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

Abstract

Background 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. The prevalence surveys included in this analysis are multi-level cluster random surveys that provide populationbased 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 findings Cost 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. Conclusion Despite 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 PLOS NEGLECTED TROPICAL DISEASES

Optimizing cluster survey designs for estimating trachomatous inflammation–follicular within trachoma control programs

“…Sample size recommendations from the simulations depend on the ability to estimate the general endemicity of a given district prior to surveying -something that may be difficult, especially for younger programs. There has also been limited work on the cost of trachoma surveys ( Chen et al, 2011 ;Slaven et al, 2020 ;Trotignon et al, 2017 ;Stelmach et al, 2019 ). Assumptions were made in deriving the cost formula, and all costs only reflected estimates.…”

“…To calculate an estimated cost for each sample design, two components were needed: the cost of measuring one household, and the cost of measuring a cluster (aside from the cost of measuring households within the cluster). Our basis for these two cost component estimates came from work similar to that conducted by Slaven et al (2020) . Based on our findings, the following function was derived to calculate overall cost (USD) of a given sampling design:…”

“…Although determining the district-level prevalence of trachoma is important because it allows for effective targeting of interventions, money spent by control programs on surveys is money unavailable for interventions such as MDA and surgical services. A recent study evaluating trachoma survey costs within the Amhara region of Ethiopia reported a median cost per survey cluster of $752, and thus $15,040 for a 20-cluster district-level survey and $22,560 for a 30-cluster survey ( Slaven et al, 2020 ). Considering that Ethiopia had 673 trachoma-endemic districts in 2020, the cost of conducting country-wide surveys to gauge prevalence rates over the next 10 years will be substantial for the country's trachoma control program -ranging from $10-30 million if we extend these district-level calculations to the whole country ( WHO, 2020b ).…”

Photographic grading for trachoma diagnosis within trachoma impact surveys in Amhara region, Ethiopia

“…Future operational studies should compare the total costs associated with traditional field-graded surveys vs photograph-graded surveys. While cost estimates have been calculated for traditional surveys in this region, 16 new categories for assessment would include the training of the photographer, the per-person time to collect photographs and the costs associated with running a grading center, including training photograph graders and management of the photographs and associated data. Costs may be reduced by this grading center approach; however, so far, photographic grading still requires having a two-person team: a ‘lid-everter’ and a photographer/data recorder.…”

Use of modelling to modify trachoma elimination strategies affected by the COVID-19 pandemic

“…The pandemic has brought novel challenges, but also exposed and amplified pre-existing challenges to trachoma elimination. Three of these are how to (1) enhance implementation activities in high prevalence districts that respond slowly to the normal implementation pressure, 4 (2) resolve the conflict between the allocation of time, money and human resources to conducting surveys rather than implementing control activities 5 and (3) conduct at-scale hygiene promotion programmes. This commentary focuses on the first two of these pre-existing challenges in the context of COVID-19.…”