Routine implementation costs of larviciding with Bacillus thuringiensis israelensis against malaria vectors in a district in rural Burkina Faso
Routine implementation costs of larviciding with Bacillus thuringiensis israelensis against malaria vectors in a district in rural Burkina Faso
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DOI：
10.1186/s12936-016-1438-8
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发表时间：
2016-07-22
期刊：
影响因子：
3
通讯作者：
Sauerborn, Rainer
中科院分区：
文献类型：
--
作者：
Dambach, Peter;Schleicher, Michael;Sauerborn, Rainer
背景：疟疾控制的关键工具是病例的早期诊断和治疗以及病媒控制。撒哈拉以南非洲目前的疟疾病媒控制战略基本上是以长效驱虫蚊帐为基础的，而室内滞留喷洒的程度要小得多。自放弃滴滴涕环境喷洒以来，防治疟疾病媒的另一个工具-幼虫来源管理-尚未在撒哈拉以南非洲得到更广泛的使用。对长效杀虫剂和室内滞留喷雾杀虫剂的局限性的日益关注以及基于杀幼虫剂的大型LSM试验的令人鼓舞的结果，为使用生物杀幼虫剂作为现有控制措施的补充工具提供了强有力的理由。反对这种综合办法的理由是，据称最低限度标准模型的执行费用很高。本研究为验证这一论点迈出了第一步。幼虫源管理的实施成本的基础上，苏云金杆菌以色列（Bti）（菌株AM 65 -52）喷洒不同的实施方案进行了分析，在农村卫生district in Burkina Faso.Methods：该分析利用详细的成本数据收集在2013年和2015年之间的大规模LSM干预。研究设置中的所有127个村庄被分配到两个治疗组和一个对照组。处理要么意味着彻底喷洒所有可用的水收集或有针对性地喷洒50%的最具生产力的幼虫来源，通过遥感和昆虫学验证的风险地图。根据两个干预方案的费用报告，人均方案费用是在两种干预方案都涵盖整个地区的假设下计算的。通过提供一个可适应的成本公式，使成本计算通用化。此外，这项研究评估了人均方案费用的敏感性相对于变化的基本成本components.Results：在主要的疟疾传播期间（6月至10月）在努纳卫生区的Bti的穷举杀幼虫的平均年人均成本计算为1.05美元。如果改为对50%最具生产力的幼虫来源进行有针对性的喷洒，人均年平均成本将减少27%，降至0.77美元。此外，人均方案成本对潜在幼虫源和喷洒重复次数的总表面变化的敏感性很高，被发现。讨论：幼虫源管理干预与BTI的人均成本约为抗疟疾药物和长效驱虫蚊帐在布基纳法索的人均年度支出的三分之一，分别为3.80美元和3.00美元。撒哈拉以南非洲的最低生活保障平均成本与IRS和长效驱虫蚊帐的平均成本相比。作者认为，在这种情况下，基于Bti喷洒的LSM在负担得起的抗疟疾策略范围内，因此，在实践中应该得到更多的关注。未来的研究包括根据研究项目期间收集的昆虫学和流行病学数据进行成本效益计算。
Background: The key tools in malaria control are early diagnosis and treatment of cases as well as vector control. Current strategies for malaria vector control in sub-Saharan Africa are largely based on long-lasting insecticide-treated nets (LLINs) and to a much smaller extent on indoor residual spraying (IRS). An additional tool in the fight against malaria vectors, larval source management (LSM), has not been used in sub-Saharan Africa on a wider scale since the abandonment of environmental spraying of DDT. Increasing concerns about limitations of LLINs and IRS and encouraging results from large larvicide-based LSM trials make a strong case for using biological larviciding as a complementary tool to existing control measures. Arguments that are often quoted against such a combined approach are the alleged high implementation costs of LSM. This study makes the first step to test this argument. The implementation costs of larval source management based on Bacillus thuringiensis israelensis (Bti) (strain AM65-52) spraying under different implementation scenarios were analysed in a rural health district in Burkina Faso.Methods: The analysis draws on detailed cost data gathered during a large-scale LSM intervention between 2013 and 2015. All 127 villages in the study setup were assigned to two treatment arms and one control group. Treatment either implied exhaustive spraying of all available water collections or targeted spraying of the 50 % most productive larval sources via remote-sensing derived and entomologically validated risk maps. Based on the cost reports from both intervention arms, the per capita programme costs were calculated under the assumption of covering the whole district with either intervention scenario. Cost calculations have been generalized by providing an adaptable cost formula. In addition, this study assesses the sensitivity of per capita programme costs with respect to changes in the underlying cost components.Results: The average annual per capita costs of exhaustive larviciding with Bti during the main malaria transmission period (June-October) in the Nouna health district were calculated to be US$ 1.05. When targeted spraying of the 50 % most productive larval sources is used instead, average annual per capita costs decrease by 27 % to US$ 0.77. Additionally, a high sensitivity of per capita programme costs against changes in total surface of potential larval sources and the number of spraying repetitions was found.Discussion: The per capita costs for larval source management interventions with Bti are roughly a third of the annual per capita expenditures for anti-malarial drugs and those for LLINs in Burkina Faso which are US$ 3.80 and 3.00, respectively. The average LSM costs compare to those of IRS and LLINs for sub-Saharan Africa. The authors argue that in such a setting LSM based on Bti spraying is within the range of affordable anti-malarial strategies and, consequently, should deserve more attention in practice. Future research includes a cost-benefit calculation, based on entomological and epidemiological data collected during the research project.