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 Public

Abstract

Background: Trachoma impact surveys (TIS) provide information to program managers on the impact of the SAFE strategy and current burden of disease, and provide a crucial component of the evidence base necessary for the validation of the elimination of trachoma as a public health problem. TIS are multi-level cluster random surveys that provide population-based estimates for program planning. This study conducted an analysis of the cost of eight rounds of trachoma impact surveys conducted in Amhara, Ethiopia, 2013 – 2016, comprising 232,365 people examined over 1,828 clusters in 187 districts. 

Methodology and Findings: Cost data were collected retrospectively from accounting and procurement records and coded by activity (i.e. training, field work, and processing) and input category (i.e. personnel, transportation, supplies, venue rental, and other). Estimates of staff time were obtained from the Carter Center’s Ethiopian project manager and staff and were included in the analysis. Data were analyzed by activity, input category, and location (East or West Amhara). The mean total cost per cluster surveyed was $753 (inter-quartile range of $670-$854). Primary drivers of costs were personnel (38.7%) and transportation (50.3%), with costs increasing in the last 3 rounds of TIS. 

Conclusion: Despite their considerable cost, trachoma impact surveys provide necessary information for program managers. Few options are available to reduce the costs of TIS. Surveys must be designed with feasibility in mind, as the need for precision is balanced against the financial and staff resources required to conduct the sight-saving components of the SAFE strategy. Program managers can use these findings to improve estimates of the total cost of a survey and its components to ensure that ample resources are budgeted accordingly.

Table of Contents

I. Background and Literature Review      viii

Trachoma: The Disease and the International Effort to Prevent the Blindness it Causes   viii

The Importance of Surveys in Program Management      x

Methods Commonly Used by Trachoma Programs to Conduct Surveys    x

Alternatives to Surveys That Use the Clinical Signs of Trachoma  xii

Efforts to Map Trachoma on a Larger Scale          xiii

Cost Analysis of Trachoma           xiv

Contribution of Student xvii

II. Manuscript in PLOSNTD Format           1

Abstract              2

Author Summary             3

Introduction      3

Methods            4

Results 7

Discussion          13

Acknowledgements       15

References        16

III. Summary, Public Health Implications, Possible Future Directions          17

IV. Appendices 20

About this Master's Thesis

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School	Rollins School of Public Health
Department	Applied Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Operations Research
Mot-clé	trachoma impact survey Carter Center Ethiopia Amhara TIS survey NTD trachoma cost
Committee Chair / Thesis Advisor	McFarland, Deborah, Emory University
Committee Members	Stewart, Aisha, The Carter Center
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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