Economic evaluation and efficacy of strategic-selective treatment of gastrointestinal parasites in dairy calves.

In the Experimental Farm of the Universidade Federal de Lavras (EF-UFLA), state of Minas Gerais, Brazil, on their day of birth, female Holstein calves were randomly selected and placed into two groups containing fifteen animals each: Strategic-Selective Treatment (S-ST) or Conventional Treatment (CT). In the S-ST, calves were treated after coproparasitological examinations according to criteria established previously by the researchers. Calves in the CT were treated according to the opinion of the veterinarian of EF-UFLA. For statistical analysis, the frequency (%) of fecal samples with count of eggs per gram of feces (EPG) ≥300, count of oocysts per gram of feces (OoPG) ≥500 and fecal samples with count of cysts of Giardia spp. ≥1 were conducted. The overall average frequency of fecal samples with EPG ≥300, OoPG ≥500 and Giardia spp. cysts ≥1, respectively, was similar (p >0.05) between S-ST (20.3%; 17.3%; and 31.5%) and CT (26.4%; 23.9%; and 37.3%). The effective operational cost, per animal, in 12 months, was of R$ 784.58 (US$ 241.41) and R$ 83.90 (US$ 25.81) in S-ST and CT, respectively. The S-ST requires adjustments to be used as a technically efficient and economically viable alternative for the control of gastrointestinal parasitosis in female Holstein calves.

More Poop, More Precision: Improving Epidemiologic Surveillance of Soil-Transmitted Helminths with Multiple Fecal Sampling using the Kato-Katz Technique.

Soil-transmitted helminths, or parasitic intestinal worms, are among the most prevalent and geographically widespread parasitic infections in the world. Accurate diagnosis and quantification of helminth infection are critical for informing and assessing deworming interventions. The Kato-Katz thick smear technique, the most widely used laboratory method to quantitatively assess infection prevalence and infection intensity of helminths, has often been compared with other methods. Only a few small-scale studies, however, have considered ways to improve its diagnostic sensitivity. This study, conducted among 4,985 school-age children in an area of rural China with moderate prevalence of helminth infection, examines the effect on diagnostic sensitivity of the Kato-Katz technique when two fecal samples collected over consecutive days are examined and compared with a single sample. A secondary aim was to consider cost-effectiveness by calculating an estimate of the marginal costs of obtaining an additional fecal sample. Our findings show that analysis of an additional fecal sample led to increases of 23%, 26%, and 100% for Ascaris lumbricoides, Trichuris trichiura, and hookworm prevalence, respectively. The cost of collecting a second fecal sample for our study population was approximately USD4.60 per fecal sample. Overall, the findings suggest that investing 31% more capital in fecal sample collection prevents an underestimation of prevalence by about 21%, and hence improves the diagnostic sensitivity of the Kato-Katz method. Especially in areas with light-intensity infections of soil-transmitted helminths and limited public health resources, more accurate epidemiological surveillance using multiple fecal samples will critically inform decisions regarding infection control and prevention.

Economic evaluation and efficacy of strategic-selective treatment of gastrointestinal parasites in dairy calves / Avaliação econômica e eficácia do tratamento estratégico-seletivo de parasitos gastrointestinais em bezerras leiteiras

Abstract In the Experimental Farm of the Universidade Federal de Lavras (EF-UFLA), state of Minas Gerais, Brazil, on their day of birth, female Holstein calves were randomly selected and placed into two groups containing fifteen animals each: Strategic-Selective Treatment (S-ST) or Conventional Treatment (CT). In the S-ST, calves were treated after coproparasitological examinations according to criteria established previously by the researchers. Calves in the CT were treated according to the opinion of the veterinarian of EF-UFLA. For statistical analysis, the frequency (%) of fecal samples with count of eggs per gram of feces (EPG) ≥300, count of oocysts per gram of feces (OoPG) ≥500 and fecal samples with count of cysts of Giardia spp. ≥1 were conducted. The overall average frequency of fecal samples with EPG ≥300, OoPG ≥500 and Giardia spp. cysts ≥1, respectively, was similar (p >0.05) between S-ST (20.3%; 17.3%; and 31.5%) and CT (26.4%; 23.9%; and 37.3%). The effective operational cost, per animal, in 12 months, was of R$ 784.58 (US$ 241.41) and R$ 83.90 (US$ 25.81) in S-ST and CT, respectively. The S-ST requires adjustments to be used as a technically efficient and economically viable alternative for the control of gastrointestinal parasitosis in female Holstein calves.

Resumo Na Fazenda Experimental da Universidade Federal de Lavras (FE-UFLA), Minas Gerais, Brasil, no dia do nascimento, bezerras da raça holandesa foram sorteadas de forma aleatória para compor um dos dois grupos, formados por 15 animais cada: Tratamento Estratégico-Seletivo (TE-S) ou Tratamento Convencional (TC). No TE-S, as bezerras foram tratadas após exames coproparasitológicos de acordo com critérios previamente estabelecidos pelos pesquisadores. No TC, as bezerras foram tratadas conforme orientação do veterinário da FE-UFLA. Em ambos grupos, as bezerras foram monitoradas a cada 14 dias, do nascimento até os 12 meses de idade, por meio de exames coproparasitológicos. Para análise estatística, considerou-se a frequência (%) de amostras fecais com contagem de ovos por grama de fezes (OPG) ≥300, contagem de oocistos por grama de fezes (OoPG) ≥500, e amostras fecais com contagem de cistos de Giardia spp. ≥1. A frequência média global de amostras fecais com contagem de OPG ≥300, OoPG ≥500 e cistos de Giardia spp. ≥1, respectivamente, foi similar (p >0,05) entre TE-S (20,3%; 17,3%; e 31,5%) e TC (26,4%; 23,9%; e 37,3%). O custo operacional efetivo, por animal, em 12 meses, foi R$ 784,58 (US$ 241.40) e R$ 83,90 (US$ 25.81) para TE-S e TC, respectivamente. O TE-S necessita de ajustes para que possa ser indicado como uma alternativa, tecnicamente eficiente e economicamente viável, no controle das parasitoses gastrointestinais em bezerras leiteiras.

Effect of sampling and diagnostic effort on the assessment of schistosomiasis and soil-transmitted helminthiasis and drug efficacy: a meta-analysis of six drug efficacy trials and one epidemiological survey.

It is generally recommended to perform multiple stool examinations in order to improve the diagnostic accuracy when assessing the impact of mass drug administration programmes to control human intestinal worm infections and determining efficacy of the drugs administered. However, the collection and diagnostic work-up of multiple stool samples increases costs and workload. It has been hypothesized that these increased efforts provide more accurate results when infection and drug efficacy are summarized by prevalence (proportion of subjects infected) and cure rate (CR, proportion of infected subjects that become egg-negative after drug administration), respectively, but not when these indicators are expressed in terms of infection intensity and egg reduction rate (ERR). We performed a meta-analysis of six drug efficacy trials and one epidemiological survey. We compared prevalence and intensity of infection, CR and ERR based on collection of one or two stool samples that were processed with single or duplicate Kato-Katz thick smears. We found that the accuracy of prevalence estimates and CR was lowest with the minimal sampling effort, but that this was not the case for estimating infection intensity and ERR. Hence, a single Kato-Katz thick smear is sufficient for reporting infection intensity and ERR following drug treatment.

Comparison of a manual and an automated method to estimate the number of uterine eggs in anisakid nematodes: to Coulter or not to Coulter. Is that the question?

Studies reporting numbers of eggs in vagina and utero in nematodes often give little information of the technique used for the estimations. This situation hampers comparison among studies, because, so far, differences in estimations provided by different techniques have not been assessed. This note examines whether a manual method based on visual counts in aliquots and an automated method using a Coulter counter yield equivalent estimations of egg numbers in vagina and utero of 3 anisakid nematode species (Anisakis simplex, Pseudoterranova decipiens, and Contracaecum osculatum). The number of eggs from 50 females per nematode species was estimated using both techniques. The automated and manual methods yielded similar egg counts (correlation coefficients >0.9 in the 3 species), but the methods were not always statistically equivalent. The automated method was more precise and seemed less dependent on egg density, whereas the manual method was less time-consuming (contrary to previous perceptions) and less expensive. Despite the higher precision of automated counts, the manual technique seemed to produce similar estimates; thus, it may be particularly useful in developing countries where nematode parasitism is prevalent in humans and domestic animals, but scientific resources are limited.

[Evaluation of the efficiency of multiple coproprological study for the diagnosis of giardiasis].

Reformation of public health system financing in Russia requires the use and distribution of the most effective and least expensive diagnostic and medical methods. Giardiasis is the most common human anthroponosis. The diagnosis and treatment of this disease call for considerable funds of the budget, medical insurance companies, and the patient himself/herself. The paper gives the results of the clinicoeconomic analysis aimed at detecting the most rational frequency of diagnostic studies. The analysis provides evidence that triple coproprological study has the greatest advantages. The findings make it possible to recommend just this study for wide use in the diagnosis ofgiardiasis.

Multiattribute evaluation of two simple tests for the detection of Cryptosporidium parvum in calf faeces.

There is a need for simple and inexpensive diagnostic and screening tests for the detection of Cryptosporidium parvum infection in calves. A sucrose wet mount test and a lateral immunochromatography test were evaluated for epidemiological sensitivity and specificity, cost per test, simplicity, test time and ease of batching. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) of the Cryptosporidium oocyst wall protein (COWP) gene locus, with gel electrophoresis, was used as a gold standard. Cohen's kappa statistic of agreement (kappa) between the Ontario Veterinary College (OVC) sucrose wet mount test and COWP PCR-RFLP was 0.82, and the sensitivity and specificity of the OVC sucrose wet mount test were 88.6% and 93.8%, respectively. The sensitivity and specificity of the lateral immunochromatography test were 78.3% and 93.3%, respectively, and agreement between this test and PCR-RFLP was good (kappa=0.73). There was substantial agreement between the OVC sucrose wet mount test and the lateral immunochromatography test (kappa=0.84). Both tests were inexpensive and easy to use; however, the lateral immunochromatography test was faster and simpler to perform than the sucrose wet mount test, and was generally more user-friendly. These tests provide practitioners and researchers with cheap, quick and accurate methods of detecting C. parvum infection in young calves.

[Benefit, effectiveness and cost of parasite investigations in the county of Copenhagen]. / Nytte, effektivitet og udgift til parasitundersøgelser i Københavns Amt.

OBJECTIVE: To evaluate the cost and effectiveness of parasite investigations in our laboratory in order to restrict the number of specimens. METHODS: The analysis were performed retrospectively on 53,701 specimens submitted for cysts, ova, and larvae, 224 specimens for intestinal trophozoites, 1,888 cellophane tape impressions, 3,134 malaria smears, and 524 bronchial aspirates. RESULTS: Potentially pathogenic parasites were demonstrated in 3.2% of specimens examined for cysts, ova, and larvae, 6% examined for intestinal trophozoites, 16% for pinworm, 7% for malaria, and 9% for Pneumocystis. The cost of demonstrating a single infection with a pathogenic parasite was calculated to be DKK 6206 for cyst, ova, and larva specimens. This cost could be reduced considerably, if the examination of patients with acute diarrhoea, but without a history of travel was omitted. Similarly, the demonstration of trophozoites, pinworm, malaria and Pneumocystis in a person was calculated to be DKK 1122, DKK 526, DKK 2874 and DKK 3716, respectively. Examination of three specimens for cysts, ova, and larvae showed 62-74% of the infections in the first sample. Two specimens increased the frequency of positive findings by 13-23% and three specimens by a further 9-12%. For the blood smears, 92% of the infections were demonstrated in the first sample. DISCUSSION: The analysis shows that to obtain an acceptable ratio between cost and diagnostic yield, the indication for the investigations should be tightened up. However, examination of three samples from each patient is necessary to exclude a parasitic infection.

A comparative analysis of the cost-effectiveness of treatment based on parasitological and symptomatic screening for Schistosoma mansoni in Burundi.

OBJECTIVES: To assess the cost-effectiveness of three alternative screening strategies in delivering treatment to patients presenting with symptoms suggestive of S. mansoni, using data collected from 17 PHCCs in the Rusizi Plain, Burundi. The three strategies were: (1) screening all symptomatic patients using a Kato-Katz smear and treating only the ones found positive; (2) treating all symptomatic patients or (3) treating only those presenting with symptoms of severe diarrhoea (blood in stool). METHODS: The database consisted of 41 051 visits of symptomatic patients to the 17 PHCCs during 1990. Effectiveness was measured as the number of infected patients treated (gold standard: 25-mg Kato-Katz smear). Cost-effectiveness ratios (CERs) (cost in US$ per infected patient treated) were used to compare the control strategies. Sensitivity analysis was performed to assess the effect of drug price and prevalence of infection on the CERs. RESULTS: The overall prevalence of S. mansoni infection was 9.5% (95% CI = 9.1%, 9.9%). Treating only those with severe symptoms of infection would have left 92% of infected patients untreated. Performing a Kato-Katz smear to confirm the diagnosis was more cost-effective than treating all symptomatic patients on a presumptive basis, with CERs of 4.2 US$ and 12.43 US$ per infected person treated, respectively. Sensitivity analysis showed that, for a cost of 0.99 US$ per dose of praziquantel, the Kato-Katz option remained the most cost-effective approach for prevalences under 76%. For a drug price of 0.21 US$ per dose, both strategies would have become equivalent. The latter value varied extensively per PHCC (range 0.17 US$ to 0.51 US$), due to the different prevalences of infection (range 0.5% to 34.3%). CONCLUSION: We found that using severe diarrhoea as an indicator for infection was not appropriate, and that screening symptomatic patients with the Kato-Katz method remained the most cost-effective approach in the given setting. The CER of treating all symptomatic patients on a presumptive basis depended very much on the drug price and the endemic level.

Independent evaluation of the Nigrosin-Eosin modification of the Kato-Katz technique.

A new modified quantitative Kato-Katz thick-smear technique for the detection of helminth eggs in faeces preserves hookworm eggs unaltered for a long time, while with the classic Kato-Katz technique, they disappear after approximately 2 h in tropical climates and thus slides must be read within hours after sample collection. For an independent comparison of these two laboratory techniques, faecal smears from 263 school children were examined in two surveys and prevalence, intensity of infection and costs of surveys calculated. There was no statistical difference between the methods in detecting prevalence and stratification of the sample in different classes of intensity. While there was no statistical difference for the arithmetic mean of the epg for T. trichiura and only a small difference for A. lumbricoides (P=0.04), we observed a highly significant difference for hookworm mean intensities of infections (P<0.001). From the public health viewpoint both methods provided similar results, but due to its simplicity and widespread use the classical Kato-Katz technique remains first choice for community investigation of soil-transmitted nematodes. However, the Nigrosin-Eosin approach has several advantages and can be a valuable alternative in certain circumstances.

Costs, benefits and operational implications of using quantitative techniques to screen for schistosomiasis haematobium in Egypt.

The official strategy for schistosomiasis control in Egypt relies on individual case detection and treatment. Screening for Schistosoma haematobium has traditionally involved urine sedimentation which shows whether or not eggs are present in the urine, thereby providing only a qualitative assessment of infection status. Recently the Ministry of Health introduced the nucleopore filtration technique into a few villages to assess its applicability for broader use in areas where S. haematobium is endemic. This method gives an indirect quantitative measure of morbidity in terms of egg counts/10 ml urine. The overall purpose of this study was to provide rapid feedback to the Ministry on the likely implications of expanding the use of the filtration technique by examining the benefits, costs and operational problems that may be involved. From 2 villages in Giza Governorate, systematic random samples were taken from the general populations and from schools. Each selected person provided a urine specimen on which the two diagnostic techniques were performed. Filtration offered no additional benefits over sedimentation in terms of defining if a person was infected or not, with sensitivities ranging from 59.6%-75% for filtration and from 60%-73.1% for sedimentation. The additional non-labor costs of using the filtration technique in the two villages were calculated and showed that, if extended to all rural health units in Egypt, the Ministry would need to find an additional 31.6 million pounds (US$9.5 million) each year. A number of operational problems would also be involved in the wider application of the technique.

[An evaluation of the economic loss from intestinal helminthiases in the Uzbek SSR]. / Otsenka ékonomicheskogo ushcherba ot kishechnykh gel'mintozov v Uzbekskoi SSR.

Calculations of economic loss costs due to procedures for helminth detection and the out-patient treatment of recognized cases of enterobiasis, hymenolepiasis, taeniasis, ascariasis, trichocephaliasis in the Uzbek SSR in 1985 were made as were the costs of inpatient treatment in the specialized clinics in 1986 with account for the loss due to the related decrease in the national output and payments for disability. Their total turned to be about 1.8 million rubles.