Category Archives: intestinal parasites

History of Health Systems in Nicaragua

intestinal parasites, NTDs

In the face of many obstacles, Nicaragua’s history in ensuring a national deworming program has shed light on the potential for success.  Former Global Network intern, Frankie Lucien, and fellow George Washington University Masters student Cara Janusz, traveled to Nicaragua and investigated the challenges and achievements of the Nicaragua experience and developed a case study with support from Children without Worms.

This week End the Neglect will be featuring a six-part series of blog posts covering interesting elements of the Nicaragua experience highlighted in the case study, entitled “Worms and WASH(ED)”. 

We’re kicking off the series with a brief history of health systems in Nicaragua and how it has shaped current public health efforts in the country.

Nicaragua’s health system today has been shaped by a civil war, poverty, and changes in the political landscape over the decades. In the 1980s, under the Frente Sandinista de Liberacion Nacional (FSLN) government, healthcare and education were expanded through an effort of government centralization to focus on the population as a whole. These efforts were hampered when contra military strategies killed healthcare workers and destroyed facilities to destabilize the social system.  The conflict led to the displacement of populations to urban areas contributing to the spread of disease, including intestinal parasite infections. Shifts in political power also contributed to fluctuations of instability within the health system. During the 1990s, an era of liberal governments shifted to a more private sector healthcare market, with the formation of fees in public health facilities and creation of the Sistema Local de Atención Integral en Salud (SILAIS). This privatization led to health inequities, particularly in poor and rural communities. When the FSLN regained power in 2007, restrictions were placed on the private sector and there was a return to government centralization. User fees were removed and a community outreach component was created through SILAIS.

Despite the political turmoil, Nicaragua was able to put into place a national vaccination program that eventually incorporated treatment of intestinal parasites. Following polio outbreaks in 1979, Nicaragua’s Ministry of Health initiated the National Immunization Program (EPI).  Conducted three times a year, the program led to reduced vaccine-preventable disease in children. Following increased social acceptance, the EPI began integrating other health programs along with vaccinations, including deworming and vitamin A distribution. By 1994, mass treatment of intestinal parasites was formally incorporated into the campaign.

In 2001, the 54th World Health Assembly placed a renewed emphasis on the control of STH infections globally with the creation of Resolution 54.19, whose purpose was to “reach75 percent coverage of all school aged children with preventative chemotherapy to control STH infection by 2010”. Nicaragua had already been incorporating mass treatment of intestinal parasites for seven years via their annual vaccination campaigns. The vaccination campaigns, which had been running since 1979, provided a stable health infrastructure in which to incorporate deworming activities. These annual campaigns are still used today for deworming and target pre-school and school-aged children, utilizing health posts and schools to deliver treatments.

To read more about the case study “Worms and WASH(ED)” please click here.

 

Lymphatic filariasis,on the spotlight in Brazil

Brazil, Culex mosquito, geohelminthes, Guyana, Haiti, intestinal parasites, leprosy, lymphatic filariasis, NTDs, PAHO, Suriname, Trinidad and Tobago, vector control, vector management

By: Agustin Caceres

In Recife, Brasil, the government is using the school system to screen and treat children for lymphatic filariasis

Brasilia, May 29th 2012 – The 11th Regional Meeting, organized by the Pan-American Health Organization (PAHO), is taking place this week in Brasilia (Brazil). In this event, more than 30 representatives of governments, academia, and donor organizations in the fight against neglected infectious disease have gathered to discuss the situation of this NID in the Americas including the success stories, and also the remaining challenges.

In the opening session, hosted by Dr. Joaquin Molina, Representative of PAHO in Brazil, and Dr. Jarbas Barbosa da Silva Jr, Secretary of Health Surveillance of the Health Ministry of Brazil, highlighted that the disease continues to represent an important challenge for the health authorities of Latin America and the Caribbean. In the region, more than 12 million people are at risk of contracting this disease including Haiti, one of the countries most at risk.

“These meetings demonstrate Brazil’s support for the elimination of this disease in the country”, said Dr. Barbosa da Silva. “We are close to the elimination of LF, and that is why this is such an important step. This disease has to remain a top priority and this is why it is key that it is addressed with an integrated approach in collaboration with primary health care services. It is not just about eradication, but also about sustained surveillance.”

Lymphatic filariasis, which is included in the group of the Neglected Infectious Diseases, affects mainly indigenous populations, as well as rural and urban populations that live in pockets of extreme deprivation in several countries in LAC. This is the case of the metropolitan area of Recife, in northeastern Brazil, where the Inter-American Development Bank is supporting a project for the control and elimination of this disease as well as others like leprosy, still present in several areas in Brazil, and geohelminthiasis (intestinal parasites), which has a strong prevalence among children in school age in many municipalities throughout the country.

More than 30 representatives of several countries in the Region are attending this event, such as Costa Rica, Trinidad and Tobago, and Suriname –countries that have certified the eradication of this disease and therefore are no longer considered endemic- together with other countries that are still fighting this disease, including Haiti, Brazil and the Dominican Republic.

The meetings have covered a wide range of topics related to the fight against this disease: from Suriname’s National Plan of Action for the control of NIDs to the experience in Integrated Vector Management in Trinidad and Tobago and the metropolitan area of Recife in Brazil, where activities to monitor and eliminate breeding sites of the culex mosquito –vector for the transmission of LF- are a key component in the strategy to eradicate this disease.

The fight against LF is part of the joint efforts of the IDB, PAHO, and the Global Network for Neglected Tropical Diseases at the Sabin Vaccine Institute as part of the Neglected Infectious Diseases Initiative for Latin America and the Caribbean, an initiative that is supporting innovative projects based with an integrated approach in both the fight against multiple diseases as well as the integration with other sectors like water, sanitation, and housing.

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Agustin Caceres is a consultant in Communications and Outreach at the Social Protection and Health Division of the Inter-American Development Bank (IDB) in Washington DC.