Honduras became the first country in Latin America and the Caribbean to launch its national and integrated plan addressing neglected tropical diseases (NTDs) in April 2012; however, information gaps regarding the prevalence and intensity of soil-transmitted helminth (STH or intestinal worm) infections remained. The first comprehensive historic review of soil-STH prevalence and research studies done in Honduras was recently published – the information analyzed and presented in the new article will be instrumental in the successful implementation of the country’s national plan on NTDs.
The article, titled “A Scoping Review and Prevalence Analysis of Soil-Transmitted Helminth Infections in Honduras,” was published in PLOS Neglected Tropical Diseases. Sabin Vaccine Institute’s Dr. Maria Elena Bottazzi, herself a Honduran and Deputy Director of Sabin’s Product Development Partnership, is one of the authors.
As part of their efforts, the researchers conducted a review of hundreds of studies dating back to May 1930, some of which had not been published. Using studies published between 2001 and 2012 that included epidemiological data from Honduras’ 18 departments, the researchers were able to produce STH prevalence maps. The researchers included the most recent information available after consulting with various groups involved in STH control activities, including the Ministry of Health, the Healthy Schools Program, the Parasitology Department of the School of Microbiology (part of the National Autonomous University of Honduras, UNAH), the World Food Program and the Pan American Health Organization (PAHO).
The results from their review are astounding – the researchers found that the prevalence of STH in 40.6 percent of the municipalities in Honduras is greater than 50 percent
The researchers also found that the STH prevalence was higher in municipalities with a lower socioeconomic status – those characterized by having a lower human development index and less access to safe drinking water or improved sanitation.
The Sabin Vaccine Institute’s Global Network for Neglected Tropical Diseases recently traveled to Honduras and witnessed the effects of intestinal worms on some of Honduras’ poorest communities, including those in the department of Choluteca. After speaking with a head teacher at Escuela Urbana Mixta Pedro Nufio (1st to 6th grade), we learned that 880 students attending the school were at risk for intestinal worms.
View photos from the trip below:
Children in Choluteca and across Honduras are being treated annually for intestinal worms thanks to Honduras’ national plan of action against NTDs. However, many children are still heavily infected. For example, some students in Choluteca expelled worms through their mouth and nose after receiving treatment – a sign of heavy infection.
However, progress is being made and the deworming of preschool children has been institutionalized as part of national vaccination week activities in the country. Honduras is continuing to lead in one of the fundamental components in the fight against NTDs: integration with infrastructure improvements in water and sanitation, supported by community education campaigns. This type of cross-sectoral integration will bring us closer to achieving the NTD 2020 control and elimination goals set by the WHO Roadmap.
We look forward to sharing stories of how the government of Honduras and its partners use the findings from this study to successfully implement their national plan on NTDs! We invite you to follow Dr. Bottazzi (@mebottazzi) and the PLOS NTDs journal (@PLOSNTDs) on Twitter, to keep up with new developments in the NTD field.
Brazil’s Bolsa Familia program contributed to a dramatic drop in poverty and inequality within the country, said Tereza Campello, Minister of Social Development and Fight Against Hunger at a January 29th event at the Woodrow Wilson Center.
The event, titled “A Conversation with Tereza Campello, Brazils Minister of Social Development and Fight Against Hunger,” was co-sponsored by the Woodrow Wilson Center’s Brazil Institute and the World Bank’s Latin America and the Caribbean Region and shed light on some of the progress made in poverty alleviation in the first 10 years of the Bolsa Família program.
Minister Campello began her discussion by saying that poverty and inequality in Brazil has dropped dramatically thanks to three main public policies: a raise in the minimum wage, the expansion of the formal job sector, and the Bolsa Família program. The program was launched in 2003 during former President Luiz Inácio Lula da Silva’s term. It is the largest conditional cash transfer program in the world, and is responsible for lifting 22 million people out of poverty. The three main goals of the program are to alleviate poverty and hunger; increase education attendance and reduce school drop-out rates; and improve access to health services for children, pregnant women, and women who are breastfeeding.
Since the beginning of the program, Bolsa Família has assisted over 50 million people over a quarter of Brazil’s population. In return for direct cash transfers, beneficiaries must ensure their children attend school and receive their vaccinations, and pregnant women must receive prenatal and postpartum care.
Minister Campello highlighted the following achievements from the Bolsa Família program in the focus area of health:
- 19.4% reduction in infant mortality rate,
- 52% decrease of chronic infant malnutrition in children up to 6 years of age,
- 58% reduction in death due to malnutrition,
- Drop from 16.8% to 14.5% in the rate of stunting in children up to 5 years of age,
- 50% increase in prenatal care,
- 46% reduction in deaths from diarrhea, and
- 99.1% vaccination rate in children.
Its impact has been greatest in the northeast and Amazon regions of the country, where poverty is more prevalent. Additionally, out of the total current beneficiaries of the program, 73% of them are afro-Brazilian women.
The success of Bolsa Família
Although Bolsa Família has been widely successful, challenges do remain. Brazil is the fifth largest country in the world with a population of more than 200 million people living in more than 5 thousand municipalities. To address this issue, the Brasil Sem Miséria plan (Brazil Without Poverty plan) was launched during President Dilma Rousseff’s term in 2011 in order to expand the reach of the Bolsa Família program. Through this complementary plan, the Ministry of Social Development and Fight Against Hunger is currently reaching out to an additional 9 million people who are not part of the Bolsa Família program but are in dire need of support.
Minister Campello closed the conversation by saying that the “end of poverty” is only the beginning. We join the Brazilian government in celebrating the first 10 years of Bolsa Família and we look forward to sharing many more success stories!
The Global Network for Neglected Tropical Diseases would like to congratulate Colombia on becoming the first country in the Americas to eliminate onchocerciasis. This Monday, July 29, Colombia received verification of the elimination of onchocerciasis from the World Health Organization (WHO). This is a great achievement in the field of neglected tropical diseases (NTDs) and global health!
Onchocerciasis, also known as river blindness, is an NTD caused by a parasitic worm and is transmitted by the bite of Simulium black flies. This NTD causes disfiguring and painful skin infections and eye lesions, and is the second leading infectious cause of blindness globally. Control and elimination efforts began in the region of the Americas in the early 1990s, primarily with the formation of the Onchocerciasis Elimination Program for the Americas (OEPA). OEPA, which is sponsored by the Carter Center, was launched in 1993 in response to the Pan American Health Organization’s (PAHO) resolution CD35.R14, which calls for the elimination of onchocerciasis from the Americas. At the time of the resolution, 500,000 people were at risk for onchocerciasis in the region and the NTD was endemic in 13 foci found in 6 countries: Brazil, Colombia, Ecuador, Guatemala, Mexico and Venezuela.
The recent success in Colombia is a result of close collaboration between Colombia’s Ministry of Health and Social Protection, Colombia’s National Institute of Health and its partners, which include The Carter Center and OEPA, PAHO, Merck and many others. In countries endemic for onchocerciasis, people were treated with ivermectin (Mectizan) through mass drug administration campaigns two to four times a year. The hard work and dedication demonstrated by the local health workers and community leaders in distributing the treatment and educational information was essential for achieving the goal to eliminate transmission of the disease. Ivermectin is donated by Merck & Co through the Mectizan Donation Program.
Ecuador may be the next country in the region to apply for verification of elimination, following the 3-year post-treatment surveillance phase established by the World Health Organization (WHO). Guatemala and Mexico will complete the 3-year post-treatment surveillance phase in 2014 and could then request verification from the WHO. The remaining two foci in the region are in southern Venezuela and northern Brazil, among the Yanomami indigenous community. A key to the elimination of onchocerciasis in the Yanomami area is an integration of activities to address other determinants of health and NTDs, such as strengthening primary care services, access to clean water and improved sanitation.
On the same day, energized by the announcement that Colombia received certification for the elimination of this NTD, the Colombian President Juan Manuel Santos and Minister of Health and Social Protection Alejandro Gaviria demonstrated once more their government’s commitment to the people of Colombia by launching its 5-year integrated national plan of action to address trachoma and soil-transmitted helminthes.
Colombia’s experience can help guide the efforts of other Latin American and African countries working towards elimination of this and other NTDs. Thanks to these great achievements, we are closer to seeing the end of the seven most common NTDs by 2020!
As we continue to celebrate all mothers around the world this week, we’d like to share with you the Global Network’s new policy brief, Better Health for Mothers and Children, which urges policymakers to integrate NTD treatment into programs designed for improving maternal, newborn and child health.
NTDs, especially intestinal parasites and schistosomiasis, contribute significantly to anemia and poor absorption of vital nutrients. In the developing world, more than half of all pregnant women are anemic and one-third of all pregnant women are infected with hookworm, which contributes to iron-deficiency anemia. NTD treatment is also important for all women of reproductive age, especially considering the estimated 10 to 19 percent of women of reproductive age who are severely undernourished.
The World Health Organization (WHO) recommends that pregnant women at risk for infection receive treatment for hookworm and schistosomiasis. The WHO also recommends deworming medication for preschool and school-aged children to protect them from these infections and to allow them to remain healthy and in school.
Integrating NTD treatment into existing maternal and child health efforts can help mitigate anemia, improve nutrition, and better equip a mother and her child’s immune system to fight off additional health threats, improving their overall health status and quality of life. As policymakers, non-profit organizations, and global leaders work to prepare the post-2015 development agenda, it is important for them to see the link between NTDs and women’s health and ensure that the programs include treatment for NTDs. For only 50 cents per person per year, pregnant mothers around the world can be protected from the effects of NTDs.
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