A cost analysis of options for schistosomiasis control MDA programs targeting children aged five years and below in uMkhanyakude District of KwaZulu-Natal Province, South

Abstract

Background Schistosomiasis negatively impacts early childhood development. Inclusion of children aged five years and below in mass drug administration (MDA) programs for controlling schistosomiasis could improve early childhood development in communities where the disease is endemic. We estimated the projected cost of implementing a schistosomiasis control MDA program for children aged five years and below in the uMkhanyakude district of South Africa.Method We calculated the cost of implementing a schistosomiasis MDA program targeting children aged five years and below using an economies of scaled based cost function. We further compared different labor composition simulations to determine the most affordable and available human resources to implement the program. We also explored programs to which the MDA program could be integrated; and estimated what the costs for would be. Moreover, we simulated cost-effectiveness and determined the cost drivers for each simulation considered.Results A ward-based outreach team (WBOT) for implementing a schistosomiasis MDA program targeting children 5 years old and below was the best labor composition option. The simulations conducted indicated that treating children in batches of 2500 using the WBOT team approach could reduce the cost of treatment by 53% compared to treating the children on batches of 500. Integrating a schistosomiasis MDA targeting children aged 5 years and below with the immunization program was estimated to cost 3% less than integration with the deworming and Vitamin A supplementation program indicating that the former option is more cost-effective. Praziquantel, the drug that is used to treat schistosomiasis contributed over 30% of the total cost for the program.Conclusion. We estimated that between US$6,5 million and US$ 7,5 million would be needed to implement a cost effective MDA program targeting children 5 years old and blow over 3 years in uMkhanyakude district.