Factors Associated with the Performance and Cost-Effectiveness of Using Lymphatic Filariasis Transmission Assessment Surveys for Monitoring Soil-Transmitted Helminths: A Case Study in Kenya
Identifieur interne : 003A94 ( Pmc/Curation ); précédent : 003A93; suivant : 003A95Factors Associated with the Performance and Cost-Effectiveness of Using Lymphatic Filariasis Transmission Assessment Surveys for Monitoring Soil-Transmitted Helminths: A Case Study in Kenya
Auteurs : Jennifer L. Smith ; Hugh J. W. Sturrock ; Liya Assefa ; Birgit Nikolay ; Sammy M. Njenga ; Jimmy Kihara ; Charles S. Mwandawiro ; Simon J. BrookerSource :
- The American Journal of Tropical Medicine and Hygiene [ 0002-9637 ] ; 2015.
Abstract
Transmission assessment surveys (TAS) for lymphatic filariasis have been proposed as a platform to assess the impact of mass drug administration (MDA) on soil-transmitted helminths (STHs). This study used computer simulation and field data from pre- and post-MDA settings across Kenya to evaluate the performance and cost-effectiveness of the TAS design for STH assessment compared with alternative survey designs. Variations in the TAS design and different sample sizes and diagnostic methods were also evaluated. The district-level TAS design correctly classified more districts compared with standard STH designs in pre-MDA settings. Aggregating districts into larger evaluation units in a TAS design decreased performance, whereas age group sampled and sample size had minimal impact. The low diagnostic sensitivity of Kato-Katz and mini-FLOTAC methods was found to increase misclassification. We recommend using a district-level TAS among children 8–10 years of age to assess STH but suggest that key consideration is given to evaluation unit size.
Url:
DOI: 10.4269/ajtmh.14-0435
PubMed: 25487730
PubMed Central: 4347340
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Factors Associated with the Performance and Cost-Effectiveness of Using Lymphatic Filariasis Transmission Assessment Surveys for Monitoring Soil-Transmitted Helminths: A Case Study in Kenya</title><author><name sortKey="Smith, Jennifer L" sort="Smith, Jennifer L" uniqKey="Smith J" first="Jennifer L." last="Smith">Jennifer L. Smith</name></author><author><name sortKey="Sturrock, Hugh J W" sort="Sturrock, Hugh J W" uniqKey="Sturrock H" first="Hugh J. W." last="Sturrock">Hugh J. W. Sturrock</name></author><author><name sortKey="Assefa, Liya" sort="Assefa, Liya" uniqKey="Assefa L" first="Liya" last="Assefa">Liya Assefa</name></author><author><name sortKey="Nikolay, Birgit" sort="Nikolay, Birgit" uniqKey="Nikolay B" first="Birgit" last="Nikolay">Birgit Nikolay</name></author><author><name sortKey="Njenga, Sammy M" sort="Njenga, Sammy M" uniqKey="Njenga S" first="Sammy M." last="Njenga">Sammy M. 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Brooker</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25487730</idno><idno type="pmc">4347340</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4347340</idno><idno type="RBID">PMC:4347340</idno><idno type="doi">10.4269/ajtmh.14-0435</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">003A95</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003A95</idno><idno type="wicri:Area/Pmc/Curation">003A94</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">003A94</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Factors Associated with the Performance and Cost-Effectiveness of Using Lymphatic Filariasis Transmission Assessment Surveys for Monitoring Soil-Transmitted Helminths: A Case Study in Kenya</title><author><name sortKey="Smith, Jennifer L" sort="Smith, Jennifer L" uniqKey="Smith J" first="Jennifer L." last="Smith">Jennifer L. Smith</name></author><author><name sortKey="Sturrock, Hugh J W" sort="Sturrock, Hugh J W" uniqKey="Sturrock H" first="Hugh J. W." last="Sturrock">Hugh J. W. Sturrock</name></author><author><name sortKey="Assefa, Liya" sort="Assefa, Liya" uniqKey="Assefa L" first="Liya" last="Assefa">Liya Assefa</name></author><author><name sortKey="Nikolay, Birgit" sort="Nikolay, Birgit" uniqKey="Nikolay B" first="Birgit" last="Nikolay">Birgit Nikolay</name></author><author><name sortKey="Njenga, Sammy M" sort="Njenga, Sammy M" uniqKey="Njenga S" first="Sammy M." last="Njenga">Sammy M. Njenga</name></author><author><name sortKey="Kihara, Jimmy" sort="Kihara, Jimmy" uniqKey="Kihara J" first="Jimmy" last="Kihara">Jimmy Kihara</name></author><author><name sortKey="Mwandawiro, Charles S" sort="Mwandawiro, Charles S" uniqKey="Mwandawiro C" first="Charles S." last="Mwandawiro">Charles S. Mwandawiro</name></author><author><name sortKey="Brooker, Simon J" sort="Brooker, Simon J" uniqKey="Brooker S" first="Simon J." last="Brooker">Simon J. Brooker</name></author></analytic><series><title level="j">The American Journal of Tropical Medicine and Hygiene</title><idno type="ISSN">0002-9637</idno><idno type="eISSN">1476-1645</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Transmission assessment surveys (TAS) for lymphatic filariasis have been proposed as a platform to assess the impact of mass drug administration (MDA) on soil-transmitted helminths (STHs). This study used computer simulation and field data from pre- and post-MDA settings across Kenya to evaluate the performance and cost-effectiveness of the TAS design for STH assessment compared with alternative survey designs. Variations in the TAS design and different sample sizes and diagnostic methods were also evaluated. The district-level TAS design correctly classified more districts compared with standard STH designs in pre-MDA settings. Aggregating districts into larger evaluation units in a TAS design decreased performance, whereas age group sampled and sample size had minimal impact. The low diagnostic sensitivity of Kato-Katz and mini-FLOTAC methods was found to increase misclassification. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Am J Trop Med Hyg</journal-id><journal-id journal-id-type="iso-abbrev">Am. J. Trop. Med. Hyg</journal-id><journal-id journal-id-type="publisher-id">tpmd</journal-id><journal-title-group><journal-title>The American Journal of Tropical Medicine and Hygiene</journal-title></journal-title-group><issn pub-type="ppub">0002-9637</issn><issn pub-type="epub">1476-1645</issn><publisher><publisher-name>The American Society of Tropical Medicine and Hygiene</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25487730</article-id><article-id pub-id-type="pmc">4347340</article-id><article-id pub-id-type="doi">10.4269/ajtmh.14-0435</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Factors Associated with the Performance and Cost-Effectiveness of Using Lymphatic Filariasis Transmission Assessment Surveys for Monitoring Soil-Transmitted Helminths: A Case Study in Kenya</article-title><alt-title alt-title-type="left-running-head">SMITH AND OTHERS</alt-title><alt-title alt-title-type="right-running-head">TAS AS A PLATFORM FOR MONITORING SOIL-TRANSMITTED HELMINTHS</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Smith</surname><given-names>Jennifer L.</given-names></name><xref ref-type="corresp" rid="COR1">*</xref></contrib><contrib contrib-type="author"><name><surname>Sturrock</surname><given-names>Hugh J. W.</given-names></name></contrib><contrib contrib-type="author"><name><surname>Assefa</surname><given-names>Liya</given-names></name></contrib><contrib contrib-type="author"><name><surname>Nikolay</surname><given-names>Birgit</given-names></name></contrib><contrib contrib-type="author"><name><surname>Njenga</surname><given-names>Sammy M.</given-names></name></contrib><contrib contrib-type="author"><name><surname>Kihara</surname><given-names>Jimmy</given-names></name></contrib><contrib contrib-type="author"><name><surname>Mwandawiro</surname><given-names>Charles S.</given-names></name></contrib><contrib contrib-type="author"><name><surname>Brooker</surname><given-names>Simon J.</given-names></name></contrib></contrib-group><aff id="AFF1">Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Global Health Group, University of California San Francisco, San Francisco, California; Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya</aff><author-notes><corresp id="COR1">*Address correspondence to Jennifer L. Smith, Global Health Group, University of California San Francisco, 50 Beale Street, San Francisco, CA 94105. E-mail: <email>Jennifer.Smith@ucsf.edu</email></corresp></author-notes><pub-date pub-type="ppub"><day>04</day><month>2</month><year>2015</year></pub-date><pub-date pub-type="pmc-release"><day>04</day><month>2</month><year>2015</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>92</volume><issue>2</issue><fpage>342</fpage><lpage>353</lpage><history><date date-type="received"><day>11</day><month>7</month><year>2014</year></date><date date-type="accepted"><day>06</day><month>10</month><year>2014</year></date></history><permissions><copyright-statement>©The American Society of Tropical Medicine and Hygiene</copyright-statement><copyright-year>2015</copyright-year><license license-type="open-access"><license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><p>Transmission assessment surveys (TAS) for lymphatic filariasis have been proposed as a platform to assess the impact of mass drug administration (MDA) on soil-transmitted helminths (STHs). This study used computer simulation and field data from pre- and post-MDA settings across Kenya to evaluate the performance and cost-effectiveness of the TAS design for STH assessment compared with alternative survey designs. Variations in the TAS design and different sample sizes and diagnostic methods were also evaluated. The district-level TAS design correctly classified more districts compared with standard STH designs in pre-MDA settings. Aggregating districts into larger evaluation units in a TAS design decreased performance, whereas age group sampled and sample size had minimal impact. The low diagnostic sensitivity of Kato-Katz and mini-FLOTAC methods was found to increase misclassification. We recommend using a district-level TAS among children 8–10 years of age to assess STH but suggest that key consideration is given to evaluation unit size.</p></abstract></article-meta></front><floats-group><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Overview of survey design characteristics and initial values for transmission assessment survey (TAS) and current recommended approaches for soil-transmitted helminth surveillance</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1">Design</th><th align="center" rowspan="1" colspan="1">Evaluation unit (EU)</th><th align="center" rowspan="1" colspan="1">Number clusters</th><th align="center" rowspan="1" colspan="1">Total sample per EU</th><th align="center" rowspan="1" colspan="1">Age range (years)</th><th align="center" rowspan="1" colspan="1">Diagnostic</th></tr></thead><tbody><tr><td rowspan="2" colspan="1">TAS</td><td rowspan="1" colspan="1">District</td><td rowspan="1" colspan="1">≥ 30<xref ref-type="table-fn" rid="TFN1">*</xref></td><td rowspan="1" colspan="1">308</td><td rowspan="1" colspan="1">6–7/8–10</td><td rowspan="1" colspan="1">Gold standard</td></tr><tr><td rowspan="1" colspan="1">Aggregated districts</td><td rowspan="1" colspan="1">≥ 30<xref ref-type="table-fn" rid="TFN1">*</xref></td><td rowspan="1" colspan="1">308</td><td rowspan="1" colspan="1">6–7/8–10</td><td rowspan="1" colspan="1">Gold standard</td></tr><tr><td rowspan="1" colspan="1">WHO</td><td rowspan="1" colspan="1">Ecological zones</td><td rowspan="1" colspan="1">5</td><td rowspan="1" colspan="1">250</td><td rowspan="1" colspan="1">5–16</td><td rowspan="1" colspan="1">Gold standard</td></tr><tr><td rowspan="1" colspan="1">Standard</td><td rowspan="1" colspan="1">Districts</td><td rowspan="1" colspan="1">5</td><td rowspan="1" colspan="1">250</td><td rowspan="1" colspan="1">5—16</td><td rowspan="1" colspan="1">Gold standard</td></tr></tbody></table><table-wrap-foot><fn id="TFN1"><label>*</label><p>Number of clusters determined according to TAS design based on population size and vector (<italic>Anopheles</italic>).</p></fn></table-wrap-foot></table-wrap><table-wrap id="T2" position="float"><label>Table 2</label><caption><p>Components used in the standard TAS evaluation and parameters varied to assess the impact of sample size and diagnostic sensitivity</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1">Component</th><th align="center" rowspan="1" colspan="1">Standard TAS design</th><th colspan="3" align="center" rowspan="1">Varied parameters</th></tr></thead><tbody><tr><td rowspan="1" colspan="1">Evaluation unit</td><td rowspan="1" colspan="1">Districts</td><td colspan="3" rowspan="1">–</td></tr><tr><td rowspan="1" colspan="1">Age range</td><td rowspan="1" colspan="1">8–10 years</td><td colspan="3" rowspan="1">–</td></tr><tr><td rowspan="2" colspan="1">Sample size</td><td rowspan="1" colspan="1">Number clusters: 30+</td><td colspan="3" rowspan="1">Number clusters: 30+</td></tr><tr><td rowspan="1" colspan="1">Total sample: 308</td><td colspan="3" rowspan="1">Total sample: 100, 200, 308, 500</td></tr><tr><td rowspan="6" colspan="1">Diagnostic<xref ref-type="table-fn" rid="TFN2">*</xref></td><td rowspan="6" colspan="1">Gold standard</td><td rowspan="3" colspan="1">Kato-Katz</td><td rowspan="1" colspan="1"><italic>A. lumbricoides</italic></td><td rowspan="1" colspan="1">63.8 (59.1–68.6)</td></tr><tr><td rowspan="1" colspan="1"><italic>T. trichiuria</italic></td><td rowspan="1" colspan="1">82.2 (80.1–84.5)</td></tr><tr><td rowspan="1" colspan="1">Hookworm</td><td rowspan="1" colspan="1">59.5 (56.9–62.2)</td></tr><tr><td rowspan="3" colspan="1">mini-FLOTAC</td><td rowspan="1" colspan="1"><italic>A. lumbricoides</italic></td><td rowspan="1" colspan="1">75.5 (54.0–95.9)</td></tr><tr><td rowspan="1" colspan="1"><italic>T. trichiuria</italic></td><td rowspan="1" colspan="1">76.2 (33.9–99.4)</td></tr><tr><td rowspan="1" colspan="1">Hookworm</td><td rowspan="1" colspan="1">79.2 (72.7–85.9)</td></tr></tbody></table><table-wrap-foot><fn id="TFN2"><label>*</label><p>Lower, midpoint, and upper sensitivity estimates correspond to those reported in <xref ref-type="table" rid="T3">Table 3</xref> and derived from Nikolay and others (in press).<xref rid="R31" ref-type="bibr">31</xref>.</p></fn><fn id="TFN3"><p>TAS = transmission assessment survey.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T3" position="float"><label>Table 3</label><caption><p>Performance of TAS, district-based and ecozone-based STH survey designs in coastal and western regions of Kenya described in <xref ref-type="table" rid="T2">Table 2</xref>. Simulations assume a perfect diagnostic sensitivity and specificity</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="2" colspan="1">Survey method</th><th align="center" colspan="3" rowspan="1">Pre MDA</th><th align="center" colspan="3" rowspan="1">Post MDA</th></tr><tr><th align="center" rowspan="1" colspan="1">Mean error<xref ref-type="table-fn" rid="TFN4">*</xref></th><th align="center" rowspan="1" colspan="1">Mean absolute error<xref ref-type="table-fn" rid="TFN5">†</xref></th><th align="center" rowspan="1" colspan="1">Proportion districts correctly classified‡</th><th align="center" rowspan="1" colspan="1">Mean error<xref ref-type="table-fn" rid="TFN4">*</xref></th><th align="center" rowspan="1" colspan="1">Mean absolute error<xref ref-type="table-fn" rid="TFN5">†</xref></th><th align="center" rowspan="1" colspan="1">Proportion districts correctly classified<xref ref-type="table-fn" rid="TFN6">§</xref></th></tr></thead><tbody><tr><td rowspan="1" colspan="1">TAS, 6–7 y</td><td rowspan="1" colspan="1">0.02</td><td rowspan="1" colspan="1">0.04</td><td rowspan="1" colspan="1">0.86</td><td rowspan="1" colspan="1">0.01</td><td rowspan="1" colspan="1">0.02</td><td rowspan="1" colspan="1">0.77</td></tr><tr><td rowspan="1" colspan="1">TAS, 8–10 y</td><td rowspan="1" colspan="1">0.02</td><td rowspan="1" colspan="1">0.03</td><td rowspan="1" colspan="1">0.88</td><td rowspan="1" colspan="1">0.01</td><td rowspan="1" colspan="1">0.02</td><td rowspan="1" colspan="1">0.76</td></tr><tr><td rowspan="1" colspan="1">TAS, aggregate, 6–7 y</td><td rowspan="1" colspan="1">−0.02</td><td rowspan="1" colspan="1">0.10</td><td rowspan="1" colspan="1">0.71</td><td rowspan="1" colspan="1">0.01</td><td rowspan="1" colspan="1">0.03</td><td rowspan="1" colspan="1">0.64</td></tr><tr><td rowspan="1" colspan="1">TAS, aggregate, 8–10 y</td><td rowspan="1" colspan="1">−0.03</td><td rowspan="1" colspan="1">0.11</td><td rowspan="1" colspan="1">0.72</td><td rowspan="1" colspan="1">0.02</td><td rowspan="1" colspan="1">0.03</td><td rowspan="1" colspan="1">0.62</td></tr><tr><td rowspan="1" colspan="1">STH survey (districts)</td><td rowspan="1" colspan="1">0.02</td><td rowspan="1" colspan="1">0.06</td><td rowspan="1" colspan="1">0.81</td><td rowspan="1" colspan="1">0.02</td><td rowspan="1" colspan="1">0.03</td><td rowspan="1" colspan="1">0.65</td></tr><tr><td rowspan="1" colspan="1">STH survey (ecozones)</td><td rowspan="1" colspan="1">−0.00</td><td rowspan="1" colspan="1">0.14</td><td rowspan="1" colspan="1">0.63</td><td rowspan="1" colspan="1">0.03</td><td rowspan="1" colspan="1">0.04</td><td rowspan="1" colspan="1">0.52</td></tr></tbody></table><table-wrap-foot><fn id="TFN4"><label>*</label><p>Mean of the estimated prevalence minus the true prevalence.</p></fn><fn id="TFN5"><label>†</label><p>Mean of the absolute value of the estimate prevalence minus the true prevalence.</p></fn><fn id="TFN6"><label>§</label><p>Proportion of times districts were correctly classified in relation to the MDA prevalence thresholds defined in <xref ref-type="table" rid="T1">Table 1</xref>.</p></fn><fn id="TFN7"><p>TAS = transmission assessment survey; STH = soil-transmitted helminth; MDA = mass drug administration.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T4" position="float"><label>Table 4</label><caption><p>Impact of variation in sample size and diagnostic sensitivity of Kato-Katz and mini-FLOTAC on performance and cost<xref ref-type="table-fn" rid="TFN8">*</xref></p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="2" colspan="1"></th><th align="center" colspan="6" rowspan="1">Proportion correctly classified<xref ref-type="table-fn" rid="TFN9">†</xref></th></tr><tr><th align="center" colspan="2" rowspan="1">Pre-MDA</th><th align="center" colspan="2" rowspan="1">Post-MDA</th><th align="center" colspan="2" rowspan="1">Survey costs</th></tr><tr><td rowspan="1" colspan="1">Sample Size</td><td rowspan="1" colspan="1">Kato-Katz</td><td rowspan="1" colspan="1">mini-FLOTAC</td><td rowspan="1" colspan="1">Kato-Katz</td><td rowspan="1" colspan="1">mini-FLOTAC</td><td rowspan="1" colspan="1">Kato-Katz</td><td rowspan="1" colspan="1">mini-FLOTAC</td></tr></thead><tbody><tr><td rowspan="1" colspan="1">100</td><td rowspan="1" colspan="1">72.1 (69.2, 74.7)</td><td rowspan="1" colspan="1">80.0 (66.2, 82.1)</td><td rowspan="1" colspan="1">71.8 (71.1, 72.1)</td><td rowspan="1" colspan="1">73.2 (70.0, 71.1)</td><td rowspan="1" colspan="1">1144</td><td rowspan="1" colspan="1">1589</td></tr><tr><td rowspan="1" colspan="1">200</td><td rowspan="1" colspan="1">74.4 (71.7, 76.8)</td><td rowspan="1" colspan="1">81.5 (68.0, 84.8)</td><td rowspan="1" colspan="1">77.0 (75.5, 77.2)</td><td rowspan="1" colspan="1">79.5 (72.6, 76.7)</td><td rowspan="1" colspan="1">1191</td><td rowspan="1" colspan="1">1948</td></tr><tr><td rowspan="1" colspan="1">308</td><td rowspan="1" colspan="1">75.5 (72.3, 77.5)</td><td rowspan="1" colspan="1">81.8 (68.8, 85.8)</td><td rowspan="1" colspan="1">78.4 (77.3, 79.4)</td><td rowspan="1" colspan="1">81.2 (72.9, 78.6)</td><td rowspan="1" colspan="1">1249</td><td rowspan="1" colspan="1">2318</td></tr><tr><td rowspan="1" colspan="1">500</td><td rowspan="1" colspan="1">76.1 (73.8, 77.7)</td><td rowspan="1" colspan="1">82.2 (69.4, 86.9)</td><td rowspan="1" colspan="1">80.0 (78.6, 81.2)</td><td rowspan="1" colspan="1">83.7 (72.9, 81.3)</td><td rowspan="1" colspan="1">1344</td><td rowspan="1" colspan="1">2868</td></tr></tbody></table><table-wrap-foot><fn id="TFN8"><label>*</label><p>Performance is measured by the proportion of times that districts were correctly classified in relation to standard prevalence thresholds by alternative district-level TAS designs in pre- and post-MDA contexts.</p></fn><fn id="TFN9"><label>†</label><p>Corresponding to midpoint, lower and upper estimates of diagnostic sensitivity.</p></fn><fn id="TFN10"><p>MDA = mass drug administration.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T5" position="float"><label>Table 5</label><caption><p>Median and 95% confidence interval of the ratio of total cost per district receiving adequate treatment (or better) based on prevalence estimates using Kato-Katz and mini-FLOTAC in pre-MDA and post-MDA contexts, compared with the median total cost per district receiving adequate treatment (or better) using TAS decision rules and Kato-Katz<xref ref-type="table-fn" rid="TFN11">*</xref><xref ref-type="table-fn" rid="TFN12">†</xref></p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="3" colspan="1">Sample size</th><th align="center" colspan="4" rowspan="1">Pre-MDA</th><th align="center" colspan="4" rowspan="1">Post-MDA</th></tr><tr><th align="center" colspan="4" rowspan="1">Cost ratio (per adequate treatment)</th><th align="center" colspan="4" rowspan="1">Cost ratio (per adequate treatment)</th></tr><tr><th align="center" colspan="2" rowspan="1">Kato-Katz</th><th align="center" colspan="2" rowspan="1">Mini-FLOTAC</th><th align="center" colspan="2" rowspan="1">Kato-Katz</th><th align="center" colspan="2" rowspan="1">Mini-FLOTAC</th></tr></thead><tbody><tr><td rowspan="1" colspan="1">100</td><td rowspan="1" colspan="1">1.14</td><td rowspan="1" colspan="1">1.01, 1.36</td><td rowspan="1" colspan="1">1.08</td><td rowspan="1" colspan="1">0.92, 1.44</td><td rowspan="1" colspan="1">0.88</td><td rowspan="1" colspan="1">0.73, 1.04</td><td rowspan="1" colspan="1">0.88</td><td rowspan="1" colspan="1">0.76, 1.03</td></tr><tr><td rowspan="1" colspan="1">200</td><td rowspan="1" colspan="1">1.11</td><td rowspan="1" colspan="1">0.99, 1.31</td><td rowspan="1" colspan="1">1.05</td><td rowspan="1" colspan="1">0.91, 1.40</td><td rowspan="1" colspan="1">0.85</td><td rowspan="1" colspan="1">0.72, 1.02</td><td rowspan="1" colspan="1">0.85</td><td rowspan="1" colspan="1">0.73, 1.02</td></tr><tr><td rowspan="1" colspan="1">308</td><td rowspan="1" colspan="1">1.10</td><td rowspan="1" colspan="1">0.99, 1.30</td><td rowspan="1" colspan="1">1.04</td><td rowspan="1" colspan="1">0.89, 1.38</td><td rowspan="1" colspan="1">0.84</td><td rowspan="1" colspan="1">0.70, 1.00</td><td rowspan="1" colspan="1">0.84</td><td rowspan="1" colspan="1">0.72, 1.01</td></tr><tr><td rowspan="1" colspan="1">500</td><td rowspan="1" colspan="1">1.09</td><td rowspan="1" colspan="1">0.99, 1.28</td><td rowspan="1" colspan="1">1.03</td><td rowspan="1" colspan="1">0.89, 1.36</td><td rowspan="1" colspan="1">0.84</td><td rowspan="1" colspan="1">0.70, 0.99</td><td rowspan="1" colspan="1">0.83</td><td rowspan="1" colspan="1">0.71, 1.01</td></tr></tbody></table><table-wrap-foot><fn id="TFN11"><label>*</label><p>Estimates include survey and treatment costs and incorporate diagnostic and sampling uncertainty by modeling the upper and lower 95% confidence interval associated with the low, high and midpoint estimate of diagnostic sensitivity. When the costs for a given prevalence design are equal to the costs of a standard TAS design using a decision rule, then the cost ratio will be one. A cost ratio greater than or less than one indicates respectively higher or lower costs per district correctly classified compared with the standard TAS with decision rule.</p></fn><fn id="TFN12"><label>†</label><p>Corresponding to midpoint, upper and lower estimates of diagnostic sensitivity.</p></fn><fn id="TFN13"><p>MDA = mass drug administration; TAS = transmission assessment survey.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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