Schistosomiais and Soil-Transmitted Helminth Control in Niger: Cost Effectiveness of School Based and Community Distributed Mass Drug Administration

Jacqueline Leslie, Amadou Garba, Elisa Bosque Oliva, Arouna Barkire, Amadou Aboubacar Tinni, Ali Djibo, Idrissa Mounkaila and Alan Fenwick

PLOS Neglected Tropical Diseases, 2011, vol. 5, issue 10, 1-11

Abstract: Background: In 2004 Niger established a large scale schistosomiasis and soil-transmitted helminths control programme targeting children aged 5–14 years and adults. In two years 4.3 million treatments were delivered in 40 districts using school based and community distribution. Method and Findings: Four districts were surveyed in 2006 to estimate the economic cost per district, per treatment and per schistosomiasis infection averted. The study compares the costs of treatment at start up and in a subsequent year, identifies the allocation of costs by activity, input and organisation, and assesses the cost of treatment. The cost of delivery provided by teachers is compared to cost of delivery by community distributers (CDD). Conclusions: The relative cost effectiveness of school and community delivery differs by country according to the composition of the population treated, the numbers targeted and treated at school and in the community, the cost and frequency of training teachers and CDDs. Options analysis of technical and implementation alternatives including a financial analysis should form part of the programme design process. Author Summary: Schistosomiasis and soil-transmitted helminth control programmes are important, relatively low cost means to improve the health of those affected, in particular rural school age children. It can also reduce schistosomiasis related morbidity in their later lives. The paper presents information on the implementation and costs of a large scale national programme in Niger. The total economic cost per treatment was $0.58. This includes programme, government and international costs. Two systems, school based and community delivery were used to treat children and targeted adults. Contrary to findings in some countries we find that school based delivery is less cost effective than community delivery. This is due to the low proportion of the population targeted and treated by the school based system. Treating adults as well as children increased the numbers treated and reduced the overall cost per treatment. Prevalence and infection is higher in children than adults and overall effectiveness in terms of infection averted is affected. The cost per infection averted is assessed for direct treatment and direct and indirect treatment effects. The study expands the evidence available for decision makers involved in programme planning and design, funding and implementation.

Date: 2011
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pntd00:0001326

DOI: 10.1371/journal.pntd.0001326

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