Assessing the burden of Taenia solium cysticercosis in Burundi, 2020.

BACKGROUND: Taenia solium cysticercosis is a zoonotic disease that is endemic in many low- and middle-income countries where risk factors for disease transmission are present. The economic impact of cysticercosis on public health and on the pig production sector is not well known in many of those countries, including Burundi. This study aimed at estimating the burden of T. solium cysticercosis in Burundi including data on humans and pigs. METHODS: Epidemiological and economic data were collected from literature up to July 30, 2021 and governmental and non-governmental agencies. Direct and indirect costs for neurocysticercosis (NCC)-associated epilepsy and losses due to porcine cysticercosis were estimated to assess the economic burden, while the health burden was estimated using zoonotic disability-adjusted life years (zDALYs). Different probability distributions (Uniform, Beta, Dirichlet and Gamma) were applied depending on the type of epidemiological parameter. Monte Carlo simulations and 100,000 iterations were used to calculate the 95% uncertainty interval (UI) for each parameter and perform sensitivity analyses. RESULTS: In Burundi, 4.26 million USD (95% UI, 1,858,308-8,190,951) were estimated as economic impact due to T. solium cysticercosis in humans and pigs, of which 40.2% (95% UI, 10.3-75.1) of the total costs were due to NCC-associated epilepsy and 59.8% (95% UI, 24.9-89.7) of the losses due to porcine cysticercosis. The cost per NCC-associated epilepsy case was 72 USD (95% UI, 25-168), representing 30.8% of the GDP per capita in 2020. The probable incident cases and deaths for NCC-associated epilepsy were 9065 (95% UI, 2370-16,716) and 61 (95% UI, 16-114), respectively. More than 2 zDALYs (95% UI, 1.1-3.4) per thousand person-years was estimated, of which an average of 1.3 DALYs [0;0] (95% UI, 0.3-2.6) was due to NCC- associated epilepsy and 0.8 animal loss equivalents (ALEs) (95% UI, 0.3-1.5) due to porcine cysticercosis. CONCLUSIONS: This study provides evidence of a significant burden of T. solium cysticercosis for Burundi's population. We urge policy makers to use these evidence-based results and put T. solium cysticercosis on the public health agenda of the country. This study recommends urgent action to find solutions for integrated control strategies for T. solium cysticercosis in Burundi.

Prevalence and risk assessment of porcine cysticercosis in Ngozi province, Burundi.

Cysticercosis is a major zoonotic disease in many developing countries leading to substantial economic and public health impacts on affected communities. Due to a lack of updated data on T. solium cysticercosis in Burundi, the present study was carried out to determine the prevalence of porcine cysticercosis and to identify potential associated risk factors in Ngozi province. This study was conducted in Ngozi and Marangara communes of Ngozi province during January and February 2020. A multistage random sampling strategy was used. Tongue palpation was performed on pigs to diagnose cysticercosis. Randomly selected heads of pig keeping households were interviewed to assess the risk factors for porcine cysticercosis. A logistic regression model was used to analyse the main risk factors associated with porcine cysticercosis. In total, 496 pigs from 321 households distributed in 16 hills, randomly selected in Ngozi and Marangara communes were inspected. The apparent prevalence by tongue palpation in Ngozi province was 15.5% (95% CI: 12.3-18.7%). In Ngozi and in Marangara communes, the prevalence was 22.9% (95% CI: 17.7-28.2%) and 8.1% (95% CI: 4.6-11.4%), respectively. The true prevalence was estimated at 31% for the province, with a prevalence of 45.8% in Ngozi and 16.2% in Marangara commune, respectively. Pig farming systems including free ranging, tethering and penned part of the day (OR = 3.5; 95% CI: 2.1-6.1; p ≤  0.001) and lack of meat inspection at home slaughter (OR = 2.5; 95% CI: 1.1-5.6; p = 0.019) were significant risk factors associated with porcine cysticercosis. The present findings show that porcine cysticercosis is highly endemic in Ngozi province and that pig management systems currently used in the area permit pigs to have access to human stool. Moreover, lack of meat inspection during home slaughter potentially gives the possibility for household and community members to eat infected pork. Total confinement of pigs, improved hygiene and sanitation in households, and improvement of meat inspection through awareness campaigns and overall health education of the community should be implemented to control T. solium infections.