Tag Archives: Global Health

3rd Progress Report on The London Declaration on Neglected Tropical Diseases Released

Uniting to Combat Neglected Tropical Diseases released its third progress report on The London Declaration on Neglected Tropical Diseases on June 25, 2015. Read the full executive summary and report. 

From the Executive Summary

In the course of human history, few public health efforts can match the scale and ambition of the endeavor to rid the world of 10 Neglected Tropical Diseases (NTDs). These efforts have accelerated over the last three years, as a diverse group of players have come together in one of the largest ever public-private partnerships to deliver the funding, drugs, and technical assistance required.

The good news is that we are beginning to see positive results from this collaboration: a growing number of endemic countries are achieving elimination goals, more people are being reached, and there is increasing national ownership of NTD programs. The political and economic gains from NTD investments make a compelling case for further investment both domestically and from donors.

Nonetheless there are challenges that threaten our ability to meet the WHO NTD Roadmap targets. Currently the supply of donated drugs exceeds our ability to reach communities and more needs to be done to scale up programs. If, as a global consortium of partners, we cannot marshal the resources required to deliver donated drugs to the communities in need, more than a billion people will remain at-risk of harm by NTDs. We need to redouble our efforts.

This third report on progress since the 2012 London Declaration on NTDs highlights important accomplishments and learnings, and identifies areas that warrant greater attention. Five principal themes have emerged within the report:

  1. Control and elimination of NTDs provide one of the strongest returns on investment in public health
  2. Leadership among endemic countries has shown a substantial increase
  3. The largest public health drug donation program in the world continues to grow
  4. Coverage is increasing, but the pace is too slow to meet key milestones
  5. National NTD programs are achieving elimination goals

 

As noted in the 2015 G7 Summit communique, “2015 is a milestone year for international cooperation and sustainable development issues”—and, the fight against NTDs is no different. We have the opportunity now, together, to reach many of the goals laid out in the WHO roadmap on NTDs and position the future elimination of these 10 NTDs as an achievable objective for this generation. Those living in extreme poverty around the world are counting on our help. Let’s not keeping them waiting.

Read the full executive summary and report. 

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.

Making Progress against NTDs in Honduras

Three to four hours. That’s how long one mother was willing to walk to make sure her child attended the annual vaccination and deworming campaign in the village of Coyalito in San Esteban, Honduras.

This past April was my third trip to Honduras in the last 14 months. On my first two trips, I spent the majority of my time running between government offices and meetings – including attending the launch of the Honduras national integrated plan on neglected tropical diseases (NTDs).  Honduras was the first country* in Latin America and the Caribbean region to launch such a plan – which ensures that the country is tackling all diseases at once – versus one at a time.

This time on my return to Honduras, I saw firsthand how that plan was being put into motion.

And I was amazed.

For a country facing severe challenges in security and violence, Honduras is a leader and innovator when it comes to tackling NTDs.

Three government divisions – the Ministries of Health, Education and Social Development are working together to reach people in even the most remote parts of the country.  They’ve taken charge by developing working groups to tackle issues and problems they notice when bringing the programs to the community.

They’re enthusiastic. They’re driven. And I’m quite positive that they’re going to succeed.

I know this because I traveled over six hours with the Ministry of Health over unpaved and rocky roadways on their visits to various districts.  Distribution was carefully arranged: a health worker used a loud megaphone to call out to members of the community to invite them to visit the vaccine and deworming campaign.  From there, mothers would bring their young children to receive essential vaccines and deworming medicine.

A nurse practitioner told me that bundling healthcare delivery– such as vaccination and deworming – often encourages more families to come. Most parents know about these diseases, especially the intestinal worms.  In Honduras, and many other countries in Latin America and the Caribbean,  there’s a common belief that if children grind their teeth at night, they have parasites. There is a demand for deworming, and mothers came armed with their child’s immunization card and found a space to account for their child’s annual deworming treatment.

The Honduran ministries are also thinking beyond treatment for NTDs to a more comprehensive approach.  These diseases are often spread due to lack of access to clean water and proper sanitation, which is a reality for some of the families in villages like Coyalito.  As a result, the ministries are pushing to incorporate water filters in schools, and other sanitation initiatives which will propel these treatment programs toward long-term success.

At the end of the day, I joined the health team in brief survey to determine attendance of the campaign. We walked around each “manzana” – or block – to knock on people’s homes and ask them if children were dewormed and vaccinated. Health workers talked to them about why it’s important to attend these campaigns and have their children treated.

Among advocacy organizations, it seems that we often divvy up health issues, as if family planning, treatment for NTDs and vaccination are all independent projects.  But, the reality is that often, at the point-of-care level, everything is bundled together. It’s very effective.

Our partners in Honduras want to expand this successful initiative to help many more families. END7 is asking supporters to help fill a funding gap to make sure this medicine reaches Honduran children in 20,061 schools. With your help we can reach 1.4 million school children and protect them harmful parasitic worms, including roundworm, hookworm, and whipworm.

Help us see the end of NTDs in Honduras by making a contribution. Read more about END7’s effort to raise money and support for NTD treatment in Honduras here.

*In March 2013, Brazil launched their integrated national plan, and currently several other countries have draft plans in development.

Project For Awesome with END7

 

END7 is excited to be part of the viral video development Project for Awesome. The Project for Awesome is an annual event that sprung out of various YouTube communities to support charities. Every year since 2007, thousands of people post videos to YouTube promoting charities on December 17th. They come together as a community to promote those videos and raise money.

http://www.youtube.com/watch?feature=player_embedded&v=HPeUP_0cGUY

Project for Awesome is an inspirational movement that shows END7 supporters that they can use their voice as well as their creativity in helping to end NTDs. END7 wants to thank two individuals that showed their support for END7. Isabella Bernal and Erica Crouch both made videos explaining their support for eliminating NTDs. We couldn’t have said it better ourselves!