Abstract
BackgroundThe Global Trachoma Mapping Project (GTMP) was implemented with the aim of completing the baseline map of trachoma globally. Over 2.6 million people were examined in 1,546 districts across 29 countries between December 2012 and January 2016. The aim of the analysis was to estimate the unit cost and to identify the key cost drivers of trachoma prevalence surveys conducted as part of GTMP.Methodology and principal findingsIn-country and global support costs were obtained using GTMP financial records. In-country expenditure was analysed for 1,164 districts across 17 countries. The mean survey cost was $13,113 per district [median: $11,675; IQR = $8,365-$14,618], $17,566 per evaluation unit [median: $15,839; IQR = $10,773-$19,915], $692 per cluster [median: $625; IQR = $452-$847] and $6.0 per person screened [median: $4.9; IQR = $3.7-$7.9]. Survey unit costs varied substantially across settings, and were driven by parameters such as geographic location, demographic characteristics, seasonal effects, and local operational constraints. Analysis by activities showed that fieldwork constituted the largest share of in-country survey costs (74%), followed by training of survey teams (11%). The main drivers of in-country survey costs were personnel (49%) and transportation (44%). Global support expenditure for all surveyed districts amounted to $5.1m, which included grant management, epidemiological support, and data stewardship.ConclusionThis study provides the most extensive analysis of the cost of conducting trachoma prevalence surveys to date. The findings can aid planning and budgeting for future trachoma surveys required to measure the impact of trachoma elimination activities. Furthermore, the results of this study can also be used as a cost basis for other disease mapping programmes, where disease or context-specific survey cost data are not available.
Highlights
An estimated 285 million people worldwide live with visual impairment, including 39 million who are blind [1]
This study provides the most extensive analysis of the cost of conducting trachoma prevalence surveys to date
The findings can aid planning and budgeting for future trachoma surveys required to measure the impact of trachoma elimination activities
Summary
An estimated 285 million people worldwide live with visual impairment, including 39 million who are blind [1]. The disease is a public health problem in 42 countries, with just over 200 million people being at risk, the majority of whom are in Sub-Saharan Africa [3]. WHO recommends the use of a strategy known as SAFE. This includes (i) Surgery to correct the advanced stage of the disease, known as trachomatous trichiasis (TT), when one or more eyelashes rub on the eyeball; (ii) Antibiotics to clear ocular Chlamydia trachomatis infection, and (iii) Facial cleanliness and (iv) Environmental improvement to reduce infection transmission.
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