SMS and eMedicine in the Elimination of NTDs

 

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This blog was originally posted by By Matthew Alexander on POLYGEIA‘s blog *

Just over a fortnight ago, 27th March saw India declared a Polio-free country; it has been over three years since 18 month-old Rukhsar Khatoon was diagnosed with the last case in South-East Asia. The disease left her with mild paralysis in her right leg.

Only three decades ago, 200,000 children per year were left with disabilities due to polio in India, and in 2009 India was still the site of 741 of the world’s 1,604 cases. Now, following the elimination of polio from India, 80% of the world is polio free. [1] The final push will involve mass vaccination of remaining endemic countries: Afghanistan, Niger and Pakistan, but with one-hundred children recently infected in Syria there is a race to prevent new epidemics before the 2018 eradication target. [2]

The Polio virus will not be the first pathogen to be eradicated by human intervention. The Variola virus (the causative agent of smallpox) has been extinct in the wild since 1977, and more recently in 2011, the Rinderpest virus was declared eradicated by the OIE. [3] The successful Smallpox campaign cost $1billion in today’s currency, with two-thirds of the financial burden on the endemic countries; this is in stark contrast to the polio programme with the Post Graduation Education Institute (PGEI) estimating that the next four years will cost $5.5 billion in addition to the billions already invested since the 1980s. Yet there is still a strong economic case for eradication, with returns of $25 billion in as few as two decades when compared to routine immunisation. [4]

So what does polio elimination have to do with Neglected Tropical Diseases (NTDs)? Like the polio virus, many of the pathogens that cause NTDs are eradicable; they cause debilitating symptoms that hinder economic and social activity; they cause much suffering to the afflicted and their families; in total, 1.7 billion people are at risk of developing these diseases. Of the 17 NTDs listed by the WHO, two are set to be eradicated worldwide and 10 have co-ordinated programmes to eliminate the disease from endemic populations, all within the next 10 years. [5]

In 2004, another disease was eliminated from India to a much smaller fanfare; Yaws begins as a cutaneous infection and spreads to cartilage inflicting disfigurement and disability. The causative pathogen, a bacterium of the Treponema pallidum species, is easily treated with a single oral dose of azithromycin and yet Ghana, Papua New Guinea and the Solomon Islands report over 10,000 cases per year. WHO hopes for its eradication by 2020 through a programme of identification of endemic areas and blanket treatment. [5]

The NTD policy team members of Polygeia are working hard to find areas where we can take novel ideas and apply them effectively to real world situations. My personal interests lie in the use of mobile phones and SMS to improve uptake of available testing, counselling and treatment concordance. Much work has been done in HIV and TB treatment with schemes such as WelTel showing promise. Under this programme, HIV positive patients were required to respond to weekly texts from a nurse and then outcomes were compared to a control group receiving standard care. Those receiving texts were 19% less likely to be non-compliant and 16% less likely to show failure of viral suppression. In other words, for every 11 people treated, one would remain well who may otherwise have developed AIDS. [6]   We hope to develop policies that will take successful concepts in eMedicine to the fight against NTDs.

References:

[1] Basu, M.  India beats the odds, beats polio. CNN, 27th March 2014

[2] Whewell ], T. Polio in Syria: An outbreak that threatens the Middle East. BBC, 26th March 2014

[3] Rinderpest Eradication, Bulletin No. 2011-12, OIE, Feb 2011

[4] Economic Case for Eradicating Polio, PGEI, 2013

[5[ Sustaining the drive to overcome the global impact of neglected tropical diseases, WHO, 2013

[6] Yaws fact sheet No. 316, WHO, 2014

[7] Lester R. T. et al, 2010. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. The Lancet, Vol. 376, Issue 9755

*Polygeia was founded to give students the opportunity to contribute to global health policy. Its core aims are:

  1. Research and disseminate high quality policy papers and follow up on their implementation where possible.
  2. Develop the skills of our researchers through our policy workshops and mentoring programme.
  3. Engage students and others with the global health issues on which we are working.

Sabin Celebrates 20 Years of Operations with a Star-Studded Event

 

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This post originally appeared on the Sabin Vaccine Institute blog.

In celebration of twenty years since its founding, the Sabin Vaccine Institute (Sabin) will bring together top leaders in the global health community for its 20th Anniversary Scientific Symposium on Friday, April 25 in Washington, DC.

The program will include an impressive lineup of speakers including Dr. Seth Berkley (GAVI Alliance); Dr. Margaret Chan (WHO); Dr. Mickey Chopra (UNICEF); Dr. Carissa Etienne (PAHO); Dr. Julio Frenk (Harvard University); Dr. Julie Gerberding (Merck Vaccines and the International Federation of Pharmaceutical Manufacturers & Associations); Dr. Lance Gordon (Bill & Melinda Gates Foundation); and Dr. Mahendra Suhardono (Biofarma and the Developing Countries Vaccine Manufacturers Network).  On behalf of Sabin’s vaccine leadership, President Dr. Peter Hotez and Executive Vice President Dr. Ciro de Quadros will also make remarks at the event.

By bringing together a diverse group of scientists, advocates and global health experts, Sabin will foster a thought-provoking discussion about best practices, lessons learned and prospects for the future of global health.  With executive leadership from the NGO community, multilateral institutions, pharmaceutical industry, and academia, attendees will hear how stakeholders from various vantage points – from the NGO, private and public sectors – are uniquely positioned to address pressing global health challenges across the world.

This event is open to the public; to register, please visit the event registration page.

Towards a Less Wormy World

 

By Nina Cromeyer Dieke*

Nigeria is – by far – Africa’s most populous nation. It recently came to light that it is the continent’s biggest economy. It also has the highest burden of NTDs in all of Africa. Therefore, when an opportunity arose in late 2013 to run our GIS training course in Abuja, we were very excited and quickly set about preparing the materials.

Nina presenting at GAHI's Modern Tools for NTD Control Programmes training

GAHI’s Jenny Smith presents on modern tools for NTD control programmes.

Part of my job as communications manager for the Global Atlas of Helminth Infections (GAHI) team at the London School of Hygiene & Tropical Medicine (LSHTM) is the coordination of our five-day course on Modern Tools for NTD Control Programmes. The course is part of GAHI’s capacity building efforts and is aimed at data and programme managers who wish to use geographic information systems (GIS) and mapping to better target their deworming and NTD control plans. The course first took place in Nairobi in May 2013, with 18 participants from 7 African countries. One of the participants was Dr. Obiageli Nebe, the Nigerian Ministry of Health’s National Coordinator for STH and schistosomiasis. We were very pleased to hear, just a few months later, that Dr. Nebe successfully advocated for the course to run in Abuja, a feat that materialised in January 2014 with 21 participants from Nigeria’s FMOH and NGO’s.

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The group of participants from GAHI’s five-day course on Modern Tools for NTD Control Programmes

After a great visit to Nigeria, the year continued to bode well for GAHI with the re-launch of our website. Still on www.thiswormyworld.org, we now have a brand new design that makes searching for maps, data and our training resources much easier, including the interactive NTD Mapping Tool. We also have a new research section with information about our ongoing work, in addition to mapping. We’re very excited about our new look!

One of the great new additions to the website is maps (and their data) showing water supply and sanitation (WSS) coverage in Sub-Saharan Africa. These are the result of a recent paper in PLOS Medicine, led by GAHI’s Rachel Pullan with Matt Freeman at Emory University, Pete Gething at Oxford, and GAHI’s Simon Brooker. The study found stark in-country inequalities in access to water and sanitation, as well as in practicing open defecation. Demonstrated inequalities for some example countries include a 33.0% to 99.5% range in district-level coverage of improved drinking water in Benin, and a 13.8% to 93.6% range in open defecation in Burkina Faso. We recognise the important links between good WSS access and NTD control, and this type of multidisciplinary research to understand the context of control is increasingly a part of our work.

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It’s been a busy year for us so far, but we’re not alone. I’m thrilled by the ever growing momentum around NTD control and elimination, most recently demonstrated at the Uniting to Combat NTDs meeting in Paris. New funding commitments and increasing multi-sector partnerships are getting us closer to 2020 goals, in countries large and small.

Follow GAHI on Twitter, @ThisWormyWorld

*Nina Cromeyer Dieke is the communications manager at Global Atlas of Helminth Infections

Connecting the Dots: Greater Integration between WASH and NTDs

 

Photo by Esther Havens

Photo by Esther Havens

Over the past month, we’ve heard many times from the neglected tropical disease (NTD) and water, sanitation and hygiene (WASH) communities about the importance of cross-sector collaboration (see here and here). Momentum has especially been building, though, in the past two weeks.

Just last week, as the part of events recognizing the second anniversary of the London Declaration, we celebrated new commitments from WaterAid and Dubai Cares that will advance integrated deworming and WASH interventions.

This week, the Global Network and partners gathered with the former President of Ghana and Global Network’s NTD Special Envoy, H.E. John Kufuor – who also serves as Chair of the Sanitation and Water for All (SWA) Partnership – to discuss the cost-effective and sustainable strategies our sectors and private industry can take.

Another important conversation also occurred this week: “Why water and toilets matter in foreign aid,” hosted by WaterAid at the National Press Club. Barbara Frost, chief executive of WaterAid UK; Henry Northover, head of policy at WaterAid UK; and Lisa Schechtman, director of policy and advocacy at WaterAid America spoke about how WASH can advance many U.S. interests. WaterAid also invited Dr. Neeraj Mistry, Global Network’s managing director, to weigh in about the health implications of poor WASH circumstances.

Lisa observed that there’s been increasing “recognition that development component isn’t just good for moral authority but that it helps bolster defense and diplomacy components.” The 2012 National Intelligence Estimate on Global Water Security emphasizes that water can be a tool of conflict or peace and makes the connection that poverty reduction – through WASH – can increase security.

Similarly, the U.S. Center for Disease Control and other collaborators published a Global Health Security Agenda in February to thwart risk of infectious diseases.

Barbara then stressed the impact that WASH has on “women’s health, girls’ lives, empowerment and what it means for their healthy development.” For instance, in many vulnerable communities, “girls drop out of school because they are carrying water or because there aren’t adequate toilets when they go through puberty.”

In the same way, NTDs disproportionately impact females. When END7 campaign ambassador Abhishek Bachchan visited a lymphatic filariasis clinic in Orissa State, India, he heard from women about how the stigma and misinformation associated with the disease prevented their daughters from getting married and participating equally in society. Women and girls with a certain form of schistosomiasis, one of the most common NTDs, are also three times more likely to contact HIV.

Henry, who noted that “dirty water is the vector for so many of the diseases that you see under the microscope,” also reflected on global challenges in the WASH community. Most importantly was that some serious challenges on how aid is targeted.

Global health is a fraction of one percent of the federal $1.012 trillion budget – and the budget for NTDs is even smaller. But this tiny amount has a huge impact, which is why the Global Network is urging the public to encourage key members of Congress to protect funding for this critical program.

Then Neeraj emphasized, “this is not an either or measure – we have to do both [WASH and NTDs] to have a significant and sustainable impact on many of these diseases.” While WASH and NTDs “may seem like disparate thematic issues in the development agenda, we are looking at similar thematic platforms” to make positive changes, in schools or during child health weeks.

Ultimately, we will not stop the transmission of NTDs without clean water, improved sanitation, and better hygiene practices, and even with good water, we need to distribute treatments to protect against disease. The Global Network looks forward to continuing its support as collaboration and dialogue between both sectors grows.