OUP accepted manuscript

Effects of paediatric schistosomiasis control programmes in sub-Saharan Africa: A systematic review

Preventive chemotherapy by mass drug administration is globally recommended as the primary method of reaching the elimination of schistosomiasis, especially in the high risk-paediatric population. This systematic review provides a summary of the effects of paediatric schistosomiasis control programs on eliminating schistosomiasis in sub-Saharan Africa. A systematic search was conducted in PubMed, EBSCOhost, and other databases to obtain studies regarding the effects of paediatric schistosomiasis control programmes in sub-Saharan Africa. 3455 studies were screened for eligibility, included articles reported on both paediatrics control programmes and schistosomiasis, and articles were excluded when they did not report on schistosomiasis control programmes in paediatrics exclusively. 40 selected studies were critically appraised using the JBI critical appraisal tools for relevance and 30 studies were included in the study. An in-depth quantitative descriptive analysis was conducted, and a comprehensive narrative summary explained the results within the scope of the review questions. The results show that despite preventive chemotherapy lowering schistosomiasis prevalence, chances of re-infection are high in endemic areas. Preventive chemotherapy without complementary interventions including safe water provision and proper sanitation, snail control and health education on the aetiology of schistosomiasis, transmission pattern and control practices might not eliminate schistosomiasis.

Behaviour Insight Shadowing: examining daily life settings for the prevention of neglected tropical disease

Background

Adaptation of daily behaviours can play a significant role in disease prevention. Behaviour Insight Shadowing (BIS) is a novel qualitative methodology, designed and used for the first time in this study, which applies the Behaviour Settings Theory as a framework for interrogating daily life patterns and identifying optimal opportunities for behaviour change.

Methods

Nine participant households were shadowed for a day, in Nigeria, the Democratic Republic of Congo and Guinea Bissau. Shadowing involved close ethnographic observation alongside integrated interviewing techniques, and then followed up with a semistructured cross-examination at the end of the observation period. Real-time insights about the attitudes and behaviours of households at high risk of neglected tropical diseases (NTDs) were then categorised by context and analysed thematically. Themes were then applied to a framework of understanding specific to NTD behaviour change and therefore informing more effective social behaviour change communications (SBCC) design. The methodology is adaptable, simple to replicate and produces in-depth, qualitative ethnographic stories.

Results

Findings highlighted important spatial and temporal aspects of target behaviours, with key differences between private and group activities. Ethnographic stories illustrated hierarchies between economic, social and temporal drivers of behaviour, and highlighted the ways in which health messages were introduced and responded to within and between households. This provided cultural levers for more impactful SBCC interventions that could tie into existing norms.

Conclusions

BIS methodology, as an adaptive ethnographic approach, provides valuable insights that enhance the findings from surveys and focus groups, specifically in the context of NTD prevention. Contextual categorisation of relevant daily behaviours is key to developing culturally appropriate SBCC and in determining whether such intervention needs to be in alignment with everyday routines and attitudes, or in disruption of them.

The development and roll-out of a new hydrocoele surgery facility assessment tool for the elimination of lymphatic filariasis

A hydrocoele surgery facility assessment tool (HSFAT) was developed to assess the readiness of hydrocoele surgery services in health facilities prior to implementation of hydrocoele surgical campaigns for the elimination of lymphatic filariasis (LF). A first version of the tool was piloted in Bangladesh, Malawi and Nepal in 2019, then, following feedback from country programme managers, a second version of the tool was rolled out across countries implementing hydrocoele surgery in the Accelerating the Control of Neglected Tropical Diseases (Ascend) West and Central Africa Programme, including Benin, Burkina Faso, Ghana, Guinea, Niger and Nigeria. The HSFAT assessed facilities across 10 domains: background information, essential amenities, emergency patient transfer, laboratory capacity, surgical procedures and trained staff, infection prevention, non-disposable basic equipment, disposable basic equipment, essential medicines and current hydrocoele practices. The HSFAT results highlight key areas for improvement in different countries and can be used to develop a quality improvement plan, which may include actions with agreed deadlines to improve the readiness and quality of hydrocoele surgery services provided by the health facility, prior to implementation of surgical campaigns and assist country programmes to achieve the dossier requirements set out by the World Health Organization for the elimination of LF.

Recognising the potential of neglected tropical disease programmes as a platform for pandemic preparedness: the Ascend experience

Living in an increasingly interconnected world, epidemics and pandemics are increasingly likely to be a vista for the future. This, coupled with the likely devastating effects of climate change, means that humanitarian crises are likely to increase. Now, more than ever before, is the time to scale up investment in prevention and preparedness strategies, and to review our current approaches to delivering health services, including those that address neglected tropical diseases. The Ascend West and Central Africa programme has illustrated the importance of innovation, multisector partnerships, resilience and the opportunity for change.

Responsive neglected tropical disease programme delivery: listening and responding to the views and perceptions of beneficiaries

In neglected tropical disease (NTD) programmes, beneficiary feedback mechanisms (BFMs) can be utilised to enhance programme quality and strengthen health outcomes by promoting the participation and empowerment of local stakeholders. This article reflects on the experiences of the Ascend programme in embedding a BFM in the Democratic Republic of Congo and Nigeria where key NTD data collection tools were adapted and prioritised across various elements of the NTD programme. Findings suggest that listening and responding to the needs of beneficiaries and building upon existing systems within NTD programmes is highly valuable in informing the planning and delivery of NTD activities.

Innovate to eliminate: a prerequisite in NTD programmes

Innovation plays a critical role in progress towards achievement of the World Health Organization's road map for neglected tropical diseases 2021-2030. As disease prevalence decreases, the cost to identify and treat remaining cases goes up. Additionally, as programmes move to the surveillance phase, diagnostic tests need to be highly sensitive and affordable. Until the early end to the Ascend West and Central Africa programme, the Ascend Learning and Innovation Fund supported five projects from 2019 to 2021. Designed for innovation, the fund encompassed a range of activities, including operational research, product development and social behavioural change. This flexibility allowed innovation to bridge the gap between strategic policy and practical implementation, piloting and proving business models to respond to information found through Ascend.

OUP accepted manuscript

As directed by the Sustainable Development Goals, the principle of ‘leave no one behind’ is a pivotal approach to improving coverage and equity within neglected tropical disease (NTD) programme activities. Displaced populations are an at-risk group who are often excluded from treatment and services due to their mobility and marginalisation. This article reflects on the experiences of two countries within the Ascend programme, which responded to the need to strategise and implement approaches that lead to more inclusive and accessible programme activities for displaced populations. With the increasing rate of insecurity and the threat of natural disasters, which is resulting in the displacement of communities and persons eligible for NTD treatment, the ‘leave no one behind’ approach is needed to move closer towards the NTD elimination agenda and to ensure effective coverage thresholds are met.