by Navneet Anand and Anuradha Singh, GreyMatters Communications
GreyMatters Communications to run a media awareness program on Lymphatic Filariasis (LF) in India. We took a group of journalists to two affected villages in Odisha to provide them exposure about the problem as well as help them evaluate challenges towards its complete elimination.
The Global Network for Neglected Tropical Diseases, an initiative of the neglected tropical diseases (NTDs).
Often falling beyond the purview of mainstream media, like many other compelling problems in the country, LF has severe enormity and has persisted in India as well as other countries of the world for many years.
Not many would be aware that LF is the world’s second leading cause of long-term disability. Although filariasis does not kill, it causes debility and imposes severe social and economic burden to the affected individuals, their families and the endemic communities. According to one estimate at one point in time 120 million people in 83 countries of the world were infected with lymphatic filarial parasites, and it was estimated that more than 1.1 billion (20% of the world’s population) are at risk of acquiring infection. Over 40 million people are severely disfigured and disabled by filariasis and 76 million are apparently normal but have hidden internal damage to lymphatic and renal systems. According to the World Health Organization, India, Indonesia, Nigeria and Bangladesh alone contribute about 70% of the infection worldwide.
Indigenous lymphatic filariasis cases have been reported from 20 Stateshttp//www.mohfw.nic.in/', 'Ministry of Health');" target="_blank">Ministry of Health.
It is rather heartening to note that the overall microfilaria rate has reduced from 1.24% in 2004 to 0.29% in 2013 (Prov.) at national level. Out of 250 districts 203 districts have reported overall microfilaria rate to less than 1%. Out of remaining 52 districts, 31 need high priority for focussed intervention as these districts have been persistently reporting microfilaria rate above 1%. Ganjam and Puri in Odisha, where we travelled, are also among the high-incidence districts in the country.
It was rather painful to come across two cases of Lakhender Swain and Kointa Swain in Kapileshwarpur village in Puri. Afflicted with this distressing disease, the two have wasted their most productive years attending to deal with this disabling disease. “I had a dream for my life but the tyranny of this disease was such that I was rendered helpless. For over 20 years now, I have lived with this heaviness in the leg and associated problems including social taboos and boycotts,” rued Lakhender, who is 45 only. Kointa, in her 60s, recalls how at one point she was extremely active and used to work “effectively” till destiny willed otherwise.
“NTDs like lymphatic filariasis hold people back not just physically, but also socially. Misunderstandings about what causes the disease, how it is transmitted and what its effects are can lead to stigma and social exclusion. This lack of understanding can cause communities to push LF patients to the margins, excluding them from employment or educational opportunities, from community festivals or celebrations and making it difficult to marry. The impact can go beyond the LF patient to also affect family members of LF patients. Self-stigma is also a problem and can impact a patient’s mental health. Social isolation compounds the impact of the infection, keeping people from trying to achieve their aspirations or have hope for the future. Although LF tends to be visible in rural and poor communities, LF is spread through mosquitos, like dengue and malaria, so anyone can be infected,” said Nandini Pillai, Programs and Operations Officer, GNNTD.
However, thanks to some serious and sustained intervention by the government as well as work by agencies like GNNTD as well as NGOs like CASA (Churchs Auxiliary for Social Action), the problem is well contained and India may well be on the verge of soon eliminating the disease altogether.
One of the key programs of the Government is Mass Drug Administration where all those at risk are administered medicine free of cost.
“The treatment is a weight-based dose of diethylcarbamizne (DEC), and a single pill of albendazole, to everyone over the age of 2 years and not ill or pregnant. Both drugs are anti-parasitic medications which prevent and expel parasites. These medicines also protect from intestinal worm infections. The treatment is safe and free and delivered to communities through ASHA workers and other community-based drug distributors. The drugs are donations from major pharmaceutical companies, like GlaxoSmithKline (GSK), or procured in India from WHO approved companies. They are completely safe,” informed Shaliesh Vaite, National NTD Advisor, GNNTD.
The 2015 MDA is underway nationwide from December 14-20.
The medical approach to defeating NTDs is through a set of medications donated by major pharmaceutical companies for free distribution to communities in need. “In India, state governments locally procure some medications and submit their requests for donated drugs to the central government, which then works with WHO to order and deliver the drugs. Community drug distributers are responsible for going door to door to hand out the drugs and ensure that people take them properly. This grassroots method for treating and protecting against NTDs takes the partnership of the whole community working in tandem, and ensures that nobody is left behind,” added Kelly Toves, Communications Officer, GNNTD.
Along with this, if media also undertakes to write more often and inform people about the ways to deal with this scourge, the process of elimination will be faster.
This post was originally published on Communicate, Connect.
Each 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.
“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 involved in END7’s work, contact the END7’s student outreach coordinator at Emily.Conron@sabin.org to learn how you can get started!
Re-posted with permission from Peter McMinn of the Lowy Institute for International Policy.
The relationship between Timor-Leste and Indonesia has improved steadily since the independence referendum in 1999. Indonesia is now one of Timor-Lestes key trade partners and has strongly supported its application for membership of ASEAN. The two countries are also working toward settling border disputes that have been unresolved for many years.
This mood of cooperation is also working in the health sector.
Since Timor-Leste regained its independence, public health officials in Dili and Indonesian West Timor have faced substantial challenges in regard to the control of tropical infections which have an enormous impact on the health of already marginalised populations. Diseases such as lymphatic filariasis (elephantiasis), intestinal worm infections (especially hookworm) and yaws are highly prevalent across the island of Timor and cause chronic disfigurement, disability and death.
Elimination of these diseases can be achieved by mass drug administration (MDA) to affected populations (target 75-80%) annually for a period of 5-7 years. Such a program requires high levels of coordination and cooperation by health officials and the engagement of affected communities.
Efforts to free the developing world from these and other tropical infections received a boost in 1998, when the World Health Assembly resolved to eliminate them globally by 2020. The chances of doing so were greatly enhanced when a consortium of pharmaceutical companies pledged to donate the drugs required to treat these infections free of charge to all countries participating in the World Health Organization (WHO) Global Elimination Program.
Many countries have now commenced this program with support from the WHO, pharmaceutical companies, the Gates Foundation and other donors. However, it has not begun in Timor-Leste and has been interrupted in Indonesian Timor due to low capacity in the health workforce and a lack of donor support. The situation has been complicated by the recurrence of conflict in Timor-Leste and the logistical challenges involved in bringing together teams to work across national borders.
In December 2011 the Timor-Leste Minister of Health signed Memoranda of Understanding (MOU) on cross-border cooperation for public health with the Indonesian Minister of Health in Jakarta and with the Governor of Nusa Tengara Timur (NTT) Province in Kupang, West Timor, both vital steps in implementing the program. Under the latter MOU it was agreed that the Government of Timor-Leste and the Indonesian Provincial Government of NTT would cooperate to monitor and implement shared public health challenges. This cross-border cooperation is particularly important for the East Timorese enclave of Oecusse, which is completely surrounded by Indonesian territory.
The program is scheduled to commence in 2014. A senior public health expert from the Ministry of Health in Jakarta has recently assisted the Timor-Leste Ministry of Health to develop a detailed program implementation plan that includes cross-border cooperation on disease surveillance and information sharing on the progress of program implementation. Furthermore, a public health official from NTT will be invited to join the Task Force and vice versa.
Cross-border cooperation will be critically important during the post-MDA enhanced surveillance program to verify disease elimination and to ensure that Timor Island can be certified free of these diseases by the WHO in the shortest possible time. Such collaboration represents a practical example of cross-border cooperation that is of mutual public health benefit for Indonesia and Timor-Leste.
Sydney Southeast Asia Centre leads a program to help Timor-Lestes health ministry implement the Lymphatic Filariasis, Hookworm and Yaws Elimination Program.
By: Alanna Shaikh
How do I think of NTDs, let me count the ways…
- As a social justice issue. The neglected tropical diseases exemplify unfairness on a global scale. NTDs disproportionately affect poor countries, and within poor countries they affect poor people. Among poor people, they disproportionately affect women and children[i]. NTDs are an assault on the members of our global community who are already living the most difficult lives and have the fewest resources to overcome the challenges of disease infection. Often disabling and disfiguring, the NTDs affect people already at risk for social exclusion – women and poor people – and push them even further to the periphery.
- As an economic issue. More than a billion people suffer from NTDs diseases with symptoms like severe pain, blindness, extreme swelling of the limbs, fatigue, cognitive impairment, and anemia. That has a serious economic impact on the countries where NTDs are endemic. One example: NTD-related reductions in agricultural productivity results in billions of dollars lost every year. A billion here, a billion there – that kind of thing starts to add up. If that amount sounds overblown to you, remember that there are a billion people with NTDs. If they each lose ten dollars because of their infection, that’s a ten billion dollar loss right there. And NTDs, as mentioned affect women, children, and men working in agriculture.