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Vere M, ten Ham-Baloyi W, Melariri PE. Effects of paediatric schistosomiasis control programmes in sub-Saharan Africa: A systematic review. PLoS One 2024; 19:e0301464. [PMID: 38696510 PMCID: PMC11065241 DOI: 10.1371/journal.pone.0301464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 03/17/2024] [Indexed: 05/04/2024] Open
Abstract
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.
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Affiliation(s)
- Maryline Vere
- Faculty of Health Sciences, Department of Environmental Health, Nelson Mandela University, University Way, Summerstrand, Gqeberha, South Africa
| | - Wilma ten Ham-Baloyi
- Faculty of Health Sciences, Department of Environmental Health, Nelson Mandela University, University Way, Summerstrand, Gqeberha, South Africa
- Faculty of Health Sciences, Department of Nursing Science, Nelson Mandela University, University Way, Summerstrand, Gqeberha, South Africa
| | - Paula Ezinne Melariri
- Faculty of Health Sciences, Department of Nursing Science, Nelson Mandela University, University Way, Summerstrand, Gqeberha, South Africa
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Wolfe CM, Barry A, Campos A, Farham B, Achu D, Juma E, Kalu A, Impouma B. Control, elimination, and eradication efforts for neglected tropical diseases in the World Health Organization African region over the last 30 years: A scoping review. Int J Infect Dis 2024; 141:106943. [PMID: 38266976 PMCID: PMC10927616 DOI: 10.1016/j.ijid.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVES NTDs historically receive less attention than other diseases in the same regions. Recent gap analyses revealed notable shortcomings despite NTD elimination progress. This systematic scoping review was conducted to understand NTD control, elimination, and eradication efforts in the WHO African region over the last 30 years. METHODS Peer-reviewed publications from PubMed, Web of Science, and Cochrane databases related to NTD control, elimination, and eradication in the WHO African Region from 1990 to 2022 were reviewed. Included articles were categorized based on NTD; study location, type, and period; and topic areas. Technical and guidance documents from WHO, UN, partner, and academic/research institutions were reviewed. Country-specific multi-year NTD master plans were documented. RESULTS Four hundred eighty peer-reviewed articles, six Cochrane reviews, and 134 technical reports were included. MDA and non-interventional/survey-related studies were common topics. Lymphatic filariasis, trachoma, schistosomiasis, and onchocerciasis were the most frequently studied NTDs. Tanzania, Ethiopia, and Nigeria were the most represented countries; multi-country studies were limited. CONCLUSION The review highlights progress made in NTD control, elimination, and eradication efforts in the WHO African Region and can inform national/regional strategies. Disease and geographical disparities were evident, warranting focus and research in certain countries. A standardized approach to NTD control programs is needed for sustained progress. FUNDING There was no funding source for this study.
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Affiliation(s)
- Caitlin M Wolfe
- World Health Organization Regional Office for Africa, B.P. 06 Cité de Djoué, Brazzaville, Congo; University of South Florida College of Public Health, 13201 Bruce B Downs Boulevard, Tampa, FL 33612, USA.
| | - Abbie Barry
- World Health Organization Regional Office for Africa, B.P. 06 Cité de Djoué, Brazzaville, Congo
| | - Adriana Campos
- World Health Organization Regional Office for Africa, B.P. 06 Cité de Djoué, Brazzaville, Congo; University of South Florida College of Public Health, 13201 Bruce B Downs Boulevard, Tampa, FL 33612, USA
| | - Bridget Farham
- World Health Organization Regional Office for Africa, B.P. 06 Cité de Djoué, Brazzaville, Congo
| | - Dorothy Achu
- World Health Organization Regional Office for Africa, B.P. 06 Cité de Djoué, Brazzaville, Congo
| | - Elizabeth Juma
- World Health Organization Regional Office for Africa, B.P. 06 Cité de Djoué, Brazzaville, Congo
| | - Akpaka Kalu
- World Health Organization Regional Office for Africa, B.P. 06 Cité de Djoué, Brazzaville, Congo
| | - Benido Impouma
- World Health Organization Regional Office for Africa, B.P. 06 Cité de Djoué, Brazzaville, Congo
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Chiphwanya J, Mkwanda S, Kabuluzi S, Mzilahowa T, Ngwira B, Matipula DE, Chaponda L, Ndhlova P, Katchika P, Mahebere Chirambo C, Moses P, Kumala J, Chiumia M, Barrett C, Betts H, Fahy J, Rebollo Polo M, Reimer L, Stanton MC, Thomas B, Freer S, Molyneux DH, Bockarie MJ, Mackenzie CD, Taylor MJ, Martindale S, Kelly-Hope LA. Elimination of lymphatic filariasis as a public health problem in Malawi. PLoS Negl Trop Dis 2024; 18:e0011957. [PMID: 38363794 PMCID: PMC10903958 DOI: 10.1371/journal.pntd.0011957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/29/2024] [Accepted: 02/01/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is a parasitic disease transmitted by mosquitoes, causing severe pain, disfiguring, and disabling clinical conditions such as lymphoedema and hydrocoele. LF is a global public health problem affecting 72 countries, primarily in Africa and Asia. Since 2000, the World Health Organization (WHO) has led the Global Programme to Eliminate Lymphatic Filariasis (GPELF) to support all endemic regions. This paper focuses on the achievements of the Malawi LF Elimination Programme between 2000 and 2020 to eliminate LF as a public health problem, making it the second sub-Saharan country to receive validation from the WHO. METHODOLOGY/PRINCIPAL FINDINGS The Malawi LF Programme addressed the widespread prevalence of LF infection and disease across the country, using the recommended WHO GPELF strategies and operational research initiatives in collaboration with key national and international partners. First, to stop the spread of infection (i.e., interrupt transmission) and reduce the circulating filarial antigen prevalence from as high as 74.4% to below the critical threshold of 1-2% prevalence, mass drug administration (MDA) using a two-drug regime was implemented at high coverage rates (>65%) of the total population, with supplementary interventions from other programmes (e.g., malaria vector control). The decline in prevalence was monitored and confirmed over time using several impact assessment and post-treatment surveillance tools including the standard sentinel site, spot check, and transmission assessment surveys and alternative integrated, hotspot, and easy-access group surveys. Second, to alleviate suffering of the affected populations (i.e., control morbidity) the morbidity management and disability prevention (MMDP) package of care was implemented. Specifically, clinical case estimates were obtained via house-to-house patient searching activities; health personnel and patients were trained in self-care protocols for lymphoedema and/or referrals to hospitals for hydrocoele surgery; and the readiness and quality of treatment and services were assessed with new survey tools. CONCLUSIONS Malawi's elimination of LF will ensure that future generations are not infected and suffer from the disfiguring and disabling disease. However, it will be critical that the Malawi LF Elimination programme remains vigilant, focussing on post-elimination surveillance and MMDP implementation and integration into routine health systems to support long-term sustainability and ongoing success. SUMMARY Lymphatic filariasis, also known as elephantiasis, is a disabling, disfiguring, and painful disease caused by a parasite that infected mosquitoes transmit to millions of people worldwide. Since 2000, the Global Programme to Eliminate Lymphatic Filariasis (GPELF) has supported endemic countries such as Malawi in south-eastern Africa, to eliminate the disease as a public health problem. The Malawi National LF Elimination Programme has worked tirelessly over the past two decades to implement the GPELF recommended strategies to interrupt the transmission with a two-drug regime, and to alleviate suffering in patients with lymphoedema and/or hydrocoele through morbidity management and disability prevention. Additionally, the LF Programme has collaborated with national and international stakeholders to implement a range of supplementary operational research projects to address outstanding knowledge gaps and programmatic barriers. In 2020, the World Health Organisation validated that Malawi had successfully eliminated LF as a public health problem, making it the second country in sub-Saharan Africa to achieve this, which is remarkable given that Malawi previously had very high infection rates. The LF Programme now remains vigilant, putting its efforts towards post-elimination surveillance and the continued implementation of care for patients with chronic conditions. Malawi's elimination of LF will ensure that future generations are not affected by this devastating disease.
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Affiliation(s)
| | | | | | - Themba Mzilahowa
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
- Centre for Health, Agriculture, Development Research, and Consulting, Blantyre, Malawi
| | - Bagrey Ngwira
- Centre for Health, Agriculture, Development Research, and Consulting, Blantyre, Malawi
| | | | | | | | | | | | - Philemon Moses
- Centre for Health, Agriculture, Development Research, and Consulting, Blantyre, Malawi
| | - Justin Kumala
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Martin Chiumia
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Carrie Barrett
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hannah Betts
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Joan Fahy
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Maria Rebollo Polo
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- World Health Organization, Geneva, Switzerland
| | - Lisa Reimer
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Michelle C. Stanton
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Brent Thomas
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sian Freer
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - David H. Molyneux
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Moses J. Bockarie
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- School of Community Health Sciences, Njala University, Bo, Sierra Leone
| | - Charles D. Mackenzie
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mark J. Taylor
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sarah Martindale
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
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Olamiju F, Isiyaku S, Olobio N, Mogaji H, Achu I, Muhammad N, Boyd S, Bakhtiari A, Ebenezer A, Jimenez C, Solomon AW, Harding-Esch EM, Mpyet CD. Prevalence of Trachoma following Implementation of the SAFE Strategy in Three Local Government Areas of Taraba State, North Eastern Nigeria. Ophthalmic Epidemiol 2023; 30:619-627. [PMID: 35353025 DOI: 10.1080/09286586.2022.2045025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 02/10/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In 2019-2020, one round of antibiotic mass drug administration (MDA) was implemented for trachoma elimination purposes in Donga, Gashaka, and Ussa local government areas (LGAs) of Taraba State, Nigeria, following baseline surveys in 2009 (Donga and Gashaka) and 2013-2014 (Ussa). Here, trachoma prevalence post-MDA in these three LGAs is reported. METHODS In 2019 (Gashaka and Ussa) and 2020 (Donga), population-based, cross-sectional surveys were conducted following World Health Organization (WHO) guidance. A two-stage cluster sampling strategy was used. All residents of selected households aged ≥1 year were examined by Tropical Data-certified graders for trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT) using the WHO simplified trachoma grading scheme. Data on water, sanitation, and hygiene (WASH) access were also collected. RESULTS A total of 1,883 households participated. From these households, 4,885 children aged 1-9 years were enumerated, and 4,866 (99.6%) examined. There were 5,050 eligible adults (aged ≥15 years) enumerated in the same households, of whom 4,888 (96.8%) were examined. Age-adjusted TF prevalence in children aged 1-9 years was 0.22% (95% CI: 0.00-0.65) in Donga, 0.0% in Gashaka, and 0.19% (95% CI: 0.00-0.44) in Ussa. The age- and gender-adjusted TT prevalence unknown to the health system in adults aged ≥15 years was 0.08% (95% CI: 0.00-0.19) in Donga, 0.02% (95% CI: 0.00-0.06) in Gashaka, and 0.10% (95% CI: 0.01-0.18) in Ussa. In Donga, Gashaka, and Ussa, respectively, 66%, 49% and 63% of households had access to an improved drinking water source, and 68%, 56% and 29% had access to an improved latrine. CONCLUSION In all LGAs, the elimination thresholds for TF and TT unknown to the health system have been attained in the target age groups. These LGAs should be re-surveyed after 2 years to show that reductions in TF prevalence have been sustained in the absence of MDA. Health authorities should continue to improve WASH facilities to reduce the risk of later recrudescence.
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Affiliation(s)
| | | | | | - Hammed Mogaji
- Department of Animal and Environmental Biology, Federal University Oye-Ekiti, Ekiti, Nigeria
| | - Ijeoma Achu
- Mission To Save The Helpless (MITOSATH), Jos, Nigeria
| | - Nasiru Muhammad
- Ophthalmology Department, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Sarah Boyd
- International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, USA
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, USA
| | | | | | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Emma M Harding-Esch
- London Centre for Neglected Tropical Disease Research, London, UK
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Caleb D Mpyet
- Sightsavers, Nigeria Country Office, Kaduna, Nigeria
- Department of Ophthalmology, College of Health Sciences, University of Jos, Jos, Nigeria
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Harding-Esch EM, Burgert-Brucker CR, Jimenez C, Bakhtiari A, Willis R, Dejene Bejiga M, Mpyet C, Ngondi J, Boyd S, Abdala M, Abdou A, Adamu Y, Alemayehu A, Alemayehu W, Al-Khatib T, Apadinuwe SC, Awaca N, Awoussi MS, Baayendag G, Badiane Mouctar D, Bailey RL, Batcho W, Bay Z, Bella A, Beido N, Bol YY, Bougouma C, Brady CJ, Bucumi V, Butcher R, Cakacaka R, Cama A, Camara M, Cassama E, Chaora SG, Chebbi AC, Chisambi AB, Chu B, Conteh A, Coulibaly SM, Courtright P, Dalmar A, Dat TM, Davids T, DJAKER MEA, de Fátima Costa Lopes M, Dézoumbé D, Dodson S, Downs P, Eckman S, Elshafie BE, Elmezoghi M, Elvis AA, Emerson P, Epée EEE, Faktaufon D, Fall M, Fassinou A, Fleming F, Flueckiger R, Gamael KK, Garae M, Garap J, Gass K, Gebru G, Gichangi MM, Giorgi E, Goépogui A, Gómez DVF, Gómez Forero DP, Gower EW, Harte A, Henry R, Honorio-Morales HA, Ilako DR, Issifou AAB, Jones E, Kabona G, Kabore M, Kadri B, Kalua K, Kanyi SK, Kebede S, Kebede F, Keenan JD, Kello AB, Khan AA, KHELIFI H, Kilangalanga J, KIM SH, Ko R, Lewallen S, Lietman T, Logora MSY, Lopez YA, MacArthur C, Macleod C, Makangila F, Mariko B, Martin DL, Masika M, Massae P, Massangaie M, Matendechero HS, Mathewos T, McCullagh S, Meite A, Mendes EP, Abdi HM, Miller H, Minnih A, Mishra SK, Molefi T, Mosher A, M’Po N, Mugume F, Mukwiza R, Mwale C, Mwatha S, Mwingira U, Nash SD, NASSA C, Negussu N, Nieba C, Noah Noah JC, Nwosu CO, Olobio N, Opon R, Pavluck A, Phiri I, Rainima-Qaniuci M, Renneker KK, Saboyá-Díaz MI, Sakho F, Sanha S, Sarah V, Sarr B, Szwarcwald CL, Shah Salam A, Sharma S, Seife F, Serrano Chavez GM, Sissoko M, Sitoe HM, Sokana O, Tadesse F, Taleo F, Talero SL, Tarfani Y, Tefera A, Tekeraoi R, Tesfazion A, Traina A, Traoré L, Trujillo-Trujillo J, Tukahebwa EM, Vashist P, Wanyama EB, WARUSAVITHANA SD, Watitu TK, West S, Win Y, Woods G, YAJIMA A, Yaya G, Zecarias A, Zewengiel S, Zoumanigui A, Hooper PJ, Millar T, Rotondo L, Solomon AW. Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys. Ophthalmic Epidemiol 2023; 30:544-560. [PMID: 38085791 PMCID: PMC10751062 DOI: 10.1080/09286586.2023.2249546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/11/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. METHODS Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. RESULTS Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. CONCLUSION This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Amza Abdou
- Programme National de Santé Oculaire, Niger
| | | | | | | | | | | | - Naomie Awaca
- Ministère de la Santé Publique, Democratic Republic of Congo
| | | | | | | | | | | | | | | | | | | | - Clarisse Bougouma
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Burkina Faso
| | | | - Victor Bucumi
- National Integrated Programme for the Control of Neglected Tropical Diseases and Blindness (PNIMTNC), Burundi
| | | | | | | | | | | | | | | | | | - Brian Chu
- International Trachoma Initiative, USA
| | | | | | - Paul Courtright
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa, South Africa
| | - Abdi Dalmar
- Ministry of Human Development and Public Services, Somalia
| | | | | | | | | | | | | | | | | | | | | | - Ange Aba Elvis
- Programme National de la Santé Oculaire et de la lutte contre l’Onchocercose, Côte d’Ivoire
| | | | | | | | | | | | | | | | | | | | - Jambi Garap
- Port Moresby General Hospital, Papua New Guinea
| | | | | | | | | | | | | | | | | | - Anna Harte
- London School of Hygiene & Tropical Medicine, UK
| | - Rob Henry
- U.S. Agency for International Development, USA
| | | | | | | | | | | | - Martin Kabore
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Burkina Faso
| | | | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Malawi
| | | | | | | | | | | | | | | | | | | | - Robert Ko
- Port Moresby General Hospital, Papua New Guinea
| | - Susan Lewallen
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa, South Africa
| | | | | | - Yuri A Lopez
- SACAICET / MINISTERIO DEL PODER POPULAR PARA LA SALUD, Venezuela
| | | | | | | | | | | | | | | | | | | | | | | | - Aboulaye Meite
- Ministère de la Santé et de l’Hygiène Publique, Cote d’Ivoire
| | | | | | | | | | | | | | - Aryc Mosher
- U.S. Agency for International Development, USA
| | | | | | | | | | | | | | | | | | | | - Cece Nieba
- Ministère de la Santé et de l’Hygiene Publique, Guinea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Oliver Sokana
- Solomon Islands Ministry of Health and Medical Services, Solomon Islands
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Kelly-Hope LA, Harding-Esch EM, Willems J, Ahmed F, Sanders AM. Conflict-climate-displacement: a cross-sectional ecological study determining the burden, risk and need for strategies for neglected tropical disease programmes in Africa. BMJ Open 2023; 13:e071557. [PMID: 37197807 DOI: 10.1136/bmjopen-2023-071557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVES Complex challenges such as political instability, climate change and population displacement are increasing threats to national disease control, elimination and eradication programmes. The objective of this study was to determine the burden and risk of conflict-related and climate-related internal displacements and the need for strategies for countries endemic with neglected tropical diseases (NTDs). DESIGN, SETTING AND OUTCOME MEASURES A cross-sectional ecological study was conducted including countries that are endemic with at least one of five NTDs requiring preventive chemotherapy in the African region. For each country, the number of NTDs, population size and the number and rate per 100 000 of conflict-related and natural disaster-related internal displacements reported in 2021 were classified into high and low categories and used in unison to stratify and map the burden and risk. RESULTS This analysis identified 45 NTD-endemic countries; 8 countries were co-endemic with 4 or 5 diseases and had populations classified as 'high' totalling >619 million people. We found 32 endemic countries had data on internal displacements related to conflict and disasters (n=16), disasters only (n=15) or conflict only (n=1). Six countries had both high conflict-related and disaster-related internal displacement numbers totalling >10.8 million people, and five countries had combined high conflict-related and disaster-related internal displacement rates, ranging from 770.8 to 7088.1 per 100 000 population. Weather-related hazards were the main cause of natural disaster-related displacements, predominately floods. CONCLUSIONS This paper presents a risk stratified approach to better understand the potential impact of these complex intersecting challenges. We advocate for a 'call to action' to encourage national and international stakeholders to further develop, implement and evaluate strategies to better assess NTD endemicity, and deliver interventions, in areas at risk of, or experiencing, conflict and climate disasters, in order to help meet the national targets.
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Affiliation(s)
- Louise A Kelly-Hope
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | | | - Johan Willems
- CBM Christoffel-Blindenmission Christian Blind Mission e.V, Bensheim, Germany
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Badia-Rius X, Adamou S, Taylor MJ, Kelly-Hope LA. Morbidity hotspot surveillance: A novel approach to detect lymphatic filariasis transmission in non-endemic areas of the Tillabéry region of Niger. Parasite Epidemiol Control 2023; 21:e00300. [PMID: 37138586 PMCID: PMC10149363 DOI: 10.1016/j.parepi.2023.e00300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/24/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023] Open
Abstract
The Niger Lymphatic Filariasis (LF) Programme is making good progress towards the elimination goal and scaling up morbidity management and disability prevention (MMDP) activities. Clinical case mapping and the increased availability of services has prompted patients to come forward in both endemic and non-endemic districts. The latter included Filingué, Baleyara and Abala districts of the Tillabéry region, and in 2019, 315 patients were found during a follow-up active case finding activity, suggesting it may have low transmission. The aim of this study was to assess the endemicity status in areas reporting clinical cases, 'morbidity hotspots', in three non-endemic districts of the Tillabéry region. A cross-sectional survey was conducted in 12 villages in June 2021. Filarial antigen was detected using the rapid Filariasis Test Strip (FTS) diagnostic, and information obtained on gender, age, residency length, bed net ownership and usage, and presence of hydrocoele and/or lymphoedema. Data were summarised and mapped using QGIS software. A total of 4058 participants between 5 and 105 years old were surveyed, with 29 (0.7%) participants found to be FTS positive. Baleyara district had significantly higher FTS positive rates than the other districts. No significant differences were found by gender (male 0.8%; female 0.6%), age group (<26 years 0.7%; ≥26 years 0. 7%), and residency length (<5 years 0.7%; ≥5 years 0.7%). Three villages reported no infections; seven villages <1%, one village 1.1% and one village 4.1%, which was on the border of an endemic district. Bed net ownership (99.2%) and usage (92.6%) was very high and there was no significant difference between FTS infection rates. The results indicate that there are low levels of transmission in populations, including children, living in districts previously classified as non-endemic. This has implications for the Niger LF programme in terms of delivering targeted mass drug administration (MDA) in transmission hotspots, and MMDP services, including hydrocoele surgery to patients. The use of morbidity data may be a practical proxy to trigger mapping of ongoing transmission in low endemic areas. Continued efforts to study morbidity hotspots, post-validation transmission, cross-border and cross-district endemicity are needed to meet the WHO NTD 2030 roadmap targets.
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Affiliation(s)
- Xavier Badia-Rius
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, UK
- Corresponding author.
| | - Salissou Adamou
- Programme National de Dévolution de l'Onchocercose et Élimination de la Filariose Lymphatique, Ministère de la Santé Publique, de la Population et des Affaires Sociales, Niger
| | - Mark J. Taylor
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, UK
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, UK
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, UK
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Downs P, Bush S, Bannerman R, Blair L, D'Souza S, Ekpo U, Gyapong M, Kar K, Kelly-Hope L, Mabey D, Mante S, Tate A, Velleman Y, Molyneux D. OUP accepted manuscript. Int Health 2022; 14:ii1-ii6. [PMID: 36130250 PMCID: PMC9492294 DOI: 10.1093/inthealth/ihab094] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/16/2021] [Accepted: 01/07/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Philip Downs
- Corresponding author: Tel: +44 1444 446600; E-mail:
| | - Simon Bush
- Director, Neglected Tropical Diseases, Sightsavers, P.O Box KIA18190, Airport, Accra, Ghana
| | - Ron Bannerman
- Sightsavers, 35 Perrymount Rd, Haywards Heath RH16 3BZ
| | - Lynsey Blair
- SCI Foundation, Edinburgh House, 170 Kennington Ln, Lambeth, London SE11 5DP, UK
| | - Susan D'Souza
- Sightsavers, 35 Perrymount Rd, Haywards Heath RH16 3BZ
| | - Uwem Ekpo
- Department of Pure and Applied Zoology, Federal University of Agriculture, Alabata Road, Abeokuta, Nigeria
| | | | - Kamal Kar
- CLTS Foundation, CB-88, CB Block, Sector 1, Bidhannager, Kolkata, West Bengal 700064, India
| | - Louise Kelly-Hope
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool Science Park IC2 Building, 146 Brownlow Hill, Liverpool L3 5RF, UK
| | - David Mabey
- London School of Hygiene and Tropical Medicine, Keppel St, Gower St., London WCIE 7HT, UK
| | - Sunny Mante
- African Filariasis Morbidity Project, P.O BOX KB-282, Korle-Bu, Accra Ghana
| | - Andrew Tate
- Sightsavers, 35 Perrymount Rd, Haywards Heath RH16 3BZ
| | - Yael Velleman
- SCI Foundation, Edinburgh House, 170 Kennington Ln, Lambeth, London SE11 5DP, UK
| | - David Molyneux
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, L3 QA, UK
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Kelly-Hope LA, Molyneux DH. Quantifying conflict zones as a challenge to certification of Guinea worm eradication in Africa: a new analytical approach. BMJ Open 2021; 11:e049732. [PMID: 34353803 PMCID: PMC8344294 DOI: 10.1136/bmjopen-2021-049732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To quantify conflict events and access across countries that remain to be certified free of transmission of Dracunculus medinensis (Guinea worm disease) or require postcertification surveillance as part of the Guinea Worm Eradication Programme (GWEP). SETTING AND PARTICIPANTS Populations living in Guinea worm affected areas across seven precertification countries and 13 postcertification sub-Saharan African countries. OUTCOME MEASURES The number of conflict events and rates per 100 000 population, the main types of conflict and actors reported to be responsible for events were summarised and mapped across all countries. Chad and Mali were presented as case studies. Guinea worm information was based on GWEP reports. Conflict data were obtained from the Armed Conflict Location and Event Data Project. Maps were created using ArcGIS V.10.7 and access was measured as regional distance and time to cities. RESULTS More than 980 000 conflict events were reported between 2000 and 2020, with a significant increase since 2018. The highest number and rates were reported in precertification Mali (n=2556; 13.0 per 100 000), South Sudan (n=2143; 19.4), Democratic Republic of Congo (n=7016; 8.1) and postcertification Nigeria (n=6903; 3.4), Central Africa Republic (n=1251; 26.4), Burkina Faso (n=2004; 9.7). Violence against civilians, protests and battles were most frequently reported with several different actors involved including Unidentified Armed Groups and Boko Haram. Chad and Mali had contracting epidemiological and conflict situations with affected regions up to 700 km from the capital or 10 hours to the nearest city. CONCLUSIONS Understanding the spatial-temporal patterns of conflict events, identifying hotspots, the actors responsible and their sphere of influence is critical for the GWEP and other public health programmes to develop practical risk assessments, deliver essential health interventions, implement innovative surveillance, determine certification and meet the goals of eradication.
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Affiliation(s)
- Louise A Kelly-Hope
- Department of Livestock and One Health, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, Merseyside, UK
- Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
| | - David H Molyneux
- Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
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