Category Archives: Soil Transmitted Helminths (STH)

Every Sample is Someone’s Life: My Experience with NTD Field Research

 

By David Obadina

Northeastern University, where I am a junior majoring in International Affairs with a minor in global health, has an amazing co-op program through which students can go on six month internships anywhere in the world and work in an area of their interest. Having learned so much about neglected tropical diseases from classes and from serving on the END7 Student Advisory Board last spring, I was excited to be able to apply what I have learned and make a difference in this field during my co-op in the summer and fall of 2014 in Kumasi, Ghana.

For my co-op, I worked at the Kumasi Center for Collaborative Research in Tropical Medicine (KCCR) in their parasitology section. I had the opportunity to work in the lab and in the field to see and experience firsthand how NTDs like lymphatic filariasis, onchocerciasis, hookworm and roundworm are treated.

The field experience was one of a kind. The staff here at KCCR were all very friendly and dedicated to their jobs. When we would go out into the field, we would travel a few hours to remote villages where people do not have easy access to healthcare and set up our equipment in a nearby school. Then, the project leader would speak to the people in charge of the village and would explain everything they intended to do. People were eager to be tested and receive treatment for NTDs.

I worked on the field microscope that was testing people on site. Probably the most interesting and meaningful experience of the field work was when I would diagnose on site looking at blood under the microscope. When I found a worm in someone’s blood I would alert them and show them the worm under the microscope to explain to them the nature of the disease afflicting them. This fieldwork raised awareness of filarial disease among these communities and actively sought to educate the community members. I was honored to be a part of this work and have gained a whole new real world perspective when it comes to the reality of NTDs and those affected by them.

Working in the laboratory, while it may not sound as exciting as the field, has been just as intriguing and is extremely essential to understanding these diseases. Something that was stressed every day in the lab is that every sample is someone’s life. Every single sample of blood that we diagnose and analyze holds meaning and is of high importance. Every diagnosis we make, whether negative or positive, has an immense effect on the lives of everyone involved, and that cannot be taken lightly.

I first became involved in the END7 campaign after being introduced to it by my epidemiology professor, Dr. Richard Wamai, in the fall of 2013, and joined the team that formed the END7 club at Northeastern. We planned many educational events and raised funds for END7, but last semester, I had the eye-opening opportunity to be on the other side of the fight against NTDs during my co-op. Now, I believe I’m better prepared to advocate for global equality and the rapid treatment of neglected diseases. At END7 events hosted at Northeastern, people would sometimes ask what it’s like for people with these diseases or how someone with an NTD looks. I could give an educated answer from what I had studied about the disease or things I had heard at global health conferences, but I couldn’t really give an accurate first hand account. After my co-op experience, I know I’ll be much more confident in giving an accurate depiction of the wide-ranging effects of NTDs on human life.

My co-op experience helped me grow in many ways. I learned a great deal about parasitology, global health networks, and what it really means to work in this field and make a difference in the lives of others. Now that I’m back in Boston, I am excited to begin another semester of education, advocacy, and fundraising with this spring.

#StopTheWorms: STH Coalition Forming New Partnerships to Reduce Intestinal Worm Infections in Children

 

This week, the Soil Transmitted Helminth (STH) Coalition and various NGOs are meeting in Paris for a Neglected Tropical Disease (NTD) NGO Network meeting to discuss effective ways of advancing the control and elimination of STH (also known as intestinal worms) and other NTDs.

The STH Coalition is a diverse group of committed organizations that are actively engaging new partners from multiple sectors to advance the goal of reducing intestinal worm infections in children. The STH Coalition is made up of partners that include the Bill and Melinda Gates Foundation, USAID, the World Health Organization (WHO) and many other organizations. The Global Network is also happy to be a part of this group of committed organizations.

Intestinal worms are some of the most common NTDs that affect the health and livelihoods of the poorest and most marginalized communities in the world. Intestinal worms affect over one billion people world-wide and destabilize global development initiatives in multiple sectors including nutrition, education and maternal health.

To accelerate the work of the STH Coalition in forging new partnerships in the fight against intestinal worms and other NTDs, Children Without Worms (CWW) has been promoting the STH Coalition’s mission via on Twitter and through their blog leading up to the NTD NDGO Network meeting in Paris.

We encourage you to share, tweet, and re-tweet content released by the STH Coalition in order to boost awareness about intestinal worms. Follow this link to learn more about the STH Coalition and their important work, and check out the infographic below – highlighting the importance of controlling intestinal worms.

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A Comprehensive Analysis of Soil-Transmitted Helminths in Honduras

 

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Honduras became the first country in Latin America and the Caribbean to launch its national and integrated plan addressing neglected tropical diseases (NTDs) in April 2012; however, information gaps regarding the prevalence and intensity of soil-transmitted helminth (STH or intestinal worm) infections remained. The first comprehensive historic review of soil-STH prevalence and research studies done in Honduras was recently published – the information analyzed and presented in the new article will be instrumental in the successful implementation of the country’s national plan on NTDs.

The article, titled “A Scoping Review and Prevalence Analysis of Soil-Transmitted Helminth Infections in Honduras,” was published in PLOS Neglected Tropical Diseases. Sabin Vaccine Institute’s Dr. Maria Elena Bottazzi, herself a Honduran and Deputy Director of Sabin’s Product Development Partnership, is one of the authors.

As part of their efforts, the researchers conducted a review of hundreds of studies dating back to May 1930, some of which had not been published. Using studies published between 2001 and 2012 that included epidemiological data from Honduras’ 18 departments, the researchers were able to produce STH prevalence maps. The researchers included the most recent information available after consulting with various groups involved in STH control activities, including the Ministry of Health, the Healthy Schools Program, the Parasitology Department of the School of Microbiology (part of the National Autonomous University of Honduras, UNAH), the World Food Program and the Pan American Health Organization (PAHO).

The results from their review are astounding – the researchers found that the prevalence of STH in 40.6 percent of the municipalities in Honduras is greater than 50 percent. The World Health Organization (WHO) recommends mass drug administration (MDA) campaigns to take place, without previous diagnosis, once a year in communities with STH prevalence over 20 percent, and twice a year in communities with STH prevalence over 50 percent. This strategy not only reduces the morbidity and the intensity of infection on those already infected with this NTD, but it also helps protect the entire community from further infection.

The researchers also found that the STH prevalence was higher in municipalities with a lower socioeconomic status – those characterized by having a lower human development index and less access to safe drinking water or improved sanitation.

The Sabin Vaccine Institute’s Global Network for Neglected Tropical Diseases recently traveled to Honduras and witnessed the effects of intestinal worms on some of Honduras’ poorest communities, including those in the department of Choluteca. After speaking with a head teacher at Escuela Urbana Mixta Pedro Nufio (1st to 6th grade), we learned that 880 students attending the school were at risk for intestinal worms.

View photos from the trip below:

Children in Choluteca and across Honduras are being treated annually for intestinal worms thanks to Honduras’ national plan of action against NTDs. However, many children are still heavily infected. For example, some students in Choluteca expelled worms through their mouth and nose after receiving treatment – a sign of heavy infection.

However, progress is being made and the deworming of preschool children has been institutionalized as part of national vaccination week activities in the country.  Honduras is continuing to lead in one of the fundamental components in the fight against NTDs: integration with infrastructure improvements in water and sanitation, supported by community education campaigns. This type of cross-sectoral integration will bring us closer to achieving the NTD 2020 control and elimination goals set by the WHO Roadmap.

We look forward to sharing stories of how the government of Honduras and its partners use the findings from this study to successfully implement their national plan on NTDs! We invite you to follow Dr. Bottazzi () and the PLOS NTDs journal () on Twitter, to keep up with new developments in the NTD field.

What Can the Experiences of Sierra Leone and Cambodia Tell Us about How to Fight NTDs?

 

By Romina Rodríguez Pose, independent consultant on international development and lead author for the Health Dimension case studies, Development Progress Project.

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Neglected tropical diseases (NTDs) affect the poorest billion people in the world. They cause number of chronic health conditions that largely limit people’s ability to study and work and consequently have a healthy and productive life. The stigma attached to them can also lead to isolation and fear for those who suffer.

Although they have been long ignored within international and national agendas, in the last decades, there has been an increasing awareness of how NTDs can impede endemic countries from achieving broader development goals. This led to the emergence of global public-private partnerships involving major drug donations from key pharmaceutical companies, the development of inexpensive control strategies and a growing number of donors earmarking funding for integrated NTD control.

These readily available solutions have enabled some endemic countries to fight the five NTDs that bear 90 percent of the global burden: onchocerciasis, also known as river blindness; schistosomiasis, also known as snail fever; lymphatic filariasis, also known as elephantiasis; soil transmitted helminths, also known as intestinal worms; and trachoma.

Image from Cambodia 8To better understand the drivers of progress, ODI’s Development Progress project has taken a closer look at two of the leading performers: Sierra Leone in Africa and Cambodia in Asia. In spite of their different contexts and epidemiological profiles, three drivers have emerged in both case studies:

1. Advances in the fight against NTDs have been driven by the availability of earmarked funds and donated drugs. These have been crucial for both resource-constrained countries, since most endemic countries are faced with several competing, and perhaps more urgent, health issues (such as high mortality rates for mothers and children in Sierra Leone and dengue outbreaks in Cambodia). As a counterpart, political will and local engagement to take advantage of global initiatives have been crucial in bringing NTDs within the national agenda. Both governments, through their Ministries of Health, have proactively looked for partners, secured funds and drugs donations and made important efforts to develop local capacity.

2. There is an important transitional role for development partners in providing access to strategies and guidelines on how to deal with NTDs until local capacity is fully developed. In both countries, this was achieved through bilateral, regional and global partnerships that helped build the local knowledge base for endemic countries to find their own solutions and to implement strategies according to the particular context. These dynamics between development partners and NTD programme managers have gradually led to a ‘transfer of ownership’ of the NTD programmes.

3. The integration of NTD activities within an existing government structure has been vital to set up cost-effective NTD programmes. Both countries have integrated the distribution of drugs within health and education systems. In Cambodia, given the main threat is from intestinal worms which particularly affect school-aged children, progress has been achieved by integrating the distribution of drugs into the school system and turning teachers into twice-yearly doctors/pharmacists. In Sierra Leone, given that the entire population is at risk from at least three NTDs, the main strategy involved the engagement and training of community members as drug distributors. Elected by their communities, their work is divided into catchment areas for which they are responsible, reaching the most remote corners of the country.

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Despite the increasing awareness of their importance, NTDs still loom large in the cycles of poverty, ill-health and under-development that afflict too many developing countries. Yes, as Sierra Leone and Cambodia show, progress can be achieved in the most difficult contexts and with minimal resources, stressing the importance of including NTD control and elimination targets within the post-2015 sustainable development goals.

All photos by Romina Rodríguez Pose.