Costos de un programa de control del vector Aedes aegypti en municipios de Colombia: el caso de Girón y Guadalajara de Buga, 2016 / Costs of an Aedes aegypti vector control program in municipalities in Colombia: a case study in Girón and Guadalajara de Buga, 2016 / Custos de um programa de controle ao vetor Aedes aegypti em municípios da Colômbia: o caso de Girón e Guadalajara de Buga, 2016

Resumen: El objetivo de este estudio fue cuantificar los costos de los programas de control de enfermedades transmitidas por vectores a nivel local en Colombia (2016). Para ello, fue realizado un análisis de costos desde la perspectiva del hacedor de política en los municipios de Girón y Guadalajara de Buga, específicamente para el programa de control del Aedes aegypti, principal vector trasmisor del dengue, Zika y chikungunya. Este análisis implicó la cuantificación de todos los costos requeridos para cada una de las estrategias de prevención y control de enfermedades transmitidas por vectores. Los costos fueron clasificados en recurrentes y de capital, además, con fines comparativos se obtuvo el costo por caso y a nivel per cápita. El costo total estimado de los programas fue de USD 146.651 en el municipio de Girón y USD 97.936 en el municipio de Guadalajara de Buga; a nivel per cápita el costo fue de USD 0,88 en Girón y en Guadalajara de Buga fue de USD 0,99. En general, las estrategias predominantes en costos fueron el control químico de vectores adultos, con un 26% del total de los costos en Girón y un 47% en Guadalajara de Buga, esta fue intensiva en costos recurrentes, con un costo de personal 40% del total de costos para esta estrategia en Girón y un 66% de costos operacionales en Guadalajara de Buga.

Abstract: The aim of this study was to measure the costs of vector-borne disease control programs at the local level in Colombia (2016). A cost analysis was performed for this purpose from the policymaker's perspective in the municipalities (counties) of Girón and Guadalajara de Buga, specifically for the Aedes aegypti control program, the principal mosquito vector of dengue, Zika, and chikungunya. The analysis involved the quantification of all the costs required for each of the prevention and control strategies in vector-borne diseases. The costs were classified as operating and capital costs, and for purposes of comparison the costs were also calculated per case and per capita. The programs' total estimated costs were USD 146,651 in Girón and USD 97,936 in Guadalajara de Buga. Per capita cost was USD 0.88 in Girón and USD 0.99 in Guadalajara de Buga. In general, the predominant cost strategies were chemical spraying of adult mosquitos, accounting for 26% of the total costs in Girón and 47% in Guadalajara de Buga, with personnel representing 40% of the total costs for this strategy in Girón and 66% of the operating costs in Guadalajara de Buga.

Resumo: O objetivo deste estudo foi quantificar os custos dos programas de controle de doenças transmitidas por vetores ao nível local na Colômbia em (2016). Para isso, foi realizada uma análise de custos desde a perspectiva do criador de políticas nos municípios de Girón e Guadalajara de Buga, especificamente para o programa de controle do Aedes aegypti, principal vector transmissor da dengue, Zika e chikungunya. Esta análise implicou a quantificação de todos os custos requeridos para cada uma das estratégias de prevenção e controle de doenças transmitidas por vetores. Os custos foram classificados em recorrentes e do capital, ademais, para fins comparativos foi obtido o custo por caso e nível per capita. O custo total estimado dos programas foi de USD 146.651 no Município de Girón e USD 97.936 no Município de Guadalajara de Buga; ao nível per capita o custo foi de USD 0,88 em Girón e em Guadalajara de Buga foi de USD 0,99. Em geral, as estratégias predominantes em custos foram o controle químico de vetores adultos, com um 26% do total dos custos em Girón e um 47% em Guadalajara de Buga, essa foi intensiva em custos recorrentes, com um custo de pessoal de um 40% do total de custos para esta estratégia em Girón e um 66% de custos operacionais em Guadalajara de Buga.

Cost of intensive routine control and incremental cost of insecticide-treated curtain deployment in a setting with low Aedes aegypti infestation

Abstract: INTRODUCTION Information regarding the cost of implementing insecticide-treated curtains (ITCs) is scarce. Therefore, we evaluated the ITC implementation cost, in addition to the costs of intensive conventional routine activities of the Aedes control program in the city of Guantanamo, Cuba. METHODS A cost-analysis study was conducted from the perspective of the Aedes control program, nested in an ITC effectiveness trial, during 2009-2010. Data for this study were obtained from bookkeeping records and activity registers of the Provincial Aedes Control Programme Unit and the account records of the ITC trial. RESULTS The annual cost of the routine Aedes control program activities was US$16.80 per household (p.h). Among 3,015 households, 6,714 ITCs were distributed. The total average cost per ITC distributed was US$3.42, and 74.3% of this cost was attributed to the cost of purchasing the ITCs. The annualized costs p.h. of ITC implementation was US$3.80. The additional annualized cost for deploying ITCs represented 19% and 48.4% of the total cost of the routine Aedes control and adult-stage Aedes control programs, respectively. The trial did not lead to further reductions in the already relatively low Aedes infestation levels. CONCLUSIONS At current curtain prices, ITC deployment can hardly be considered an efficient option in Guantanamo and other comparable environments.

Costo-efectividad de prácticas en salud pública: revisión bibliográfica de las intervenciones de la Iniciativa Mesoamericana de Salud / Cost-effectiveness of public health practices: A literature review of public health interventions from the Mesoamerican Health Initiative

OBJETIVO: Presentar y analizar información de costo-efectividad de intervenciones propuestas por la Iniciativa Mesoamericana de Salud (IMS) en las áreas de nutrición infantil, inmunizaciones, paludismo, dengue y salud materno-infantil y reproductiva. MATERIAL Y MÉTODOS: Se llevó a cabo una revisión sistemática de la literatura de evaluaciones económicas publicadas entre el año 2000 y agosto 2009 sobre intervenciones en las áreas de la salud mencionadas, en los idiomas inglés y español. RESULTADOS: Las intervenciones en nutrición y de salud materno-infantil mostraron ser altamente costo-efectivas (con rangos menores a US$200 por año de vida ajustado por discapacidad [AVAD] evitado para nutrición y US$100 para materno-infantil). En dengue sólo se encontró información sobre la aplicación de larvicidas, cuya razón de costo efectividad estimada fue de US$40.79 a US$345.06 por AVAD evitado. Respecto al paludismo, las intervenciones estudiadas resultaron costo-efectivas (

OBJECTIVE: Present and analyze cost-effectiveness information of public health interventions proposed by the Mesoamerican Health Initiative in child nutrition, vaccination, malaria, dengue, and maternal, neonatal, and reproductive health. MATERIAL AND METHODS: A systematic literature review was conducted on cost-effectiveness studies published between January 2000 and August 2009 on interventions related to the health areas previously mentioned. Studies were included if they measured effectiveness in terms of Disability-Adjusted Life Year (DALY) or death averted. RESULTS: Child nutrition and maternal and neonatal health interventions were found to be highly cost-effective (most of them below US$200 per DALY averted for nutritional interventions and US$100 for maternal and neonatal health). For dengue, information on cost-effectiveness was found just for application of larvicides, which resulted in a cost per DALY averted ranking from US$40.79 to US$345.06. Malarial interventions were found to be cost-effective (below US$150 per DALY averted or US$4,000 per death averted within Africa). In the case of pneumococcus and rotavirus vaccination, cost-effectiveness estimates were always above one GDP per capita per DALY averted. CONCLUSIONS: In Mesoamerica there are still important challenges in child nutrition, vaccination, malaria, dengue and maternal, neonatal, and reproductive health, challenges that could be addressed by scaling-up technically feasible and cost-effective interventions.

Diseño mixto de evaluación de la iniciativa Salud Mesoamérica 2015 / Mixed design for the evaluation of the Mesoamerica Health 2015 initiative

El propósito de la iniciativa Salud Mesoamérica 2015 (SM-2015) es mejorar el estado de salud y nutrición de la población con mayor grado de vulnerabilidad en Mesoamérica. El objetivo de la evaluación es generar evidencia sobre la efectividad conjunta de un paquete de intervenciones diseñadas para mejorar las condiciones de salud en la región. Se propone una evaluación de impacto con métodos mixtos, para conocer la magnitud de los cambios atribuibles a la SM-2015, e identificar los significados de estos cambios para la población objetivo, en el contexto de cada país. El eje conductor es un panel de localidades con el que se colectará información de individuos, hogares y unidades de salud de primero y segundo nivel de atención. El diseño que se describe en este documento fue desarrollado entre junio y diciembre de 2009, y su articulación se llevó a cabo en talleres realizados en Cuernavaca (México), Managua (Nicaragua), y San José (Costa Rica). El diseño propuesto permitirá generar evidencia sobre la efectividad conjunta del paquete de intervenciones propuesto en los planes maestros mesoamericanos. El éxito de este diseño radica en la voluntad y en el compromiso político de los países y los donantes.

Since the Salud Mesoamerica 2015 initiative (SM-2015) aim is to improve health and nutrition conditions of those most vulnerable in Mesoamerica, the goal of the evaluation is to generate evidence of the joint effectiveness of a package of interventions designed to improve the health conditions. We propose a mix design for the evaluation, which will allow to know the magnitude of changes attributable to the interventions, as well as the meanings of these changes for the target population, taking into account the specificities of each country. The main axis of this design is a locality panel where information about individuals, households, and health facilities (first and second level) will also be collected. The evaluation design described in this paper was developed between June and December, 2009, and it was integrated during workshops in Cuernavaca (Mexico), Managua (Nicaragua), and San Jose (Costa Rica). The proposed design will allow to generate evidence about the joint effectiveness of the package of interventions proposed for the SM-2015. The success of this design rests on the political commitment of countries and donors.

Análisis costo-beneficio del control de vectores en la transmisión potencial de dengue / Cost-benefit analysis of vector control in areas of potential dengue transmission

OBJETIVOS: Evaluar el costo-beneficio de una intervención de control de mosquitos adultos con fumigación, junto con actividades de control de formas inmaduras de Aedes aegypti, para evitar la transmisión en una situación de alto riesgo. MÉTODOS: Se realizó un análisis de costo-beneficio desde una perspectiva social. Se comparó una intervención para el control de mosquitos adultos y formas inmaduras contra una hipótesis de no-intervención, de enero a abril de 2007, en la ciudad de Clorinda, Argentina. Se consideraron los costos directos y los beneficios indirectos e intangibles, estandarizados a dólares internacionales (I$) utilizando la paridad de poder adquisitivo. Se asumió una incidencia de 50 casos de dengue por 1 000 habitantes en la hipótesis de no-intervención. RESULTADOS: De enero a abril de 2007 se presentaron 176 casos de dengue en Clorinda, pero sólo cinco fueron autóctonos. El valor presente neto fue de I$ 196 879 en la estrategia de aplicación de control, mientras que en la de no aplicación se calculó en I$ -106 724, lo que significaría un ahorro de I$ 303 602 (I$ 6,46 por habitante) con la intervención. El análisis de sensibilidad evidenció que, con más de 1 363 casos de dengue (incidencia total de 29 por 1 000 habitantes) y un caso de dengue hemorrágico, la intervención es costo-benéfica. CONCLUSIONES: Los resultados sugieren que el control vectorial, incluyendo la fumigación para mosquitos adultos, debe evaluarse en situaciones de alto riesgo de transmisión como una alternativa costo-benéfica en países no endémicos.

OBJECTIVES: To evaluate the cost-benefit of an intervention utilizing fumigation against adult mosquitoes along with actions to control immature Aedes aegypti to prevent transmission in a high-risk area. METHODS: A cost-benefit analysis was performed from the social perspective. A program to control both adult mosquitoes and immature forms was compared to a non-intervention hypothesis, from January to April 2007, in the city of Clorinda, Argentina. Direct costs, as well as indirect and intangible benefits, were taken into account and standardized in international dollars (I$) using purchasing power parity. An incidence rate of 50 cases of dengue per 1 000 inhabitants was used in the non-intervention hypothesis. RESULTS: From January to April 2007 there were 176 cases of dengue in Clorinda, but only five were autochthonous. The net present value was I$ 196 879 with the control strategy, whereas the non-intervention was calculated to be I$ -106 724, indicating a savings of I$ 303 602 (I$ 6.46 per inhabitant) for the intervention. The sensitivity analysis showed that, with more than 1 363 cases of dengue (total incidence rate of 29 per 1 000 inhabitants) and one case of dengue hemorrhagic fever, there is a cost-benefit to intervention. CONCLUSIONS: The results suggest that vector control, including fumigation of adult mosquitoes, should be considered in high-risk areas as a cost-effective option for non-endemic countries.

Insecticide treated mosquito nets for malaria control in India-experience from a tribal area on operational feasibility and uptake

The study assessed the operational feasibility and acceptability of insecticide-treated mosquito nets (ITNs) in one Primary Health Centre (PHC) in a falciparum malaria endemic district in the state of Orissa, India, where 74 percent of the people are tribes and DDT indoor residual spraying had been withdrawn and ITNs introduced by the National Vector Borne Disease Control Programme. To a population of 63,920, 24,442 ITNs were distributed free of charge through 101 treatment centers during July-August 2002. Interview of 1,130, 1,012 and 126 respondents showed that the net use rates were 80 percent, 74 percent and 55 percent in the cold, rainy and summer seasons, respectively. Since using ITNs, 74.5-76.6 percent of the respondents observed reduction of mosquito bites and 7.2-32.1 percent reduction of malaria incidence; 37 percent expressed willingness to buy ITNs if the cost was lower and they were affordable. Up to ten months post-treatment, almost 100 percent mortality of vector mosquitoes was recorded on unwashed and washed nets (once or twice). Health workers re-treated the nets at the treatment centers eight months after distribution on a cost-recovery basis. The coverage reported by the PHC was only 4.2 percent, mainly because of unwillingness of the people to pay for re-treatment and to go to the treatment centers from their villages. When the re-treatment was continued at the villages involving personnel from several departments, the coverage improved to about 90 percent.Interview of 126 respondents showed that among those who got their nets re-treated, 81.4 percent paid cash for the re-treatment and the remainder were reluctant to pay. Majority of those who paid said that they did so due to the fear that if they did not do so they would lose benefits from other government welfare schemes. The 2nd re-treatment was therefore carried out free of charge nine months after the 1st re-treatment and thus achieved coverage of 70.4 percent. The study showed community...

Cálculo de dosificaciones, recursos y personal para el trabajo de la campaña antivectorial en Santiago de Cuba / Calculation of dosages, resources and personnel for the work of the antivector campaign in Santiago de Cuba

Este trabajo surgió por la imperiosidad de comprobar de forma segura los cálculos realizados a diario en la labor de la campaña antivectorial en la provincia de Santiago de Cuba. Consta de diferentes tablas en Microsoft Excel, donde se incluyen las fórmulas para estimar dichos valores y en las cuales, según necesidades, consumos promedios y otras disponibilidades reales (por ejemplo, cantidades de equipos de fumigación), se introdujeron las variables requeridas para obtener inmediatamente los resultados. Estas tablas pueden ser utilizadas por personas poco experimentadas y garantizar datos confiables. El sistema de cálculo vectorial se encuentra en proceso de otorgamiento de la patente nacional.

This work emerged due to the need of checking in a reliable way the daily calculations carried out during the antivectorial campaign in Santiago de Cuba province. It consists of different charts in Microsoft Excel, where the formulas to estimate these values are included and in which, according to necessities, averages consumptions and other real avaliabilities (for example, number of fumigation teams), the required variables were introduced to obtain the results immediately. These charts can be used by people with litle experience and they guarantee reliable data. The system of vectorial calculation is in process of awarding the national patent.

Guidelines on the cost-effectiveness of larval control programs to reduce dengue transmission in Puerto Rico

OBJECTIVE: In the past 20 years, the emphasis for avoiding dengue epidemics has focused on larval control of Aedes aegypti, the principal mosquito vector of dengue viruses. A general consensus is that mosquito larval control holds the best promise for reducing dengue epidemics, although its actual effectiveness is still unknown and subject to a great deal of uncertainty. The objective of this research was to assess the cost-effectiveness of emergency larval control programs for reducing dengue transmission in the Caribbean island of Puerto Rico and to develop guidelines to help choose between carrying out a rapid-response, emergency larval control intervention and not conducting such an intervention. DESIGN AND METHODS: Data on dengue transmission and its likely impacts in Puerto Rico were used as a case study to develop intervention guidelines. A distribution of economic impacts was simulated using available data on disease rates and economic variables, including the costs of treating patients and the opportunity costs represented by lost wages. Successful larval control interventions were assessed by determining two parameters: (1) the costs of an intervention and (2) the expected reduction in the reported case rate of dengue. In addition, we examined how these guidelines would change with an early warning system that provides information on a possible outbreak of dengue. RESULTS: In Puerto Rico, larval control programs that are expected to reduce dengue transmission by 50 percent and cost less than US$ 2.50 per person will be cost-effective. Programs that cost more per person but that further reduce transmission are still likely to be cost-effective. Having an early warning system, even one that provides a low level of accuracy, can extend the range of larval control programs that are cost-effective. For example, with an early warning system, a larval control program that reduces dengue transmission by 50 percent and that costs less than US$ 4.50 per person would be expected to be cost-effective. CONCLUSIONS: Guidelines such as the ones that we developed for Puerto Rico can be useful to public health authorities in helping to decide whether or not to spend resources for a larval control program to reduce dengue transmission. The range of larval control interventions that are cost-effective can be increased by having an early warning system that provides even a small amount of information regarding possible outbreaks

Baixa aderência e alto custo como fatores de insucesso do uso de mosquiteiros impregnados com inseticida no controle da malária na Amazônia Brasileira / Low adherence and high cost as failure factors of impregnated bed nets with inseticide for malaria control in the Brazilian Amazon

Em 1992, durante um ensaio com mosquiteiros impregnados com deltametrina, condurido em Porto Murtinho, município de Costa Marques, Rondônia, na Amazônia Brasileira, analisou-se a aderência e os fatores econômicos capazes de reduzir o impacto do uso de mosquiteiros impregnados sobre a morbidade da malária. Os mosquiteiras impregnados tiveram excelente receptividade pela populaçäo local. No entanto, a aderência foi muito baixa, principalmente pelos adultos maiores de 15 anos de idade e, durante a estiagem. O preço do mosquiteiro impregnado foi calculado em US$18,83 para casal e, em US$13,82, para solteiro. Apesar das vantagens econômicas do emprego dos mosquiteiras impregnados em larga escala, desde que subsidiados pelas agências governamentais, a baixa aderência verificada, aliada aos fatores epidemiológicos locais, näo permitem indicar o uso de mosquiteiros impregnados como medida de proteçäo em massa na Amazônia

Anopheline species complexes & malaria control.

Species complexes comprising morphologically indistinguishable biological species that are reproductively isolated, are of common occurrence among anophelines. A list of anopheline species complexes identified so far in the world has been given. To demonstrate the importance of species complexes in malaria control, we report the Anopheles culicifacies complex as a case study. An. culicifacies is a major vector of malaria in India and neighbouring countries. This complex comprises four sibling species, A, B, C and D. Stratification of U.P. state and district Allahabad has been shown taking into consideration the biological differences among sibling species, viz., sibling species composition and vectorial potential- species B is a non-vector while others are vectors. To achieve cost effective vector control, microlevel stratification at least at the block level has been suggested. Implications of differential responses of sibling species to DDT and malathion in field operations have been discussed. To achieve selective and sustainable control, and to reduce the unnecessary selection pressure of insecticides, an insecticide spray strategy to control An. culicifacies has been provided.

Study of simplified measures for malaria surveillance in the late consolidation phase in China.

This paper presents the results of a study on simplified surveillance methods conducted in 23 pilot counties in 11 provinces and municipalities in China where reside 15 million people and malaria control has been in the late consolidation phase. Two simplified surveillance Schemes (A and B) taking treatment of clinical cases as the main measure were implemented in 1992-1994. The rate of annual blood examination for case detection was 1.0% in pilot Scheme A, while in areas of scheme B it was 0.3%. The implementation of both Scheme A and Scheme B, simplified or without treatment of infection foci and management of mobile populations, acquired satisfactory effects against malaria. Consequently, malaria incidence was declining steadily, only a few indigenous and introduced cases were detected. The parasite rate in residents and the IFA positive rate in children were very low. The results of pilot studies and cost-effectiveness analysis indicated that Scheme B is effective, rational and economic, and can be implemented to replace the routine surveillance measures in areas where malaria has been at the late consolidation phase in China.

Malaria: cost to India and future trends.

A study of the economic loss due to malaria and its future trends revealed that malaria in India was responsible for economic loss between US$ 0.5 to 1.0 billion annually. The study also brought out that malariogenic potential of the country is increasing, and new malaria paradigms have been established requiring new approaches for its control. Unless this trend is checked losses due to malaria will increase in the coming decades. Effective malaria control requires immediate remedial measures to prevent environmental degradation conductive to vector proliferation; and renewed attack on malaria based on local epidemiological, entomological and social determinants. The first requirement for such an action is a reliable data base, both on the malariometric indices and the causative factors. Research therefore should be intensified to fill the gaps, generate new knowledge, disseminate malaria information as widely as possible and provide training for success in malaria control by the implementation of the global malaria control strategy.

Field evaluation of bednets impregnated with deltamethrin for malaria control.

Trials were undertaken in a hypoendemic area of malaria in an area bordering Vietnam, in Napo County of Guangxi Zhuang Autonomous Region, China. The aim was to compare the relative cost effectiveness of DDT residual spraying and of bednets impregnated with deltamethrin in the malaria control program. The trials were divided into three subgroups: (1) two farming areas and one coal mining area with a total population > 20,000, where the trial consisted of mass bednets impregnated with deltamethrin 15 mg/m2 net surface once a year, (2) one farming area with a population of approximately 3,600 where DDT residual spraying at 2g/m2 was carried out twice a year in May and August; (3) one farming area and one coal mining village with a population of > 4,000 were used as a control. The malaria vector population consisted mainly of Anopheles minimus and An. anthropophagus with a small contribution from An. sinensis. After bednets were impregnated with deltamethrin the mosquitos resting on the surface of the bednets decreased significantly, although there was less effect on the total vector population. The results showed that malaria incidence decreased significantly both in areas where impregnated bednets were used and in areas where residual spraying was undertaken. The positive IFAT rates of residents who slept under impregnated bednets decreased significantly in farming areas, especially in that area where bednet impregnation as a vector control measure had been undertaken for two years, but there was no change in the IFAT rate in DDT sprayed or control areas.(ABSTRACT TRUNCATED AT 250 WORDS)

A cost benefit analysis of fish culture strategy towards the control of mansonioides in Shertallai, Kerala state.

The cost benefit analysis of fish culture as a means for vector control towards the containment of Brugian filariasis in Shertallai, a highly endemic tract for this disease in Kerala was carried out. While the financial gain accrued to the community was to the tune of Rs. 1,82,052 in ponds (under monoculture) with Chinese grass carp from 763 ponds, it was Rs. 1,83,740 from 1000 ponds under polyculture with Catla catla, Cyprinus carpio, Labeo rohita, Labeo fimbriatus, Cirrhina mrigala and Ctenopharyngodon idella (Chinese grass carp). Monoculture with Giant gourami (Osphronemous goramy) fetched an income of Rs. 7,654 to the community from 128 ponds. A marked reduction in weed reinfestation/vector breeding was observed in ponds under fish culture than other without fishes. The study clearly indicates that fish culture is an ideal strategy for Mansonioides control as it can bring perceptible benefits to the community.

Cost-effectiveness research in malaria control and the need for health behaviour and socio-economic research in malaria control in Thailand.

The complexity of the malaria situation in Thailand requires behavioural and socio-economic research in wide variety of areas including; migration, illness behaviour, motivation of staff and communities and the relationship of institutional and community expenditure to reduction in morbidity. The research ideally should be constructed in such a way as to maximize the availability of methods for incorporation into routine monitoring, evaluation, and policy making activities of the Anti-Malaria Programme.

Evaluation of the effectiveness of permethrin and DDT impregnated bed-nets against Anopheles maculatus.

A laboratory evaluation of cotton and nylon bed-nets treated with permethrin and DDT was carried out by releasing blood-fed An. maculatus for 30 minutes in the treated net. Results show almost 100% mortality up to one year after treatment. A ten minute exposure on the outside of the net also gave similar results. Even after washing the nets continued to give very good results. A method of treating the nets is described.