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- All Subjects: Elimination
- Creators: Mubayi, Anuj
Description
Soil-transmitted helminthiasis (STH), a neglected tropical disease (NTD) remains a major health problem all over the world especially in developing countries such as, Cameroon with a prevalence of 30.8%, Nigeria and Ghana with a prevalence of 25.4% (Pullan et. al, 2014). This study touches on transmission patterns and investigates the effectiveness of policies on mass drug administration as a means to control STH in Ghana. The government of Ghana currently focuses mass drug administration efforts on school aged children (SAC) that are children between the ages of 5-14 years. This paper develops and evaluates a different mass drug administration strategy by hypothesizing that it would be more cost-effective to target some percentage of vulnerable adults in MDA efforts as opposed to only targeting SAC between ages 5-14 years in Ghana. This we hypothesize would lead to a faster reduction in prevalence over time, would be cost-effective and would hopefully lead to an eventual reduction in morbidity caused by this disease to a level of no public health significance in Ghana. We conduct three cost-effectiveness analyses based on three different case setups. Given the parameter values from literature, our results suggest that it is most cost-effective to cover 20% of adults while covering at least 24% of children in mass drug administration assuming that the number of individuals covered is equal to 80% a figure which is the current total coverage of school-aged children.
ContributorsMohammed, Rasheeda (Author) / Mubayi, Anuj (Thesis director) / Popova, Laura (Committee member) / School of Human Evolution and Social Change (Contributor) / School of Public Affairs (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
Description
Neglected tropical diseases (NTDs) comprise of diverse communicable diseases that affect mostly the developing economies of the world, the “neglected” populations. The NTDs Visceral Leishmaniasis (VL) and Soil-transmitted Helminthiasis (STH) are among the top contributors of global mortality and/or morbidity. They affect resource-limited regions (poor health-care literacy, infrastructure, etc.) and patients’ treatment behavior is irregular due to the social constraints. Through two case studies, VL in India and STH in Ghana, this work aims to: (i) identify the additional and potential hidden high-risk population and its behaviors critical for improving interventions and surveillance; (ii) develop models with those behaviors to study the role of improved control programs on diseases’ dynamics; (iii) optimize resources for treatment-related interventions.
Treatment non-adherence is a less focused (so far) but crucial factor for the hindrance in WHO’s past VL elimination goals. Moreover, treatment non-adherers, hidden from surveillance, lead to high case-underreporting. Dynamical models are developed capturing the role of treatment-related human behaviors (patients’ infectivity, treatment access and non-adherence) on VL dynamics. The results suggest that the average duration of treatment adherence must be increased from currently 10 days to 17 days for a 28-day Miltefosine treatment to eliminate VL.
For STH, children are considered as a high-risk group due to their hygiene behaviors leading to higher exposure to contamination. Hence, Ghana, a resource-limited country, currently implements a school-based Mass Drug Administration (sMDA) program only among children. School staff (adults), equally exposed to this high environmental contamination of STH, are largely ignored under the current MDA program. Cost-effective MDA policies were modeled and compared using alternative definitions of “high-risk population”. This work optimized and evaluated how MDA along with the treatment for high-risk adults makes a significant improvement in STH control under the same budget. The criticality of risk-structured modeling depends on the infectivity coefficient being substantially different for the two adult risk groups.
This dissertation pioneers in highlighting the cruciality of treatment-related risk groups for NTD-control. It provides novel approaches to quantify relevant metrics and impact of population factors. Compliance with the principles and strategies from this study would require a change in political thinking in the neglected regions in order to achieve persistent NTD-control.
Treatment non-adherence is a less focused (so far) but crucial factor for the hindrance in WHO’s past VL elimination goals. Moreover, treatment non-adherers, hidden from surveillance, lead to high case-underreporting. Dynamical models are developed capturing the role of treatment-related human behaviors (patients’ infectivity, treatment access and non-adherence) on VL dynamics. The results suggest that the average duration of treatment adherence must be increased from currently 10 days to 17 days for a 28-day Miltefosine treatment to eliminate VL.
For STH, children are considered as a high-risk group due to their hygiene behaviors leading to higher exposure to contamination. Hence, Ghana, a resource-limited country, currently implements a school-based Mass Drug Administration (sMDA) program only among children. School staff (adults), equally exposed to this high environmental contamination of STH, are largely ignored under the current MDA program. Cost-effective MDA policies were modeled and compared using alternative definitions of “high-risk population”. This work optimized and evaluated how MDA along with the treatment for high-risk adults makes a significant improvement in STH control under the same budget. The criticality of risk-structured modeling depends on the infectivity coefficient being substantially different for the two adult risk groups.
This dissertation pioneers in highlighting the cruciality of treatment-related risk groups for NTD-control. It provides novel approaches to quantify relevant metrics and impact of population factors. Compliance with the principles and strategies from this study would require a change in political thinking in the neglected regions in order to achieve persistent NTD-control.
ContributorsThakur, Mugdha (Author) / Mubayi, Anuj (Thesis advisor) / Hurtado, Ana M (Committee member) / Paaijmans, Krijn (Committee member) / Michael, Edwin (Committee member) / Arizona State University (Publisher)
Created2020