Abstract
BackgroundWork 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 findingsSome 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/SignificanceThe 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.
Highlights
The World Health Organization has set the absence of new infections as a goal for 2030
To achieve this, screening and treatment of patients is supplemented by tsetse control
The cost comes to only United States dollars (USD) 0.5 per person protected per year
Summary
In 2007, a consultation held at the World Health Organization (WHO) headquarters concluded that the elimination of the gambiense form of human African trypanosomiasis (gHAT) as a public health problem was a viable goal and the year 2020 was set as the target for achieving this [1,2]. Control of gHAT has relied mainly on active disease surveillance through periodic screening programmes, followed by treatment of patients found and sometimes supplemented with tsetse control [4]. Both forms of the disease, known as sleeping sickness, have been known for centuries and chronicled by colonial doctors and historians [5–7]. 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. This paper examines the costs of controlling Glossina palpalis palpalis in the focus of Bonon in Cote d’Ivoire from 2016 to 2017
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