Measuring Success: Your Guide to the New Global NTD Indicator

Community Drug distributor Raymond Kenneh with Nana Jusu.

Community Drug distributor Raymond Kenneh measures Nana Jusu with a dosing stick.

The Headline: The Inter-agency and Expert Group on the Sustainable Development Goals (IAEG-SDGs) has approved the inclusion of an indicator for neglected tropical diseases (NTDs).

What are the Sustainable Development Goals?

The Sustainable Development Goals (SDGs) are a set of 17 global targets that will define and guide the international community’s efforts to end extreme poverty, fight inequality and injustice, and create a healthier environment by 2030. They are essentially the world’s to-do list, and they were adopted by the United Nations (UN) General Assembly in September.

A bit of history: The SDGs replace the eight Millennium Development Goals (MDGs), which were established in 2000 and expire this year. The MDGs accelerated progress in many of their target areas, unifying the global community behind common goals.

What’s all this about an indicator?

In addition to “targets” that establish broad objectives, the SDGs include indicators to measure success on the targets. The indicators serve as a rallying point for the global community. With so many issues competing for resources, measurable, attainable goals are critical to command attention.

For this very reason, the NTD community has been pushing for an indicator to measure global NTD progress. More than 1.4 billion people around the world are infected with at least one NTD, but because of their low mortality rate, these diseases don’t get much attention on the global stage. However, treating NTDs is necessary to ensure that efforts to improve nutrition, education, health and economic productivity are successful. Controlling and eliminating NTDs is critical to ending extreme poverty.

The indicator, “number of people requiring interventions against NTDs,” got the green light at a meeting of the IAEG-SDG in October.

How did this happen?

NTD advocates have been pushing for an indicator for months. NTDs were little more than a footnote in the MDGs, so the NTD community has been working hard to secure some much-deserved attention in the SDGs.

The Global Network worked closely with the NTD community to advocate for this indicator, through correspondence with IAEG-SDGs members, an oral statement urging the inclusion of an indicator during a high-level meeting at the UN’s Economic and Social Council, and a community letter to all IAEG-SDGs members. END7, the Global Network’s advocacy campaign, also led three advocacy petitions urging the UN to prioritize NTDs in the SDGs.

So, we’re all good now, right?

Not quite. Once the IAEG-SDGs finishes its work, it will submit its proposed recommendations for the indicator and monitoring framework to the UN Statistical Commission. More unified advocacy from the NTD community will be needed to ensure that the final document is adopted in March 2016 without change.

Introducing Ishmael Tamba Jalloh, October’s END7 Student of the Month

sl_murraytown_chc.jpgEach month, END7 honors one student who has made a significant contribution to our growing movement of student advocates dedicated to seeing the end of NTDs. We are very proud to introduce our October 2015 Student of the Month, Ishmael Tamba Jalloh, a pharmacy student at the University of Sierra Leone College of Medicine and Allied Health Sciences. Ishmael joined the END7 Campus Leaders Council to raise awareness of neglected tropical diseases (NTDs) in Sierra Leone by engaging students at his university in community engagement and outreach to local leaders.

As we reported while profiling Sierra Leone for our NTD Success Stories series last month, six NTDs are found in all 14 health districts in Sierra Leone, threatening nearly the entire population of the country. Strong leadership from Sierra Leone’s Ministry of Health and in-country partners has helped drive tremendous progress against NTDs like lymphatic filariasis (LF), also known as elephantiasis. More than 57 million NTD treatments had been delivered nationwide by the beginning of 2014, putting the country on track to begin the World Health Organization process of verifying the elimination of lymphatic filariasis (LF) in eight of 14 health districts. Unfortunately, when the West African Ebola epidemic reached Sierra Leone in May 2014, all public health program activities were suspended — including mass drug administration (MDA) for NTDs.

One year later, with the Ebola epidemic receding, MDA restarted in Sierra Leone. Just this month, from October 9-13, the Ministry of Health’s NTD Program, through the District Health Management Team, ran an MDA campaign targeting 1.4 million people with drugs for LF and soil-transmitted helminths (STH). Ishmael volunteered to assist with the MDA, putting his pharmacy education at the service of his community. He shares:

“The mass drug administration campaign ran from October 9th to the 13th. Before the start of the campaign, there was a training for all the health workers and volunteers at the Murray Town Community Health Center [pictured above]. After the training, we were divided into pairs (a health worker and a volunteer) and sent to various communities in Ward 390, Constituency 111, in the western part of Freetown, the capital of Sierra Leone.

“At the start of the drug administration, my team targeted a secondary school, the Sierra Leone Grammar School, in the Murray Town community. At the school, we administered albendazole and ivermectin as a prophylactic treatment for elephantiasis to 850 pupils and 50 teachers. For the remaining days of the MDA campaign, I worked in a slum community called Cockle. In that community, we targeted 1,500 residents for drug distribution.

sl_dosing.jpg“During the campaign, we used a measuring rod as a guide for the dosage we should give [pictured left]. If the individual’s height was at the 4th mark, we administered 4 tablets of ivermectin and a tablet of albendazole; if the individual’s height was at the 3rd mark, we administered 3 tablets of ivermectin and a tablet of albendazole, and so on with the second and first marks. This made it easy to give everyone the proper dose to keep them safe from elephantiasis.

“During the campaign, I found out that people are only aware of one out of the seven neglected tropical diseases — elephantiasis, which is called ‘Big Foot’ in our local language. Now, I am thinking that more work needs to be done about all of the NTDs in Sierra Leone.

“Also, during the campaign, I met an 18-year-old girl named Isatu who for the past two weeks has been developing signs of elephantiasis. Her family are saying her swollen legs are caused by witchcraft or black magic, but I advised them go to the hospital and have Isatu be tested for elephantiasis. I hope she receives the treatment she needs, and I am glad to have met her during the campaign.

“All in all, our campaign targeted 1.4 million people in Freetown. I hope my contribution to the campaign made a difference.”

Now, Ishamel is working to establish the first END7 chapter in Africa at the University of Sierra Leone. We are so grateful for Ishmael’s commitment to the fight against NTDs in Sierra Leone and around the world, and we are excited to see our community of student supporters like him grow. If you are ready to get your school involved in END7’s work, contact the END7’s student outreach coordinator at to learn how you can get started!

Celebrating NTD Success Stories: Sierra Leone’s Inspiring Progress in the Face of Ebola

Community health officer Hawa Margai speaks about onchocerciasis to a group of women gathered at the Levuma community health center in the town of Levuma, Sierra Leone on Friday July 13, 2012.

Community health officer Hawa Margai speaks about onchocerciasis to a group of women at the Levuma community health center.

During the month of October, END7 student supporters are celebrating NTD Success Stories from four countries — Haiti, India, Sierra Leone and the Philippines — that have overcome incredible obstacles to make progress towards NTD control and elimination. This week’s success story comes from Sierra Leone, where inspiring efforts are being made to fight NTDs in the wake of the Ebola epidemic.

Six NTDs are found in all 14 health districts in Sierra Leone, threatening nearly the entire population of the country. Sierra Leone faces many health and development challenges, but the government has exerted strong leadership in the fight against NTDs. By 2004, the national NTD program had successfully mapped the prevalence of targeted NTDs nationwide, and in 2005 they launched a mass drug administration (MDA) campaign to treat every at-risk community with the participation of nearly 30,000 volunteer community drug distributors. Supported by the U.S. Agency for International Development (USAID), Sierra Leone’s Ministry of Health had distributed more than 57 million NTD treatments nationwide by the beginning of 2014. As a result of these efforts, the country was on track to begin the World Health Organization process of verifying the elimination of lymphatic filariasis (LF) in eight of 14 health districts in 2014. Unfortunately, when the West African Ebola epidemic reached Sierra Leone in May of that year, all public health program activities were suspended as the country raced to stop the spread of Ebola. As a result, the Sierra Leone NTD Program was unable to carry out MDA in 2014, interrupting progress towards LF elimination.

But today, the government of Sierra Leone and partner organizations are working hard make up for lost time. In May of 2015, on the heels of nationwide malaria and vaccination campaigns, MDA restarted in Sierra Leone. Just this month, from October ninth to 13th, the Ministry of Health’s NTD Program, through the District Health Management Team, ran an MDA campaign targeting 1.4 million people with drugs for LF and soil-transmitted helminths (STH).

The relaunch of MDA this year required careful preparation, including refresher training session for community drug distributors and program administrators. Extensive social mobilization campaigns, aimed at educating communities still reeling from the Ebola epidemic about the importance of participating in MDA, were conducted through community meetings and radio spots. As a result of this careful preparation, early indications are that Sierra Leone’s 2015 MDAs have been successful.

The consistent key to Sierra Leone’s inspiring success tackling NTDs before and after the Ebola epidemic has been the leadership and commitment of volunteer community drug distributors. Elected by their communities, these volunteers reach the most remote corners of the country, enabling Sierra Leone to consistently achieve treatment coverage above 75 percent in targeted communities.

Given Sierra Leone’s small geographic size, the strong political support of the government and the commitment of the volunteer community drug distributors who form the backbone of MDA programs, the country is in the unique position to become one of the first countries in Africa to control snail fever and intestinal worms and eliminate river blindness and elephantiasis. Sierra Leone’s NTD program has also successfully demonstrated that MDA can be achieved in highly populated urban settings. But additional support is needed. By integrating NTD treatment with schools and other health programs, millions of people at risk for NTDs can live free of these diseases of poverty and their devastating effects including malnutrition, disability, social stigmatization and a loss of productivity.

Sierra Leone’s progress against NTDs despite the challenges posed by the Ebola epidemic should inspire other countries to redouble their efforts to address these diseases. Now more than ever, support for robust public health efforts like Sierra Leone’s NTD Program is needed to build on this impressive progress. END7 supporters are eager to celebrate Sierra Leone’s progress and look forward to celebrating more milestones as the country moves closer to its ultimate goal of controlling and eliminating NTDs.

NTD Article Round-Up


The Global Network will be presenting a round-up of articles on neglected tropical diseases (NTDs). Check back regularly for the latest studies. To suggest an article, you may post a comment below.

1. Associations between School- and Household-Level Water, Sanitation and Hygiene Conditions and Soil-Transmitted Helminth Infection among Kenyan School Children

Parasites and Vectors – Published August 7, 2015
Freeman MC, Chard AN, Nikolay B, Garn JV, Okoyo C, Kihara J, Njenga SM, Pullan RL, Brooker SJ, Mwandawiro CS

“Soil-transmitted helminths, a class of parasitic intestinal worms, are pervasive in many low-income settings. Mass treatment, typically administered through schools, with yearly or biannual drugs is inexpensive and can reduce worm burden, but reinfection can occur rapidly. Access to and use of sanitation facilities and proper hygiene can reduce infection, but rigorous data are scarce. Among school-age children, infection can occur at home or at school, but little is known about the relative importance of WASH in transmission in these two settings.  We explored the relationships between school and household water, sanitation, and hygiene conditions and behaviors during the baseline of a large-scale mass drug administration programme in Kenya. We assessed several WASH measures to quantify the exposure of school children, and developed theory and empirically-based parsimonious models.  Results suggest mixed impacts of household and school WASH on prevalence and intensity of infection. WASH risk factors differed across individual worm species, which is expected given the different mechanisms of infection.  No trend of the relative importance of school versus household-level WASH emerged, though some factors, like water supply were more strongly related to lower infection, which suggests it is important in supporting other school practices, such as hand-washing and keeping school toilets clean.”

2. Should the Goal for the Treatment of Soil Transmitted Helminth (STH) Infections Be Changed from Morbidity Control in Children to Community-Wide Transmission Elimination?

PLoS Neglected Tropical Diseases – Published August 20, 2015
Roy M. Anderson, Hugo C. Turner, James E. Truscott, T. Déirdre Hollingsworth, Simon J. Brooker

This article examines the feasibility of reaching the World Health Organization goal of mass drug administration coverage for 75% of those at-risk of soil-transmitted helminths. It weighs alternative goals to achieve morbidity control and the elimination of transmission.

“We are still a long way from the 2020 target of 75%. Even if this target is reached, will it be enough to eliminate transmission and the disease arising from heavy infections with STH? If not, how should the guidelines be changed to push towards morbidity control, and ideally, the eventual elimination of transmission?”

3. Impact of Community Mass Treatment with Azithromycin for Trachoma Elimination on the Prevalence of Yaws

PLoS Negelcted Tropical Diseases – Published August 4, 2015
Marks M, Vahi V, Sokana O, Chi KH, Puiahi E, Kilua G, Pillay A, Dalipanda T, Bottomley C, Solomon AW, Mabey DC

“Yaws is a bacterial infection closely related to syphilis. The WHO has launched a worldwide campaign to eradicate yaws by 2020. This strategy relies on mass treatment of the whole community with the antibiotic azithromycin. Mass treatment with the same antibiotic is also recommended by WHO to treat the eye condition trachoma, but with a lower dose. This study assesses the impact of a trachoma control programme in the Solomon Islands on yaws. Following a single round of mass treatment the number of yaws cases fell significantly compared to before treatment. The findings suggest that mass treatment with the lower dose of azithromycin is also effective as a treatment for yaws. In countries where both yaws and trachoma are found it may be possible to develop an integrated strategy for both conditions.”

4. Nodding Syndrome May Be Only the Ears of the Hippo

PLoS Neglected Tropical Diseases – Published August 13, 2015
Joseph Francis Wamala, Mugagga Malimbo, Floribert Tepage, Luswa Lukwago, Charles Lukoya Okot, Robert O. Cannon, Anne Laudisoit, Robert Colebunders

“Epidemiological studies suggest a strong association between NS and onchocerciasis.  In this paper, the authors argue in favor of expanding the research on NS to include the study of all forms of epilepsy in onchocerciasis-endemic regions and to investigate in well-designed intervention studies whether ivermectin, with or without larviciding rivers, is able to decrease the incidence of epilepsy in onchocerciasis-endemic regions. APOC estimates there are currently 36 million people with onchocerciasis. Therefore, if 1% (equivalent to the approximate excess prevalence over non-endemic areas) were to develop epilepsy, the number of excess cases of epilepsy due to onchocerciasis would be on the order of 360,000. The authors hypothesize that most of this excess in prevalence of epilepsy is potentially preventable by increasing the coverage of ivermectin treatment and by maintaining it over many years. If it is confirmed that OV increases the risk of epilepsy, this will be an additional argument to strengthen onchocerciasis elimination plans.”

5. Historical Perspective and Risk of Multiple Neglected Tropical Diseases in Coastal Tanzania: Compositional and Contextual Determinants of Disease Risk

PLoS Neglected Tropical Diseases – Published August 4, 2015
Frederick Ato Armah, Reginald Quansah, Isaac Luginaah, Ratana Chuenpagdee, Herbert Hambati, Gwyn Campbell

“In the past decade, research on neglected tropical diseases (NTDs) has intensified in response to the need to enhance community participation in health delivery, establish monitoring and surveillance systems, and integrate existing disease-specific treatment programs to control overlapping NTD burdens and detrimental effects. In this paper, we evaluated the geographical distribution of NTDs in coastal Tanzania. We also assessed the collective (compositional and contextual) factors that currently determine risks to multiple NTDs using a cross sectional survey of 1253 individuals in coastal Tanzania. The results show that the effect size in decreasing order of magnitude for non-binary predictors of NTD risks is as follows: NTD comorbidities > poverty > educational attainment > self-reported household quality of life > ethnicity. Compositional (biosocial and sociocultural) factors explained more variance at the neighborhood level than at the regional level, whereas contextual factors, such as access to health services and household quality, in districts explained a large proportion of variance at the regional level but individually had modest statistical significance, demonstrating the complex interactions between compositional and contextual factors in generating NTD risks. NTD risks were inequitably distributed over geographic space, which has several important policy implications. First, it suggests that localities of high burden of NTDs are likely to diminish within statistical averages at higher (regional or national) levels. Second, it indicates that curative or preventive interventions will become more efficient provided they can be focused on the localities, particularly as populations in these localities are likely to be burdened by several NTDs simultaneously, further increasing the imperative of multi-disease interventions.”