Tag Archives: Africa

Children at dusk in Malawi

Calling Time on Urogenital Schistosomiasis

Africa, NTDs, schistosomiasis, , , ,

I spent many of my teenage years living in Malawi, enjoying swimming in beautiful Lake Malawi. Wind on to age 30, and I was struggling to get pregnant. Eventually, following illness, I was diagnosed with schistosomiasis by a consultant and colleague at the Liverpool School of Tropical Medicine. I was told that I had probably been infected for a while and that it might be affecting my fertility. So I took praziquantel, the only available drug against the parasite, and soon after I was pregnant. Today my first born daughter is 10 years old. Whilst the links between urogenital schistosomiasis, sub-fertility and HIV have become increasingly well-established over my first born daughter’s life time, a combined and robust health systems action that brings together neglected tropical disease, sexual and reproductive health and HIV communities to address and scale up treatment for urogenital schistosomiasis is sadly lacking.

It is 20 years since the Beijing Women’s Conference and the International Conference Population and Development and the sexual and reproductive community have been taking stock on progress, challenges and future priorities. I attended a research agenda setting meeting on sexual and reproductive health, rights and gender at the WHO on 12th and 13th of January, where we discussed how to best decide priorities for action. Scaling up treatment for urogenital schistosomiasis is arguably a win-win.

The global burden of disease

Schistosomiasis is wide spread and there are two forms of disease, intestinal and urogenital. An estimated 600 million people are at risk of being infected and approximately 200-220 million people are living with schistosomiasis in Africa. Of the people infected with urogenital schistosomiasis it is thought that between about 100 and 120 million suffer from urinary and reproductive tract damage, which also impacts directly with HIV co-infection and sub-fertility in general. Typically many adolescent girls and women exhibit several symptoms in their lower genital tract where overt bleeding and unpleasant discharge, general discomfort and pain during sex can lead to low self-esteem, depression and stigma.

Peter Hotez estimates that globally there are between 67-200 million cases of urogenital schistosomiasis among girls and women. Hotez argues that between 20 million and 150 million girls are affected, possibly making it one of the most common gynaecological conditions in sub-Saharan Africa but unfortunately much under-reported. Urogenital schistosomiasis, as in my experience, also affects fertility and it is estimated to reduce a woman’s reproductive health capacity by up to 75%.

The links between urogenital schistosomiasis in women (female genital schistosomiasis) and HIV are well established. Writing in the Lancet, Stoever and colleagues argue that up to 75% of girls and women infected with female genital schistosomiasis develop often irreversible lesions in the vulva, vagina, cervix, and uterus, creating a lasting entry point for HIV and discuss how research in Zimbabwe showed that women with female genital schistosomiasis had a threefold increased risk of having HIV. In a recent review of the evidence Pamela Mbabazi and colleagues argue that “Studies support the hypothesis that urogenital schistosomiasis in women and men constitutes a significant risk factor for HIV acquisition due both to local genital tract and global immunological effects”.

Gender, equity and rights

There is remarkable overlap between the maps showing high HIV prevalence in Africa (particularly amongst women and adolescents girls) and those showing cases of female genital schistosomiasis. A complex interplay of biological, social and cultural factors means that young women are particularly vulnerable to HIV in sub-Saharan Africa. Gender norms also shape exposure to urogenital schistosomiasis, with women being particularly responsible for activities involving water in many communities (washing, cleaning, collecting water etc). Drawing on work from Ghana, Vlassoff and Manderson have shown that women interact with water significantly more often than men.

What to do?

Several tens of millions of praziquantel tablets are now donated each year by Merck-KGaA for mass drug administration campaigns as a cost-effective method to protect people from the urogenital schistosomiasis. Hotez argues that by preventing female genital schistosomiasis in sexually active women we have an innovative and timely opportunity to reduce and likely much reduce HIV transmission throughout many rural areas of sub-Saharan Africa.

But in infected communities treatment also needs to start early.

Stoever and colleagues argue that periodic and regular treatment with praziquantel from when children are first infected should prevent the development of genital lesions, which increase HIV risk and cause gynaecological problems. Treatment, however, may need to be started even earlier as the extent and burden of schistosomiasis in pre-school-aged children is being more fully described.

To make progress in this area we need joint action between the HIV, sexual and reproductive health and neglected tropical disease communities. Health workers and communities need more information on the multiple impacts of urogenital schistosomiasis and how it can be treated.

The lack of action to date on urogenital schistosomiasis clearly illustrates the importance of new partnerships and new approaches to scaling up strategies to address neglected tropical diseases. COUNTDOWN, a new initiative in Cameroon, Ghana and Liberia, will be paying close attention to the potential role of close-to-community providers such as drug distributors in providing an interface between communities and health systems.   We will also evaluate how to deliver equitable drug delivery for schistosomiasis through the inclusion of preschool-aged-children, out-of-school-children and adults. The Director of COUNTDOWN is helping to co-organise a meeting in South Africa later in the month where several members of COUNTDOWN will also attend. It brings together world leaders in the field of schistosomiasis, HIV and paediatrics to present on the current state and future direction of research on female genital schistosomiasis.

COUNTDOWN is set to foster and to stimulate others in thinking of innovative ways of prompting a synergistic approach to neglected tropical diseases which crosses sectors and builds strength in national health systems.

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This blog post was writtem by Sally Theobald, COUNTDOWN Consortium & Research in Gender and Ethics: Building stronger health systems (RinGs), and was originally posted on Cross-Talk: A Place to Share New approaches to Neglected Tropical Diseases.

Photo courtesy of .

NTD Workshop in Nigeria Equips States with Necessary Skills and Resources to Succeed

Africa, NTDs, WHO, , ,

 

Together with international partners and NGOs, the government of Nigeria has the potential to drastically expand and strengthen their neglected tropical disease (NTD) program to treat and protect its population from the devastating impact of NTDs. Nigeria bears the largest NTD burden within sub-Saharan Africa, but the country’s national plan to tackle NTDs has already laid the groundwork for controlling and eliminating these diseases by 2020. However, additional training, especially at the state level, will help Nigeria scale up and maintain a sustainable NTD program that could lead to the control and elimination of NTDs by 2020.

Nigeria’s geography poses a unique challenge in the fight against NTDs. For example, each Nigerian state possesses its own quasi-autonomous state ministry of health — each with its own integrated NTD program. With this challenge in mind, The World Health Organization (WHO) and partners developed a training program for the first week in February for the 36 Nigerian states and the Federal Capital Territory (FCT) to provide representatives with the tools and technical skills needed to establish, scale up and sustain integrated NTD programs within their respective states. The training was supported by The Envision project, The United project, and was attended by state representatives, including federal ministers of health, members of federal NTD teams and zonal coordinators and NGO partners.

Highlights from the 5-day training were shared through Twitter, thanks to and RTIinterntional:

 

Throughout the training, facilitators from Nigeria and the U.S. led sessions on scaling up integrated MDA programs, monitoring and evaluation, data management and advocacy. The facilitators also went over some basic but essential tasks – including filling out the appropriate forms to apply for NTD medications.

During her session, Global Network senior program officer Wangechi Thuo stressed the importance of effective advocacy in creating sustainable NTD programs. She led participants through exercises, demonstrating how to effectively raise awareness about NTDs among key policy influencers with the goal of garnering sustained ownership, leadership, and commitment from governments and their partners for NTD programs

 

The training also brought together key government partners including Nigeria’s National Agency for Food and Drug Administration and Control (NAFDAC) and the National Primary Health Care Development Agency. Together, partners discussed ways to better and more effectively distribute NTD medicine to populations in need. While Nigeria has the medicine necessary to treat its population, delivering the medicine to more than a hundred million Nigerians is a difficult task.

As the globe moves towards NTD elimination by 2020, Nigeria must remain a top priority given its large NTD burden. Thanks to this month’s NTD workshop, Nigeria’s government expects to see more and more people treated for NTDs, and more precise monitoring and evaluation of drug delivery in the coming year. Through continued government and partner support, Nigeria can see the end of NTDs. In the words of Dr. Bridget Okuaguale, Director of Public Health (DPH) at the Federal Ministry of Health, “We must work as a team, or we cannot go anywhere.”

The African Union Takes on Neglected Tropical Diseases

Africa,

 

African_Union_flag_(2014)In late January, the African Union’s (AU) 22nd Heads of State Summit launched 2014 as the Year of Agriculture and Food Security. Through increased dialogue, innovations, and advocacy, the AU is seeking to make lasting advances in improving nutrition, ending hunger, increasing gender equality and creating jobs.

But those aren’t all the positive steps the AU is taking to accelerate poverty reduction.

In her speech to the Heads of State and Government, HE Dr. Nkosazana Dlamini Zuma, Chairperson of the African Union Commission envisioned the African continent in 2063. She said, “If I have to single out one issue that made peace happen, it was our commitment to invest in our people.  …  Coupled with our concerted campaigns to eradicate the major diseases, to provide access to health services, good nutrition, water and sanitation … our people indeed became and are our most important resource.”

We couldn’t agree more. The fight against neglected tropical diseases and other diseases is about much more than just ensuring good health. It’s about empowering individuals to live productively and engage in society – having the potential for a radical transformation that leads to growth of all kinds ahead.

It is remarkable, therefore, that at the Summit, the AU adopted the Continental Framework on the Control and Elimination of Neglected Tropical Diseases (NTDs) in Africa by 2020 called “Neglected Tropical Diseases in Africa, the End is Possible.”

This is a tremendous momentum builder for efforts to combat neglected tropical diseases (NTDs) – which exacerbate the lack of food security and malnutrition – and reaffirms African leaders’ commitment to making NTDs a priority for Africa’s health and development agenda.

This key Framework was first discussed during the Sixth Conference of African Union Ministers of Health (CAMH6) held last year.  This document echoes the World Health Organization’s goal to end NTDs as public health treats by 2020 and calls attention to the milestone London Declaration for NTDs.

Simply put, the Global Network is thrilled to see the AU’s leadership on NTDs. Controlling and eliminating NTDs by 2020 will not be possible without African country government ownership in expanding commitments to prioritize NTDs, mobilize resources, strengthen advocacy and coordination, collaborate with partners, and enhance monitoring and evaluation.

Summiting to See the End of Neglected Tropical Diseases

Africa, END Fund, ,

 

SummittoseetheEND

 

Eliminating the most prevalent neglected tropical diseases (NTDs) from our planet is an ambitious goal. It requires commitment, patience, know-how and dedication: qualities that are also required to summit Mount Kilimanjaro. This summer, the END Fund together with dedicated visionaries, NTD experts, humanitarians and business entrepreneurs, will trek to the top of one of the world’s highest peaks while raising awareness and resources for the fight against NTDs as part of the organization’s initiative, Summit to See the END.

According to Sarah Marchal Murray, Senior Vice President of the END Fund, Summit to See the END came into fruition after a new board member and avid hiker joined the END Fund team this past summer. His combined passion for hiking and ending NTDs in children fueled the idea. In November, the END Fund turned this idea into a reality as they “soft launched” the project and started to spread the word amongst the END Fund community.

The ultimate goal of the journey is three-fold:

  1. to demonstrate the exhilaration that comes from tackling the 19,341 ft summit and draw the parallel in tackling NTDs,
  2. to raise awareness about NTDs and how they affect the most impoverished populations, and
  3. to mobilize crucial donations for the END Fund’s work in 2014 and beyond.

Hikers also pledge to reach out to their networks to help achieve these goals, in addition to making an initial individual commitment. After summiting Kilimanjaro, they will also participate in an NTD learning day where they’ll be able to see NTD control programs in action, interact with those closest to the cause, and meet members of a community affected by these debilitating and disfiguring diseases.

But the journey to the top of Mount Kilimanjaro is far more meaningful than a set of goals typed on a website. Sarah sees this trek as a life-changing and transformative journey that requires those involved to deliberately reflect on their own commitment to ending NTDs, as well as the lives of those suffering from these debilitating diseases.

Besides getting the body and mind in shape for the hike, the training process also provides the hikers with another way to connect with their families and communities and increase NTD awareness.

The END Fund hopes that the experience will leave a lasting impression, fueling the hiker’s engagement with the NTD cause and motivating each hiker to share their experiences with those close to them – further expanding the network and increasing awareness for NTDs.

“Providing our community with a link to the people we serve was important to us. We think the summit is symbolically significant: if each individual hiker comes home and shares with their networks and circles how it personally touches them, there’s a ripple effect,” Sarah explained. “While financial resources are imperative if the NTD community is going to reach our aims of control and eradication by 2020, there is great power in the amplification of our voices amongst each hiker’s personal circles.”

For hikers like Sarah, this experience is a very personal one. In a letter addressed to her friends and family, she explained why she is making the trek.

“Partially because of where my husband and I are lucky enough to live, we won’t have to worry about our daughter contracting one of the five disabling, debilitating and deadly diseases known as NTDs. A group of parasitic and bacterial infections, they affect nearly 800 million children and are the cause of death for over 500,000 people per year.”

“So [I am hiking] to prove to myself and my daughter that anything is possible.” In addition, she writes, “[I am hiking] so that the only worms I need to educate my daughter about live in the ground and not inside children her own age.”

Ultimately, like the fight to end NTDs, the preparation and hike up Mount Kilimanjaro is a marathon – not just a sprint.

“NTDs won’t be wiped off the planet this year,” Sarah said. But if we concentrate our efforts, join together with the growing international movement committed to seeing their END, and continue to push forward, “we can summit to see the END in our lifetimes.”

Learn more about the END Fund and Summit to See the END.