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.
*In March 2013, Brazil launched their integrated national plan, and currently several other countries have draft plans in development.
PLoS Neglected Tropical Diseases talks about how Chagas has spread from Latin America to other parts of the world, take a read:
Chagas disease, caused by the parasite Trypanosoma cruzi, was once thought to be an exotic disease, confined to endemic areas of Latin America and hence of little importance to anyone outside of these endemic regions, including most physicians and scientists. The impact of the lack of physician awareness and lack of scientific attention is undefined, but may contribute to the continued neglect of Chagas disease and the affected populations. Despite historical evidence and growing recognition of the spread of Chagas disease, the prevention and control of this disease outside of Latin America is only now being addressed.
By Ramon D’Bello, Pan American Health and Education Foundation (www.pahef.org)
While most of the Western world has never heard of Chagas disease, 200,000 new cases are reported every year and between 40 to 120 million people are at risk of infection in Latin America. Chagas disease is endemic in 21 Latin American countries and responsible for an average of 14,000 deaths each year. Estimates suggest that up to 11 million people are currently infected in the Americas.
How it Spreads
Trypanosoma cruzi, a parasite also known as T. cruzi, causes Chagas disease through vector-borne infection. Chagas disease is usually spread by the feces of insects called Triatomine bugs, commonly known as the “kissing” bug. The insects become infected after biting an infected animal or person. Once infected, insects become carriers and pass the disease parasites to their victims when it takes a blood meal and releases trypomastigotes in its feces near the site of the bite wound. Trypomastigotes enter the human body through the wound or through mucus membranes, such as the conjunctiva.
There are other means of transmission such as the consumption of food that has been contaminated by the Triatomine bugs, transplants, and in utero from a pregnant woman to her baby. People at highest risk of contracting the disease are often extremely poor and live in inadequate housing with little access to sanitation.
Just this week the Ministry of Health and several other partners in the restated its dedication to eliminating river blindness in the Americas by 2012 and this announcement is an important step towards achieving that goal.
Onchocerciasis is transmitted by the bite of the black fly and a small, bite-transmitted worm parasite. This parasite, Onchocerca volvulus, causes skin irritation and can cause loss of sight. The illness is known as river blindness because the black flies breed in fast-moving bodies of water near affected communities. In order to break the disease transmission cycle, implementing organizations utilize the common practice of mass drug administration (MDA). In MDA programs, safe and affordable (often donated) drugs are distributed to entire communities several times a year. For onchocerciasis treatments, the Merck produced drug Mecitzan (ivermectan) is used at no cost. In the last twenty years over eight million doses have been distributed across the region in endemic communities.
OEPA is a regional collaboration that was started in 1993 by The Carter Center to treat the more than 500,000 people at risk for this disease across Latin America. The partnership includes the Pan American Health Organization (World Health Organization), the pharmaceutical company Merck, the Pan American Health and Education Foundation (PAHEF), Lions Clubs International Foundation, and the Bill and Melinda Gates Foundation. The OEPA program targets the six Latin American countries (Brazil, Ecuador, Guatemala, Mexico and Venezuela) where onchocerciasis is still a public health threat. Originally there were seven countries on this list, but Colombia achieved transmission interruption in 2008. In light of this week’s announcement, this list will be shortened to only five countries.
With a growing interest in the potential for elimination of onchocerciasis from Africa, the success of the programs in the Americas provides an experience base that can guide the next phase of the onchocerciasis program in Africa.