The cost of responding to a waterborne cholera outbreak in a village in Uganda compared to a simple hypothetical intervention, 2016

Introduction : in September 2015, a cholera outbreak occurred in a village in Hoima District, western Uganda. The Ministry of Health assembled a rapid response team, with support by CDC, UNICEF and WHO, to investigate the outbreak, establish the Kaiso Cholera Treatment Center (KCTC), and implement control measures. The team identified 120 cholera cases (with 5 deaths) and determined that drinking contaminated water from the lakeshore caused this outbreak. We sought to determine the cost of investigating and controlling this outbreak, and compare it to a would-be simple preventive measure, constructing deep wells to provide cleaner water. Methods : we collected cost data, including personnel and material costs at KCTC, health facilities, Hoima District Health Office, Uganda Public Health Fellowship Program, UNICEF, CDC, and WHO. We defined direct cost of responding to this outbreak as expenditure on medications, medical equipment and supplies, utilities, and allowances and transport for responders; indirect cost included salary and other compensations for responders. We did not include difficult-to-measure costs such as vehicle depreciation, building maintenance, and loss of productivity to case-persons due to illness and deaths. The cost of constructing deep wells was quoted by a U.S.-based NGO. Results : the total cost incurred in investigating and controlling this outbreak was $71,769, including $21,059 in direct cost ($19,225 for allowances and transportation, $1,774 for medical equipment and supplies, and $60 for utilities), and $50,620 in indirect cost (74,484 person-hours of salary and other compensations for responders). Conversely, constructing a deep well to provide cleaner water would cost approximately $2500. Essentially, the total cost incurred in this outbreak would have been enough to construct 28 (=71769/2500) deep wells; even the direct cost only would have been enough to construct 8 (=21059/2500) deep wells. One such deep well would have prevented this outbreak and averted future waterborne outbreaks. Conclusion : a simple prevention measure such as constructing deep wells for village residents can be substantially cost-effective for preventing waterborne diseases such as cholera. We recommend that the government should proactively implement prevention measures for waterborne outbreaks whenever possible, instead of passively responding to these outbreaks.