Category Archives: NTDs

Eliminating Neglected Tropical Diseases: My Role as a Student

Students from around the world wrote essays as part of their application for leadership positions with END7 for the upcoming academic year. Two students were awarded scholarships to attend the Millennium Campus Conference in Washington, DC. We are publishing the best essays on our blog during the Millennium Campus Conference this week. Runner-up Gerald Oyeki of Makere University (Kampala, Uganda) wrote this essay in response to the prompt “How do you think students and young people can be agents of meaningful change contributing to the fight against NTDs?:”

By Gerald Oyeki
Makere University (Kampala, Uganda)

Nelson Mandela, one of Africa’s greatest statesmen quoted, ‘Education is the most powerful weapon which you can use to change the world.’ Students and young people constitute the most significant medium of change, transformation and generational growth, given that they are sources of energy, charisma and fountains of knowledge and innovation. Thus, their contribution in addressing global crises plays a pivotal role.

END7 is an international advocacy campaign that seeks to raise the awareness and funding necessary to control and eliminate the seven most common neglected tropical diseases (NTDs), which are a group of chronic and debilitating conditions, caused by parasitic and bacterial infections, by 2020.  These diseases include elephantiasis, river blindness, snail fever, trachoma, roundworm and hookworm. They are mainly poverty-driven and are most prevalent in the poorest populations in the world in Asia, Latin America and Africa, with women and children who live in unsanitary environments facing the biggest threats. Such areas have little access to clean water or proper ways to dispose of human waste which are predisposing factors for the occurrence of these diseases. Neglected tropical diseases impair physical and cognitive development, contribute to maternal and child illness and death, and make it difficult to farm or earn a living – thus, the drive to end extreme poverty may not yield fruit if they are not dealt with.

According to the United Nations Human Development Report 2007/2008, Sub-Saharan Africa faces a serious threat for the occurrence and spread of NTDs and thus the urgency for action cannot be ignored. This has led to several integrated efforts to combat the diseases including mass sensitization and education, improvement of basic water, sanitation and hygiene, and mass drug administration as strategies pursued by various stakeholders, policy makers, implementers, funders and the society at large. For instance, in Uganda, the “One Health” concept appreciates and acknowledges that animal health, human health and the environment are a united system that cannot be independent of each other, and that the wellbeing of humans has got a significant dependence on the health of animals and the environment. This has facilitated the fight against zoonotic diseases, like rabies and soil-transmitted helminthes. Programs like the USAID NTD program, the Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity and College of Health Sciences, the Ministry of Health and the Ministry of Agriculture, Livestock Industry and Fisheries have taken lead roles in the fight against these diseases to support Uganda’s goal of eliminating lymphatic filariasis and blinding trachoma by 2020.

However, the fight to end NTDs is still yet to be accomplished with a number of challenges like low awareness of these diseases, low education levels, and financial constraints for treatment programs. To address these challenges, engaging young people will be key. According to the 2014 United Nations Population Fund (UNFPA) ‘State of the world’ report, Sub-Saharan African countries have a disproportionally large youth cohort. In fifteen countries in sub-Saharan Africa, half the population is under age 18. UNFPA’s review of youth-related policies in these countries suggest that the vast majority have committed to investments in youth-related initiatives and recognize their importance. Students and the youth population are in a strong position to create awareness NTDs and how they can be treated and prevented, actively participate in mass drug administration campaigns, influence government policy and priorities towards funding and fighting NTDs through advocacy led by student clubs and associations. One example of a group that could lead this effort is the One Health Students Club at Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity, for which I serve as speaker emeritus. Our group carries out mass vaccination of animals, most commonly dogs, against zoonotic diseases like rabies (an NTD). The Acholi Students Union, for which I’m currently speaker, engages in mass sensitization of the Acholi ethnic group through radio talk shows, school visits and community outreach, which could be directed towards NTD education. Students can also engage in fundraising drives to boost resources for the fight against NTDs. Furthermore, students can advance NTD research at their universities.

The Millennium Campus Conference is a rich platform for me to use my oratory and leadership skills to interact with peers involved in international development, share knowledge, and convince student leaders from other parts of the world, of all different backgrounds – from both low, middle, and high income countries – of the urgency to eliminate NTDs, and how an integrated global youth approach could help accomplish this goal.

END7 at the University of Sierra Leone Leading Social Mobilization and Campus Engagement to Support Mass Drug Administration

By Ishmael I. T. Jalloh
END7 Campus Leaders Council Representative, University of Sierra Leone

Ishmael I. T. Jalloh is a pharmacy student at the University of Sierra Leone (USL) College of Medicine and Allied Health Sciences. He launched an END7 chapter at his school last fall and with his peers launched additional chapters at USL Institute of Public Administration and Management and Fourah Bay College, creating a growing movement of students and young people committed to seeing the end of NTDs in Sierra Leone.

In May, these students embarked on an 11-day social mobilization and campus engagement campaign to raise awareness about a major mass drug administration (MDA) campaign to prevent lymphatic filariasis (elephantiasis). Through visits to local schools and colleges, media outreach, and creative communication, the students encouraged everyone in their community to participate in the MDA – and even helped with drug distribution in some areas.

Lymphatic filariasis (LF) is caused by infection with one of three species of filarial nematode (Wuchereria bancroft i, Brugia malayi or B. timori) that are transmitted by mosquitoes. Adult worms live almost exclusively in humans and lodge in the lymphatic system. Repeated mosquito bites over several months to years are needed to become infected with LF. The infection commonly acquired during childhood but usually manifests during adulthood as hydrocele, lymphoedema and elephantiasis.

All the districts in Sierra Leone are endemic for LF ( >1% prevalence), and it is a leading cause of permanent disability in the country. Communities frequently shun and reject women and men disfigured by the disease. Affected people frequently are unable to work because of their disability, and this harms their families and their communities.

To combat LF, preventive chemotherapy through mass drug administration (MDA) of ivermectin and albendazole started in 2008 in western rural Sierra Leone, but was interrupted in 2014 due to the Ebola outbreak. MDA was restarted in October 2015 and continued in May 2016.

END7 is an international advocacy campaign of the Sabin Vaccine Institute with student chapters active around the world. In May of 2016, END7 student supporters at the University of Sierra Leone (USL) led an 11-day campaign to raise awareness and educate students about the LF MDA in Western Area, Freetown, Sierra Leone.

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The END7 USL team prepares to launch their social mobilization campaign.

The objectives of the social mobilization and campus engagement campaign were to:

  • Increase public awareness of the MDA
  • Educate heads of colleges and students on the importance of MDA
  • Educate heads of colleges and students about the drugs being distributed (ivermectin and albendazole)
  • Advocate to District Health Management Team so that community health workers would be sure to take these drugs to the colleges
  • Encourage heads of colleges and students to take these drugs

The social mobilization and awareness raising targeted people in authority and the most influential people in the colleges and campuses: heads of colleges, deans of faculties, administrative assistants, wardens of Colleges, Student Union presidents, and leaders of Christian organization, Muslim organization and other recognized organizations in the colleges. By targeting these leaders, we hoped to encourage them to use their influence to encourage many more people to participate in the MDA.

The awareness raising and campus engagement campaign started on the May 20 and ran until May 31. In that time, the END7 USL team of student leaders visited eight colleges in Freetown. We started at the Milton Margai College of Education and Technology, Congo Cross campus. The END7 USL team met with the student governor, Dean of Campus, Mr. Umaru Bah and students in various classes of the college to educate students about LF and the importance of the MDA.

Next, at Milton Margai College of Education and Technology, Goderich, the END7 USL team met with the student Union President Bilal Afiz Kabba, Ag. Registrar of the college, Mr. Sherifu Bangura, the Vice-Principal of the College, Dr. Tabita, and students gathered at the college hall. END7 students raised awareness and educated the students about the MDA. The END7 team also advocated to the Vice-Principal to include NTDs in the college curriculum.

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The END7 USL team meets with students in a college hall to educate them about the MDA

At Liccsal Business College, the END7 USL team met with the Vice-Principal Dr. Roland Buck, the Assistant Director of student’s affairs, Ibrahim Bangura, and Mr. Benjamin Lebbie, as well as many students of the college.

Then, the END7 team visited the Wilberforce Community Health Center to encourage community health workers based there to treat the students in the surrounding colleges during the MDA. We wanted to make sure that all of our peers would have the chance to receive the drugs they need to stay safe and healthy.

Next, at Freetown Teachers College, the END7 team met with the Registrar, M.I. Sesay, and met with students at the college hall to raise awareness and educate them about the MDA and elephantiasis. At Njala University Freetown, END7 students met with the Deputy Registrar, Christiana Pearce, and visited students in their classes.

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Students gave presentations on LF to encourage students to participate in the MDA.

At the University of Sierra Leone College of Medicine and Allied Health Sciences, after raising awareness about the MDA, END7 student leaders actually assisted in the distribution of the drugs on campus, working with the pharmacy board team to distribute the drugs to administrative staff at the college.

When we visited the University of Sierra Leone Institute of Public Administration and Management, they were in the middle of their examination period, which made it more difficult to reach students with our message. So, we spoke to administrative staff and students who were around on campus.  Then, we traveled to Parliament Hospital to advocate for the MDA team there to visit the IPAM campus clinic. We succeeded in bringing the MDA team to treat students at IPAM, but unfortunately, when they arrived on campus, students were not around because of the examination period.

Fourah Bay College was also in the middle of an examination period when our team visited campus, so we made use of the public address system at the nearby airport terminal that was playing the message of the MDA, and met with some administrative staff and students in their classrooms.

In addition to our campus visits, END7 USL was also involved in media outreach to promote the MDA. As president of END7 USL, I was interviewed on a program on Star Television Network to raise awareness of LF and educate Sierra Leoneans about the MDA.

Ishamel being interviewed on the Star Television Network

Ishamel being interviewed on the Star Television Network

The END7 USL team faced a few challenges during the social mobilization campaign, as this was the first time we planned activities to support an MDA. One of our greatest challenge was advocating to community health workers to take drugs to the colleges so university students could participate in the MDA. Eighty percent of the colleges we visited were treated during the MDA, but this still leaves many students without access to treatment. We will continue our activities to raise awareness of these important public health campaigns, encourage our peers and fellow community members to participate, and advocate to make sure everyone has the chance to be part of MDA campaigns so Sierra Leone can end NTDs for good.

We want to offer special thanks to Hellen Keller International, Sierra Leone for providing the funding and support for us to carry out our social mobilization and campus engagement activities, and a big thank you to the Ministry of Health and Sanitation District Health Management Team for a successful MDA!

Follow END7 USL on Facebook to learn more about their work and see more pictures from their campaign, and check out END7’s Success Stories Factsheet on Sierra Leone to learn more about progress being made against NTDs in the country. If you’re a student looking to get involved in the fight against NTDs, check out our ideas and resources!

Fourth Progress Report on The London Declaration on Neglected Tropical Diseases Released

Last year, pharmaceutical companies donated medicine to treat 1.5 billion people for neglected tropical diseases (NTDs), more than ever before.

The release of the Uniting to Combat Neglected Tropical Diseases scorecard and report today underscores the urgency and the opportunity before us to control and eliminate the most common NTDs. For the first time, the global coverage rate exceeded 50 percent. But progress is not being made across all regions or all diseases. For instance, only 20 percent of the nearly 259 million people at risk of schistosomiasis received medication in 2015.

Four years ago, leaders from 13 pharmaceutical companies, the governments of the United States, United Kingdom and United Arab Emirates, the Bill & Melinda Gates Foundation, the World Bank and other global health organizations pledged new and extended commitments in support of the WHO’s goal to control or eliminate 10 NTDs by 2020. The global effort to control and eliminate NTDs is now one of the largest public health initiatives in history. But the fourth progress report from Uniting to Combat Neglected Tropical Diseases finds that many deadlines have been missed.

Just 40 of 73 countries are now on track to eliminate lymphatic filariasis by 2020, including India. Although India continues to have the most cases of lymphatic filariasis, 87% of endemic districts are now assessing whether they have interrupted transmission and, as a result, can stop mass drug administration.

Dr. P.K. Srivastava, the Joint Director – Nodal officer of India’s Elimination of Lymphatic Filariasis Programme, shares his thoughts on India’s efforts and challenges in a post on our blog. No other government will have a greater influence on whether we reach the 2020 goals.

As we advance toward elimination goals, the challenges will change – mapping and wider use of new diagnostic tests will provide data needed to make more informed decisions. Ensuring that we have a full arsenal of tools including drugs, vaccines and diagnostics to complement existing treatment programs will be critical.

Ending extreme poverty and achieving the Sustainable Development Goals (SDGs) requires controlling and eliminating NTDs. Achieving NTD disease goals is projected to produce up to $184 in improved economic productivity for every dollar invested, helping to bring communities out of poverty (SDG 1). At the same time, strategies for success against NTDs are strongly linked with other development priorities, including universal health coverage (SDG 3) and water and sanitation (SDG 6).

Progress against NTDs over the last four years has accelerated, but not fast enough. As we approach the fifth anniversary of the London Declaration, the 2012 pledge to end NTDs by 2020, we must assist countries to scale up programs to ensure no one is left behind.

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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.