The cost of mapping trachoma: Data from the Global Trachoma Mapping Project

Abstract

BackgroundThe Global Trachoma Mapping Project (GTMP) was implemented with the aim of completing the baseline map of trachoma globally. Over 2.6 million people were examined in 1,546 districts across 29 countries between December 2012 and January 2016. The aim of the analysis was to estimate the unit cost and to identify the key cost drivers of trachoma prevalence surveys conducted as part of GTMP.Methodology and principal findingsIn-country and global support costs were obtained using GTMP financial records. In-country expenditure was analysed for 1,164 districts across 17 countries. The mean survey cost was $13,113 per district [median: $11,675; IQR = $8,365-$14,618], $17,566 per evaluation unit [median: $15,839; IQR = $10,773-$19,915], $692 per cluster [median: $625; IQR = $452-$847] and $6.0 per person screened [median: $4.9; IQR = $3.7-$7.9]. Survey unit costs varied substantially across settings, and were driven by parameters such as geographic location, demographic characteristics, seasonal effects, and local operational constraints. Analysis by activities showed that fieldwork constituted the largest share of in-country survey costs (74%), followed by training of survey teams (11%). The main drivers of in-country survey costs were personnel (49%) and transportation (44%). Global support expenditure for all surveyed districts amounted to $5.1m, which included grant management, epidemiological support, and data stewardship.ConclusionThis study provides the most extensive analysis of the cost of conducting trachoma prevalence surveys to date. The findings can aid planning and budgeting for future trachoma surveys required to measure the impact of trachoma elimination activities. Furthermore, the results of this study can also be used as a cost basis for other disease mapping programmes, where disease or context-specific survey cost data are not available.

A Population-Based Trachoma Prevalence Survey Covering Seven Districts of Sangha and Likouala Departments, Republic of the Congo

“…In this study, we employed the momentum, 18,27 systems 19,28 and funding 29 of the GTMP to investigate whether trachoma was a public health problem in an area felt to be the most at-risk part of the Republic of the Congo, a hitherto-unsurveyed country. This survey was set up as the epidemiological equivalent of a canary in the mine, with the understanding that finding trachoma at levels indicative of a public health problem here would prompt further trachoma surveys in surrounding health districts, 3,4 and potentially further afield.…”

“…The base population was all non-urban residents of those districts, as projected to 2015 from the 2007 population census. 17 After excluding the urban areas of Betou (estimated population 8188), Ouesso Town (31,882), Impfondo (29,823), and Pokola (18,040), an estimated 101,723 people remained as residents of the EU. We followed the principles and processes of the Global Trachoma Mapping Project (GTMP), 18 and determined sample size based on considerations relating to TF, as previously described.…”

Impact of the Global Trachoma Mapping Project

“…Using a standardized, valid, reliable and reproducible methodology, the GTMP surveyed over 1546 districts and examined over 2.6 million people across 29 countries in just 3 years, making it the largest infectious disease survey ever undertaken. 2 The results of the GTMP were immediately relevant for national Ministries of Health, international nongovernmental organizations, and donors in their programmatic activities. 3 And while mapping of some low-security areas is still required (e.g., South Sudan, Central African Republic, Yemen), the results have been immensely helpful for clarifying the progress toward global elimination.…”

Cost implications of a nationwide survey of schistosomiasis and other intestinal helminthiases in Sudan

“…In recent years, several studies [6][7][8][9][10] have begun exploring the main drivers of NTD survey costs and the potential effects of modifying standard operating procedures. The first study [6] analyzed the cost of the integrated surveys for lymphatic filariasis, schistosomiasis, and STH infection conducted in South Sudan by Kolaczinski and colleagues [6].…”

“…However, the survey in South Sudan was not conducted throughout the nation (instead, it was carried out only in one state), and previous studies [6][7][8][9][10] were limited to analyzing cost only.…”