Kigali, Rwanda — The Ministry of Health, in partnership with Columbia University’s Access Project, organized the Neglected Tropical Diseases (NTDs) 2010 annual workshop, which was held at Laico Umubano Hotel on July 20, 2010. The objective of the meeting was to share the achievements accomplished by the NTD Control Program since its inception 3 years ago and to discuss the integration of the NTD Control Program strategies into existing initiatives.
The permanent secretary of the Ministry of Health, Dr. Agnes Binagwaho, launched the workshop by applauding the program’s impressive achievements over the past 3 years.
“We are happy with all the achievements in the fight against intestinal worms and bilharzias in Rwanda, but together with our stakeholders invited to this workshop, we are expecting to come up with strong program implementation strategies and discuss the feasibility of successfully integrating the program into existing initiatives” she said.
The NTD Control Program’s first activity was conducting a national assessment on the five most important NTDs in Rwanda, namely soil transmitted helminths (STHs), schistosomiasis, lymphatic filariasis and onchocerchiasis.
The Maternal Health Taskforce has launched a great new platform to highlight work that organizations worldwide are doing in the maternal health arena.
According to their website:
“It aims to bring you closer to one another and facilitate communication both within and beyond the maternal health community.
The Partner Channel provides a place where you can look forward to finding out what others in our field are doing, thinking, and planning. We envision the Channel becoming a forum for institutional knowledge sharing across a variety of sectors. We look forward to many new Partners from allied fields joining us to expand the maternal health dialogue. Together, we can broaden the reach and impact of maternal health information.”
The Global Network is the newest organization to join their partner channel.
Approximately 20 percent of the world is either infected or at risk for STH infections. Children between the ages of 5 and 15 years old suffer the most, and make up one-third of the global STH burden. Children with chronic infections are at increased risk for physical and mental impairments, which can lead to learning disabilities and poor school performance. Children can also be affected before they are even born – infected pregnant women are at high risk for low birth-weight babies and poor milk production. Additionally, their infants have higher rates of malnutrition and mortality. Furthermore, pregnant women who develop anemia while infected are three and a half times more likely to die in childbirth.
Photo Courtesy of http://www.who.int/wormcontrol/statistics/useful_info/en/index2.html
The most effective prevention methods for controlling chronic STH transmission include both proper sanitation management efforts and educational campaigns aimed at the use of latrines. As previously mentioned, two drugs are available to treat active STH infection, Albendazole and Mebendazole.
In 2001, the World Health Assembly passed a resolution to eliminate STH as a public health problem by regularly treating 75 percent of at risk children by 2010. Unfortunately, less than 20 percent of this population was reached with deworming treatment in 2005. This pressing global health issue must be addressed now and we need your help. To see how you can help control STH transmission, please visit the Global Network’s and CWW’s websites. Together we can control these infections, and assist in providing a better life for the bottom billion!
Happy Wednesday! New reading list for your reading pleasure! Today we’re reading Professor Alan Fenwick’s – Tropical Parasitology at Imperial College London and Director of the Schistosomiasis Control Initiative for Neglected Tropical Diseases – paper on NTDs for the Summer 2010 issue of “A Global Village,” Canada’s announcement of putting $1 billion into maternal and child health activities, iBio’s licensing of vaccine technology to CMB, and advances in lymphatic filariasis (LF) drug research. Enjoy!
The Global Alliance to Eliminate Lymphatic Filariasis (GAELF) is an initiative to support the elimination of lymphatic filariasis (LF) by way of public-private health partnerships and resource mobilization. The organization is currently holding its 6th GAELF meeting in Seoul, Korea “to further accelerate the global effort for LF elimination as well as relevant research studies.” This three day meeting beginning June 1 – June 3, 2010 is focusing on developing strategies for LF elimination for the next 10 years. Within this past decade, The Global Program has already established interventions to address LF in 51 of the 80 endemic countries.
Lymphatic filariasis, which is one of the seven most common NTDs, is caused by a worm and spread to humans by infected mosquitoes. Also known as elephantiasis, LF affects more than 40 million people worldwide and is one of the most socially stigmatizing NTDs due to its disfiguring effect. The disease can be treated using a combination of drugs with a cost of just a few pennies. For more information about LF and the 6th Meeting of GAELF, please visit GAELF’s website: http://www.filariasis.org/
A new paper on NTDs covers the current debate on the best approach for combating them. Should we focus on mass drug administration? Environmental approaches? Horizontal programs? Written by Jerry M. Spiegel, Shafik Dharamsi, Kishor M. Wasan, Annalee Yassi, Burton Singer, Peter J. Hotez, Christy Hanson, and Donald A. P. Bundy, the article brings together respected experts on neglected tropical diseases to identify the most effective ways to fight them. Not surprisingly, these experts don’t agree. They propose substantially different methods to reduce the impact of NTDs.
All the authors make interesting points. Jerry Spiegel, Shafik Dharamsi, Kishor Wasan, and Annalee Yassi are proponents of addressing the social determinants of NTDs, and they make some fascinating, radical arguments. They cite an excessive focus on developing new drugs, and state that it “diverts attention and funding away from complementary strategies needed to sustainably reduce disease burden…” They go on to call for a new financing mechanism for addressing the root causes of NTDs: “We propose that whenever a research program on an NTD innovation is funded, a proportion of the funding is set aside (‘‘offset’’) to address related socio-environmental and health system aspects.”
On the other hand, Peter J. Hotez, Christy Hanson, and Donald A. P. Bundy argue for integrated control of NTDs based on mass drug administration. They couch their case in effectiveness terms “In terms of both health impact and cost-effectiveness, few other interventions can rival mass drug administration for NTDs, and increasingly this approach is being recognized for its beneficial effects on strengthening health systems, improving economic development, and achieving the Millennium Development Goals.” They then describe the progress made in NTD control as a result of drug administration. Their pick for the most effective approach is integrated control of NTDs; in other words, administering the drugs for more than one NTD at a time. That avoids unnecessary duplication of logistical and personnel efforts.
Burton Singer, arguing for primary prevention of NTDs, has two excellent quotes. First, he points out that “You don’t find a demand for drugs to treat hookworm in the southern United States today, because an integrated program of drugs to treat infected cases and installation of toilets (a tool for prevention) as a route for human feces—initially containing hookworm eggs—put an end to the problem almost a century ago.” He goes on to state that “nearly half of the measurable population-level health improvements in sub-Saharan Africa in the 1990s were a consequence of positive inputs in water and sanitation, housing, transportation, and communication…”
I have a tendency to come out of discussions like these agreeing with every side, and this paper is no exception. I am not sold on social offsets. Beyond that, though, I agree with everyone. Drug administration works. It works right away, and it can be organized with a minimum of host country capacity. If you want to make a rapid dent in the human impact of NTDs, mass drug administration is the answer. At the same time, primary prevention is key to long-term impact. Burton Singer is right -- we don’t have a whole lot of NTDs in the US, and it’s not drug administration that got us to this point.
The thing is, the different approaches aren’t mutually exclusive. You can do both mass drug administration and primary prevention. In fact, that would be the best approach -- if we had enough funding for it. What we really have here is a more pie situation. And we can all fight for more pie for NTDs.
Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk.She also serves as a frequently contributing blogger to ‘End the Neglect.”
Lymphatic filariasis (also known as elephantiasis) is another mosquito borne disease that plagues much of the population in malaria endemic areas. In fact is is the same anophelene species of mosquitoes which carry malaria that also transmit lymphatic filariasis in much of Africa. With talk of integration of disease control programs, one wonders what are the potential synergies of combining efforts against malaria and lymphatic filariasis?
Both share the preventive measure of bed nets, which is a major strategy for malaria control, but the main approach to eliminating filariasis is Mass Drug Administration (MDA). Two drugs in combination, ivermectin (or diethylcarbamizine citrate) and albendazole, are given annually. These annual doses kill the microfilaria and have some effect on the adult worms. Success as measured by prevalence below 1% can b achieved after 6 rounds of MDA depending on 1) initial level of LF endemicity; 2) effectiveness of vector mosquitoes; 3) MDA drug regimen; 4) population compliance.
If the two diseases share geography and in some cases a vector, have there been any actual attempts at a joint effort? At least two countries have attempted such within the context of their global fund grants for malaria, Togo and Papua New Guinea (PNG). Togo’s Round 4 GFATM grant aimed at “demonstrating the synergy effect of MDA on the impact of malaria control activities” in co-endemic areas. This was based in part of research that showed a negative impact of helminths on malaria infection.
An innovation in the PNG GFATM proposal is “Training of field staff to disseminate information about malaria and HIV/AIDS (who) will also be used for annual mass drug administration for lymphatic filariasis elimination.”
An NGO example of integration has been piloted by the Carter Center. “In 2004, the Carter Center-assisted Lymphatic Filariasis Elimination Program received 57,000 bed nets from the Nigerian Ministry of Health in a combined effort to prevent the spread of lymphatic filariasis, being addressed by the Center, and malaria, a project of the health ministry. The nets are treated with the insecticide deltamethrin, which is safe for humans yet kills the mosquitoes that are the carriers of both diseases in rural Africa. The bed nets have been distributed in four local government areas of Plateau and Nasarawa states in Nigeria, which are endemic for both diseases.”
The Carter Center has been using the same community distribution system found effective for onchocerciasis control. “Community volunteers distributed 38,600 insecticide-treated bed nets, while simultaneously treating 150,800 persons with ivermectin/albendazole.” A 30-cluster survey found a 9-fold increase in bednet ownership compared to baseline. “This first linkage of insecticide-treated bed net distribution with mass drug administration resulted in substantial improvement in insecticide-treated bed net ownership and usage, without adversely affecting mass drug administration coverage. Such integration allowed two programs to share resources while realizing mutual benefit, and is one model for rapidly improving insecticide-treated bed net coverage objectives.”
Since the Global Fund programs have yet to focus on neglected tropical diseases, these examples of integration between malaria and lymphatic filariasis, may be the best way to ensure parasite-free populations in endemic areas.
With the release of Obama’s proposed FY11 budget yesterday and the $155 million allocated to NTDs specifically, we’re reading many different articles about the Administration’s 9% increase in global health funding. We’re also reading about the recent $13 million grant that the Gates Foundation has given to The Washington University School of Medicine in St. Louis to eliminate elephantiasis (lymphatic filariasis) and river blindness (onchocerciasis), in the developing world. Lots of exciting things happening for the NTD community!
Listen to Dr. Hotez’s interview on WNYC radio’s Leonard Lopate show to discuss hookworm, national security, and why investing in NTDs is a “best buy” in public health!
Amidst the frenzy of World Toilet Day and hysteria in Indonesia, we’d be remiss to not wish one of our Global Network Ambassadors, Gov. Tommy Thompson, a very happy birthday!
Gov. Thompson surrounded by children at an NTD control campaign in Rwanda
Thompson, a 4-term governor of Wisconsin and former Health and Human Services Secretary, has also been actively involved with the Global Network since July of 2008. After hearing about the devastation caused by NTDs and the cost-effective solutions available, he jumped at the opportunity to travel to Rwanda to see our treatment efforts first-hand (watch his dynamic trip video diaries here). He’s also been a huge supporter of integrated efforts with the malaria community and the concept of medical diplomacy.
From the entire Global Network Team, happy birthday Gov. Thompson! Thank you for your commitment to advocacy and policy work on behalf over a billion people suffering from NTDs around the world.
The Global Network for Neglected Tropical Diseases is a major advocacy and resource mobilization initiative of the Sabin Vaccine Institute dedicated to raising the awareness, political will, and funding necessary to control and eliminate the most common neglected tropical diseases (NTDs)--a group of disabling, disfiguring, and deadly diseases affecting more than 1.4 billion people worldwide living on less than $1.25 a day.
Dr. Hotez urges #BRIC countries to support #NTD control and elimination in his recently released @PLoS editorial http://bit.ly/chuQaaby Global_Network about about 8 hours ago
FACT:65 mil Africans have been treated 4 lymphatic filariasis. More than 14 mil were treated 4 schisto last year alone. #MDGs #ntds @whonewsby Global_Network about 2 days ago
