Economic burden of rabies and its impacts on local communities in Tanzania Maganga Sambo

Slides:



Advertisements
Similar presentations
1 The Experience of Private Hospitals In the Republic of Yemen Success and Problems Dr. Ali K. Abbas Yemen International Health & Education Consultants.
Advertisements

REACH Healthcare Foundation Prepared by Mid-America Regional Council 2013 Kansas City Regional Health Assessment.
HEALTH INEQUITIES EXPERIENCED IN RURAL V URBAN Alicia Haywood Policy & Advocacy Manager.
Figure 1. Central America and the Caribbean Source: World Health Organisation, Pan American Health Organisation, Library of the University of Texas. Student.
INTEGRATED RABIES EPIDEMIOLOGY IN REMOTE INUIT COMMUNITIES IN QUÉBEC, CANADA: A “ONE HEALTH” APPROACH C. Aenishaenslin, A. Simon, T. Forde, A. Ravel, J-F.
P U B L I C S E R V I C E S Workshop on Microinsurance Insurance and Regulatory Development (IRDA) Institute of Insurance and Risk Management (IIRM) United.
Kidane Asmerom and Teh wei-Hu
Philip M. Kitala 1 and Stella Kiambi 2 1 University of Nairobi Dept Public Health, Pharm and Toxi 2 Ministry.
Towards universal coverage in DRC: spatial and financial barriers to accessing care Presented by Caryn Bredenkamp Health Economist, World Bank, Washington.
GLOBAL TB PROGRAMME Knut Lönnroth Global TB Programme, WHO Monitoring social protection Sickness insurance Food package Disability grants Other welfare.
Medical Insurance in China How is it different from India? Medical Insurance in China Global Conference of Actuaries Mumbai, February 2010.
2000/2001 Household Budget Survey (HBS) Conducted by The National Bureau of Statistics.
Measuring Social Transfers in Kind in the UK Richard Tonkin, James Lewis & Nathan Thomas 2 nd - 4 th December 2013
G. Robert Weedon, DVM, MPH Veterinary Outreach Coordinator Alliance for Rabies Control The Global Burden of Rabies.
Health Status in Palestine
Asiimwe Grace Karimu, F. Monje, D. Mugabi, H. Mulondo, C. Odong, H. Kazoora, T. Odoch, C. Ohuobunwo, K. Ssemogerere.
Sudan Experience on Poverty Survey Somaia K.E.Omer Date 7-8 Aug بسم الله الرحمن الرحيم.
The new HBS Chisinau, 26 October Outline 1.How the HBS changed 2.Assessment of data quality 3.Data comparability 4.Conclusions.
THE POTENTIAL OF COMMUNITY LEVEL SOCIAL GRANTS AS PROMOTIVE SOCIAL PROTECTION MEASURE FLORA KESSY INTERNATIONAL SOCIAL PROTECTION CONFERENCE DECEMBER.
ABSTRACT SELECTING NATURAL INSULIN IMPROVES ACCESS TO COST-EFFECTIVE THERAPY OF DIABETIC PATIENTS IN THE PUBLIC SECTOR OF DAR ES SALAAM, TANZANIA Title:
Poorer populations are Two times more likely to have TB Three times less likely to access TB care Four times less likely to complete treatment Many.
Expanding DOTS? Time for cost-effective diagnostic strategies for the poorest in Malawi. Mann G 1, Squire SB 2,, Nhlema B 3, Luhanga T 4, Salaniponi FML.
US$ 40 in Africa US$ 49 in Asia PhP The study described the epidemiological characteristics of animal bite cases consulting at the Anti-Rabies.
ABSTRACT THE CHALLENGE OF INTEGRATING A RDU TRAINING MODEL INTO THE REALITY OF A HEALTH SYSTEM CONTEXT Problem Statement: The Dar es Salaam Urban Health.
Health care utilization patterns and economic consequences of TB Dr. K. Zaman ICDDR,B National TB Conference 2007, NATAB.
The Cost and Impact of Scaling-up Medical Male Circumcision in Uganda: An Empirical Analysis International AIDS Conference Vienna July 2010 Nazarius Mbona.
Sokoine University of Agriculture The UBS Rabies Surveillance Project
Planning, preparation and conducting TQS in Tajikistan Agency on statistics under the President of Tajikistan.
Using surveillance to evaluate control efforts Sunny Townsend, Katie Hampson, Sarah Cleaveland, Tiziana Lembo, Zac Mtema Boyd Orr Centre for Population.
Five Years of Flu Seasons: A Study of Trends and Lessons Learned in Maryland Tiffany Tate, MHS Maryland Partnership for Prevention, Inc. National Immunization.
Rabies – One Health Model disease Outcome of Group work Regional Training in Animal and Human Health Epidemiology in South Asia.
Susan Brower, Minnesota State Demographer
The Greater Boston Housing Challenge Barry Bluestone
PRESENTATION OF FINDINGS GRANTEES NEED ASSESSMENT
Economic Costs of Violence Against Women
Emergency department pediatric psychiatric services
TB- HIV Collaborative activities in Romania- may 2006 status
The Access Crisis: Are Employer Mandates Part of the Solution?
The following are slide excerpts from a presentation to a state hospital association CEO committee by a hospital food service director.
A study of certain sociodemographic factors among patients with dog bite in Community Health Centre, Mulky, Dakshina Kannada District, INDIA Dr N UDAYA.
Siriporn Poripussarakul, Mahidol University, Thailand
D.C. Policy Center October 2017
Influenza Information Needs of Primary Care Physicians
The Debswana Anti Retroviral Therapy Programme
Social Protection, Nutrition and Resilience
Dr. Omesh Kumar, Shimla Municipal Corporation Health officer
Assessing the clinical efficacy of exclusive local infiltration of bite wounds with equine Rabies Immunoglobulin (eRIG) along with Intra-Dermal Rabies.
Drs Omesh K Bharti, Uppinder Kumar, Adarsh Kumar & Archana Phull
ISI SATELLITE MEETING ON AGRICULTURAL STATISTICS
Safety Net Primary Care Demand and Supply Analysis April 2007
Influenza Vaccine Effectiveness Against Pediatric Deaths:
THE COST OF MENTAL ILLNESS:
Haksoon Ahn, PhD Associate Professor
New Market Tax Credits Introduction
Evaluation Goal: Ensure learnings from the program are identified and recorded, in particular: What roles can CHCs best play in addressing SDOH? What types.
Congressional Budget Office
Kandeke C, Chibuta C, Banda D
The Ontario Experience National Immunization Conference
Haksoon Ahn, PhD Associate Professor
National Foundation for Transplants
Affiliation: TURKISH STATISTICS INSTITUTE
Waunakee Housing Task Force
Vice President, Health Care Coverage and Access
The Cancer Incidence Rate
What makes a successful vaccination campaign?
The Growing Cost Burden of Employer Health Insurance for U. S
Provincial Measles Immunization Catch-Up Program
SPENDING NEEDS A BOOST According to the latest data from the American Dental Association (ADA)/Health Policy Institute (HPI), total dental spending.
Belize Presentation Dr. Ines Mendez-Moguel
Stocktaking of Early Childhood Development (ECD)
Presentation transcript:

Economic burden of rabies and its impacts on local communities in Tanzania Maganga Sambo

Introduction What is rabies? Challenges in controlling and preventing rabies Challenges of seeking human pre exposure prophylaxis (PEP) Methods Results Bite and death incidence Costs associated with receiving PEP Conclusions Talk overview

What are major challenges associated with canine rabies control? Low dog vaccination coverage Poor estimate of dog population - insufficient/ ineffective vaccination campaigns Poor dog management and control (roaming dogs and High dog population turnover ) OUTCOMES: - High probability of being bitten by unvaccinated dog - High demand for human rabies prevention

PEP seeking process HOSPITAL Get there on foot or bicycle, few costs Get there on bicycle or bus, pay fare, food and medical costs Get there on bus/ train, pay fare, food, lodge and medical costs

Costs facing patients after a bite Indirect Medical costs Travel costs, Accommodation costs, other costs like food, airtime, Direct Medical costs PEP cost, Consultation fees, Syringes and needles, Wound treatment costs and antibiotics Exposure to a rabid dog Loss of labour force due to incapacity or severe wound, Loss of labour force due to escorts or care of the victims Loss of school due to treatment seeking or severe wound Medical costs Opportunity costs Total Costs

Bulletin of the World Health Organization | May 2005, 83 (5) Note: These estimate did not fully capture indirect medical costs or inequalities between rural and urban areas

Research Objectives 1) To compare previous costs and estimated burden (Knobel 2005) with empirical data with consideration of rural-urban settings 2) To quantify the economic burden of rabies (incidence of bites, costs of PEP, rabies deaths and their related costs) 3) To identify who are worst affected by these costs

Methodology Compilation of hospital and livestock records as starting point for contact tracing Contact tracing to estimate human death and bite incidence Questionnaire surveys to capture costs incurred by patients and validate them using receipt and market price Human demographic data (census) to estimate population structure and growth rate Tanzanian Household Budget Survey (HBS) of 2007 used to estimate daily income and annual income for rural and urban bite victim

Study area

Contact tracing and questionnaire After interviews I normally take GPS code of area where bites happened and educate them concerning rabies

Results  A questionnaire was administered to in April to Sept 2009  706 people bitten by animals from Jan 2006 to Dec 2009 were interviewed. Of these, 415 (59%) were suspect rabid cases  About 53% were to children <15 years of age (overall range 1-80 years)  Of these 63% of suspect bites were from rural areas

People bitten by suspected rabid animal (Jan 2008-Dec 2008)

Bite and death incidence/per 100,000 people (Jan Dec 08) District Human population* Human growth rate (%) Average annual incidence/ bite death Ulanga Kilombero Serengeti * according to the 2002 census

Estimated average costs Components Estimated cost ($) per dose RuralUrban Direct medical costs Travel costs Accommodation cost Other costs Lost income[days lost from work] Total costs Note: Knobel 2005 study estimated only $2 per single clinic visit

What are major implications of these costs? Delays to hospital (delays in receiving PEP) Poor compliance Poverty (absence from work, high interest loans) Deaths

What are implications and coping strategies to these costs?

Compliance to PEP regimens

Sources of fund to pay for PEP

How can we reduce the burden and increase compliance? Make PEP available locally (increase access) Subsidy PEP (increase affordability) Vaccinate dogs (reduce chances of being bitten by unvaccinated dogs) Use ID regimen (share PEP and reduce clinic visits)

Compliance with 5 dose Essen regimen (1ml/dose, IM) Cost scenarioCost of PEP/cost scenario (in US$) Percentage of annual income RuralUrban Rural Urban No subsidies %18% 100% subsidised %11% 100% subsidised and decentralised %7% Note: PEP costs are often prohibitive, Hampson et al (2008) Majority of Tanzanians survive at <$1 a day

Compliance with 4 dose Essen regimen (0.1 mil/dose, ID) Cost scenarioCost of PEP/cost scenario (in US$) Percentage of annual income RuralUrban Rural Urban No subsidies %14% 100% subsidised %9% 100% subsidised and decentralised %6%

Compliance with 3 dose Tanzanian regimen(1 ml/dose, IM) Cost scenarioCost of PEP/cost scenario (in US$) Percentage of annual income RuralUrban Rural Urban No subsidies %12% 100% subsidised %7% 100% subsidised and decentralised %4%

Note: Knobel 2005 study estimation based on free/ subsidized PEP (at cost to government of $10/dose) which costs

Conclusions 24 The rural poor are worst affected The burden of rabies is substantially underestimated Rabies need national and global attention and its burden should be re-evaluated PEP should be subsidised and decentralized Shortages of PEP is common at district hospitals

Acknowledgements The Wellcome Trust: For funding the project University of Glasgow: Sunny Townsend, Sarah Cleaveland, Tiziana Lembo, Zacharia Mtema, Heather Ferguson and Katie Hampson Ifakara Health Institute: Lwitiko Sikana, Joel Changalucha, Kennedy Lushashi and Honorathy Urassa Sokoine University of Agriculture: Rudovick Kazwala and Gurdeep Jaswant Afya Serengeti: Cleophas Simon, Zilpah Kaare and Matthias Magoto Staff from District veterinary and medical office, village leaders and to the community

Asanteni sana