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Sassa M, Yoneoka D, Ng CFS, Cao AQ, Devanathan G, Hashizume M, Nomura S. A comprehensive assessment of deworming coverage among pregnant women in low- and middle-income countries, 2000-30. J Glob Health 2024; 14:04002. [PMID: 38419465 PMCID: PMC10902802 DOI: 10.7189/jogh.14.04002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Background Intestinal parasitic infections pose a significant global public health issue, particularly among pregnant women, who are generally more susceptible due to their elevated need for iron and nutrients. Deworming stands as a secure and efficacious public health intervention. The World Health Organization (WHO) set a target for the national deworming coverage rate among pregnant women at 75% by 2030. Nonetheless, the existing body of evidence on deworming among pregnant women in low- and middle-income countries (LMICs) remains limited. Methods Based on Demographic Health Survey (DHS) data from 56 LMICs (n = 924 277) between 2000 and 2022, we used Bayesian hierarchical models to estimate trends of deworming coverage up to 2030 and to analyse determinant factors of deworming. Results We found that, despite progress in deworming coverage estimates for most countries, only 11 (<20%) are on track to achieve the WHO target coverage at the national level. Inequality gaps were projected to increase in most LMICs. A multilevel model showed that increased numbers of antenatal care, access to safe water, and a higher wealth index were associated with higher odds of deworming. Conclusions The progress on deworming coverage and inequality in many countries remains insufficient for achieving the WHO target by 2030. Additional investments in the health sector towards the expansion of deworming programmes, along with integration with existing health services, are urgently required, as is the introduction of effective policies and strengthening programmes within the context of the 'Leave No One Behind' agenda.
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Affiliation(s)
- Miho Sassa
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Daisuke Yoneoka
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
| | - Chris Fook Sheng Ng
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Alton Quan Cao
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ganan Devanathan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuhei Nomura
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
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Mukherjee S. The United States Food and Drug Administration (FDA) regulatory response to combat neglected tropical diseases (NTDs): A review. PLoS Negl Trop Dis 2023; 17:e0011010. [PMID: 36634043 PMCID: PMC9836280 DOI: 10.1371/journal.pntd.0011010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The availability and accessibility of safe and effective drugs, vaccines, and diagnostics are essential to reducing the immense global burden of neglected tropical diseases (NTDs). National regulatory authorities, such as the United States Food and Drug Administration (FDA), play an essential role in this effort to ensure access to safe and effective medical products by working within a set of legal frameworks and regulatory functions. However, medical product development for NTDs remains neglected, as combating NTDs is not a viable commercial market for pharmaceutical companies. To spur research and development (R&D) of NTD products, the US government has authorized various programs and policies to engage pharmaceutical companies, many of which provide FDA with the legal authority to implement NTD programs and pathways. Thus, this review provides a clear overview of the various regulatory pathways and programs employed by the FDA to increase the availability of NTD drugs, vaccines, and diagnostics. The review assesses the available information on various regulatory considerations and their impact on NTD product development as a first step in estimating the importance of such programs. Next, findings related to currently approved NTD products through these programs are discussed. Lastly, gaps in NTD R&D are identified and suggestions on how to address these are presented. The available data shows that while such incentive programs are factored into companies' decisions to pursue NTD R&D, approved products for NTDs remains vastly insufficient. Most approved products that utilize these NTD regulatory pathways and programs are overwhelmingly for tuberculosis and malaria-both of which are not considered NTDs by the World Health Organization (WHO). Dedicated efforts are needed to facilitate and accelerate NTD product including employing multiple incentive programs, regular assessment of such programs, and leveraging on public-private partnerships.
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Affiliation(s)
- Sanjana Mukherjee
- Center for Global Health Science and Security, Department of Microbiology and Immunology, Georgetown University, Washington, District of Columbia, United States of America
- * E-mail:
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Gal LB, Bruck M, Tal R, Baum S, Ali JM, Weldegabriel LL, Sabar G, Golan R, Bentwich Z. Sustainable Elimination of Schistosomiasis in Ethiopia-A Five-Year Follow-Up Study. Trop Med Infect Dis 2022; 7:tropicalmed7090218. [PMID: 36136629 PMCID: PMC9501490 DOI: 10.3390/tropicalmed7090218] [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: 07/07/2022] [Revised: 08/21/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
In 2009, Mekele, the capital of the Tigray Region in Ethiopia, presented a mean prevalence of 44.7% of schistosomiasis (S. mansoni) in school children. Termed a public health problem, NALA, an international public health non-governmental organization, and their partners implemented a novel model of intervention, which aimed to compliment mass drug administration (MDA) campaigns with behavioral change (BC) and improved sanitation to achieve sustained elimination of schistosomiasis. The four-year intervention (2009−2012) covered 38 primary schools. The objective of this study was to examine factors associated with control or resurgence of the disease, and the association between the behavioral change program and disease prevalence, ten years after initiation. Eleven primary schools were selected for this follow-up study. All students provided a stool sample and filled in a knowledge, attitude and practice (KAP) questionnaire. In seven out of eleven schools (63.6%) the prevalence of schistosomiasis was maintained below 2% ten years after the initiation of the intervention. In four schools, prevalence returned to pre-intervention levels, defining them as persistent hot spots (PHS). Students from PHS schools scored lower on KAP questionnaires compared to students from responder schools; 3.9 ± 0.9 vs. 4.2 ± 0.9 (p-value < 0.001) for practice questions and 4.4 ± 1.4 vs. 4.6 ± 1.5 (p-value = 0.03) for attitude questions. The prevalence of schistosomiasis correlated positively with age, (p-value = 0.049), sex (relative risk = 1.7, p-value < 0.001), and location. Semi-urban locations (n = 382) had higher disease prevalence than urban locations (n = 242), (22.7% vs. 5.5%, p-value < 0.001). Students residing in semi-urban areas and close to a river (<500 m) were at higher risk of contracting schistosomiasis than those living in urban areas far from the river (RR = 5.95, p-value < 0.001). Finally, a correlation between prevalence and proximity of schools to rivers was found (semi-urban areas; RR = −0.91, p-value = 0.001 vs. urban areas; RR = −0.51, p-value = 0.001). Soil-transmitted-helminths prevalence in 2009 was 8.1% and declined during the intervention years to 0.5%. Prevalence in 2018 was found to be stable at 0.8%. These results demonstrate the long-term success of NALAs’ comprehensive model of intervention for elimination of schistosomiasis in school children, combining behavioral change and improved sanitation with MDA.
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Affiliation(s)
| | - Michal Bruck
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
| | - Robyn Tal
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
| | - Sarit Baum
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
| | - Jemal Mahdi Ali
- Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | | | - Galia Sabar
- The Department of Middle Eastern and African History, Tel Aviv University, Tel Aviv-Yafo P.O. Box 39040, Israel
| | - Rachel Golan
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
- Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Beer Sheva P.O. Box 653, Israel
| | - Zvi Bentwich
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
- Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer Sheva P.O. Box 653, Israel
- Correspondence: ; Tel.: +972-522440060
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Villacorta Linaza R, Garner T, Genovezos C. Building supply chain capacity for neglected tropical diseases: experience from the Ascend West and Central Africa programme. Trans R Soc Trop Med Hyg 2021; 115:841-846. [PMID: 33991417 PMCID: PMC8194841 DOI: 10.1093/trstmh/trab068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/30/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
The Ascend West and Central Africa programme, funded by the UK Foreign, Commonwealth and Development Office (FCDO) is supporting integrated preventative chemotherapy for up to five neglected tropical diseases (NTDs), including intestinal worms, lymphatic filariasis, river blindness, trachoma and schistosomiasis. The programme is implemented across 13 countries by a consortium of four leading international development partners: Sightsavers, Liverpool School of Tropical Medicine, Schistosomiasis Control Initiative Foundation and Mott Macdonald. This paper presents messages learnt from country assessments that took place prior to the global outbreak of coronavirus disease 2019 (COVID-19). These messages remain relevant post-COVID-19, with greater priority being given to the challenges for national NTD programmes in continuing to deliver mass drug administration (MDA) during the pandemic. Stakeholder coordination from the earliest stages of the pandemic has occurred at two levels: in the first mile with global partners of the NTD Supply Chain Forum and in the last mile with implementing partners in each country. This has been instrumental to manage delayed MDA, including the impact delays have on the shipment of NTD donated drugs and the distribution of stock held in country. The Ascend West and Central Africa programme is supporting countries with the resumption of MDA through a risk assessment and mitigation action (RAMA) process.
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Affiliation(s)
- Rocio Villacorta Linaza
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK
| | - Timothy Garner
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, UK
| | - Chantelle Genovezos
- Hypha Group Limited, 320 Firecrest Court Centre Park, Warrington, UK, WA1 1RG, UK
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Wainwright E, Evans D, Rotondo L, Pou B, Yevstigneyeva V, Zoerhoff KL, Ottesen EA, Reithinger R. The Elimination of Neglected Tropical Diseases: A Case Study Exemplifying How Foreign Assistance Funding Can Be Catalytic in Reducing the Burden of Major Global Health Conditions. Clin Infect Dis 2021; 70:958-964. [PMID: 31402376 DOI: 10.1093/cid/ciz742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/01/2019] [Indexed: 11/13/2022] Open
Abstract
In 2006, following direct advocacy and published rationale, the US Agency for International Development (USAID) established a neglected tropical diseases (NTDs) program to support the scale-up of integrated platforms to target the elimination and control of 5 NTDs-lymphatic filariasis, trachoma, onchocerciasis, schistosomiasis, and soil-transmitted helminthiasis. By 2017, more than 2.3 billion NTD treatments had been delivered to at-risk populations in 25 countries, leveraging $19 billion in donated drugs-approximately $26 dollars in donated medicine per $1 spent by USAID. As a result, most of the supported countries are on track to achieve their elimination goals (for lymphatic filariasis and trachoma) by 2020 or 2021 and their control goals soon thereafter. Though "small" when compared to other global health initiatives, this investment proved to be catalytic, and indeed highlights how foreign assistance funding can be transformative, in reducing the burden of major global health conditions such as NTDs.
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Affiliation(s)
| | - Darin Evans
- US Agency for International Development, Washington, DC, USA
| | | | | | | | | | - Eric A Ottesen
- RTI International, Washington, DC, USA.,Task Force for Global Health, Decatur, Georgia, USA
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Elfar E, Asem N, Yousof H. The awareness of neglected tropical diseases in a sample of medical and nursing students in Cairo University, Egypt: A cross-sectional study. PLoS Negl Trop Dis 2020; 14:e0008826. [PMID: 33206641 PMCID: PMC7673504 DOI: 10.1371/journal.pntd.0008826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 09/14/2020] [Indexed: 12/22/2022] Open
Abstract
Neglected tropical diseases (NTDs) are a group of chronic diseases affecting 1.2 billion people worldwide, with more burden in the developing communities. Improving awareness about NTDs is a powerful affordable long-term intervention for infection control. In literature, there is a limited number of studies in the developing countries assessing the awareness of healthcare providers regarding these diseases. The present study aimed at assessing the awareness of a sample of Cairo University medical and nursing students regarding NTDs. A cross-sectional descriptive study was conducted on 184 medical and nursing students in Cairo University. An anonymous self-administered questionnaire in English language with an estimated completion time of 15 minutes was used for evaluation. It included question categories which cover the knowledge about NTDs and control measures as well as the willingness to participate in NTDs control activities. Content analysis was performed on the materials and specifications of the epidemiology course given to medical and nursing students. Out of the study participants, 26% knew the meaning of NTDs. The main source of their knowledge was social media followed by the epidemiology course. A percentage of 33% of the students agreed that NTDs are of public health importance in Egypt. Thirty four percent of the participants expressed their willingness to participate in control activities for NTDs. Comparing medical and nursing students, a higher percentage of the nursing students stated that NTDs are causing a public health problem in Egypt with a statistically significant difference (P value < 0.001), while a statistically significant higher percentage of medical students believed that the awareness level regarding NTDs in Egypt is low (P value = 0.002). Cairo University medical and nursing students in this study showed a gap in the level of knowledge regarding NTDs and their control activities which represents a great threat to the control of these diseases.
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Affiliation(s)
- Eman Elfar
- Public Health and Community Medicine Department, Faculty of Medicine, Cairo University, Egypt
| | - Noha Asem
- Public Health and Community Medicine Department, Faculty of Medicine, Cairo University, Egypt
| | - Hanaa Yousof
- Public Health and Community Medicine Department, Faculty of Medicine, Cairo University, Egypt
- * E-mail:
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Phillips AE, Tohon Z, Dhanani NA, Sofo B, Gnandou I, Sidikou B, Noma AG, Madougou B, Alto O, Sebangou H, Halilou KM, Andia R, Garba A, Fenwick A, Hamidou AA. Evaluating the impact of biannual school-based and community-wide treatment on urogenital schistosomiasis in Niger. Parasit Vectors 2020; 13:557. [PMID: 33203477 PMCID: PMC7672903 DOI: 10.1186/s13071-020-04411-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) coordinated a five-year study implemented in several countries, including Niger, to provide an evidence-base for programmatic decisions regarding cost-effective approaches to preventive chemotherapy for schistosomiasis control. Methods This was a cluster-randomised trial investigating six possible combinations of annual or biannual community-wide treatment (CWT), school-based treatment (SBT), and holidays from mass treatment over four years. The most intense arm involved two years of annual CWT followed by 2 years of biannual CWT, while the least intensive arm involved one year of annual SBT followed by a year without treatment and two more years of annual SBT. The primary outcome of interest was prevalence and intensity of Schistosoma haematobium among 100 children aged 9–12 years sampled each year. In addition, 100 children aged 5–8 years in their first year of school and 50 adults (aged 20–55 years) were tested in the first and final fifth year of the study. Results In total, data were collected from 167,500 individuals across 225 villages in nine districts within the Niger River valley, Western Niger. Overall, the prevalence of S. haematobium decreased from baseline to Year 5 across all study arms. The relative reduction of prevalence was greater in biannual compared with annual treatment across all arms; however, the only significant difference was seen in areas with a high starting prevalence. Although adults were not targeted for treatment in SBT arms, a statistically significant decrease in prevalence among adults was seen in moderate prevalence areas receiving biannual (10.7% to 4.8%) SBT (P < 0.001). Adults tested in the annual SBT group also showed a decrease in prevalence between Year 1 and Year 5 (12.2% to 11.0%), but this difference was not significant. Conclusions These findings are an important consideration for schistosomiasis control programmes that are considering elimination and support the idea that scaling up the frequency of treatment rounds, particularly in areas of low prevalence, will not eliminate schistosomiasis. Interestingly, the finding that prevalence decreased among adults in SBT arms suggests that transmission in the community can be reduced, even where only school children are being treated, which could have logistical and cost-saving implications for the national control programmes.
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Affiliation(s)
- Anna E Phillips
- London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Zilahatou Tohon
- Aménagement et Lutte (RISEAL NIGER), Réseau International Schistosomiases Environnement, Avenue de l'indépendance, BP. 13724, Niamey, Niger
| | - Neerav A Dhanani
- Schistosomiasis control Initiative (SCI), Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Boubacar Sofo
- Aménagement et Lutte (RISEAL NIGER), Réseau International Schistosomiases Environnement, Avenue de l'indépendance, BP. 13724, Niamey, Niger
| | | | - Boubacar Sidikou
- Hôpital National de Niamey rond-point Hôpital, BP 238, Niamey, Niger
| | - Adamou Garba Noma
- Aménagement et Lutte (RISEAL NIGER), Réseau International Schistosomiases Environnement, Avenue de l'indépendance, BP. 13724, Niamey, Niger
| | - Bassirou Madougou
- Aménagement et Lutte (RISEAL NIGER), Réseau International Schistosomiases Environnement, Avenue de l'indépendance, BP. 13724, Niamey, Niger
| | - Oumarou Alto
- Aménagement et Lutte (RISEAL NIGER), Réseau International Schistosomiases Environnement, Avenue de l'indépendance, BP. 13724, Niamey, Niger
| | - Hannatou Sebangou
- Aménagement et Lutte (RISEAL NIGER), Réseau International Schistosomiases Environnement, Avenue de l'indépendance, BP. 13724, Niamey, Niger
| | - Kader M Halilou
- Aménagement et Lutte (RISEAL NIGER), Réseau International Schistosomiases Environnement, Avenue de l'indépendance, BP. 13724, Niamey, Niger
| | - Roumanatou Andia
- Aménagement et Lutte (RISEAL NIGER), Réseau International Schistosomiases Environnement, Avenue de l'indépendance, BP. 13724, Niamey, Niger
| | - Amadou Garba
- Aménagement et Lutte (RISEAL NIGER), Réseau International Schistosomiases Environnement, Avenue de l'indépendance, BP. 13724, Niamey, Niger
| | - Alan Fenwick
- Schistosomiasis control Initiative (SCI), Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Amina A Hamidou
- Aménagement et Lutte (RISEAL NIGER), Réseau International Schistosomiases Environnement, Avenue de l'indépendance, BP. 13724, Niamey, Niger
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Current status of neglected tropical diseases (NTDs) in the Philippines. Acta Trop 2020; 203:105284. [PMID: 31786109 DOI: 10.1016/j.actatropica.2019.105284] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 11/21/2022]
Abstract
In the Philippines, ten NTDs are prevalent, but only six namely LF, schistosomiasis, STH, food-borne trematodiases, rabies and leprosy are considered to be of public health importance. The 81 provinces in the country are endemic for at least one of these NTDs. Others may be endemic for two or even more of these diseases. Since 2000, after the Philippines accepted and implemented the WHO guidelines for NTDs prevention, control and elimination, significant progress has been achieved in reducing the magnitude of NTDs endemic in the country. Since 2009, out of 46 filariasis-endemic provinces, the number of provinces that has eliminated LF has progressively increased so that by 2015, 76% are already LF-free. By 2019, only four provinces remain endemic for LF. For schistosomiasis, as of 2012, report from the Department of Health (DOH) put the number of high endemic provinces at 10, moderately endemic at 6 and low to elimination levels at 12. For STH, results of the National Parasite Survey in the Philippines among school-aged children conducted in 2015 by the Research Institute for Tropical Medicine, the research arm of the Philippine DOH, however, showed that the overall cumulative prevalence was 28.4% with a prevalence range between 7.1% and 67.4%. The figures are way above the <20% prevalence standard set by the World Health Organization. Control and prevention efforts for FBTs just gained traction with the call of WHO for elimination of NTDs in 2015. There is an urgent need to update information by an intensive national baseline survey that can validate previous data as well as generate new information on the magnitude of the FBT problem in the Philippines. For leprosy, elimination activities have been intensified in high prevalence areas and from 2009 to 2013, case detection and prevalence were sustained at <1.0 per 10,000 population. Rabies elimination activities have been effective that by 2011, only five regions out of 16 remained with the highest number of rabies cases. In a period of seven years from 2010 to 2017, the number of rabies-free provinces and municipalities increased from 3 to 49. Problems continue to hound the NTD programmes in the Philippines as priorities shift to more urgent health problems in a country that is weighed down not only by the triple burden of disease but serious health consequences of emergencies and disasters and the fast-growing population itself. Paradigm shifts are suggested to replace the traditional and conventional perspectives of control. These include change from disease approach to intervention approach to allow for integration of strategies targeting several NTDs and multisectoral, multidisciplinary approach requiring strong, viable and sustainable partnerships involving various agencies of the government, public and private sector, pharmaceuticals, academe, researchers, local government units and the endemic communities themselves.
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Macfarlane CL, Dean L, Thomson R, Garner P. Community drug distributors for mass drug administration in neglected tropical disease programmes: systematic review and analysis of policy documents. J Glob Health 2019; 9:020414. [PMID: 31662849 PMCID: PMC6790237 DOI: 10.7189/jogh.09.020414] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Mass drug administration (MDA) programmes for neglected tropical diseases (NTDs) depend on voluntary community drug distributors (CDDs) to deliver drugs, and these volunteer schemes need regular training and supervision. NTD policy now includes integration of multiple disease programmes, but we are unsure if there is clarity in what is currently expected of CDDs and how they are managed. We therefore analysed World Health Organization (WHO) policy, strategy and implementation guidance, and select national NTD programme implementation plans. Methods Included are a) WHO global and WHO-Regional Office for Africa guidelines, strategies, operational manuals and meeting reports published between January 2007 to February 2018 that included policy and plans for CDDs; and b) national NTD programme master plans for Cameroon, Ghana, Liberia and Nigeria. For both review components, we examined the CDD responsibilities through a framework developed iteratively against the documents and prepared a narrative synthesis. Results Twenty WHO policy documents met the inclusion criteria. In the twelve global and eight regional documents, the CDD role was not explicitly or comprehensively defined. Three documents mentioned CDDs will distribute drugs; some mentioned health promotion, data handling and engagement in clinical care. Four WHO documents noted a need for CDD training or management, eight detailed some aspect of this, and one regional document provided a comprehensive overview. In the national plans, additional responsibilities included case management in two countries and transmission control in two countries. Every plan included training and supervision, but this was not always explicit, and details of the purpose and frequency varied. In all national plans, CDD motivation was identified as a challenge but not comprehensively addressed, although one document mentioned provision of bicycles. Conclusions WHO and national policies and plans assume CDDs will implement NTD programmes. However, there is almost no clear delineation of responsibilities, nor is there up-to-date practical guidance to guide managers. This ambiguity, in relation to the lack of explicit policies or programmatic guidance, probably impairs the effectiveness of NTD programmes.
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Affiliation(s)
- Cara L Macfarlane
- Centre for Evidence Synthesis in Global Health, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Rachael Thomson
- Department for Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul Garner
- Centre for Evidence Synthesis in Global Health, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Turner HC, Walker M, Pion SDS, McFarland DA, Bundy DAP, Basáñez M. Economic evaluations of onchocerciasis interventions: a systematic review and research needs. Trop Med Int Health 2019; 24:788-816. [PMID: 31013395 PMCID: PMC6617745 DOI: 10.1111/tmi.13241] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To provide a systematic review of economic evaluations that has been conducted for onchocerciasis interventions, to summarise current key knowledge and to identify research gaps. METHOD A systematic review of the literature was conducted on the 8th of August 2018 using the PubMed (MEDLINE) and ISI Web of Science electronic databases. No date or language stipulations were applied to the searches. RESULTS We identified 14 primary studies reporting the results of economic evaluations of onchocerciasis interventions, seven of which were cost-effectiveness analyses. The studies identified used a variety of different approaches to estimate the costs of the investigated interventions/programmes. Originally, the studies only quantified the benefits associated with preventing blindness. Gradually, methods improved and also captured onchocerciasis-associated skin disease. Studies found that eliminating onchocerciasis would generate billions in economic benefits. The majority of the cost-effectiveness analyses evaluated annual mass drug administration (MDA). The estimated cost per disability-adjusted life year (DALY) averted of annual MDA varies between US$3 and US$30 (cost year variable). CONCLUSIONS The cost benefit and cost effectiveness of onchocerciasis interventions have consistently been found to be very favourable. This finding provides strong evidential support for the ongoing efforts to eliminate onchocerciasis from endemic areas. Although these results are very promising, there are several important research gaps that need to be addressed as we move towards the 2020 milestones and beyond.
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Affiliation(s)
- Hugo C. Turner
- Oxford University Clinical Research UnitWellcome Africa Asia ProgrammeHo Chi Minh CityVietnam
- Centre for Tropical Medicine and Global HealthNuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Martin Walker
- London Centre for Neglected Tropical Disease ResearchDepartment of Pathobiology and Population SciencesRoyal Veterinary CollegeHatfieldUK
- London Centre for Neglected Tropical Disease ResearchDepartment of Infectious Disease EpidemiologySchool of Public HealthImperial College LondonLondonUK
| | - Sébastien D. S. Pion
- Institut de Recherche pour le DéveloppementUMI 233‐INSERMU1175‐Montpellier UniversityMontpellierFrance
| | | | | | - María‐Gloria Basáñez
- London Centre for Neglected Tropical Disease ResearchDepartment of Infectious Disease EpidemiologySchool of Public HealthImperial College LondonLondonUK
- MRC Centre for Global Infectious Disease AnalysisDepartment of Infectious Disease EpidemiologySchool of Public HealthImperial College LondonLondonUK
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Aribodor DN, Bassey SA, Yoonuan T, Sam-Wobo SO, Aribodor OB, Ugwuanyi IK. Analysis of Schistosomiasis and soil-transmitted helminths mixed infections among pupils in Enugu State, Nigeria: Implications for control. Infect Dis Health 2019; 24:98-106. [PMID: 30648601 DOI: 10.1016/j.idh.2018.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Schistosomiasis and Soil-transmitted helminthiasis cause considerable morbidity and mortality in developing countries, especially among children. To this end it, a cross-sectional survey to determine the pattern of Schistosomiasis and Soil-transmitted helminthiasis co-infection was undertaken among primary school pupils in Oduma Community in Enugu State, Nigeria. METHODS Fresh urine and stool samples were collected from pupils. The urine and stool samples were examined using sedimentation and Kat-Katz techniques respectively. RESULTS Of the 236 pupils examined, 137 (58.1%) were found positive for at least one helminth infection. Ascaris lumbricoides was the most prevalent soil-transmitted helminth (STH), with a prevalence rate of 40.3%, followed by Trichuris trichiura (15.3%) and hookworm (8.9%). Infection with Schistosoma haematobium was detected in 13.6% of the pupils while Schistosoma mansoni infection prevalence was 7.2%. Age group 4 -7 years recorded the highest prevalence for S. haematobium, A. lumbricoides, T. Trichiura and hookworm infections. Multiple infections were also recorded, with 22.9% having double infections and 2.5% having triple infections. The most common double infection was A. lumbricoides with T. trichiura (8.9%), while the most common triple infection was A. lumbricoides, S. haematobium and hookworm (1.7%). CONCLUSION The results from the present study revealed an evident need for the systematic and sustained administration of school-based chemotherapy program targeting the control of STH infection and Schistosomiasis using Albendazole and Praziquantel respectively in the community, instead of a one-off approach that was carried out.
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Affiliation(s)
- Dennis N Aribodor
- Department of Parasitology and Entomology, Faculty of Biosciences, Nnamdi Azikiwe University, P.M.B 5025, Awka, Anambra State, Nigeria.
| | - Simon A Bassey
- Department of Parasitology and Entomology, Faculty of Biosciences, Nnamdi Azikiwe University, P.M.B 5025, Awka, Anambra State, Nigeria.
| | - Tippayarat Yoonuan
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Sammy O Sam-Wobo
- Department of Pure and Applied Zoology, Federal University of Agriculture, P.M.B 2240, Abeokuta, Nigeria.
| | - Ogechukwu B Aribodor
- Department of Zoology, Faculty of Biosciences, Nnamdi Azikiwe University, P.M.B 5025, Awka, Anambra State, Nigeria.
| | - Ifeoma K Ugwuanyi
- Department of Parasitology and Entomology, Faculty of Biosciences, Nnamdi Azikiwe University, P.M.B 5025, Awka, Anambra State, Nigeria.
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Standley C, Boyce MR, Klineberg A, Essix G, Katz R. Organization of oversight for integrated control of neglected tropical diseases within Ministries of Health. PLoS Negl Trop Dis 2018; 12:e0006929. [PMID: 30462639 PMCID: PMC6281257 DOI: 10.1371/journal.pntd.0006929] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/05/2018] [Accepted: 10/16/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) are communicable diseases that impact approximately 1 billion people, but receive relatively little research, funding, and attention. Many NTDs have similar treatments, epidemiology, and geographic distribution, and as a result, the integration of control efforts can improve accountability, efficiency, and cost-effectiveness of programs. Here, we examine the landscape of efforts towards NTD integration across countries with the highest burden of disease, and review the administrative management of integration in order to identify approaches and pathways for integration. METHODOLOGY AND PRINCIPAL FINDINGS We utilized a standardized system to score countries for NTD endemnicity to create a list of 25 countries with the highest overall burden of NTDs. We then conducted a literature review to characterize the NTD control programs in the focus countries. Six countries were selected for key informant interviews to validate literature review results and gather additional data on opportunities and obstacles to NTD integration, from an administrative perspective. The majority of countries included in the study were located in Africa, with the remainder from Asia, North America, and South America. Multiple models and pathways were observed for the integration of NTD programs, in combination with other NTD programs, other diseases, or other health programs. Substantial heterogeneity existed with respect to the NTD control programs, and no country had integrated all of their NTD control efforts into a single program. NTDs that can be treated with preventative chemotherapy were frequently integrated into a single program. Leprosy control was also frequently integrated with those of other communicable diseases, and notably tuberculosis. Barriers to NTD integration may result from internal administrative obstacles or external obstacles. CONCLUSIONS Although many countries have begun to integrate NTD control efforts, additional work will be required to realize the full benefits of integration in most of the countries examined here. Moving forward, NTD integration efforts must ensure that administrative structures are designed to maximize the potential success of integrated programs and account for existing administrative processes.
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Affiliation(s)
- Claire Standley
- Georgetown University Medical Center, Center for Global Health Science and Security, Washington, District of Columbia, United States of America
| | - Matthew R. Boyce
- Georgetown University Medical Center, Center for Global Health Science and Security, Washington, District of Columbia, United States of America
| | - Anna Klineberg
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, Houston, Texas, United States of America
| | - Gabrielle Essix
- Georgetown University Medical Center, Center for Global Health Science and Security, Washington, District of Columbia, United States of America
| | - Rebecca Katz
- Georgetown University Medical Center, Center for Global Health Science and Security, Washington, District of Columbia, United States of America
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13
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Ondigo BN, Ndombi EM, Nicholson SC, Oguso JK, Carter JM, Kittur N, Secor WE, Karanja DMS, Colley DG. Functional Studies of T Regulatory Lymphocytes in Human Schistosomiasis in Western Kenya. Am J Trop Med Hyg 2018; 98:1770-1781. [PMID: 29692308 PMCID: PMC6086154 DOI: 10.4269/ajtmh.17-0966] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Immunoregulation is considered a common feature of Schistosoma mansoni infections, and elevated levels of T regulatory (Treg) lymphocytes have been reported during chronic human schistosomiasis. We now report that the removal of Treg (CD4+/CD25hi/CD127low lymphocytes) from peripheral blood mononuclear cells (PBMCs) of S. mansoni–infected individuals leads to increased levels of phytohemagglutinin (PHA)-stimulated interferon gamma (IFNγ) production and decreased interleukin-10 (IL-10) responses. Exposure to schistosome antigens did not result in measurable IFNγ by either PBMC or Treg-depleted populations. Interleukin-10 responses to soluble egg antigens (SEA) by PBMC were unchanged by Treg depletion, but the depletion of Treg greatly decreased IL-10 production to soluble worm antigenic preparation (SWAP). Proliferative responses to PHA increased upon Treg removal, but responses to SEA or SWAP did not, unless only initially low responders were evaluated. Addition of anti-IL-10 increased PBMC proliferative responses to either SEA or SWAP, but did not alter responses by Treg-depleted cells. Blockade by anti-transforming growth factor-beta (TGF-β) increased SEA but not SWAP proliferative responses by PBMC, whereas anti-TGF-β increased both SEA- and SWAP-stimulated responses by Treg-depleted cultures. Addition of both anti-IL-10 and anti-TGF-β to PBMC or Treg-depleted populations increased proliferation of both populations to either SEA or SWAP. These studies demonstrate that Treg appear to produce much of the antigen-stimulated IL-10, but other cell types or subsets of Treg may produce much of the TGF-β. The elevated levels of Treg seen in chronic schistosomiasis appear functional and involve IL-10 and TGF-β in antigen-specific immunoregulation perhaps leading to regulation of immunopathology and/or possibly decreased immunoprotective responses.
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Affiliation(s)
- Bartholomew N Ondigo
- Department of Biochemistry and Molecular Biology, Egerton University, Nakuru, Kenya.,Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eric M Ndombi
- Department of Pathology, Kenyatta University, Nairobi, Kenya.,Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Sarah C Nicholson
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - John K Oguso
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Jennifer M Carter
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Nupur Kittur
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Diana M S Karanja
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Daniel G Colley
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia.,Department of Microbiology, University of Georgia, Athens, Georgia
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Prevalence, intensity and spatial co-distribution of schistosomiasis and soil transmitted helminths infections in Ogun state, Nigeria. ACTA ACUST UNITED AC 2018. [DOI: 10.1017/pao.2018.4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractA cross-sectional survey was carried out in primary schools to determine prevalence, intensity and spatial co-distribution of Schistosomiasis and soil transmitted helminths (STH) infections in Ogun State, Nigeria. A total of 2148 pupils from 42 schools were examined forSchistosomaand STH infections from urine and fresh fecal samples respectively. Ethyl ether concentration method prepared in sodium acetate – acetic acid – formalin ether was used to concentrate parasites’ ova before microscopic examination. The overall prevalence of schistosomiasis and STH infections were 4.0% (95% CI = 3.21–4.92) and 34.64% (95% CI = 32.62–36.69) respectively.Schistosoma haematobiumandAscaris lumbricoideswere the most prevalent across the study area among theSchistosomaand STH species respectively. Overall, intensity of infection was higher in males than in females for allSchistosomaand STH infections, but with no significant difference (P > 0.05), except forTrichuris trichiura(χ2 = 6.490,P < 0.05). Infection intensity was significantly inversely correlated (χ2 = 12.953,P < 0.05) with an increase in age group. Co-distribution ofSchistosomaand STH infections occurred in 15 (35.7%) out of 42 schools, and only 30 children (1.4%) had co-infection ofSchistosomaand STH. This study provides information on the prevalence and spatial risk of schistosomiasis and STH in Ogun State. This will serve as decision-support tool for Ogun State programme managers to help facilitate integration of schistosomiasis and STH control.
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Phillips AE, Gazzinelli-Guimaraes PH, Aurelio HO, Ferro J, Nala R, Clements M, King CH, Fenwick A, Fleming FM, Dhanani N. Assessing the benefits of five years of different approaches to treatment of urogenital schistosomiasis: A SCORE project in Northern Mozambique. PLoS Negl Trop Dis 2017; 11:e0006061. [PMID: 29220347 PMCID: PMC5745126 DOI: 10.1371/journal.pntd.0006061] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/27/2017] [Accepted: 10/21/2017] [Indexed: 12/22/2022] Open
Abstract
Background In Mozambique, schistosomiasis is highly endemic across the whole country. The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) coordinates a five-year study that has been implemented in various African countries, including Mozambique. The overall goal of SCORE was to better understand how to best apply preventive chemotherapy with praziquantel (PZQ) for schistosomiasis control by evaluating the impact of alternative treatment approaches. Methods This was a cluster-randomised trial that compared the impact of different treatment strategies in study areas with prevalence among school children of ≥21% S. haematobium infection by urine dipstick. Each village was randomly allocated to one of six possible combinations of community-wide treatment (CWT), school-based treatment (SBT), and/or drug holidays over a period of four years, followed by final data collection in the fifth year. The most intense intervention arm involved four years of CWT, while the least intensive arm involved two years of SBT followed by two consecutive years of PZQ holiday. Each study arm included 25 villages randomly assigned to one of the six treatment arms. The primary outcome of interest was change in prevalence and intensity of S. haematobium among 100 children aged 9-to-12-years that were sampled each year in every village. In addition to children aged 9-to-12 years, 100 children aged 5–8 years in their first-year of school and 50 adults (aged 20–55 years) were tested in the first and final fifth year of the study. Prevalence and intensity of S. haematobium infection was evaluated by two filtrations, each of 10mL, from a single urine specimen. Principal findings In total, data was collected from 81,167 individuals across 149 villages in ten districts of Cabo Delgado province, Northern Mozambique. Overall PZQ treatment resulted in a significant reduction in the prevalence of S. haematobium infection from Year 1 to Year 5, where the average prevalence went from 60.5% to 38.8%, across all age groups and treatment arms. The proportion of those heavily infected also reduced from 17.6% to 11.9% over five years. There was a significantly higher likelihood of males being infected than females at baseline, but no significant difference between the sexes in their response to treatment. The only significant response based on a study arm was seen in both the 9-to-12-year-old and first-year cross sections, where two consecutive treatment holidays resulted in a significantly higher final prevalence of S. haematobium than no treatment holidays. When the arms were grouped together, four rounds of treatment (regardless of whether it was CWT or SBT), however, did result in a significantly greater reduction in S. haematobium prevalence than two rounds of treatment (i.e. with two intermittent or consecutive holiday years) over a five-year period. Conclusions Although PC was successful in reducing the burden of active infection, even among those heavily infected, annual CWT did not have a significantly greater impact on disease prevalence or intensity than less intense treatment arms. This may be due to extremely high starting prevalence and intensity in the study area, with frequent exposure to reinfection, or related to challenges in achieving high treatment coverage More frequent treatment had a greater impact on prevalence and intensity of infection when arms were grouped by number of treatments, however, cost efficiency was greater in arms only receiving two treatments. Finally, a significant reduction in prevalence of S. haematobium was seen in adults even in the SBT arms implying the rate of transmission in the community had been decreased, even where only school children have been treated, which has significant logistical and cost-saving implications for a national control programme in justifying CWT. Urogenital schistosomiasis is highly endemic in Mozambique. This study was part of a multi-country trial, including Mozambique, designed to understand the impact of different schistosomiasis treatment strategies involving community-wide treatment (CWT), school-based (SBT), and treatment holidays over a five-year period. Results from Mozambique showed that although preventive chemotherapy was successful in reducing the prevalence of Schistosoma haematobium over five-years, the most intense treatment approach, annual CWT, did not have a significantly greater impact than less intense treatment strategies, such as bi-annual SBT. Infection rates were higher among males, but there was no difference in response to treatment by gender. Four rounds of treatment (regardless of whether it was given in the community or school) did result in a significantly greater reduction of S. haematobium prevalence than two rounds of treatment over a five-year period. There was, however, a resurgent increase in prevalence and intensity of S. haematobium infection shown after two consecutive treatment-holiday years, implying a bounce back in infection after a two year pause in treatment. Interestingly and unexpectedly, there was a significant reduction in prevalence of schistosomiasis in adults even in communities that had received SBT implying the force of transmission in the community had been decreased, even where only school children had been treated. These findings provide an evidence-base with significant logistical and cost-saving implications for programmatic decisions on how best to gain control of Schistosoma haematobium.
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Affiliation(s)
- Anna E. Phillips
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- * E-mail:
| | - Pedro H. Gazzinelli-Guimaraes
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Herminio O. Aurelio
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- Faculdade of Health Sciences, Universidade Católica de Moçambique (UCM) Beira, Moçambique
| | - Josefo Ferro
- Faculdade of Health Sciences, Universidade Católica de Moçambique (UCM) Beira, Moçambique
| | - Rassul Nala
- Laboratório de Parasitologia Intestinal e Vesical do Instituto Nacional de Saúde de Moçambique, Ministerio da Saúde, Maputo, Moçambique
| | - Michelle Clements
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Charles H. King
- Center for Global Health and Diseases, School of Medicine, Case Western Reserve University, Euclid Avenue, Cleveland, Ohio, United States of America
- Schistosomiasis Consortium for Operational Research and Evaluation, University of Georgia, Athens, Georgia, United States of America
| | - Alan Fenwick
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Fiona M. Fleming
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Neerav Dhanani
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
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Emerging and Neglected Infectious Diseases: Insights, Advances, and Challenges. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5245021. [PMID: 28286767 PMCID: PMC5327784 DOI: 10.1155/2017/5245021] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 01/05/2017] [Accepted: 01/16/2017] [Indexed: 11/17/2022]
Abstract
Infectious diseases are a significant burden on public health and economic stability of societies all over the world. They have for centuries been among the leading causes of death and disability and presented growing challenges to health security and human progress. The threat posed by infectious diseases is further deepened by the continued emergence of new, unrecognized, and old infectious disease epidemics of global impact. Over the past three and half decades at least 30 new infectious agents affecting humans have emerged, most of which are zoonotic and their origins have been shown to correlate significantly with socioeconomic, environmental, and ecological factors. As these factors continue to increase, putting people in increased contact with the disease causing pathogens, there is concern that infectious diseases may continue to present a formidable challenge. Constant awareness and pursuance of effective strategies for controlling infectious diseases and disease emergence thus remain crucial. This review presents current updates on emerging and neglected infectious diseases and highlights the scope, dynamics, and advances in infectious disease management with particular focus on WHO top priority emerging infectious diseases (EIDs) and neglected tropical infectious diseases.
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Jenny AM, Li M, Ashbourne E, Aldrink M, Funk C, Stergachis A. Assessment of the scope and practice of evaluation among medical donation programs. Global Health 2016; 12:69. [PMID: 27814729 PMCID: PMC5096304 DOI: 10.1186/s12992-016-0210-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Medical donation programs for drugs, other medical products, training and other supportive services can improve access to essential medicines in low- and middle-income countries (LMICs) and provide emergency and disaster relief. The scope and extent to which medical donation programs evaluate their impact on recipients and health systems is not well documented. Methods We conducted a survey of the member organizations of the Partnership for Quality Medical Donations (PQMD), a global alliance of non-profit and corporate organizations, to identify evaluations conducted in conjunction with donation programs. Results Twenty-five out of the 36 PQMD organizations that were members at the time of the survey participated in the study, for a response rate of 69 %. PQMD members provided information on 34 of their major medical donation programs. Half of the donation programs reported conducting trainings as a part of their donation program. Twenty-six (76 %) programs reported that they conduct routine monitoring of their donation programs. Less than 30 % of donation programs were evaluated for their impact on health. Lack of technical staff and lack of funding were reported as key barriers to conducting impact evaluations. Conclusions Member organizations of PQMD provide a broad range of medical donations, targeting a wide range of public health issues and events. While some level of monitoring and evaluation was conducted in nearly 80 % of the donation programs, a program’s impact was infrequently evaluated. Opportunities exist to develop consistent metrics for medical donation programs, develop a common framework for impact evaluations, and advocate for data collection and analysis plans that collect meaningful metrics.
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Affiliation(s)
- Alisa M Jenny
- Department of Global Health, Global Medicines Program, University of Washington, Harris Hydraulics Building, Room 321, 1705 NE Pacific St., Box 357965, Seattle, WA, 98195-7965, USA.
| | - Meng Li
- Department of Pharmacy, Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, USA
| | | | | | | | - Andy Stergachis
- Department of Global Health, Global Medicines Program, University of Washington, Harris Hydraulics Building, Room 321, 1705 NE Pacific St., Box 357965, Seattle, WA, 98195-7965, USA.,Department of Pharmacy, Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, USA
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Controlling Neglected Tropical Diseases (NTDs) in Haiti: Implementation Strategies and Evidence of Their Success. PLoS Negl Trop Dis 2016; 10:e0004954. [PMID: 27706162 PMCID: PMC5051938 DOI: 10.1371/journal.pntd.0004954] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/05/2016] [Indexed: 12/04/2022] Open
Abstract
Lymphatic filariasis (LF) and soil-transmitted helminths (STH) have been targeted since 2000 in Haiti, with a strong mass drug administration (MDA) program led by the Ministry of Public Health and Population and its collaborating international partners. By 2012, Haiti’s neglected tropical disease (NTD) program had reached full national scale, and with such consistently good epidemiological coverage that it is now able to stop treatment for LF throughout almost all of the country. Essential to this success have been in the detail of how MDAs were implemented. These key programmatic elements included ensuring strong community awareness through an evidence-based, multi-channel communication and education campaign facilitated by voluntary drug distributors; strengthening community trust of the drug distributors by ensuring that respected community members were recruited and received appropriate training, supervision, identification, and motivation; enforcing a “directly observed treatment” strategy; providing easy access to treatment though numerous distribution posts and a strong drug supply chain; and ensuring quality data collection that was used to guide and inform MDA strategies. The evidence that these strategies were effective lies in both the high treatment coverage obtained– 100% geographical coverage reached in 2012, with almost all districts consistently achieving well above the epidemiological coverage targets of 65% for LF and 75% for STH—and the significant reduction in burden of infection– 45 communes having reached the target threshold for stopping treatment for LF. By taking advantage of sustained international financial and technical support, especially during the past eight years, Haiti’s very successful MDA campaign resulted in steady progress toward LF elimination and development of a strong foundation for ongoing STH control. These efforts, as described, have not only helped establish the global portfolio of “best practices” for NTD control but also are poised to help solve two of the most important future NTD challenges—how to maintain control of STH infections after the community-based LF “treatment platform” ceases and how to ensure appropriate morbidity management for patients currently suffering from lymphatic filarial disease. We present evidence of Haiti’s successful neglected tropical disease (NTD) program targeting lymphatic filariasis and soil-transmitted helminths and the methods used to achieve this success. By 2012, Haiti’s NTD program had reached full national scale, with such consistently good treatment coverage that the program is now able to stop treatment for lymphatic filariasis in much of the country. These findings are in line with the predictions and expectations of the global community for countries where high coverage is achieved for program implementation. In addition to the evidence of successful program outcomes, we present a detailed description of how the program was implemented—from facilitating the effectiveness of the drug distributors to improving drug logistics and supporting a well-informed population. These methods described can be used to inform the design of other mass drug administration programs and enhance the development of global “best practices” guidance.
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19
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Fleming FM, Matovu F, Hansen KS, Webster JP. A mixed methods approach to evaluating community drug distributor performance in the control of neglected tropical diseases. Parasit Vectors 2016; 9:345. [PMID: 27305942 PMCID: PMC4910194 DOI: 10.1186/s13071-016-1606-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/25/2016] [Indexed: 11/10/2022] Open
Abstract
Background Trusted literate, or semi-literate, community drug distributors (CDDs) are the primary implementers in integrated preventive chemotherapy (IPC) programmes for Neglected Tropical Disease (NTD) control. The CDDs are responsible for safely distributing drugs and for galvanising communities to repeatedly, often over many years, receive annual treatment, create and update treatment registers, monitor for side-effects and compile treatment coverage reports. These individuals are ‘volunteers’ for the programmes and do not receive remuneration for their annual work commitment. Methods A mixed methods approach, which included pictorial diaries to prospectively record CDD use of time, structured interviews and focus group discussions, was used to triangulate data on how 58 CDDs allocated their time towards their routine family activities and to NTD Programme activities in Uganda. The opportunity costs of CDD time were valued, performance assessed by determining the relationship between time and programme coverage, and CDD motivation for participating in the programme was explored. Results Key findings showed approximately 2.5 working weeks (range 0.6–11.4 working weeks) were spent on NTD Programme activities per year. The amount of time on NTD control activities significantly increased between the one and three deliveries that were required within an IPC campaign. CDD time spent on NTD Programme activities significantly reduced time available for subsistence and income generating engagements. As CDDs took more time to complete NTD Programme activities, their treatment performance, in terms of validated coverage, significantly decreased. Motivation for the programme was reported as low and CDDs felt undervalued. Conclusions CDDs contribute a considerable amount of opportunity cost to the overall economic cost of the NTD Programme in Uganda due to the commitment of their time. Nevertheless, programme coverage of at least 75 %, as required by the World Health Organisation, is not being achieved and vulnerable individuals may not have access to treatment as a consequence of sub-optimal performance by the CDDs due to workload and programmatic factors. Electronic supplementary material The online version of this article (doi:10.1186/s13071-016-1606-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fiona M Fleming
- Schistosomiasis Control Initiative, Imperial College London, London, UK.
| | - Fred Matovu
- School of Economics, Makerere University, Kampala, Uganda
| | - Kristian S Hansen
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanne P Webster
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Department of Pathology and Pathogen Biology, Centre for Emerging, Endemic and Exotic Diseases (CEEED), Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK
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20
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Ezeamama AE, He CL, Shen Y, Yin XP, Binder SC, Campbell CH, Rathbun S, Whalen CC, N'Goran EK, Utzinger J, Olsen A, Magnussen P, Kinung'hi S, Fenwick A, Phillips A, Ferro J, Karanja DMS, Mwinzi PNM, Montgomery S, Secor WE, Hamidou A, Garba A, King CH, Colley DG. Gaining and sustaining schistosomiasis control: study protocol and baseline data prior to different treatment strategies in five African countries. BMC Infect Dis 2016; 16:229. [PMID: 27230666 PMCID: PMC4880878 DOI: 10.1186/s12879-016-1575-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 05/17/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was established in 2008 to answer strategic questions about schistosomiasis control. For programme managers, a high-priority question is: what are the most cost-effective strategies for delivering preventive chemotherapy (PCT) with praziquantel (PZQ)? This paper describes the process SCORE used to transform this question into a harmonized research protocol, the study design for answering this question, the village eligibility assessments and data resulting from the first year of the study. METHODS Beginning in 2009, SCORE held a series of meetings to specify empirical questions and design studies related to different schedules of PCT for schistosomiasis control in communities with high (gaining control studies) and moderate (sustaining control studies) prevalence of Schistosoma infection among school-aged children. Seven studies are currently being implemented in five African countries. During the first year, villages were screened for eligibility, and data were collected on prevalence and intensity of infection prior to randomisation and the implementation of different schemes of PZQ intervention strategies. RESULTS These studies of different treatment schedules with PZQ will provide the most comprehensive data thus far on the optimal frequency and continuity of PCT for schistosomiasis infection and morbidity control. CONCLUSIONS We expect that the study outcomes will provide data for decision-making for country programme managers and a rich resource of information to the schistosomiasis research community. TRIAL REGISTRATION The trials are registered at International Standard Randomised Controlled Trial registry (identifiers: ISRCTN99401114 , ISRCTN14849830 , ISRCTN16755535 , ISRCTN14117624 , ISRCTN95819193 and ISRCTN32045736 ).
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Affiliation(s)
- Amara E Ezeamama
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, GA, USA.
| | - Chun-La He
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, GA, USA
| | - Ye Shen
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, GA, USA
| | - Xiao-Ping Yin
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, GA, USA
| | - Sue C Binder
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, USA
| | - Carl H Campbell
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, USA
| | - Stephen Rathbun
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, GA, USA
| | - Christopher C Whalen
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, GA, USA
| | - Eliézer K N'Goran
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.,Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | | | | | - Alan Fenwick
- Schistosomiasis Control Initiative, Imperial College, London, UK
| | - Anna Phillips
- Schistosomiasis Control Initiative, Imperial College, London, UK
| | - Josefo Ferro
- Catholic University of Mozambique, Beira, Mozambique
| | - Diana M S Karanja
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pauline N M Mwinzi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - W Evan Secor
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amina Hamidou
- Réseau International Schistosomoses, Environnement, Aménagement et Lutte (RISEAL-Niger), Niamey, Niger
| | - Amadou Garba
- Réseau International Schistosomoses, Environnement, Aménagement et Lutte (RISEAL-Niger), Niamey, Niger
| | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - Daniel G Colley
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, USA.,Department of Microbiology, University of Georgia, Athens, GA, USA
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School-based combined mass drug administration for soil-transmitted helminthiases and schistosomiasis among school-age children: lessons from two co-endemic areas in the Philippines. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(14)60797-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nakagawa J, Ehrenberg JP, Nealon J, Fürst T, Aratchige P, Gonzales G, Chanthavisouk C, Hernandez LM, Fengthong T, Utzinger J, Steinmann P. Towards effective prevention and control of helminth neglected tropical diseases in the Western Pacific Region through multi-disease and multi-sectoral interventions. Acta Trop 2015; 141:407-18. [PMID: 23792012 DOI: 10.1016/j.actatropica.2013.05.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 04/22/2013] [Accepted: 05/21/2013] [Indexed: 12/13/2022]
Abstract
Neglected tropical diseases (NTDs) cause serious health, social and economic burdens in the countries of the World Health Organization Western Pacific Region. Among the NTDs, helminth infections are particularly prominent with regard to the number of infected individuals and health impact. Co-endemicity is common among impoverished and marginalized populations. To achieve effective and sustainable control of helminth NTDs, a deeper understanding of the social-ecological systems governing their endemicity and strategies beyond preventive chemotherapy are required to tackle the multiple causes of infection and re-infection. We discuss the feasibility of implementing multi-disease, multi-sectoral intervention packages for helminth NTDs in the Western Pacific Region. After reviewing the main determinants for helminth NTD endemicity and current control strategies, key control activities that involve or concern other programmes within and beyond the health sector are discussed. A considerable number of activities that have an impact on more than one helminth NTD are identified in a variety of sectors, suggesting an untapped potential for synergies. We also highlight the challenges of multi-sectoral collaboration, particularly of involving non-health sectors. We conclude that multi-sectoral collaboration for helminth NTD control is feasible if the target diseases and sectors are carefully selected. To do so, an incentive analysis covering key stakeholders in the sectors is crucial, and the disease-control strategies need to be well understood. The benefits of multi-disease, multi-sectoral approaches could go beyond immediate health impacts by contributing to sustainable development, raising educational attainment, increasing productivity and reducing health inequities.
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Affiliation(s)
- Jun Nakagawa
- World Health Organization, Regional Office for the Western Pacific, Division of Combating Communicable Diseases, P.O. Box 2932, 1000 Manila, Philippines
| | - John P Ehrenberg
- World Health Organization, Regional Office for the Western Pacific, Division of Combating Communicable Diseases, P.O. Box 2932, 1000 Manila, Philippines
| | - Joshua Nealon
- World Health Organization, Regional Office for the Western Pacific, Division of Combating Communicable Diseases, P.O. Box 2932, 1000 Manila, Philippines
| | - Thomas Fürst
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Padmasiri Aratchige
- World Health Organization, Regional Office for the Western Pacific, Division of Combating Communicable Diseases, P.O. Box 2932, 1000 Manila, Philippines
| | - Glenda Gonzales
- World Health Organization, Regional Office for the Western Pacific, Division of Combating Communicable Diseases, P.O. Box 2932, 1000 Manila, Philippines
| | - Chitsavang Chanthavisouk
- World Health Organization, Regional Office for the Western Pacific, Division of Combating Communicable Diseases, P.O. Box 2932, 1000 Manila, Philippines
| | - Leda M Hernandez
- Infectious Disease Office, National Centre for Disease Prevention and Control, Department of Health, Sta. Cruz, 1000 Manila, Philippines
| | - Tayphasavanh Fengthong
- Department of Hygiene and Health Promotion, Ministry of Health, P.O. Box 1232, Vientiane, Lao People's Democratic Republic
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Peter Steinmann
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland.
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Ichimori K, King JD, Engels D, Yajima A, Mikhailov A, Lammie P, Ottesen EA. Global programme to eliminate lymphatic filariasis: the processes underlying programme success. PLoS Negl Trop Dis 2014; 8:e3328. [PMID: 25502758 PMCID: PMC4263400 DOI: 10.1371/journal.pntd.0003328] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kazuyo Ichimori
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Jonathan D. King
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Dirk Engels
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Aya Yajima
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Alexei Mikhailov
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Patrick Lammie
- Division of Parasite Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Eric A. Ottesen
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia, United States of America
- RTI International, Washington, D.C., United States of America
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Bardosh K. Global aspirations, local realities: the role of social science research in controlling neglected tropical diseases. Infect Dis Poverty 2014; 3:35. [PMID: 25320672 PMCID: PMC4197218 DOI: 10.1186/2049-9957-3-35] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 09/16/2014] [Indexed: 11/23/2022] Open
Abstract
Neglected Tropical Diseases (NTDs) are both drivers and manifestations of poverty and social inequality. Increased advocacy efforts since the mid-2000s have led to ambitious new control and elimination targets set for 2020 by the World Health Organisation. While these global aspirations represent significant policy momentum, there are multifaceted challenges in controlling infectious diseases in resource-poor local contexts that need to be acknowledged, understood and engaged. However a number of recent publications have emphasised the “neglected” status of applied social science research on NTDs. In light of the 2020 targets, this paper explores the social science/NTD literature and unpacks some of the ways in which social inquiry can help support effective and sustainable interventions. Five priority areas are discussed, including on policy processes, health systems capacity, compliance and resistance to interventions, education and behaviour change, and community participation. The paper shows that despite the multifaceted value of having anthropological and sociological perspectives integrated into NTD programmes, contemporary efforts underutilise this potential. This is reflective of the dominance of top-down information flows and technocratic approaches in global health. To counter this tendency, social research needs to be more than an afterthought; integrating social inquiry into the planning, monitoring and evaluating process will help ensure that flexibility and adaptability to local realities are built into interventions. More emphasis on social science perspectives can also help link NTD control to broader social determinants of health, especially important given the major social and economic inequalities that continue to underpin transmission in endemic countries.
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Affiliation(s)
- Kevin Bardosh
- Centre of African Studies, School of Social and Political Science, College of Humanities and Social Science, The University of Edinburgh, 58 George Square, Edinburgh, EH8 9LD UK ; Division of Pathway Medicine and Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
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Okorie PN, Bockarie MJ, Molyneux DH, Kelly-Hope LA. Neglected tropical diseases: a systematic evaluation of research capacity in Nigeria. PLoS Negl Trop Dis 2014; 8:e3078. [PMID: 25121582 PMCID: PMC4133230 DOI: 10.1371/journal.pntd.0003078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 06/04/2014] [Indexed: 11/30/2022] Open
Abstract
Background Nigeria carries the highest burden and diversity of neglected tropical diseases (NTDs) in sub-Saharan Africa and is preparing to scale up its efforts to control/eliminate these diseases. To achieve this it will require a range of internal technical support and expertise for mapping, monitoring and evaluating, operational research and documenting its success. In order to begin to evaluate this potential in Nigeria, this study collated and analysed information for lymphatic filariasis (LF), onchocerciasis, schistosomiasis and soil-transmitted helminths (STH), which are currently being targeted with preventive chemotherapy through mass drug administration (MDA). Methodology/Principal Findings Information from 299 scientific articles published on the selected NTDs in 179 journals between January 2008 and September 2013 was extracted and systematically compiled into a geo-referenced database for analysis and mapping. The highest number of articles was from the southern geo-political zones of the country. The majority of articles focused on one specific disease, and schistosomiasis and STH were found to have the highest and most wide ranging research output. The main type of study was parasitological, and the least was biotechnological. Nigerian authors were mostly affiliated with universities, and there was a wide range of international co-authors from Africa and other regions, especially the USA and UK. The majority of articles were published in journals with no known impact factor. Conclusions/Significance The extensive database and series of maps on the research capacity within Nigeria produced in this study highlights the current potential that exists, and needs to be fully maximized for the control/elimination of NTDs in the country. This study provides an important model approach that can be applied to other low and middle income countries where NTDs are endemic, and NTD programmes require support from the expertise within their own country, as well as internationally, to help raise their profile and importance. Nigeria carries the highest burden and diversity of neglected tropical diseases (NTDs) in sub-Saharan Africa and is preparing to increase the control and elimination of these diseases. The aim of this study was to provide information on the disease focus and type of studies carried out by scientists working on lymphatic filariasis (LF), onchocerciasis, schistosomiasis, soil-transmitted helminths (STH)) and Loa loa filariasis in Nigeria. Information on these diseases from all published literature on the scientific articles by Nigerian authors published between January 2008 and September 2013 was collated and mapped. The results show that many institutions are working on NTDs in Nigeria and their capacity could be readily enhanced with training and resources to boost their skills and to increase their range of technical activities and research visibility, which will also help to provide essential technical and laboratory support to the national NTD programmes.
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Affiliation(s)
- Patricia N. Okorie
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- * E-mail:
| | - Moses J. Bockarie
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - David H. Molyneux
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Downs PW, Bardin LE, McFarland DA. Modeling the dynamics of incentives in community drug distribution programs. Trends Parasitol 2014; 30:317-9. [PMID: 24793100 DOI: 10.1016/j.pt.2014.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 03/26/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
Abstract
Neglected tropical disease (NTD) control programs rely on an army of volunteers, or community drug distributors (CDDs), to distribute preventative drug packages through community and school-based platforms. Both monetary and non-monetary incentives are frequently provided to CDDs, although the impact on program performance is not well documented or understood. This article presents a descriptive framework to help visualize the dynamics of incentives as part of mass drug administration (MDA) campaigns and to guide future research in this area.
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Affiliation(s)
- Philip W Downs
- Research Triangle Institute (RTI) International, Washington, DC, USA.
| | - Lauren E Bardin
- Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA
| | - Deborah A McFarland
- Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA
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Woodhall DM, Mkwanda S, Dembele M, Lwanga H, Drexler N, Dubray C, Harris J, Worrell C, Mathieu E. Exploring innovative ways to conduct coverage surveys for neglected tropical diseases in Malawi, Mali, and Uganda. Acta Trop 2014; 132:119-24. [PMID: 24462795 DOI: 10.1016/j.actatropica.2014.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 10/18/2013] [Accepted: 01/09/2014] [Indexed: 11/29/2022]
Abstract
Currently, a 30-cluster survey to monitor drug coverage after mass drug administration for neglected tropical diseases is the most common methodology used by control programs. We investigated alternative survey methodologies that could potentially provide an estimation of drug coverage. Three alternative survey methods (market, village chief, and religious leader) were conducted and compared to the 30-cluster method in Malawi, Mali, and Uganda. In Malawi, drug coverage for the 30-cluster, market, village chief, and religious leader methods were 66.8% (95% CI 60.3-73.4), 74.3%, 76.3%, and 77.8%, respectively. In Mali, results for round 1 were 62.6% (95% CI 54.4-70.7), 56.1%, 74.8%, and 83.2%, and 57.2% (95% CI 49.0-65.4), 54.5%, 72.2%, and 73.3%, respectively, for round 2. Uganda survey results were 65.7% (59.4-72.0), 43.7%, 67.2%, and 77.6% respectively. Further research is needed to test different coverage survey methodologies to determine which survey methods are the most scientifically rigorous and resource efficient.
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Affiliation(s)
- Dana M Woodhall
- Parasitic Diseases Branch Centers for Disease Control Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States.
| | - Square Mkwanda
- Ministry of Health, P.O. Box 30377, Capital City, Lilongwe 3, Malawi.
| | | | - Harriet Lwanga
- RTI Uganda, P.O. Box 1661, Buganda Road, Kampala, Uganda.
| | - Naomi Drexler
- Parasitic Diseases Branch Centers for Disease Control Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States
| | - Christine Dubray
- Parasitic Diseases Branch Centers for Disease Control Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States
| | - Jennifer Harris
- Parasitic Diseases Branch Centers for Disease Control Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States
| | - Caitlin Worrell
- Parasitic Diseases Branch Centers for Disease Control Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States
| | - Els Mathieu
- Parasitic Diseases Branch Centers for Disease Control Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States
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Kappagoda S, Ioannidis JPA. Prevention and control of neglected tropical diseases: overview of randomized trials, systematic reviews and meta-analyses. Bull World Health Organ 2014; 92:356-366C. [PMID: 24839325 DOI: 10.2471/blt.13.129601] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/18/2013] [Accepted: 01/02/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To analyse evidence from randomized controlled trials (RCTs) on the prevention and control of neglected tropical diseases (NTDs) and to identify areas where evidence is lacking. METHODS The Cochrane Central Register of Controlled Trials and PubMed were searched for RCTs and the Cochrane Database of Systematic Reviews and PubMed were searched for meta-analyses and systematic reviews, both from inception to 31 December 2012. FINDINGS Overall, 258 RCTs were found on American trypanosomiasis, Buruli ulcer, dengue, geohelminth infection, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, rabies, schistosomiasis or trachoma. No RCTs were found on cysticercosis, dracunculiasis, echinococcosis, foodborne trematodes, or human African trypanosomiasis. The most studied diseases were geohelminth infection (51 RCTs) and leishmaniasis (46 RCTs). Vaccines, chemoprophylaxis and interventions targeting insect vectors were evaluated in 113, 99 and 39 RCTs, respectively. Few addressed how best to deliver preventive chemotherapy, such as the choice of dosing interval (10) or target population (4), the population coverage needed to reduce transmission (2) or the method of drug distribution (1). Thirty-one publications containing 32 systematic reviews (16 with and 16 without meta-analyses) were found on American trypanosomiasis, dengue, geohelminths, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, schistosomiasis or trachoma. Together, they included only 79 of the 258 published RCTs (30.6%). Of 36 interventions assessed, 8 were judged effective in more than one review. CONCLUSION Few RCTs on the prevention or control of the principal NTDs were found. Trials on how best to deliver preventive chemotherapy were particularly rare.
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Affiliation(s)
- Shanthi Kappagoda
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, United States of America (USA)
| | - John P A Ioannidis
- Stanford Prevention Research Center, Stanford University School of Medicine, 1265 Welch Road, MSOB X306, Stanford, California, 94305-5411, USA
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Resource planning for neglected tropical disease (NTD) control programs: feasibility study of the Tool for Integrated Planning and Costing (TIPAC). PLoS Negl Trop Dis 2014; 8:e2619. [PMID: 24587453 PMCID: PMC3937228 DOI: 10.1371/journal.pntd.0002619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Gupta R, Wise PH. Leveraging information technology to improve control of neglected tropical diseases. PLoS Negl Trop Dis 2013; 7:e2353. [PMID: 24244759 PMCID: PMC3820753 DOI: 10.1371/journal.pntd.0002353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Rajesh Gupta
- Stanford Health Policy, Stanford University, Stanford, California, United States of America
- * E-mail:
| | - Paul H. Wise
- Stanford Health Policy, Stanford University, Stanford, California, United States of America
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
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King JD, Buolamwini J, Cromwell EA, Panfel A, Teferi T, Zerihun M, Melak B, Watson J, Tadesse Z, Vienneau D, Ngondi J, Utzinger J, Odermatt P, Emerson PM. A novel electronic data collection system for large-scale surveys of neglected tropical diseases. PLoS One 2013; 8:e74570. [PMID: 24066147 PMCID: PMC3774718 DOI: 10.1371/journal.pone.0074570] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 08/05/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Large cross-sectional household surveys are common for measuring indicators of neglected tropical disease control programs. As an alternative to standard paper-based data collection, we utilized novel paperless technology to collect data electronically from over 12,000 households in Ethiopia. METHODOLOGY We conducted a needs assessment to design an Android-based electronic data collection and management system. We then evaluated the system by reporting results of a pilot trial and from comparisons of two, large-scale surveys; one with traditional paper questionnaires and the other with tablet computers, including accuracy, person-time days, and costs incurred. PRINCIPLE FINDINGS The electronic data collection system met core functions in household surveys and overcame constraints identified in the needs assessment. Pilot data recorders took 264 (standard deviation (SD) 152 sec) and 260 sec (SD 122 sec) per person registered to complete household surveys using paper and tablets, respectively (P = 0.77). Data recorders felt a lack of connection with the interviewee during the first days using electronic devices, but preferred to collect data electronically in future surveys. Electronic data collection saved time by giving results immediately, obviating the need for double data entry and cross-correcting. The proportion of identified data entry errors in disease classification did not differ between the two data collection methods. Geographic coordinates collected using the tablets were more accurate than coordinates transcribed on a paper form. Costs of the equipment required for electronic data collection was approximately the same cost incurred for data entry of questionnaires, whereas repeated use of the electronic equipment may increase cost savings. CONCLUSIONS/SIGNIFICANCE Conducting a needs assessment and pilot testing allowed the design to specifically match the functionality required for surveys. Electronic data collection using an Android-based technology was suitable for a large-scale health survey, saved time, provided more accurate geo-coordinates, and was preferred by recorders over standard paper-based questionnaires.
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Affiliation(s)
- Jonathan D. King
- The Carter Center, Atlanta, Georgia, United States of America
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Joy Buolamwini
- Department of Computer Science, Georgia Institute of Technology, Atlanta, United States of America
| | | | - Andrew Panfel
- Department of Computer Science, Georgia Institute of Technology, Atlanta, United States of America
| | | | | | | | - Jessica Watson
- Department of Computer Science, Georgia Institute of Technology, Atlanta, United States of America
| | | | - Danielle Vienneau
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jeremiah Ngondi
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Peter Odermatt
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Paul M. Emerson
- The Carter Center, Atlanta, Georgia, United States of America
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Hooper PJ, Zoerhoff KL, Kyelem D, Chu B, Flueckiger RM, Bamani S, Bougma WR, Fleming F, Onapa A, Paré AB, Torres S, Traore MO, Tuinsma M, Linehan M, Baker M. The effects of integration on financing and coverage of neglected tropical disease programs. Am J Trop Med Hyg 2013; 89:407-10. [PMID: 23836563 DOI: 10.4269/ajtmh.13-0018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
When the U.S. Agency for International Development (USAID) began to support national programs integrating their neglected tropical disease (NTD) program activities, the expected impact on individual disease-specific programs was unclear, particularly with respect to program financing and coverage. To assess this impact, data were collected by NTD program managers and their non-governmental organization (NGO) partners in Burkina Faso, Mali, and Uganda from 2 years prior and 2 years after their individual programs received funding for an integrated NTD program. Findings show that these countries experienced some increases in overall funding available for integrated NTD programs, an expansion of geographical coverage and of the number of persons treated, and the addition of treatments targeted at new diseases. What is not clear is whether these achievements can be sustained if there are decreases in external support in the future. Seeking increased government commitment or sustained external donor support should be a top priority.
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Affiliation(s)
- Pamela J Hooper
- Lymphatic Filariasis Support Center, Task Force for Global Health, Decatur, GA, USA.
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Noa Noatina B, Kagmeni G, Mengouo MN, Moungui HC, Tarini A, Zhang Y, Bella ALF. Prevalence of trachoma in the Far North region of Cameroon: results of a survey in 27 Health Districts. PLoS Negl Trop Dis 2013; 7:e2240. [PMID: 23717703 PMCID: PMC3662655 DOI: 10.1371/journal.pntd.0002240] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 01/02/2013] [Indexed: 12/05/2022] Open
Abstract
Background Cameroon is known to be endemic with trachoma. To appreciate the burden of the disease and facilitate the national planning of trachoma control in the integrated control program for the neglected tropical diseases, an epidemiological mapping of trachoma was conducted in the Far North region in 2010–11. Methodology A cross-sectional, cluster random sampling survey was carried out. The survey focused on two target populations: children aged 1 to 9 years for the prevalence of active trachoma and those aged 15 and over for the prevalence of trichiasis (TT). The sample frame was an exhaustive list of villages and neighborhoods of Health Districts (HDs). The World Health Organization simplified trachoma grading system was used for the recognition and registration of cases of trachoma. Principal Findings 48,844 children aged 1 to 9 years and 41,533 people aged 15 and over were examined. In children aged 1–9 years, the overall prevalence of trachomatous inflammation–follicular (TF) was 11.2% (95% confidence intervals (CI): 11.0–11.5%). More girls were affected than boys (p = 0.003). Thirteen (13) of 27 HDs in the region showed TF prevalence of ≥10%. The overall TT prevalence was 1.0% (95% CI: 0.9–1.1%). There were estimated 17193 (95% CI: 12576–25860) TT cases in the region. The prevalence of blindness was 0.04% (95% CI: 0.03–0.07%) and visual impairment was 0.09% (95% CI: 0.07–0.13%). Conclusions/Significance The survey confirmed that trachoma is a public health problem in the Far North region with 13 HDs qualified for district-level mass drug administration with azithromycin. It provided a foundation for the national program to plan and implement the SAFE strategy in the region. Effort must be made to find resources to provide the surgical operations to the 17193 TT cases and prevent them from becoming blind. Trachoma is the leading infectious cause of blindness in the world, which is caused by repeated eye infections with the bacterium Chlamydia trachomatis. The global objective of trachoma control is to eliminate trachoma as a blinding disease worldwide by Year 2020, using the World Health Organization-endorsed SAFE strategy (Surgery to correct trichiasis, Antibiotics to treat infection, Facial cleanliness and Environmental improvement to interrupt transmission). In order to implement the control program, the knowledge of the disease distribution and prevalence in each district is essential. Disease mapping surveys were conducted in 27 health districts in the Far North region in Cameroon. Thirteen health districts have a prevalence of trachomatous inflammation–follicular ≥10% in children aged 1–9 years and qualify for district-level mass antibiotic treatment as well as intensive implementation of other components of SAFE. There are estimated to be 17193 trichiasis cases in the region, which need surgical operations to prevent from being blinded. The survey provided a foundation for the national program to plan and implement the SAFE strategy in the region.
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Affiliation(s)
- Blaise Noa Noatina
- Programme National de Lutte Contre la Cécité, Ministère de la Santé, Yaoundé, Cameroun.
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Deribe K, Meribo K, Gebre T, Hailu A, Ali A, Aseffa A, Davey G. The burden of neglected tropical diseases in Ethiopia, and opportunities for integrated control and elimination. Parasit Vectors 2012; 5:240. [PMID: 23095679 PMCID: PMC3551690 DOI: 10.1186/1756-3305-5-240] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 10/01/2012] [Indexed: 12/04/2022] Open
Abstract
Background Neglected tropical diseases (NTDs) are a group of chronic parasitic diseases and related conditions that are the most common diseases among the 2·7 billion people globally living on less than US$2 per day. In response to the growing challenge of NTDs, Ethiopia is preparing to launch a NTD Master Plan. The purpose of this review is to underscore the burden of NTDs in Ethiopia, highlight the state of current interventions, and suggest ways forward. Results This review indicates that NTDs are significant public health problems in Ethiopia. From the analysis reported here, Ethiopia stands out for having the largest number of NTD cases following Nigeria and the Democratic Republic of Congo. Ethiopia is estimated to have the highest burden of trachoma, podoconiosis and cutaneous leishmaniasis in sub-Saharan Africa (SSA), the second highest burden in terms of ascariasis, leprosy and visceral leishmaniasis, and the third highest burden of hookworm. Infections such as schistosomiasis, trichuriasis, lymphatic filariasis and rabies are also common. A third of Ethiopians are infected with ascariasis, one quarter is infected with trichuriasis and one in eight Ethiopians lives with hookworm or is infected with trachoma. However, despite these high burdens of infection, the control of most NTDs in Ethiopia is in its infancy. In terms of NTD control achievements, Ethiopia reached the leprosy elimination target of 1 case/10,000 population in 1999. No cases of human African trypanosomiasis have been reported since 1984. Guinea worm eradication is in its final phase. The Onchocerciasis Control Program has been making steady progress since 2001. A national blindness survey was conducted in 2006 and the trachoma program has kicked off in some regions. Lymphatic Filariasis, podoconiosis and rabies mapping are underway. Conclusion Ethiopia bears a significant burden of NTDs compared to other SSA countries. To achieve success in integrated control of NTDs, integrated mapping, rapid scale up of interventions and operational research into co implementation of intervention packages will be crucial.
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Affiliation(s)
- Kebede Deribe
- Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom.
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