The Disease Burden of Taenia solium Cysticercosis in Cameroon

et al. (2009) The Disease Burden of Taenia solium Cysticercosis in Cameroon. PLoS Negl Trop Dis 3(3): e406. doi:10.1371/journal.pntd.0000406 The Disease Burden of Taenia solium Cysticercosis in Cameroon Nicolas Praet 0 Niko Speybroeck 0 Rafael Manzanedo 0 Dirk Berkvens 0 Denis Nsame Nforninwe 0 Andre Zoli 0 Fabrice Quet 0 Pierre-Marie Preux 0 He le` ne Carabin 0 Stanny Geerts 0 Hector H. Garcia, Universidad Peruana Cayetano Heredia, Peru 0 1 Institute of Tropical Medicine, Antwerp, Belgium, 2 Institute of Health and Society, Universite Catholique de Louvain , Brussels , Belgium , 3 Batibo District Hospital , Batibo , Cameroon , 4 University of Dschang, Dschang, Cameroon, 5 Institute of Neuroepidemiology and Tropical Neurology , Limoges , France , 6 College of Public Health, The University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma , United States of America Background: Taenia solium cysticercosis is an important zoonosis in many developing countries. Human neurocysticercosis is recognised as an important cause of epilepsy in regions where the parasite occurs. However, it is largely underreported and there is a lack of data about the disease burden. Because a body of information on human and porcine cysticercosis in Cameroon is becoming available, the present study was undertaken to calculate the impact of this neglected zoonosis. Methods: Both the cost and Disability Adjusted Life Year (DALY) estimations were applied. All necessary parameters were collected and imported in R software. Different distributions were used according to the type of information available for each of the parameters. Findings: Based on a prevalence of epilepsy of 3.6%, the number of people with neurocysticercosis-associated epilepsy was estimated at 50,326 (95% CR 37,299-65,924), representing 1.0% of the local population, whereas the number of pigs diagnosed with cysticercosis was estimated at 15,961 (95% CR 12,320-20,044), which corresponds to 5.6% of the local pig population. The total annual costs due to T. solium cysticercosis in West Cameroon were estimated at 10,255,202 Euro (95% CR 6,889,048-14,754,044), of which 4.7% were due to losses in pig husbandry and 95.3% to direct and indirect losses caused by human cysticercosis. The monetary burden per case of cysticercosis amounts to 194 Euro (95% CR 147-253). The average number of DALYs lost was 9.0 per thousand persons per year (95% CR 2.8-20.4). Interpretation: This study provides an estimation of the costs due to T. solium cysticercosis using country-specific parameters and including the human as well as the animal burden of the zoonotic disease. A comparison with a study in South Africa indicates that the cost of inactivity, influenced by salaries, plays a predominant role in the monetary burden of T. solium cysticercosis. Therefore, knowing the salary levels and the prevalence of the disease might allow a rapid indication of the total cost of T. solium cysticercosis in a country. Ascertaining this finding with additional studies in cysticercosisendemic countries could eventually allow the estimation of the global disease burden of cysticercosis. The estimated number of DALYs lost due to the disease was higher than estimates already available for some other neglected tropical diseases. The total estimated cost and number of DALYs lost probably underestimate the real values because the estimations have been based on epilepsy as the only symptom of cysticercosis. - Taenia solium cysticercosis is an important but neglected zoonotic disease of man and pigs in many developing countries. Human cysticercosis is an under-recognised disease due to the large variety of clinical symptoms, epilepsy being recognised as the most important one, and the unavailability of appropriate diagnostic tools in endemic areas [1]. Similarly, porcine cysticercosis is underreported due the absence of clinical symptoms in affected pigs and due to the poorly functioning meat inspection services in many endemic countries. Consequently, there is a lack of reliable data on the disease burden of cysticercosis. Although a proper assessment of the global burden of T. solium cysticercosis is essential, there has been so far a limited number of studies estimating the impact of this disease in endemic countries [2,3]. The large amount of data available on porcine and human cysticercosis in the West of Cameroon (which can be considered as an endemic country) [4], allows a study of its public health and economic relevance and consequently a better estimate of the burden of T. solium cysticercosis which is highly needed [5]. To this end and as already achieved for other neglected diseases [6,7], two approaches are considered namely the cost and the Disability Adjusted Life Year (DALY) estimations. A comparison with previous studies may provide indications on key factors in the more global burden of T. solium cysticercosis. Taenia solium cysticercosis is a zoonotic disease occurring in many developing countries. A relatively high prevalence in humans and pigs has been reported in several parts of the world, but insufficient data are available on the disease burden. Disease impact assessment needs detailed information on well-defined epidemiological and economic parameters. Our work conducted in West Cameroon over several years allowed us to collect the necessary information to estimate the impact of the parasite on the human and animal populations in this area using both cost and Disability Adjusted Life Year (DALY) estimations. This study identified the professional inactivity caused by the disease as the major loss factor in comparison to the cost of health care and losses due to infected pigs. These findings should allow a simpler estimation of the global disease burden based on information on salary levels and human cysticercosis prevalence in endemic areas of the world. In addition, the number of DALYs lost was higher than estimates already available for some other neglected tropical diseases in sub-Saharan Africa. Materials and Methods Study area West Cameroon comprises three provinces (West, South-West and North-West) with a population of about five million inhabitants [8]. Together with the north of Cameroon the western provinces are the main pig breeding regions of the country. Pig husbandry is still very traditional. Human defecation occurs quite often in the pigsties, so that many pigs have access to human faeces [911]. All conditions are present for an easy transmission of T. solium from man to pigs and vice versa [9,12]. Slaughtering of pigs usually occurs at home or on marketplaces with limited or no veterinary supervision. Tongue inspection is commonly carried out to detect cases of cysticercosis. Although there is a good network of private and public health centres in the region, the number of neurologists, neurosurgeons and psychiatrists in Cameroon is very small (8 for the whole country, nobody in West Cameroon) [13]. Imaging equipmen (...truncated)