A cost-analysis of conducting population-based prevalence surveys for the validation of the elimination of trachoma as a public health problem in Amhara, Ethiopia.

Randall P Slaven,Scott D Nash,Mulat Zerihun,Zerihun Tadesse,Paul M Emerson,Demelash Gessese,Tigist Astale,Eshetu Sata,Deborah A Mcfarland,Melsew Chanyalew,Aisha E P Stewart,Berhanu Melak,E Kelly Callahan,Richard Reithinger

doi:10.1371/journal.pntd.0008401

Abstract

BackgroundTrachoma prevalence surveys, including impact surveys (TIS) and surveillance surveys (TSS), provide information to program managers on the impact of the SAFE (surgery, antibiotics, facial cleanliness, and environmental improvement) strategy and current burden of disease, and they provide a crucial component of the evidence base necessary for the validation of the elimination of trachoma as a public health problem. The prevalence surveys included in this analysis are multi-level cluster random surveys that provide population-based estimates for program planning. This study conducted an analysis of the cost of 8 rounds of TIS/TSS executed in Amhara, Ethiopia, 2012–2016, comprising 232,357 people examined over 1,828 clusters in 187 districts.Methodology and findingsCost data were collected retrospectively from accounting and procurement records from the implementing partner, The Carter Center, and coded by survey activity (i.e. training and field work) and input category (i.e. personnel, transportation, supplies, venue rental, and other). Estimates of staff time were obtained from The Carter Center Ethiopia. Data were analyzed by activity and input category. The mean total cost per cluster surveyed was $752 (standard deviation $101). Primary cost drivers were personnel (39.6%) and transportation (49.2%), with costs increasing in the last 3 rounds of TIS/TSS.ConclusionDespite the considerable cost of conducting TIS and TSS, these surveys provide necessary information for program managers. Limited options are available to reduce the costs of TIS/TSS and gain economies of scale, as the surveys must be designed to achieve their designated sample size. However, surveys must also be designed in a way that is possible to be executed given the financial resources, personnel, and time required. Program managers can use these findings to improve estimates of the total cost of a survey and its components to ensure that sufficient resources are budgeted accordingly.

Highlights

Trachoma, a neglected tropical disease, is one of the leading causes of infectious blindness worldwide [1]
Limited options are available to reduce the costs of TIS/ Trachoma surveillance surveys (TSS) and gain economies of scale, as the surveys must be designed to achieve their
International Foundation; the United Kingdom Department for International Development; in 2013 the generous support of the American People through the United States Agency for International Development and the ENVISION project led by RTI International under cooperative agreement No AID-OAA-A-11-00048; and the William H

Summary

Introduction

A neglected tropical disease, is one of the leading causes of infectious blindness worldwide [1]. Trachoma impact surveys (TIS) are used to monitor districts for the impact of the SAFE (surgery, antibiotics, facial cleanliness, and environmental improvement) strategy on the prevalence of TF among children aged 1 to 9 years after several years of intervention and whether continued interventions are required [5]. Given the number of TIS/TSS surveys that will be required to build the evidence base necessary to validate the elimination of trachoma as a public health problem world-wide, it is vital to better understand the ongoing costs of these surveys. Trachoma prevalence surveys, including impact surveys (TIS) and surveillance surveys (TSS), provide information to program managers on the impact of the SAFE (surgery, antibiotics, facial cleanliness, and environmental improvement) strategy and current burden of disease, and they provide a crucial component of the evidence base necessary for the validation of the elimination of trachoma as a public health problem. This study conducted an analysis of the cost of 8 rounds of TIS/TSS executed in Amhara, Ethiopia, 2012–2016, comprising 232,357 people examined over 1,828 clusters in 187 districts

Methods

Results

Discussion

Conclusion