Category Archives: NTDs

Children at dusk in Malawi

Calling Time on Urogenital Schistosomiasis

I spent many of my teenage years living in Malawi, enjoying swimming in beautiful Lake Malawi. Wind on to age 30, and I was struggling to get pregnant. Eventually, following illness, I was diagnosed with schistosomiasis by a consultant and colleague at the Liverpool School of Tropical Medicine. I was told that I had probably been infected for a while and that it might be affecting my fertility. So I took praziquantel, the only available drug against the parasite, and soon after I was pregnant. Today my first born daughter is 10 years old. Whilst the links between urogenital schistosomiasis, sub-fertility and HIV have become increasingly well-established over my first born daughter’s life time, a combined and robust health systems action that brings together neglected tropical disease, sexual and reproductive health and HIV communities to address and scale up treatment for urogenital schistosomiasis is sadly lacking.

It is 20 years since the Beijing Women’s Conference and the International Conference Population and Development and the sexual and reproductive community have been taking stock on progress, challenges and future priorities. I attended a research agenda setting meeting on sexual and reproductive health, rights and gender at the WHO on 12th and 13th of January, where we discussed how to best decide priorities for action. Scaling up treatment for urogenital schistosomiasis is arguably a win-win.

The global burden of disease

Schistosomiasis is wide spread and there are two forms of disease, intestinal and urogenital. An estimated 600 million people are at risk of being infected and approximately 200-220 million people are living with schistosomiasis in Africa. Of the people infected with urogenital schistosomiasis it is thought that between about 100 and 120 million suffer from urinary and reproductive tract damage, which also impacts directly with HIV co-infection and sub-fertility in general. Typically many adolescent girls and women exhibit several symptoms in their lower genital tract where overt bleeding and unpleasant discharge, general discomfort and pain during sex can lead to low self-esteem, depression and stigma.

Peter Hotez estimates that globally there are between 67-200 million cases of urogenital schistosomiasis among girls and women. Hotez argues that between 20 million and 150 million girls are affected, possibly making it one of the most common gynaecological conditions in sub-Saharan Africa but unfortunately much under-reported. Urogenital schistosomiasis, as in my experience, also affects fertility and it is estimated to reduce a woman’s reproductive health capacity by up to 75%.

The links between urogenital schistosomiasis in women (female genital schistosomiasis) and HIV are well established. Writing in the Lancet, Stoever and colleagues argue that up to 75% of girls and women infected with female genital schistosomiasis develop often irreversible lesions in the vulva, vagina, cervix, and uterus, creating a lasting entry point for HIV and discuss how research in Zimbabwe showed that women with female genital schistosomiasis had a threefold increased risk of having HIV. In a recent review of the evidence Pamela Mbabazi and colleagues argue that “Studies support the hypothesis that urogenital schistosomiasis in women and men constitutes a significant risk factor for HIV acquisition due both to local genital tract and global immunological effects”.

Gender, equity and rights

There is remarkable overlap between the maps showing high HIV prevalence in Africa (particularly amongst women and adolescents girls) and those showing cases of female genital schistosomiasis. A complex interplay of biological, social and cultural factors means that young women are particularly vulnerable to HIV in sub-Saharan Africa. Gender norms also shape exposure to urogenital schistosomiasis, with women being particularly responsible for activities involving water in many communities (washing, cleaning, collecting water etc). Drawing on work from Ghana, Vlassoff and Manderson have shown that women interact with water significantly more often than men.

What to do?

Several tens of millions of praziquantel tablets are now donated each year by Merck-KGaA for mass drug administration campaigns as a cost-effective method to protect people from the urogenital schistosomiasis. Hotez argues that by preventing female genital schistosomiasis in sexually active women we have an innovative and timely opportunity to reduce and likely much reduce HIV transmission throughout many rural areas of sub-Saharan Africa.

But in infected communities treatment also needs to start early.

Stoever and colleagues argue that periodic and regular treatment with praziquantel from when children are first infected should prevent the development of genital lesions, which increase HIV risk and cause gynaecological problems. Treatment, however, may need to be started even earlier as the extent and burden of schistosomiasis in pre-school-aged children is being more fully described.

To make progress in this area we need joint action between the HIV, sexual and reproductive health and neglected tropical disease communities. Health workers and communities need more information on the multiple impacts of urogenital schistosomiasis and how it can be treated.

The lack of action to date on urogenital schistosomiasis clearly illustrates the importance of new partnerships and new approaches to scaling up strategies to address neglected tropical diseases. COUNTDOWN, a new initiative in Cameroon, Ghana and Liberia, will be paying close attention to the potential role of close-to-community providers such as drug distributors in providing an interface between communities and health systems.   We will also evaluate how to deliver equitable drug delivery for schistosomiasis through the inclusion of preschool-aged-children, out-of-school-children and adults. The Director of COUNTDOWN is helping to co-organise a meeting in South Africa later in the month where several members of COUNTDOWN will also attend. It brings together world leaders in the field of schistosomiasis, HIV and paediatrics to present on the current state and future direction of research on female genital schistosomiasis.

COUNTDOWN is set to foster and to stimulate others in thinking of innovative ways of prompting a synergistic approach to neglected tropical diseases which crosses sectors and builds strength in national health systems.

If you would like to find out more follow us on Twitter or email Rachael Thompson.

This blog post was writtem by Sally Theobald, COUNTDOWN Consortium & Research in Gender and Ethics: Building stronger health systems (RinGs), and was originally posted on Cross-Talk: A Place to Share New approaches to Neglected Tropical Diseases.

Photo courtesy of Andrew Whalley. Children at Dusk.

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Powerful Testimonies Urge Action on Neglected Tropical Diseases

 

SFOPS_hearing

Earlier this month, The Senate Appropriations Subcommittee on State, Foreign Operations and Related Programs, chaired by Sen. Lindsay Graham (R-SC), conducted a hearing on Global Health Programs highlighting U.S. investments in significant  global health efforts  such as the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

Powerful testimonies were delivered from dedicated global health advocates, including Ambassador-at-Large Deborah L. Birx, M.D., Coordinator of the United States Activities to Combat HIV/AIDS and Special Representative for Global Health Diplomacy, U.S. Department of State; Dr. Mark Dybul, Executive Director, The Global Fund; Sir Elton John, Founder, Elton John AIDS Foundation; and Dr. Rick Warren, Pastor, Saddleback Church.

While discussing the financial and programmatic difficulties of working to combat diseases such as HIV/AIDS, tuberculosis and malaria, Ranking Member Leahy (D-VT) underscored the importance of investing in prevention stating that “Many of these diseases can be prevented for just a few dollars.” As we have learned from the recent Ebola outbreak in West Africa, investing in preventative measures is much more cost-effective than attempting to contain a major outbreak. The Senator added:

“Very few Americans suffer from malaria, polio, Dengue fever, or river blindness. Can you imagine if they did? You’d have people lined up out here saying ‘What are you spending, let’s do something about it!’…This goes beyond politics or economics…we can do better.”

Dengue fever and river blindness are neglected tropical diseases (NTDs) transmitted to humans through bites of infected blackflies and mosquitoes, respectively. Dengue fever can cause severe joint, muscle and bone pain, and river blindness, also known as onchocerciasis, can lead to visual impairment and permanent blindness. Globally, 1.9 billion people are at risk for NTDs. These diseases result in severe physical disabilities and they prevent children from attending school or adults from working – resulting in an endless cycle of economic hardship.

By adding NTDs to the conversation, Sen. Leahy drew attention to a critical link between NTDs and other infectious diseases such as malaria, for example. In many parts of the world, NTDs are a result of inadequate water supply, limited access to sanitation facilities and poor hygiene. Mosquitoes breed in areas with stagnant water and can transmit not only malaria, but also NTDs including dengue fever, lymphatic filariasis and chikungunya.

Synergies such as these stress the importance of partnerships and building more resilient health systems. One way that initiatives such as the Global Fund and PEPFAR work to strengthen health systems in countries and communities is by investing in community health workers.

The Global Network thanks Chairman Graham and Sen. Leahy for holding this productive hearing. The testimonies from this panel of experts underscore the critical role the U.S. Government plays in combating global health issues. Because we have made such enormous strides in the fight against many infectious diseases, including NTDs, we cannot risk reversing the results we have achieved so far.  Those living in extreme poverty around the world are counting on our help.


Funding for the U.S. Agency for International Development’s Neglected Tropical Disease (USAID’s NTD) Program is at risk due to the President’s proposed budget of $86.5 million for FY2016 – a $13.5 million drop  from the $100 million allocated by Congress for FY2014 and FY2015. The USAID NTD Program is an extremely successful and cost-effective public-private partnership that has reached more than 465 million individuals in 25 countries with life-saving treatments.

The Global Network’s END7 campaign is taking action against the proposed budget cuts with its “Call to Action” petition. To get involved and speak out, add your name here.

National Science Academies Urge G7 Leaders to Address NTDs

 

 

In advance of every G7 summit, the national science academies of the G7 countries prepare policy statements on the priority issues identified by the G7 host country. This year, the national science academies delivered statements on neglected tropical diseases, antibiotic resistance, and the future of the ocean.

In the statement on NTDs, they note that progress on NTDs “would be a major step towards alleviating poverty.”

NTDs affect the world’s poorest people and place an economic burden on low and middle-income countries. The academies called on G7 leaders to support efforts to reach WHO control and elimination targets by 2020:

“In principle, NTDs are preventable, treatable, controllable and some even eradicable. Moreover, most interventions against NTDs are highly cost-effective. To make progress toward preventing, controlling and eliminating NTDs, the G7 Academies of Sciences call for: (1) increasing efforts to empower and build capacity in affected countries to deal with these diseases, (2) intensifying research on NTDs, (3) developing and delivering affordable and accessible treatments, and (4) NTDs to be fully accounted for in the Sustainable Development Goals.

Much more needs to be done with a much greater urgency to reach the 2020 targets for all major NTDs. The specificity of diseases as well as the likely adverse impacts of severe climate events, risks of conflicts, increasing mobility/migration, and political instability need to be taken into account when developing strategies for tackling the NTD challenges. NTDs should be fully accounted for in the Sustainable Development Goals.”

Chancellor Angela Merkel, who carries the G7 Presidency this year, invited representatives of the national science academies to a G7 dialogue forum to share their scientific expertise in advance of the 2015 G7 Summit, to be held in June in Schloss Elmau, Bavaria. The event was hosted by Leopoldina, the German National Academy of Science.

In his keynote speech at the G7 Dialogue Forum Science Conference on April 30th, Professor David Molyneux addressed NTDs and the work still needed to achieve the control and elimination goals outlined at the London Declaration in 2012.  Professor Molyneux is a Sabin partner and professor at the Liverpool School of Tropical Medicine where NTDs are a major focus of research. In his speech, he highlighted the need for increased aid to combat NTDs — only 0.6% of overseas development assistance is allocated to NTDs.

Professor Molyneux said that policy makers must be convinced that NTDs are the markers of poverty, that control of these diseases reflect the capacity of health systems to ensure healthier communities and by default reduce the burden of poverty. He argued that addressing the “chronic pandemic of NTDs” requires capacity at all levels across the broad spectrum of health sciences.

After receiving the statement from the academies, Chancellor Merkel responded with a call to strengthen the WHO’s ability to combat disease. “I will attend the World Health Assembly in May, and neglected tropical diseases are on the agenda this year. This will hopefully help to encourage Member States to persevere in the fight against these terrible diseases, especially since simple treatments and measures are often enough to prevent them.”

As the G7 Summit approaches, we hope world leaders heed the national science academies’ call to develop and deliver affordable and accessible treatments for NTDs, and support multilateral efforts to address NTDs as part of the Sustainable Development Goals and the post-2015 development agenda.