Participatory disease surveillance: Cost effectiveness relative to passive surveillance in Kajiado County, Kenya

Abstract

Effective surveillance for infectious diseases is an essential and resource-consuming activity for mitigating
unwanted consequences for animal and public health. Allocation of scarce resources for surveillance must
be considered against alternative prevention and control measures and regularly reviewed. Few studies
estimate 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 and
participatory disease surveillance (PDS) compared with routine passive surveillance. Focusing on a 6-month
interval in a primarily pastoralist district in Kenya, basic performance indicators for surveillance measured
were (1) number of outbreaks; (2) number of samples generated from suspected outbreaks; (3) number of
positive laboratory confirmations. Costs of passive surveillance and interventions mounted were determined
for the 6-month interval. In the same district, PE surveys were conducted in randomly selected communities
to determine the number of outbreaks of notifiable cattle diseases in the same 6-month interval. Additional
information was collected on the scale of morbidity and mortality for historical outbreaks (numbers and
duration), the value of individual animals and the number of active outbreaks. Costs associated with
mounting PE visits were ascertained and extrapolated to district level. One month after completion of PE
visits, district level stakeholders were interviewed to determine the response, if any, to outbreaks detected
during 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 applied
at regular intervals. In addition, the findings consider available prevention and control responses and provide
decision-makers with evidence to inform future application of participatory approaches in animal disease
surveillance.