title: The actual and potential costs of meningitis surveillance in the African meningitis belt: Results from Chad and Niger.
abstract: BACKGROUND
  The introduction of serogroup A meningococcal conjugate vaccine in the African meningitis belt required strengthened surveillance to assess long-term vaccine impact. The costs of implementing this strengthening had not been assessed.
  
  
  METHODS
  The ingredients approach was used to retrospectively determine bacterial meningitis surveillance costs in Chad and Niger in 2012. Resource use and unit cost data were collected through interviews with staff at health facilities, laboratories, government offices and international partners, and by reviewing financial reports. Sample costs were extrapolated to national level and costs of upgrading to desired standards were estimated.
  
  
  RESULTS
  Case-based surveillance had been implemented in all 12 surveyed hospitals and 29 of 33 surveyed clinics in Niger, compared to six out of 21 clinics surveyed in Chad. Lumbar punctures were performed in 100% of hospitals and clinics in Niger, compared to 52% of the clinics in Chad. The total costs of meningitis surveillance were US$ 1,951,562 in Niger and US$ 338,056 in Chad, with costs per capita of US$ 0.12 and US$ 0.03, respectively. Laboratory investigation was the largest cost component per surveillance functions, comprising 51% of the total costs in Niger and 40% in Chad. Personnel resources comprised the biggest expense type: 37% of total costs in Niger and 26% in Chad. The estimated annual, incremental costs of upgrading current systems to desired standards were US$ 183,299 in Niger and US$ 605,912 in Chad, which are 9% and 143% of present costs, respectively.
  
  
  CONCLUSIONS
  Niger's more robust meningitis surveillance system costs four times more per capita than the system in Chad. Since Chad spends less per capita, fewer activities are performed, which weakens detection and analysis of cases. Countries in the meningitis belt are diverse, and can use these results to assess local costs for adapting surveillance systems to monitor vaccine impact.
authors.affiliation: Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1). Electronic address: mirurzunlopez@aamp.org.
authors.forename: Maite
authors.initials: M
authors.lastname: Irurzun-Lopez
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom(2).
authors.forename: Ngozi A
authors.initials: NA
authors.lastname: Erondu
authors.affiliation: Faculté de Médecine Université de Niamey, Niger(3).
authors.forename: Ali
authors.initials: A
authors.lastname: Djibo
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom(2).
authors.forename: Ulla
authors.initials: U
authors.lastname: Griffiths
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom(2); World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland(4).
authors.forename: James M
authors.initials: JM
authors.lastname: Stuart
authors.affiliation: World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland(4).
authors.forename: Katya
authors.initials: K
authors.lastname: Fernandez
authors.affiliation: World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland(4).
authors.forename: Olivier
authors.initials: O
authors.lastname: Ronveaux
authors.affiliation: Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1).
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Le Gargasson
authors.affiliation: Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1).
authors.forename: Bradford D
authors.initials: BD
authors.lastname: Gessner
authors.affiliation: Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1).
authors.forename: Anaïs
authors.initials: A
authors.lastname: Colombini
mesh_terms: D002596:Chad / Q000453:epidemiology; D003365:Costs and Cost Analysis; D062665:Epidemiological Monitoring; D017048:Health Care Costs; D006801:Humans; D016920:Meningitis, Bacterial / Q000191:economics* / Q000453:epidemiology*; D009548:Niger / Q000453:epidemiology; D011159:Population Surveillance
keywords: Chad; Cost; Meningitis; Niger; Surveillance