant reduction of trypanosomiasis cases will be possible to achieve only if a concerted long-term Pan-African approach, based on financial security, the continuity of expert staff, and a well-planned, ecologically sound land use, is generally accepted.

Tsetse flies: genetics, evolution, and role as vectors.

Tsetse flies (Diptera: Glossinidae) are an ancient taxon of one genus, Glossina, and limited species diversity. All are exclusively haematophagous and confined to sub-Saharan Africa. The Glossina are the principal vectors of African trypanosomes Trypanosoma sp. (Kinetoplastida: Trypanosomatidae) and as such, are of great medical and economic importance. Clearly tsetse flies and trypanosomes are coadapted and evolutionary interactions between them are manifest. Numerous clonally reproducing strains of Trypanosoma sp. exist and their genetic diversities and spatial distributions are inadequately known. Here I review the breeding structures of the principle trypanosome vectors, G. morsitans s.l., G. pallidipes, G. palpalis s.l. and G. fuscipes fuscipes. All show highly structured populations among which there is surprisingly little detectable gene flow. Rather less is known of the breeding structure of T. brucei sensu lato vis à vis their vector tsetse flies but many genetically differentiated strains exist in nature. Genetic recombination in Trypanosoma via meiosis has recently been demonstrated in the laboratory thereby furnishing a mechanism of strain differentiation in addition to that of simple mutation. Spatially and genetically representative sampling of both trypanosome species and strains and their Glossina vectors is a major barrier to a comprehensive understanding of their mutual relationships.

Crisis, what crisis? Control of Rhodesian sleeping sickness.

There is an urgent need for cost-effective strategies for the sustainable control of Trypanosoma brucei rhodesiense (Rhodesian) sleeping sickness, which is a fatal zoonotic disease that has caused devastating epidemics during the past century. Sleeping sickness continues to be controlled by crisis management, using active case detection, treatment and vector control - activities that occur only during major epidemics; during the intervening periods, farmers and communities must fend for themselves. There are several methods for assessing the burden of this disease and there is a series of farmer-led methodologies that can be applied to reduce the burden of human and animal trypanosomiases.

Knowledge, attitudes and practices on tsetse and sleeping sickness among communities living in and around Serengeti National Park, Tanzania.

A study was undertaken to investigate knowledge, attitudes and practices about sleeping sickness (human African trypanosomiasis) among communities living in and around Serengeti National Park (SENAPA). Structured questionnaires were administered to a total of 1490 consenting participants. Of the respondents, 924 (62%) knew sleeping sickness, and 807 (87.3%) knew the right place to seek healthcare. Of 924 who knew sleeping sickness, 386 (42%) said the disease was present in the areas they live. Most respondents (85.4%) knew that sleeping sickness infections were acquired in the bush and forest. The most common (69.3%) sources of information about sleeping sickness were relatives and friends. Symptoms of sleeping sickness mentioned included abnormal sleep (45.2%), fever (35.3%), body malaise (14.5%), headache (7.6%) and lymph node enlargement (6.1%). Of 1490 people interviewed 90.4% knew tsetse flies and 89.8% had been bitten by tsetse flies. The majority (86.6%) of the respondents knew that sleeping sickness is transmitted through a tsetse bite. Activities that exposed people to tsetse bites included working in tsetse infested bushes/forests, grazing livestock in tsetse infested areas and hunting game animals. In conclusion, communities living in and around SENAPA were knowledgeable about tsetse and sleeping sickness. The communities can thus understand and support community based tsetse and sleeping sickness control programmes to ensure success.

Recent advances in research and control of malaria, leishmaniasis, trypanosomiasis and schistosomiasis.

In the Eastern Mediterranean Region of the World Health Organization (WHO), malaria, schistosomiasis, leishmaniasis and trypanosomiasis are the parasitic diseases of major importance. Our review focuses on recent advances in the control and treatment of these diseases with particular reference to diagnosis, chemotherapy, vaccines, vector and environmental control. The Roll Back Malaria Programme, for example, emphasizes the use of insecticide treated bednets in Africa and targets a 30-fold increase in treated bednet use by 2007. Increasing risk factors for leishmaniasis include urbanization, extended agricultural projects and civil unrest and the increase in patients with Leishmania infantum and HIV co-infection in the Region may signal a new threat. In the past 20 years, human African trypanosomiasis has resurged in sub-Saharan Africa; within the Region it has become more common in the southern Sudan where anthroponotic and zoonotic sub-species infections overlap. Schistosomiasis in the Region is caused by either Schistosoma haematobium or S. mansoni and large-scale control efforts include providing regular treatment to at-risk groups and supporting drug delivery through schools.

[History of the onset and spread of sleeping sickness in Bipindi (southern Cameroon), from 1896 to today]. / Historique de l'installation et de la propagation de la maladie du sommeil à Bipindi (sud-Cameroun), de 1896 à nos jours.

The aim of this article is to provide historical background on the onset and spread of sleeping sickness in the Bipindi area of southern Cameroon, from the first suspected cases in 1896 until today. Two recent events have created the need for historical perspective on this topic. In December 1994, an OCEAC mission led by Francis Louis discovered 7 cases in the area between the Lolodorf and Bipindi districts. The epicentre was the village of Bidjouka. Five years later, mass screening of all residents in the Bipindi district revealed a total of 44 cases. Although no previous medical studies are available, historical research indicates that the disease has always present in Bipindi area in a less prevalent and virulent form than in neighboring regions along the Nyong River. Bipindi is located about 140 kilometers northeast of Campo, an area on the border between Cameroon and Equatorial Guinea where sleeping sickness has been a low-grade health problem since the 1880s. Many Cameroonian refugees forced to live in Campo during a war that ended in February 1916 returned with the trypanosome and subsequently contaminated people who stayed in Bipindi. Transmission of sleeping sickness in Bipindi can also be attributed to economic development since the end of the nineteenth century. Numerous plantations have been installed in the area. Migration and trade with the Gulf of Guinea have expanded greatly, especially involving areas on the border between Cameroon and Equatorial Guinea. This study is based on written documentations obtained from the National Archives in Yaoundé (Cameroon) and the "Colegio Claret" Library, in Luba (Republic of Equatorial Guinea) and on firsthand reports from reliable sources in the Bipindi area.

Control and surveillance of African trypanosomiasis. Report of a WHO Expert Committee.

Current estimates indicate that 60 million people are at risk of infection with human African trypanosomiasis or sleeping sickness, with about 300,000 new cases each year. However, less than 4 million people are under surveillance and only 10% of new cases are diagnosed and treated. This report of a WHO Expert Committee reviews current epidemiological information on African trypanosomiasis and its vectors, and evaluates recent advances in drug treatment and the development of tools for the control and surveillance of the disease. The report provides examples of treatment schedules, vector control operations, indicators for monitoring control and surveillance activities and sample calculations for analysing the cost-effectiveness of different strategies, as well as details of methods for cryopreservation of trypanosome-infected blood samples and a description of traps and screens for the control of the insect vector, Glossina. Although primarily addressed to health policy-makers in countries endemic for sleeping sickness, this report will also be a useful reference source for health care staff at all levels, including physicians, nurses, auxiliary staff and students, as well as those engaged in research on the disease.

[Is vector control needed in the fight against sleeping sickness? A biomathematical approach]. / Faut-il ou non un contrôle des vecteurs dans la lutte contre la maladie du sommeil? Une approche bio-mathématique du problème.

Vector control and the detection (followed by treatment) of infected individual are the two methods currently available for the control of sleeping sickness. The basic reproduction rate of a compartmental model (Kermack and McKendrick) is used to analyze and compare the two strategies. The model shows that when there is a long first stage characteristic of an endemic situation, the detection of sick individuals is more efficient than vector control. This higher efficiency of detection decreases in a epidemic situation. In this case vector control in the form of a decrease in vector density and/or an increase in vector mortality is relatively more efficient than detection. Because it is squared in the basic reproduction rate, the probability of a tsetse blood meal on humans is an important and sensitive parameter in the study of control strategies. This sensitivity has been observed previously and empirically by field workers. When the probability of a tsetse blood meal on humans is above a certain value, vector control becomes warranted or even necessary.

The impact of nagana.

The disease in cattle, called nagana in Zululand, was linked with trypanosomal parasitaemia and tsetse flies. Nagana occurs in livestock throughout the tsetse belts of Africa. Wild animals are tolerant of trypanosomal infections. Nagana affects individual animals, herds and socio-economic development. In susceptible animals nagana may be acute, but chronic infections are more common. The host-parasite interaction produces extensive pathology and severe anaemia. Clinically affected animals lose condition and become weak and unproductive. Nagana is often fatal and, at herd level, its impact is wide ranging. All aspects of production are depressed: fertility is impaired; milk yields, growth and work output are reduced; and the mortality rate may reduce herd size. Africa has to feed its rapidly growing human population, and animal products are a vital dietary component. However, in most tsetse areas, there is not enough meat and milk. Furthermore, animal draft power is often not available, which limits cultivation and local transport. These factors lower household incomes and retard socio-economic development. Sustainable rural development requires that nagana be controlled. This in turn needs considerable resources, whichever control strategy is adopted.

[The role of environmental factors in the current recrudescence of human African trypanosomiasis]. / Rôle des facteurs environnmentaux dans la recrudescence actuelle de la trypanosomiase humaine africaine.

The authors highlight the major target for the prevention of human african trypanosomiasis (HAT) i.e. decrease of parasites reservoir. For this purpose, they state that it is necessary to detect HAT patients, to treat them, and to break down the contact between human and vectors. Then, they review the environmental factors that could be involved in the HAT outbreak. A political direction would strengthen the HAT prevention by the increase of resources attributable to the disease. But, choice of priorities is based on technical criteria which are not in favour of HAT. Many difficult situations, occurring at the borders of concerned states, are restricting factors for a global and co-ordinated prevention. Moreover, internal political disturbances and local conflicts lead to a mismanagement of health care departments. These conflicts lead also to a migratory flow of populations; thereafter, the individuals have no access to medical structure. Beside the economical and political factors, some others have a great importance: human behavior, estimation of risk by the authorities, psychological perception of the disease by the population. The part of these different factors must be perfectly identified to avoid any disturbance in the actions of HAT prevention. The least failure leads to a quick increase of parasites transmission, and the HAT control has to start all over again.

[A community battle against a tropical endemic disease: supernatural beliefs and tsetse fly traps in the Congo]. / La lutte communautaire contre une endémie tropicale: croyances surnaturelles et pièges à tsétsé au Congo.

Community participation in the control of tropical diseases is of major importance nowadays, particularly for sleeping sickness (Gambian trypanosomiasis). Indeed, the authoritarian measures used with success to control this disease during the colonial period are difficult to apply now. Moreover, in the Congo, cultural and financial restrictions are such that patients sometimes refuse treatment. Thus, it has become highly desirable for vector control to be carried out at the same time as the treatment of patients. Trapping tsetse flies (or Glossina) is an ingenious and effective anti-vectorial method which has been tested in 55 villages of the Congo. The blue-black pyramid trap used does not require insecticide impregnation, and is hung in the branches by means of a capture-bag containing diesel oil. These trials, conducted in the sleeping sickness focus of the Niari river, have demonstrated the feasibility of local communities taking over the responsibility for the traps, while at the same time revealing certain obstacles. Indeed, the efficacy of this method depends on the optimization of trapping. This involves the determination of strategic capture sites by periodically harvesting the flies and moving the traps in order to catch the maximum number of flies. It also involves regular maintenance of the traps (i.e. repairs, checking the capture bag, clearing vegetation...). However, although these activities would appear to be feasible at community level, they are not always carried out satisfactorily. This results in the insufficient viability of the traps and finally to the reinvasion of the treated area by the tsetse. This study presents aspects of the present-day Congolese socio-cultural environment characterized by the revitalization of traditional Bantou mysticism and religious worship. The possessors of the 'Vital Force' or Kundu (sorcerers and healers) are confronted at night in an 'over-reality' consisting of the visible reality together with innumberable beings and objects existing specifically in the invisible state. This nocturnal confrontation may modify the local balance of power and relationships, and is also thought to cause certain symptoms of sleeping sickness and other diseases. During the colonial period, Kundu was prohibited. Under the influence of the Christian church, and because of the progress of modern medicine, the power of the sorcerers and healers gradually decreased. Then, in the 1960s, the eruption of Marxism as an anti-religious theory, modified the balance of power once more.(ABSTRACT TRUNCATED AT 400 WORDS)