Category Archives: NTDs

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Scaling up NTD treatment and prevention: India’s experience scaling up mass drug administration for lymphatic filariasis

by Dr. P.K. Srivastava is the Joint Director – Nodal officer of Elimination of Lymphatic Filariasis Programme, Government of India

Of the more than a billion people in the world affected by NTDs, 34% live in India. This is in large part due to the number of people living in India at risk of being infected with lymphatic filariasis (LF).  India alone is responsible for 42% of the global burden of LF and 16 states and 5 union territories are endemic for the disease. Many factors make LF a challenge to tackle in India.  First, there is the wide geographic spread of endemic areas in a country with one of the largest populations in the world — from the tip of the subcontinent in Kerala to the reaches of the Sundarban mangrove forests in West Bengal. The demographic and climactic diversity is also a challenge — progress in rural areas may be offset by changes in the way urban populations respond to mass drug administration (MDA), MDA schedules may be interrupted by annual cyclones or floods, and subtle changes in the monsoon rains may change vector patterns.

India has a long history of addressing LF, beginning with a pilot project in 1949 that shaped global standards for elimination.  India started administering diethylcarbamazine (DEC) in highly endemic areas in 1955. The lessons from these early years informed the launch of a revised strategy in 1997 when India signed the World Health Assembly resolution to eliminate LF.  Three years later, the then health secretary Mr. Javid Chowdhary was appointed the chairperson of the Global Program to Eliminate LF (GPELF).  Mr. Chowdhary committed to launching a program that covered 40 million people at risk of contracting LF, beginning with 20 million people that year. In 2002, India set 2015 as a target for LF elimination in the National Health Policy.

The current strategy to eliminate LF was launched in 2004. Between 2004 and 2007, the program scaled up to reach 421 million people, achieving 100% geographic coverage, all 250 endemic districts[1]. Coverage rates started out high, at 73% on average across the country, and continued to increase, reaching 83% in 2007 and 88.8% in 2014. India has benefited from drug donations of albendazole, provided for all annual MDAs against LF.

This increase in national average coverage may not seem like much over the course of a decade, but consider the challenges faced: as annual MDAs continue, LF infections become less common, serious complications related to LF, lymphedema and hydrocele, become less visible in the community and young people may be less motivated to participate in the annual MDA.  Rigorous pre-testing prior to undertaking transmission assessment surveys also requires technical human and laboratory resources at the regional and state level- something that can be challenging in the mostly rural areas where the disease has traditionally taken hold.  33 districts have been identified as “hotspot” districts, where microfilaria rates remain high and programs have not been as effective at tackling LF. Still, the scale the program has achieved is remarkable.  This rapid scale would not have been possible without the lessons from earlier pilots, the strong political will demonstrated on national and global platforms, local technical expertise, and the existence of an integrated, multi-level health system.

India’s efforts to scale MDAs and tackle LF have proven successful.  Of the 255 endemic districts, 222 have microfilaria rates below 1%, qualifying them for transmission assessment surveys (TAS).  72 districts have already passed the first round.  Although the 2015 deadline for elimination has passed, it is estimated that a first round of TAS will be underway in all 255 endemic districts by 2017. The fight will not end there. There is more to be done to scale up community based and facility based morbidity management, and surgical options have to be made accessible and affordable for those who can benefit from them.  We will need to continuously monitor the situation to not only ensure success against LF, but also sustain deworming efforts once MDAs for LF end. Fortunately, India’s National Deworming Day initiative will scale up school and community based deworming for children as LF MDAs start to scale down.

Just as getting to this point has been as result of a coordinated effort of technical, political, and community based partners, the road ahead will depend on coordinated monitoring and surveillance, community-based support from civil society, NGOs, and village health workers, accommodations in the health system and political support to see LF elimination to the end.  India’s success impacts the global progress on NTDs and will be a model for other nations, and so we encourage you to check back with us at the end of 2017.

Dr. P.K. Srivastava is the Joint Director – Nodal officer of Elimination of Lymphatic Filariasis Programme, Government of India

[1] The number of endemic districts in now 255, due to geo-political realignment of state and district boundaries.

India Should Not Lose Sight of Programs to Combat Diseases of Poverty

_MG_0672_CopyAn editorial, “To our health,” in The Indian Express, published on March 31, 2016, highlighted an initiative to update India’s public health framework in a time-bound process. The updates, which may be finalized in three months, will bring a new focus to preventing non-communicable diseases and operationalizing plans that have been in development. Programs focused on neglected tropical diseases (NTDs), including lymphatic filariasis and visceral leishmaniasis, are specifically mentioned as opportunities to meet targets set in global frameworks. While this initiative is a positive step, the editors note there are risks to the plan.

As new scourges replace the epidemic killers of old, public health in India has suffered for want of a regime for early detection. However, the government must be aware that a refocus on new disorders draws attention away from programmes against older threats to the poor — filariasis was supposed to be history in 2015, but is still out there.

The Indian Express is one of India’s most widely circulated daily newspapers.

END7 Funds NTD Projects Around the World

This spring, we awarded nearly $400,000 in new grants for neglected tropical disease (NTD) control and elimination activities in 2016.

This funding is made possible by generous donations to END7, an international advocacy campaign that seeks to raise the awareness and funding necessary to control and eliminate the seven most common NTDs. The campaign is managed by the Global Network for Neglected Tropical Diseases and 100% of donations to the END7 campaign go straight to NTD programs. Donations to Sabin Foundation Europe, a partner of the U.S.-based Sabin Vaccine Institute and the Global Network also helped make these grants possible.

The grants will make a significant impact in supporting integrated NTD programs in six countries. All projects are coordinated with Ministries of Health and/or the World Health Organization in each country. Many of the projects include mass drug administration (MDA) for the most common NTDs and training of health care workers. These projects are expected to benefit nearly six million individuals at risk from NTDs and train tens of thousands of health workers and volunteers to lead the NTD control and elimination effort into the future.

Awarded to existing efforts that faced a funding gap, these projects will have a lasting impact on improving and expanding existing programs to reach ambitious NTD control and elimination goals in Africa, Asia and Latin America – the regions with the largest NTD burden:

Nigeria
$50,000 to support integrated MDA for seven NTDs, administered by Sightsavers with the support of the Federal and Kebbi State Ministries of Health. Nearly 5.9 million people will receive donated medicine in Kebbi state, in northwest Nigeria, where all seven NTDs are widespread. Sightsavers will continue their successful MDA in the region and expand to new areas.

Somalia
$66,200 to support the first integrated MDA in five regions of southwestern Somalia by the new NTD Program of the Ministry of Health and Human Services. The MDA will target schistosomiasis (snail fever), ascariasis (roundworm), hookworm and trichuriasis (whipworm) among school-age children and adults in areas of high prevalence. The NTD Programme was established in 2015; success this year will help scale up the delivery of donated medicine to the rest of the country.

Cote d’Ivoire
$28,789 to support water, sanitation and hygiene education to prevent NTDs in Cote d’Ivoire, administered by Helen Keller International. More than 7,000 health workers, school teachers and community health volunteers will be trained to reach more than 2.5 million people.

Guyana
$111,146 to support MDA to eliminate lymphatic filariasis in the most populous region of the country, administered by the Pan American Health Organization and the Ministry of Public Health. Guyana is on track to eliminate lymphatic filariasis (also known as elephantiasis) by 2020. These funds were raised for END7 by the Sabin City Group in London.

India
$60,546 to assist a local NGO, Churches Auxiliary for Social Action (CASA), to expand their successful efforts to treat and prevent lymphatic filariasis to West Bengal. This grant will enable CASA to train community members to manage the swelling and disability that often results from later stages of lymphatic filariasis. Each infected patient will receive a hygiene kit with soap, a towel and antifungal ointment and be shown how to care for themselves to reduce swelling. CASA will also promote the government’s annual MDA targeting 500,000 people for lymphatic filariasis treatment in West Bengal.

Myanmar
$75,645 to assist the Department of Public Health to determine where MDA for lymphatic filariasis has succeeded and can be concluded. Nine districts with a population of nearly 7 million have already conducted more than five rounds of MDA for lymphatic filariasis. Officials will determine whether transmission has been interrupted.

The Global Network team reviewed 37 proposals from a range of partners tackling NTDs around the world and selected projects with the potential to have the most lasting impact, leverage further investment and bolster country-led efforts to eliminate NTDs.

To date the Global Network has awarded more than US$1 million in grants to 19 partners. From individual donors contributing $5 a month to student groups raising $10,000 over the course of a school year, the END7 campaign has mobilized a diverse and growing community of supporters from countries around the world dedicated to supporting the fight against NTDs. Together, these contributions are moving the NTD elimination effort forward by helping communities set up treatment programs they can run themselves. END7 supporters fill funding gaps in successful NTD treatment programs, highlighting the tremendous impact of this inexpensive treatment and the power of partnership in the fight against NTDs.

Donate to END7