Modelling optimal allocation of resources in the context of an incurable disease

Nodding syndrome has affected and led to the deaths of children between the ages of 5 and 15 in Northern Uganda since 2009. There is no reliable explanation of the disease, and currently the only treatment is through a nutritional programme of vitamins, combined with medication to prevent symptoms. In the absence of a proper medical treatment, we develop a dynamic compartmental model to plan the management of the syndrome and to curb its effects. We use incidence data from 2012 and 2013 from Pader, Lamwo and Kitgum regions of Uganda to parameterize the model. The model is then used to look at how to best plan the nutritional programme in terms of first getting children on to the programme through outreach, and then making sure they remain on the programme, through follow-up. For the current outbreak of nodding disease, we estimate that about half of available resources should be put into outreach. We show how to optimize the balance between outreach and follow-up in this particular example, and provide a general methodology for allocating resources in similar situations. Given the uncertainty of parameter estimates in such situations, we perform a robustness analysis to identify the best investment strategy. Our analysis offers a way of using available data to determine the best investment strategy of controlling nodding syndrome.自2009年起，点头综合征（Nodding syndrome）已对乌干达北部5至15岁儿童造成健康损害并导致其死亡。目前针对该疾病尚无可靠的病因解释，现有唯一治疗方案仅为采用维生素营养干预结合症状预防药物的联合疗法。鉴于缺乏有效的临床治疗手段，我们构建了动态分室模型，以规划该综合征的防控管理并抑制其扩散影响。我们使用乌干达帕德（Pader）、兰沃（Lamwo）和基图姆（Kitgum）地区2012年与2013年的发病数据对模型进行参数化校准。随后依托该模型探索最优的营养干预方案规划策略：首先通过外展服务推动儿童加入干预项目，再通过随访保障儿童坚持完成全程干预。针对本次点头病暴发疫情，我们估算得出约需将可用资源的半数投入外展服务环节。本研究展示了在该特定案例中如何优化外展服务与随访之间的资源分配平衡，并提出了一套可在类似场景下指导资源分配的通用方法论。考虑到此类场景中参数估计存在不确定性，我们开展了稳健性分析以确定最优资源投入策略。本研究为利用现有数据制定点头综合征防控的最优资源投入方案提供了可行路径。