Cost effectiveness analysis of participatory disease surveillance in Kenya

Effective surveillance for infectious diseases is an essential and resource-consuming activity for mitigatingunwanted consequences for animal and public health. Allocation of scarce resources for surveillance mustbe considered against alternative prevention and control measures and regularly reviewed. Few studiesestimate cost-effectiveness and benefits of different animal disease surveillance approaches and systems.In this study, we considered the benefits and resource costs of participatory epidemiology (PE) surveys andparticipatory disease surveillance (PDS) compared with routine passive surveillance. Focusing on a 6-monthinterval in a primarily pastoralist district in Kenya, basic performance indicators for surveillance measuredwere (1) number of outbreaks; (2) number of samples generated from suspected outbreaks; (3) number ofpositive laboratory confirmations. Costs of passive surveillance and interventions mounted were determinedfor the 6-month interval. In the same district, PE surveys were conducted in randomly selected communitiesto determine the number of outbreaks of notifiable cattle diseases in the same 6-month interval. Additionalinformation was collected on the scale of morbidity and mortality for historical outbreaks (numbers andduration), the value of individual animals and the number of active outbreaks. Costs associated withmounting PE visits were ascertained and extrapolated to district level. One month after completion of PEvisits, district level stakeholders were interviewed to determine the response, if any, to outbreaks detectedduring the visits. The study provides cost effectiveness estimates at a district level for the 6-month interval,including losses which occurred from outbreaks missed by passive surveillance and costs if PE were appliedat regular intervals. In addition, the findings consider available prevention and control responses and providedecision-makers with evidence to inform future application of participatory approaches in animal diseasesurveillance.