Assessment of the socio-economic impact of Taenia solium cysticercosis in Angónia District, Mozambique

Description

Abstract:
Taenia solium cysticercosis is an emerging zoonosis causing both public health and agricultural problems in many low-income countries. NCC is considered a cause of epilepsy in people of all ages and one of the most important human parasitic neurological diseases.
Since epidemiological data on human and porcine cysticercosis were available for Angónia District, Mozambique, the present study was carried out to assess the socio – economic impact of the disease on the population. Data was obtained from PhD and MSc studies conducted from 2008-2012 combined with interviews of  key informants. All data were compiled in ‘R software’. Different distributions were used according to the type of information available. To estimate the total costs a cost analysis model was used. To estimate the DALYs lost due to NCC associated epilepsy a DALY calculator was used. The uncertainty of the parameters was modelled using Monte Carlo simulations.
Based on a prevalence of epilepsy of 15.6% the number of people with NCC associated epilepsy was estimated at 21,828 (95% CR, 17,998-26,168), representing 6.6% of the total population. Of these more than half had never received treatment. The number of adult pigs diagnosed with cysticercosis was estimated at 7,129 (95% CR, 6,401-7,879), which corresponded to 35% of the total adult pig population. The total annual costs due to T. solium cysticercosis were estimated at around 1 million Euro (1,058,445 (95% CR, 671,138-1,570,446)) (3.2 € per person per year). Of these 15% were losses due to pig production and 85% to direct and indirect costs caused by human cysticercosis. The annual monetary burden per case of NCC associated epilepsy amounted at 41 Euro (95% CR, 24.30-62.0). The estimated average number of DALYs lost was 7.7 (95% CR, 4.5-12.0) per thousand persons per year.
The cost estimates in Angónia District were lower than that of other studies carried out before. This is mainly due to the fact that the salaries in Angónia District are very low. On the other hand the DALY results of this study seem very high compared to other studies that estimated the health burden of the disease in other parts of the world. This is mainly due to the fact that burden estimates are based on prevalence. In Angónia District the epilepsy prevalence used was very high compared to epilepsy prevalence of other studies. The epidemiological parameters for human and porcine cysticercosis used to calculate the burden were collected in the same district and during the same time period, thus high context specific. Angónia District should be considered a high endemic area for T. solium cysticercosis, causing serious public health and agricultural threats which affects the livelihood of the subsistence farmers by reducing dramatically their economic and societal wellbeing.
A “One Health” approach is essential to control this parasitic disease and to increase the wealth of the poorest.