Category Archives: hookworm

The Global NGO Deworming Inventory: Taking Stock of Progress against NTDs

Child receiving treatment CameroonAccording to the World Health Organization (WHO), an estimated 873 million children are at risk of soil-transmitted helminths (STH), including roundworm, hookworm and whipworm. In children, STH infections can lead to malnutrition, anemia and stunting. In both adults and children, they can cause fatigue, intense abdominal pain and chronic diarrhea. In severe cases they can even cause bowel obstruction, rectal prolapse and appendicitis.

To improve health and development in infected communities and reduce the prevalence of neglected tropical diseases (NTDs), WHO aims to control STH and schistosomiasis by 2020. Meeting this goal requires regularly deworming at minimum 75 percent of the preschool-age and school-age children who are at risk of STH or schistosomiasis. To ensure such an ambitious global goal is met, it is paramount that ministries of health, WHO and non-governmental organizations (NGOs) coordinate and share data.

WHO operates the Preventive Chemotherapy and Transmission Control (PCT) Databank, which tracks the number of children given PCT for STH, schistosomiasis and three other NTDs. The databank is populated largely by information reported by ministries of health and helps policymakers and implementers understand where deworming programs are active and where more interventions are needed to meet the WHO target of controlling STH and schistosomiasis by 2020.

However, gaps in the PCT Databank have become apparent. The 2013 STH preschool treatment data was recently revised when supplementary data was submitted by UNICEF. This data caused a 104 percent increase in the recorded number of preschool-age children treated for STH. Clearly, better coordination is needed to ensure the global community meets 2020 goals.

To facilitate better coordination among WHO, ministries of health and NGOs, the Global NGO Deworming Inventory collects data from NGOs administering deworming treatments for STH and schistosomiasis. The data are compiled into a single database with disease-specific information by Children Without Worms (CWW).

After the data are compiled, WHO will merge the CWW database with national program data provided by ministries of health to the PCT Databank. This effort will make deworming dollars go even further by strengthening program monitoring and leading to an efficient use of resources. Ultimately, it will be an important step in controlling STH and schistosomiasis.

You can learn more about the Global NGO Deworming Inventory — and implementers can submit their data — at

Helen Keller International and TOMS: Motivating Community Drug Distributors in Sierra Leone



Efforts to fight Neglected Tropical Diseases (NTDs) are truly massive undertakings, since their success hinges upon the ability of national NTD programs to literally reach millions of people and provide each and every person with preventive medications.

Sierra Leone is one of many countries that has risen to this challenge. With a population exceeding 6 million people, the country’s NTD program relies on approximately 30,000 Community Drug Distributors (CDDs) to distribute NTD medications throughout its 12 rural districts.

And if recruiting, organizing and managing that many CDDs weren’t enough of a challenge, there’s one other detail that’s worth noting. Although these 30,000 CDDs must spend days, if not weeks, ensuring that their communities receive drugs that will prevent blindness, kidney and liver disease, malnutrition, and physical deformities, none receive any payment for their services.

In an effort to motivate and reward the CDDs for their important work and to reduce attrition, Helen Keller International (HKI) and the National NTD Program have partnered with TOMS, a US-based, philanthropically minded company that has given away over 45 million pairs of shoes to children in over 70 countries. To date, Sierra Leone has received two shipments of TOMS Shoes—over 300,000 pairs –between 2013-2014 to distribute to the CDDS and their children.

In 2013, each CDD received three pairs of shoes for his or her family; this was increased to five pairs in 2014. Shoes were also distributed to others whose support has been instrumental to the success of the country’s NTD mass drug administration (MDA), such as community leaders, peripheral health unit (PHU) staff, and members of the district health management team.

From a logistical standpoint, ensuring that CDDs receive these shoes is almost as complex an undertaking as conducting the MDAs themselves for Helen Keller International (HKI), the sub-grantee organization that supports Sierra Leone’s NTD Program in partnership with END in Africa’s administrator, FHI360. First, HKI helps the National NTD Program determine the total number of participating CDDs and estimate the total number of shoes needed, as well as the number of pairs per size. An order is then placed with TOMS Shoes.

Once the shoes arrive at the Freetown port several months later, they must be trucked to six distribution points throughout the country. Shoes are then divided up by district; and the districts assume the responsibility for ensuring that their PHUs receive enough shoes for all the CDDs in their areas. Finally, the CDDs receive shoes for themselves and their children.

The children are ecstatic about getting a new pair of TOMS Shoes. Eight-year-old Fatmata remembers the day she received her pair of TOMS Shoes: “My old shoes are worn out and I was thinking if my parents can afford to buy me another pair of shoes before the opening of school.” Her grandfather appreciated their value as well, noting that they’ll not only motivate Fatmata to go to school, but they’ll also help reduce her risk of hookworm infection from walking barefoot.

Despite the challenges, the National NTD Program and HKI officials agree that getting shoes to each of the CDDs is well worth the considerable effort it takes to administer the initiative. After all, the National NTD Program would not be able to conduct MDAs without the CDDs; indeed, their success hinges on the work of the CDDs. Without their commitment and hard work, millions of persons would still be suffering from preventable and treatable diseases.

HKI and Sierra Leone’s NTD Program look forward to continuing to partner with TOMS, and plan to distribute additional TOMS shoes in 2015.

This blog was originally published by End Neglected Tropical Diseases in Africa.

Photo: Wearing her new TOMS shoes, Fatmata gets a hug from her father, a volunteer who distributes medicines to prevent NTDs in Sierra Leone. Credit Helen Keller International

Artfully Bringing Stories of Neglected Tropical Diseases to Life


Update: We’re happy to share the news that Shelly Xie was recently awarded the 2013 ASTMH Communications Award

There are several ways to describe the impact of neglected tropical diseases (NTDs) on millions of families worldwide. But this may be one of the most artful and poetic we’ve seen.

Last week, medical student and artist Shelly Xie showcased two sand animations that thoughtfully illustrated stories of families infected with hookworm and Chagas disease at the Pan American Health Organization’s (PAHO) 52nd Directing Council. Shelly’s poetic narration, mixed with moving music and sand drawings, gave these complex stories life.

Shelly’s first animation tells the story of a Brazilian family. Maria, Antonio and their daughter Francisca contract hookworm – a parasitic disease which leaves them sick, tired and unable to work, go to school or take care of their crops.  This story is illustrative of the broader burden NTDs have on millions of Latin American and Caribbean families. Over 13.8 million preschool and 31 million school age children are at risk of hookworm and other parasitic intestinal worms.

Shelly’s second animation tells the story of a young couple in Argentina who contracts Chagas disease. After being bit by the Triatomine bug, both the husband and wife become too sick to work and take care of their livestock. Even worse, the mother is expecting a child who now has a chance of contracting Chagas disease as well. After a week, the couple begins to feel better – but what they don’t know is the side-effects of Chagas disease could lead to an enlarged colon and esophagus, or even heart failure in the years to come. It is estimated that 10 to 11 million people in Latin America and the Caribbean are living with Chagas, Shelly explains.

Shelly’s animations are part of PAHO’s Art Research Project – a program that works with different sectors of society to show how we can all have an impact on global health efforts. Her unique and artistic messaging has the power to include an even wider audience in NTD advocacy and awareness efforts worldwide.

Public Health: Some Promising News from Timor



Photo by Peter McMinn


Re-posted with permission from Peter McMinn of the Lowy Institute for International Policy.

The relationship between Timor-Leste and Indonesia has improved steadily since the independence referendum in 1999. Indonesia is now one of Timor-Leste’s key trade partners and has strongly supported its application for membership of ASEAN. The two countries are also working toward settling border disputes that have been unresolved for many years.

This mood of cooperation is also working in the health sector.

Since Timor-Leste regained its independence, public health officials in Dili and Indonesian West Timor have faced substantial challenges in regard to the control of tropical infections which have an enormous impact on the health of already marginalised populations. Diseases such as lymphatic filariasis (elephantiasis), intestinal worm infections (especially hookworm) and yaws are highly prevalent across the island of Timor and cause chronic disfigurement, disability and death.

Elimination of these diseases can be achieved by mass drug administration (MDA) to affected populations (target 75-80%) annually for a period of 5-7 years. Such a program requires high levels of coordination and cooperation by health officials and the engagement of affected communities.

Efforts to free the developing world from these and other tropical infections received a boost in 1998, when the World Health Assembly resolved to eliminate them globally by 2020. The chances of doing so were greatly enhanced when a consortium of pharmaceutical companies pledged to donate the drugs required to treat these infections free of charge to all countries participating in the World Health Organization (WHO) Global Elimination Program.

Many countries have now commenced this program with support from the WHO, pharmaceutical companies, the Gates Foundation and other donors. However, it has not begun in Timor-Leste and has been interrupted in Indonesian Timor due to low capacity in the health workforce and a lack of donor support. The situation has been complicated by the recurrence of conflict in Timor-Leste and the logistical challenges involved in bringing together teams to work across national borders.

In December 2011 the Timor-Leste Minister of Health signed Memoranda of Understanding (MOU) on cross-border cooperation for public health with the Indonesian Minister of Health in Jakarta and with the Governor of Nusa Tengara Timur (NTT) Province in Kupang, West Timor, both vital steps in implementing the program. Under the latter MOU it was agreed that the Government of Timor-Leste and the Indonesian Provincial Government of NTT would cooperate to monitor and implement shared public health challenges. This cross-border cooperation is particularly important for the East Timorese enclave of Oecusse, which is completely surrounded by Indonesian territory.

The program is scheduled to commence in 2014. A senior public health expert from the Ministry of Health in Jakarta has recently assisted the Timor-Leste Ministry of Health to develop a detailed program implementation plan that includes cross-border cooperation on disease surveillance and information sharing on the progress of program implementation. Furthermore, a public health official from NTT will be invited to join the Task Force and vice versa.

Cross-border cooperation will be critically important during the post-MDA enhanced surveillance program to verify disease elimination and to ensure that Timor Island can be certified free of these diseases by the WHO in the shortest possible time. Such collaboration represents a practical example of cross-border cooperation that is of mutual public health benefit for Indonesia and Timor-Leste.


Professor Peter McMinn from the Sydney Southeast Asia Centre leads a program to help Timor-Leste’s health ministry implement the Lymphatic Filariasis, Hookworm and Yaws Elimination Program.