Monthly Archives: October 2015

Celebrating NTD Success Stories: Sierra Leone’s Inspiring Progress in the Face of Ebola

Africa, END7, , , ,
Community health officer Hawa Margai speaks about onchocerciasis to a group of women gathered at the Levuma community health center in the town of Levuma, Sierra Leone on Friday July 13, 2012.

Community health officer Hawa Margai speaks about onchocerciasis to a group of women at the Levuma community health center.

During the month of October, END7 student supporters are celebrating NTD Success Stories from four countries — Haiti, India, Sierra Leone and the Philippines — that have overcome incredible obstacles to make progress towards NTD control and elimination. This week’s success story comes from Sierra Leone, where inspiring efforts are being made to fight NTDs in the wake of the Ebola epidemic.

Six NTDs are found in all 14 health districts in Sierra Leone, threatening nearly the entire population of the country. Sierra Leone faces many health and development challenges, but the government has exerted strong leadership in the fight against NTDs. By 2004, the national NTD program had successfully mapped the prevalence of targeted NTDs nationwide, and in 2005 they launched a mass drug administration (MDA) campaign to treat every at-risk community with the participation of nearly 30,000 volunteer community drug distributors. Supported by the U.S. Agency for International Development (USAID), Sierra Leone’s Ministry of Health had distributed more than 57 million NTD treatments nationwide by the beginning of 2014. As a result of these efforts, the country was on track to begin the World Health Organization process of verifying the elimination of lymphatic filariasis (LF) in eight of 14 health districts in 2014. Unfortunately, when the West African Ebola epidemic reached Sierra Leone in May of that year, all public health program activities were suspended as the country raced to stop the spread of Ebola. As a result, the Sierra Leone NTD Program was unable to carry out MDA in 2014, interrupting progress towards LF elimination.

But today, the government of Sierra Leone and partner organizations are working hard make up for lost time. In May of 2015, on the heels of nationwide malaria and vaccination campaigns, MDA restarted in Sierra Leone. Just this month, from October ninth to 13th, 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).

The relaunch of MDA this year required careful preparation, including refresher training session for community drug distributors and program administrators. Extensive social mobilization campaigns, aimed at educating communities still reeling from the Ebola epidemic about the importance of participating in MDA, were conducted through community meetings and radio spots. As a result of this careful preparation, early indications are that Sierra Leone’s 2015 MDAs have been successful.

The consistent key to Sierra Leone’s inspiring success tackling NTDs before and after the Ebola epidemic has been the leadership and commitment of volunteer community drug distributors. Elected by their communities, these volunteers reach the most remote corners of the country, enabling Sierra Leone to consistently achieve treatment coverage above 75 percent in targeted communities.

Given Sierra Leone’s small geographic size, the strong political support of the government and the commitment of the volunteer community drug distributors who form the backbone of MDA programs, the country is in the unique position to become one of the first countries in Africa to control snail fever and intestinal worms and eliminate river blindness and elephantiasis. Sierra Leone’s NTD program has also successfully demonstrated that MDA can be achieved in highly populated urban settings. But additional support is needed. By integrating NTD treatment with schools and other health programs, millions of people at risk for NTDs can live free of these diseases of poverty and their devastating effects including malnutrition, disability, social stigmatization and a loss of productivity.

Sierra Leone’s progress against NTDs despite the challenges posed by the Ebola epidemic should inspire other countries to redouble their efforts to address these diseases. Now more than ever, support for robust public health efforts like Sierra Leone’s NTD Program is needed to build on this impressive progress. END7 supporters are eager to celebrate Sierra Leone’s progress and look forward to celebrating more milestones as the country moves closer to its ultimate goal of controlling and eliminating NTDs.

NTD Article Round-Up

NTDs
 END7_Malindi_MoScarpelli_web_19

The Global Network will be presenting a round-up of articles on neglected tropical diseases (NTDs). Check back regularly for the latest studies. To suggest an article, you may post a comment below.

1. Associations between School- and Household-Level Water, Sanitation and Hygiene Conditions and Soil-Transmitted Helminth Infection among Kenyan School Children

Parasites and Vectors – Published August 7, 2015
Freeman MC, Chard AN, Nikolay B, Garn JV, Okoyo C, Kihara J, Njenga SM, Pullan RL, Brooker SJ, Mwandawiro CS

“Soil-transmitted helminths, a class of parasitic intestinal worms, are pervasive in many low-income settings. Mass treatment, typically administered through schools, with yearly or biannual drugs is inexpensive and can reduce worm burden, but reinfection can occur rapidly. Access to and use of sanitation facilities and proper hygiene can reduce infection, but rigorous data are scarce. Among school-age children, infection can occur at home or at school, but little is known about the relative importance of WASH in transmission in these two settings.  We explored the relationships between school and household water, sanitation, and hygiene conditions and behaviors during the baseline of a large-scale mass drug administration programme in Kenya. We assessed several WASH measures to quantify the exposure of school children, and developed theory and empirically-based parsimonious models.  Results suggest mixed impacts of household and school WASH on prevalence and intensity of infection. WASH risk factors differed across individual worm species, which is expected given the different mechanisms of infection.  No trend of the relative importance of school versus household-level WASH emerged, though some factors, like water supply were more strongly related to lower infection, which suggests it is important in supporting other school practices, such as hand-washing and keeping school toilets clean.”

2. Should the Goal for the Treatment of Soil Transmitted Helminth (STH) Infections Be Changed from Morbidity Control in Children to Community-Wide Transmission Elimination?

PLoS Neglected Tropical Diseases – Published August 20, 2015
Roy M. Anderson, Hugo C. Turner, James E. Truscott, T. Déirdre Hollingsworth, Simon J. Brooker

This article examines the feasibility of reaching the World Health Organization goal of mass drug administration coverage for 75% of those at-risk of soil-transmitted helminths. It weighs alternative goals to achieve morbidity control and the elimination of transmission.

“We are still a long way from the 2020 target of 75%. Even if this target is reached, will it be enough to eliminate transmission and the disease arising from heavy infections with STH? If not, how should the guidelines be changed to push towards morbidity control, and ideally, the eventual elimination of transmission?”

3. Impact of Community Mass Treatment with Azithromycin for Trachoma Elimination on the Prevalence of Yaws

PLoS Negelcted Tropical Diseases – Published August 4, 2015
Marks M, Vahi V, Sokana O, Chi KH, Puiahi E, Kilua G, Pillay A, Dalipanda T, Bottomley C, Solomon AW, Mabey DC

“Yaws is a bacterial infection closely related to syphilis. The WHO has launched a worldwide campaign to eradicate yaws by 2020. This strategy relies on mass treatment of the whole community with the antibiotic azithromycin. Mass treatment with the same antibiotic is also recommended by WHO to treat the eye condition trachoma, but with a lower dose. This study assesses the impact of a trachoma control programme in the Solomon Islands on yaws. Following a single round of mass treatment the number of yaws cases fell significantly compared to before treatment. The findings suggest that mass treatment with the lower dose of azithromycin is also effective as a treatment for yaws. In countries where both yaws and trachoma are found it may be possible to develop an integrated strategy for both conditions.”

4. Nodding Syndrome May Be Only the Ears of the Hippo

PLoS Neglected Tropical Diseases – Published August 13, 2015
Joseph Francis Wamala, Mugagga Malimbo, Floribert Tepage, Luswa Lukwago, Charles Lukoya Okot, Robert O. Cannon, Anne Laudisoit, Robert Colebunders

“Epidemiological studies suggest a strong association between NS and onchocerciasis.  In this paper, the authors argue in favor of expanding the research on NS to include the study of all forms of epilepsy in onchocerciasis-endemic regions and to investigate in well-designed intervention studies whether ivermectin, with or without larviciding rivers, is able to decrease the incidence of epilepsy in onchocerciasis-endemic regions. APOC estimates there are currently 36 million people with onchocerciasis. Therefore, if 1% (equivalent to the approximate excess prevalence over non-endemic areas) were to develop epilepsy, the number of excess cases of epilepsy due to onchocerciasis would be on the order of 360,000. The authors hypothesize that most of this excess in prevalence of epilepsy is potentially preventable by increasing the coverage of ivermectin treatment and by maintaining it over many years. If it is confirmed that OV increases the risk of epilepsy, this will be an additional argument to strengthen onchocerciasis elimination plans.”

5. Historical Perspective and Risk of Multiple Neglected Tropical Diseases in Coastal Tanzania: Compositional and Contextual Determinants of Disease Risk

PLoS Neglected Tropical Diseases – Published August 4, 2015
Frederick Ato Armah, Reginald Quansah, Isaac Luginaah, Ratana Chuenpagdee, Herbert Hambati, Gwyn Campbell

“In the past decade, research on neglected tropical diseases (NTDs) has intensified in response to the need to enhance community participation in health delivery, establish monitoring and surveillance systems, and integrate existing disease-specific treatment programs to control overlapping NTD burdens and detrimental effects. In this paper, we evaluated the geographical distribution of NTDs in coastal Tanzania. We also assessed the collective (compositional and contextual) factors that currently determine risks to multiple NTDs using a cross sectional survey of 1253 individuals in coastal Tanzania. The results show that the effect size in decreasing order of magnitude for non-binary predictors of NTD risks is as follows: NTD comorbidities > poverty > educational attainment > self-reported household quality of life > ethnicity. Compositional (biosocial and sociocultural) factors explained more variance at the neighborhood level than at the regional level, whereas contextual factors, such as access to health services and household quality, in districts explained a large proportion of variance at the regional level but individually had modest statistical significance, demonstrating the complex interactions between compositional and contextual factors in generating NTD risks. NTD risks were inequitably distributed over geographic space, which has several important policy implications. First, it suggests that localities of high burden of NTDs are likely to diminish within statistical averages at higher (regional or national) levels. Second, it indicates that curative or preventive interventions will become more efficient provided they can be focused on the localities, particularly as populations in these localities are likely to be burdened by several NTDs simultaneously, further increasing the imperative of multi-disease interventions.”

The Intersections of Poverty, Handwashing and Neglected Tropical Diseases

Global Health, NTDs, Water and Sanitation
Sabha and her friends drink water and wash their hands from a village well in Ghorahuan Village, Bihar State, India

Sabha and her friends drink water and wash their hands from a village well in Ghorahuan Village, Bihar State, India

Today marks the 7th Global Handwashing Day. This year’s Global Handwashing Day is a particularly important one for neglected tropical diseases (NTDs). Just two months ago, the World Health Organization (WHO) launched a global strategy to better integrate water, sanitation and hygiene (WASH) services — including handwashing education and access to handwashing facilities — with other public health interventions to eliminate and eradicate NTDs by 2020. The strategy aims to provide evidence-based guidance on effective ways for WASH and NTDs groups to collaborate to meet common goals.

Improved WASH is one of five interventions recommended by the WHO roadmap for the fight against NTDs. Access to clean water, handwashing facilities, proper waste management and good hygiene practices are critical to preventing NTDs from spreading. This is especially important for trachoma, the world’s leading cause of preventable blindness of infectious origin.

Approximately 232 million people are at risk of trachoma, and it is estimated to be responsible for the visual impairment of about 1.8 million people. A bacterial infection of the eyelid, trachoma is a highly contagious disease that can cause blindness if left untreated. It is spread by the eye, nose or throat secretions of an infected individual. These secretions are commonly spread by hands — as well as flies and shared facial cloths or tissues. Washing and other hygiene measures are critical to the success of trachoma interventions.

WASH and NTDs are both significant challenges to global development. WHO estimates that 1.9 billion people across 149 countries are at risk of at least one NTD, with many people at risk of suffering more than one. Likewise, 2.4 billion of the world’s population lacks access to adequate sanitation, while 1 billion people practice open defecation and 663 million do not have access to improved sources of drinking water. Both impacting the most impoverished communities, there is a significant overlap in the communities where NTDs are endemic and in which WASH resources are limited.

Notably, the strategy calls on endemic countries and partners to, “include, where possible, WASH indicators to contribute to success on NTD targets, and NTD indicators to contribute to success on WASH targets within the national frameworks for reporting progress against SDGs [Sustainable Development Goals].” NTD stakeholders have also recommended an NTD indicator to monitor progress on the SDGs. Because of the close links between poverty, the prevalence of parasitic diseases and access to WASH, measuring progress against NTDs provides insight into how effectively the global community is progressing towards ensuring equitable access to clean drinking water, improved sanitation and proper hygiene — and ultimately eradicating extreme poverty.

You can join the effort by asking your country’s representative to the United Nations to support and promote the inclusion of a global NTD indicator in the SDGs.

TAKE ACTION: Make NTDs count in the SDGs, send a message.

 

Leave a comment

Celebrating NTD Success Stories: India’s Historic NTD Progress

END7, India, MDA, NTDs, , , ,
A student holds an Albendazole tablet at a mass drug administration at the Ghorahuan School in Bihar, India.

A student holds an Albendazole tablet at a mass drug administration at the Ghorahuan School in Bihar, India.

During the month of October, END7 student supporters are celebrating NTD Success Stories from Haiti, India, Sierra Leone and the Philippines. Each country we are spotlighting has overcome their own challenges, ranging from earthquakes to the Ebola epidemic, to make sure communities receive NTD treatment and progress towards disease control and elimination. The examples of these four diverse countries help communicate not just the scope of the suffering caused by NTDs, but the hope we have of ending these diseases for good. Last week, we celebrated Haiti’s inspiring progress towards the elimination of lymphatic filariasis, and this week we’re looking across the globe to India, a historic leader against that and many other NTDs.

India’s diverse population has experienced rapid economic growth over the past two decades, but the country still faces significant health challenges due to its size and high burden of disease. Almost half of the 1.2 billion people at risk of lymphatic filariasis (LF) infection globally live in India. Additionally, NTDs such as soil-transmitted helminths (STH) negatively impact hundreds of millions of children in the country, causing delays in cognitive and physical development. These NTDs take a heavy toll on economic productivity and chronic infections perpetuate the cycle of poverty. However, the Indian government has one of the largest and most successful NTD programs in the world, and treatment scale-up is paving the way towards the elimination of LF and the control of STH infections on the subcontinent.

The Indian government first launched a pilot program to tackle LF in 1949. Over the next four decades, the government supported important research and demonstration studies that became the technical backbone of the World Health Organization’s Global Programme to Eliminate LF, launched in 2000. India’s experience with LF provided the evidence for the operational and technical feasibility of mass drug administration (MDA) to eliminate LF — a strategy that has since been adopted in countries around the world.

Today, India leads the world’s largest MDA program, reaching more than 400 million people with an annual dose of preventative medicine for LF. To date, India is one of only two countries who have achieved MDA coverage at a national level, and the population at risk of LF in the country has been reduced from 600 million to 460 million as a result. The country has also successfully scaled up efforts to control STH infections at the state level, particularly through school-based deworming programs, and recently launched a National Deworming Day to coordinate multiple platforms for deworming into one cohesive push to tackle STH in children under 19. This initiative will encourage coordinated efforts, budgeting, and monitoring to improve the efficacy and reach of deworming programs.

Several districts in India are in the process of undergoing Transmission Assessment Surveys, evaluations designed to register whether LF transmission has been interrupted and annual MDA can cease. Moving forward, bi-annual MDAs will continue in districts with a high burden of LF. Continued efforts aimed at interrupting transmission of diseases, disease surveillance, early diagnosis and response, as well as continued community mobilization and education to change risk behaviors will be critical to reducing the LF burden in India. Managing the disease among existing patients, particularly those disabled by LF with elephantiasis or hydrocele, is also a high priority.

India’s Ministry of Health and Family Welfare worked with the Global Network for Neglected Tropical Diseases in November 2014 to produce a mass media campaign, Hathipaon Mukt Bharat (Filaria Free India) to raise awareness of LF and encourage people to participate in MDAs. The video created for the campaign, entitled , won silver at the Cannes Festival of Creativity in 2015. Bollywood star Abhishek Bachchan is also supporting India’s effort against NTDs as the END7 campaign’s first official ambassador in India.

These ongoing social mobilization efforts will be critical to achieving national, regional and global NTD control and elimination goals by 2020. If India’s current NTD efforts can be maintained and expanded, those at risk for NTDs can live free of these diseases of poverty and their devastating effects. And as the leader of one of the oldest and largest programs to tackle NTDs, India can be a leader in assisting other endemic countries hoping to replicate their success around the world.

There’s ample reason to hope that history will repeat itself in India as the country celebrates the elimination of polio and looks towards new goals, like the elimination of LF. The country’s example shows that directing the expertise of different agencies and organizations towards a common goal can be successful even in a country with a large and diverse population. END7 supporters are eagerly following the good news from India — the second success story we’re spreading in a month that’s already offered many reasons to celebrate — and hoping to see it replicated worldwide.