How resource limitations and household economics may?compromise efforts to safeguard children during outbreaks

摘要

Background: Epidemiological models have been employed with great success to explore the efficacy of alternativestrategies at combating disease outbreaks. These models have often incorporated an understanding of age-basedsusceptibility and severity of outcome, considering how to limit the adverse outcomes or disease burden relative toan age structure. Such models frequently recommend the preferential treatment/vaccination of children orthe elderly, demonstrating how prevention of serious disease within these etiological subgroups can provide bothprotection within the subgroup itself and indirect protection to the broader population. However, it is mostfrequently the case that these target populations are consumers, rather than providers, of household resources. Inareas of the globe where continued health of household members relies on continued provision of resources, thesemodels may fail to provide the most effective overall strategies for health outcomes in both target populations andoverall. This is particularly important for tropical diseases impacting rural and low-income areas in which the diseasemay be endemic or newly emergent, particularly in the wake of natural disasters.Methods: We propose a modified epidemiological model with targeted treatment in resource-limited populations.We evaluate the model over a broad parameter space.Results: This model demonstrates how economic limitations may shift the optimal strategy. It may beadvantageous to treat populations at lesser direct risk if they are responsible for providing secondary protection tohigher-risk population(s) by producing household resources. Evaluation of this model over the parameter spacereveals that, in some cases, targeting treatment towards consumers may result in greater numbers of consumerinfections.Conclusions: Our results demonstrate how household resource limitation can drastically affect the impact oftargeted treatment strategies for limiting epidemics. Depending on the economic circumstances, it is possible thatfocusing treatment on consumers such as children can produce a counter-intuitive outcome in which morechildren contract the disease.