Tag Archives: Global Network

Trinidad and Tobago. A Success Story in the Fight Against NTDs.

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This Caribbean country has succeeded in controlling or eliminated most NTDs. Dr. Dave Chadee, Professor of Environmental Health at the University of the West Indies, shares his vision about this success story, and highlights ideas that can be applied in other countries where the Neglected Tropical Diseases Initiative for LAC is implementing several projects.

Dr. Chadee, what is the situation regarding NTDs in Trinidad and Tobago?

The situation regarding NTDs in my country is quite different from that of our neighbor’s. The country has eliminated lymphatic filariasis (LF) as well as malaria, and leprosy has been reduced to less than 1 case in every 100,000 inhabitants so it is no longer considered a major public health problem. We have also reduced the incidence of hookworms and recent surveys have not found cases of this infection. Today, the NTDs that are still considered a real challenge are yellow fever, which still persists in some pockets in forested areas (a zoonosis), and dengue, the most extensive  and problematic vector-borne disease in Trinidad and Tobago and the Caribbean region.

Dr. Dave Chadee

In your opinion, what are the main factors that have helped control and eliminate these diseases in the country?

Well, first of all the fact that Trinidad and Tobago has an universal, free to all health care system that has helped in controlling or eliminating most of the local and imported diseases. This is an advantage compared to other countries in the Caribbean region, because offering free treatments to all for any NTD makes it easier for people to seek help when they need it, no matter their ability to pay for these services and whether they are nationals or non nationals.

I also think that having staff that have received specific training on NTDs is key, and not only do they need to acquire the knowledge: they need to keep informed of new developments in their field by receiving updates or refresher training.

Another success story for the country involves the strategy against NTDs – which involves continuing monitoring and evaluation activities. We know of programs that have implemented wonderful strategies but did not incorporate internal audits to check their effectiveness, strengths and weaknesses over time, significantly reducing the efficacy of the programs.

Last but not least, I believe that the political support of local authorities is key, both for the implementation of effective programs and to keep morale high among health workers. NTD work can be tedious because it is a battle that is never complete, so keeping the morale of the teams high, making workers feel appreciated, is very important.

What is the importance of vector management in the fight against NTDs?

Our experience has demonstrated that integrated vector management can help combat these diseases more effectively. At my university we have developed vector control strategies that are effective against Culex quinquefasciatus and other container breeding mosquitoes. Also, our research demonstrates that integrated vector management can be useful if used together with mass drug administration programs, and can help raise awareness about LF and other NTDs among communities.

Based on your latest research about transmission of LF, what are the changes you have observed in the habits of the Culex mosquito in the last years?

Based on my research, there is evidence that the blood feeding times of the Culex quinquefasciatus mosquito, the main vector for the transmission of LF, have shifted significantly. Previous studies showed the peak biting times in Trinidad and Tobago was between 10 pm and 3 am. Now we are finding a bimodal pattern with an early peak between 7 and 9 pm, as well as the 10-3am peak. This shift may be due to any of several factors like the use of air conditioning and fans in the household and the change of light regimens in cities such as the use of indoor lights and security lights from dusk to dawn. This means that the Culex mosquitoes  have access to people  between 7 and 11 pm, when they  are relaxing  at home and are likely to be casually dressed and  exposing larger skin surface area to foraging mosquitoes. In addition, our preliminary study shows more biting in areas around the legs and arms, thereby increasing the possibility of LF transmission at an earlier time during the night than previously thought. We think it is important to take these factors into account when designing programs to fight LF and other vector-born NTDs.

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PROFILE

Dr. Dave D. Chadee is a Professor of Environmental Health in the Department of Life Sciences, UWI. His breakthrough research includes the development of the Xenomonitoring/PCR approach to Lymphatic filariasis, a new assay method for detecting mosquito preferences, the pupal index for dengue epidemiology and control, detected and eradicated two malaria outbreaks in Trinidad and the paper published in Science entitled, Genetics: a breakthrough for global public health.

Prof. Chadee has published over 200 papers and book chapters and has numerous collaborations in the USA and the UK. Prof. Chadee is a graduate of Naparima College, Trinidad, Dalhousie University (BSc Hons.), The University of the West Indies (MPhil) and the University of Dundee (PhD, M.PH, DSc).

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

A Call to Action: Deworming Needs in Latin America and the Caribbean

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Child infected with a STH.

Washington, D.C. – A new report released today by the Global Network for Neglected Tropical Diseases, an initiative of the Sabin Vaccine Institute, highlights theimpact that a small group of neglected diseases are having on children in the Americas and presents concrete policy recommendations that can lead to significant progress in achieving several Millennium Development Goals in the Americas by 2015.

Entitled A Call to Action: Addressing Soil-transmitted Helminths in Latin America and the Caribbean, the report was developed in partnership with the Pan American Health Organization and the Inter-American Development Bank. The findings shed light on the health and economic toll imposed on at-risk populations by three types of parasitic intestinal worms, known collectively as soil-transmitted helminths (STH).

At least 46 million children in the Americas, or nearly 20% in the region, are at risk of becoming infected by these parasites. Infection often leads to chronic malnutrition, impairment of physical and cognitive development, and traps vulnerable populations in a cycle of poverty.

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Looking Back on a Week Dedicated to Maternal Child Health

Global HealthBill Frist, Carol Shea-Porter, , , Orin Levine, pneumonia, , World Pneumonia DayErin Hohlfelder

This morning in the Capitol, a number of us from the Global Network and Sabin Vaccine Institute participated in a breakfast reception capping off a week’s worth of events around World Pneumonia Day.  The speakers themselves were thoughtful, engaging, and succinct (a beautiful thing in this city).  Senator Bill Frist, involved through his work with Save the Children and Hope Through Healing Hands, spoke about the need for public private partnerships around pneumonia and other maternal child health interventions; he also urged the community to keep pushing bills like S.1966, the Global Child Survival Act of 2009, for co-sponsors and ‘teachable moments’ with staff around the issues.  Rep. Carol Shea-Porter, whose resolution recognizing World Pneumonia Day passed this week, was also on hand to advocate for continued pneumonia awareness, urging advocates to ‘be the conscience’ for Representatives on maternal child health.  Finally, Dr. Orin Levine–a leading pneumonia advocate and member of PACE–spoke movingly about how appalling it is to have pneumonia kill so many children each year when known solutions are cheap and available.

But as I sat there drinking my coffee, I was struck by two thoughts tertiary to the event itself:

  • The Mansfield Room, in which the reception was held, is like many rooms in the Capitol in that its appearance conveys a sense of grandeur and gravitas.  To be in that room discussing maternal child health issues signaled to me that we have come a long way in bringing these issues to the fore as important, urgent matters for key policymakers
  • At the Global Network, it is easy to fall into an NTD-focused mindset. Yet an event like today’s, focused primarily on pneumonia, was remarkably relevant to the work we are doing around maternal child health as a broader platform.  Even the messaging–“cheap interventions, proven solutions, a need for partnership to deliver treatments in the field…”–echoed the messages we recite daily with respect to NTDs.  As we move forward with our policy and advocacy work, it serves both the NTD and the broad MCH communities well to exploit such overlap to the benefit of millions of mothers and children around the world.

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