1
|
Ayisi F, de Souza DK, Tallant J, Biholong BD, Fokam EB, Boakye DA. Onchocerciasis in the Cameroon-Chad border area after more than 20 years of annual mass ivermectin distribution. Parasit Vectors 2024; 17:219. [PMID: 38741212 DOI: 10.1186/s13071-024-06284-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/17/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The main vectors of onchocerciasis in Africa are Simulium damnosum sensu lato, which transmit the causative agent Onchocerca volvulus. The force of transmission is driven by the vector density, hence influencing the disease prevalence and intensity. Onchocerciasis is currently targeted for elimination using mass drug administration (MDA) of ivermectin, a potent microfilaricide. MDA in Cameroon began in 1987 in the Vina Valley, an endemic cross-border area with Chad, known for high vector densities and precontrol endemicity. Evaluations in 2008-2010 in this area showed ongoing transmission, while border areas in Chad were close to interrupting transmission. This study aimed to evaluate transmission in this area after several rounds of MDA since the last evaluation surveys. METHODS Black flies were collected by human landing catches at seven border sites in Cameroon, twice a week, from August 2021 to March 2022. A fraction of the flies was dissected for parity assessment and identification of Onchocerca larval stages. The transmission indices were estimated. Black fly larvae were also collected from the breeding sites at the fly catching sites and identified to species level by cytotaxonomy. RESULTS A total of 14,303 female flies were collected, and 6918 were dissected. Of these, 4421 (64.0%) were parous. The total biting rates were high, reaching up to 16,407 bites/person/study period, and transmission potential (third-stage larvae (L3) from head/all L3) were 367/702, 146/506, 51/55, 20/32, 0/3, 0/0, and 0/0 infective larvae/person, respectively, for Mbere-Tchad, Babidan, Hajam/V5, Gor, Djeing, Touboro, and Koinderi. Infectivity rates (L3 from head) were 16.00, 12.75, 5.15, and 4.07 infective females (L3H)/1000 parous flies for Haijam, Mbere-Tchad, Babidan, and Gor, respectively. These values exceed the World Health Organization (WHO) thresholds of ≤ 20 annual transmission potential (ATP) or < 1 infective female/1000 parous females. The major vectors identified were Simulium damnosum sensu stricto, S. squamosum, and for the first time in the area, S. yahense. CONCLUSIONS More than 20 years of MDA has not eliminated onchocerciasis in the study area; hence, this area is a potential source of reintroduction of onchocerciasis in Chad and would require alternative treatment strategies. Many factors such as MDA efficiency, effectiveness of ivermectin, and cytospecies composition may be contributing to transmission persistence.
Collapse
Affiliation(s)
- Franklin Ayisi
- African Regional Postgraduate Programme in Insect Science (ARPPIS), University of Ghana, PMB LG 59, Legon, Accra, Ghana.
- National Onchocerciasis Control Programme, Sub Department in Charge of Malaria and Neglected Tropical Diseases, Department of Control of Diseases, Epidemics and Pandemics, Ministry of Public Health, Yaoundé, Cameroon.
| | - Dziedzom Komi de Souza
- Department of Parasitology, Noguchi Memorial Institute for Medical Research (NMIMR), College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | | | - Benjamin Didier Biholong
- National Onchocerciasis Control Programme, Sub Department in Charge of Malaria and Neglected Tropical Diseases, Department of Control of Diseases, Epidemics and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Eric Bertrand Fokam
- Department of Animal Biology and Conservation, University of Buea, Buea, Cameroon
| | - Daniel Adjei Boakye
- Department of Parasitology, Noguchi Memorial Institute for Medical Research (NMIMR), College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- The END Fund, New York, NY, USA
| |
Collapse
|
2
|
Tate A, Kollie K, Senyonjo L, Sturrock H, Downs P, Bush S, Bedell A, Molyneux D. Is the neglected tropical disease mass drug administration campaign approach an effective strategy to deliver universal health coverage? A case study of the Liberia neglected tropical disease programme. Int Health 2024; 16:283-292. [PMID: 37191201 PMCID: PMC11062188 DOI: 10.1093/inthealth/ihad035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/14/2023] [Accepted: 04/25/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Access to affordable, quality healthcare is the key element of universal health coverage (UHC). This study examines the effectiveness of the neglected tropical disease (NTD) mass drug administration (MDA) campaign approach as a means to deliver UHC, using the example of the Liberia national programme. METHODS We first mapped the location of 3195 communities from the 2019 national MDA treatment data reporting record of Liberia. The association between coverage for onchocerciasis and lymphatic filariasis treatment achieved in these communities was then explored using a binomial geo-additive model. This model employed three key determinants for community 'remoteness': population density and the modelled travel time of communities to their supporting health facility and to their nearest major settlement. RESULTS Maps produced highlight a small number of clusters of low treatment coverage in Liberia. Statistical analysis suggests there is a complex relationship between treatment coverage and geographic location. CONCLUSIONS We accept the MDA campaign approach is a valid mechanism to reach geographically marginal communities and, as such, has the potential to deliver UHC. We recognise there are specific limitations requiring further study.
Collapse
Affiliation(s)
- Andrew Tate
- Sightsavers, 35 Perrymount Road, Haywards Heath, Sussex, RH16 3BW, UK
| | - Karsor Kollie
- Director, Programme for Neglected Tropical Diseases, Monrovia, Liberia
| | - Laura Senyonjo
- Sightsavers, 35 Perrymount Road, Haywards Heath, Sussex, RH16 3BW, UK
| | | | - Phil Downs
- Sightsavers, 35 Perrymount Road, Haywards Heath, Sussex, RH16 3BW, UK
| | - Simon Bush
- Director, Neglected Tropical Diseases, Sightsavers, P.O. Box KIA 18190, Airport, Accra, Ghana
| | - Alex Bedell
- Liberia Country Office, Sightsavers, Monrovia, Liberia
| | - David Molyneux
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| |
Collapse
|
3
|
Lubanga AF, Bwanali AN, Munthali LE, Mphepo M, Chumbi GD, Kangoma M, Matola Y, Kaonga B, Moyo CS. Exploring the Role of Community Involvement in Reducing the Burden of Schistosomiasis and Other Neglected Tropical Diseases in Malawi: Where are We in the Fight Against Neglected Tropical Diseases? Res Rep Trop Med 2024; 15:51-58. [PMID: 38435085 PMCID: PMC10909323 DOI: 10.2147/rrtm.s448425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/24/2024] [Indexed: 03/05/2024] Open
Abstract
Schistosomiasis has been endemic in Malawi since 1947. Despite the longevity of endemicity of the disease, it still maintains a high burden in Malawi. This could be attributed to insufficient coverage of preventive and therapeutic mass drug administration (MDA) which mainly targets school-aged children, leaving out adults who also bear a high burden of the disease. Additionally, despite well documented impact of community involvement in boosting up the effectiveness of health programmes, there is minimal community involvement in schistosomiasis control and prevention programmes. Therefore, this perspective seeks to discuss the historical background of schistosomiasis in Malawi, gaps in community engagement and participation and suggest ways of enhancing the role of the community in prevention and control programmes. Amongst other challenges, the control programmes are centralised, leading to minimal input at the district and community level as well as low awareness of schistosomiasis control and prevention methods at the community level. It is of utmost significance therefore to provide comprehensive schistosomiasis health education to the communities and devise a thorough outline of the specific roles and responsibilities of all stakeholders including community members in the fight against schistosomiasis and other neglected tropical diseases.
Collapse
Affiliation(s)
- Adriano Focus Lubanga
- Education and Research, Clinical Research Education and Management Services Ltd (CREAMS), Lilongwe, Malawi
- Department of Clinical Services, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Akim Nelson Bwanali
- Education and Research, Clinical Research Education and Management Services Ltd (CREAMS), Lilongwe, Malawi
- Department of Clinical Services, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Mzati Mphepo
- Department of Clinical Services, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Melina Kangoma
- Department of Clinical Services, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Yankho Matola
- Department of Clinical Services, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Byenala Kaonga
- Department of Clinical Services, Kamuzu Central Hospital, Lilongwe, Malawi
| | | |
Collapse
|
4
|
Gbogbo S, Amu H, Dowou RK, Ayanore MA. Management of onchocerciasis among adolescents in nkwanta north district of Ghana: Qualitative study of adolescents' perception, community and health system support. PLoS Negl Trop Dis 2023; 17:e0011577. [PMID: 37643153 PMCID: PMC10464985 DOI: 10.1371/journal.pntd.0011577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Onchocerciasis affects the quality of life to a greater extent among affected individuals. The World Health Organization (WHO)'s Onchocerciasis Control Program (OCP) has effectively reduced the prevalence of onchocerciasis by interrupting the transmission of the parasite and by mass population treatment in the regions at risk of the disease. Despite the successful reduction of the prevalence of onchocerciasis by WHO, the socioeconomic burden resulting from the disabilities caused by onchocerciasis are still immense. This study sought to explore the adolescents' perception regarding the management of onchocerciasis, community and health system support in Nkwanta North District of Ghana. METHOD This study adopted a qualitative phenomenological design and exploratory, descriptive qualitative approach. An in-depth interview guide was developed to collect data for the study. One-on-one interview was conducted. Data collected from 16 onchocerciasis adolescent patients were analysed thematically using ATLAS.ti v7.5.7. Quotes from the participants were presented verbatim to substantiate the themes realised. RESULTS Most of the 12 participants (75.0%) were aged 15-18 years old. It was noted that 6(37.50%) of participants were in Junior High School (JHS), while 4(25.0%) were in Senior High School (SHS). It was noted that community members have diverse understandings and perceptions of onchocerciasis, including beliefs that Onchocerciasis is a serious disease that can cause blindness; it is caused by the consumption of some types of food products or stressful work. Adolescents believed that onchocerciasis was caused by insect bite blood infection, poor environmental hygiene, sun or could have been inherited from parents. Ivermectin treatment was noted by adolescents to have helped relieve the symptoms of ochocerciasis they were experiencing. However, the adolescents indicated that they had experienced some side effects, including fever, headache, body itching, rushes, swollen body and blurred vision from the drug. CONCLUSION Inadequate education and communication about onchocerciasis resulted in diverse and erroneous meanings of onchocerciasis among community members. Our research recognises that community and health system supports is very important in the effective management of Onchocerciasis, contributing to the attainment of Sustainable Development Goal (SDG) 3.3, which is targeted at ending the epidemic of NTDs like onchocerciasis by 2030.
Collapse
Affiliation(s)
- Sitsofe Gbogbo
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Science, Hohoe, Ghana
| | - Hubert Amu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Science, Hohoe, Ghana
| | - Robert Kokou Dowou
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Science, Hohoe, Ghana
| | - Martin Amogre Ayanore
- Health Policy Planning and Management, University of Health and Allied Science, Hohoe, Ghana
| |
Collapse
|
5
|
Lee L, Moo E, Angelopoulos T, Yashadhana A. Integrated people-centered eye care: A scoping review on engaging communities in eye care in low- and middle-income settings. PLoS One 2023; 18:e0278969. [PMID: 36656849 PMCID: PMC9851534 DOI: 10.1371/journal.pone.0278969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/24/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Community engagement has been endorsed as a key strategy to achieving integrated people-centered eye care that enables people and communities to receive a full spectrum of eye care across their life-course. Understanding the ways communities are engaged in eye care, to what degree participation is achieved, and the factors associated with intervention implementation is currently limited. OBJECTIVE The scoping review aimed to assess how community engagement is approached and implemented in eye care interventions in low- and middle-income countries, and to identify the barriers and facilitators associated with intervention implementation. METHODS Searches were conducted across five databases for peer-reviewed research on eye care interventions engaging communities published in the last ten years (January 2011 to September 2021). Studies were screened, reviewed and appraised according to Cochrane Rapid Reviews methodology. A hybrid deductive-inductive iterative analysis approach was used. RESULTS Of 4315 potential studies screened, 73 were included in the review. Studies were conducted across 28 countries and 55 targeted populations across more than one life-course stage. A variety of community actors were engaged in implementation, in four main domains of eye care: health promotion and education; drug and supplement distribution and immunization campaigns; surveillance, screening and detection activities; and referral and pathway navigation. With the approaches and level of participation, the majority of studies were community-based and at best, involved communities, respectively. Involving community actors alone does not guarantee community trust and therefore can impact eye care uptake. Community actors can be integrated into eye care programs, although with varying success. Using volunteers highlighted sustainability issues with maintaining motivation and involvement when resources are limited. CONCLUSION This scoping review provides researchers and policy makers contextual evidence on the breadth of eye care interventions and the factors to be considered when engaging and empowering communities in integrated people-centered eye care programs.
Collapse
Affiliation(s)
- Ling Lee
- International Programs Division, The Fred Hollows Foundation Australia, Melbourne, Australia
- School of Optometry and Vision Science, The University of New South Wales, Sydney Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Elise Moo
- International Programs Division, The Fred Hollows Foundation Australia, Melbourne, Australia
| | - Tiffany Angelopoulos
- International Programs Division, The Fred Hollows Foundation Australia, Melbourne, Australia
| | - Aryati Yashadhana
- International Programs Division, The Fred Hollows Foundation Australia, Melbourne, Australia
- Centre for Primary Health Care and Equity, The University of New South Wales, Sydney, Australia
- School of Population Health, The University of New South Wales, Sydney, Australia
| |
Collapse
|
6
|
Ogundo CLA, Bascaran C, Habtamu E, Buchan J, Mwangi N. Eye Health Integration in Southern and Eastern Africa: A Scoping Review. Middle East Afr J Ophthalmol 2023; 30:44-50. [PMID: 38435102 PMCID: PMC10903717 DOI: 10.4103/meajo.meajo_320_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 03/05/2024] Open
Abstract
Integrated health systems are deemed necessary for the attainment of universal health coverage, and the East, Central, and Southern Africa Health Community (ECSA-HC) recently passed a resolution to endorse the integration of eye health into the wider health system. This review presents the current state of integration of eye health systems in the region. Eight hundred and twelve articles between 1946 and 2020 were identified from four electronic databases that were searched. Article selection and data charting were done by two reviewers independently. Thirty articles met the eligibility criteria and were included in the narrative synthesis. Majority were observational studies (60%) and from Tanzania (43%). No explicit definition of integration was found. Eye health was prioritized at national level in some countries but failed to cascade to the lower levels. Eye health system integration was commonly viewed in terms of service delivery and was targeted at the primary level. Eye care data documentation was inadequate. Workforce integration efforts were focused on training general health-care cadres and communities to create a multidisciplinary team but with some concerns on quality of services. Government funding for eye care was limited. The findings show eye health system integration in the ECSA-HC region has been in progress for about four decades and is focused on the inclusion of eye health services into other health-care programs. Integration of comprehensive eye care into all the health system building blocks, particularly financial integration, needs to be given greater emphasis in the ECSA-HC.
Collapse
Affiliation(s)
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Eyu-Ethiopia: Eye Health Research, Training and Service Centre, Bahir Dar, Ethiopia
- Department of Ophthalmology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - John Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nyawira Mwangi
- Department of Ophthalmology, Kenya Medical Training College, Nairobi, Kenya
| |
Collapse
|
7
|
Rust J, Clark A, Woodgate M, Koch C, Mohammed T, Steinmann P, Krentel A, Torres-Vitolas CA, Carlin A, Pavluck A. Innovate to eliminate: a prerequisite in NTD programmes. Int Health 2022; 14:ii20-ii24. [PMID: 36130249 PMCID: PMC9492231 DOI: 10.1093/inthealth/ihac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/09/2022] [Accepted: 04/05/2022] [Indexed: 11/15/2022] Open
Abstract
Innovation plays a critical role in progress towards achievement of the World Health Organization's road map for neglected tropical diseases 2021-2030. As disease prevalence decreases, the cost to identify and treat remaining cases goes up. Additionally, as programmes move to the surveillance phase, diagnostic tests need to be highly sensitive and affordable. Until the early end to the Ascend West and Central Africa programme, the Ascend Learning and Innovation Fund supported five projects from 2019 to 2021. Designed for innovation, the fund encompassed a range of activities, including operational research, product development and social behavioural change. This flexibility allowed innovation to bridge the gap between strategic policy and practical implementation, piloting and proving business models to respond to information found through Ascend.
Collapse
Affiliation(s)
- Jennifer Rust
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, RH16 3BZ, UK
| | - Amy Clark
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, RH16 3BZ, UK
| | - Mary Woodgate
- Accenture Development Partnerships, London, EC3M 3BD, UK
| | - Christina Koch
- Accenture Development Partnerships, Berlin, 10117, Germany
| | | | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Allschwil CH-4123, Switzerland
- University of Basel, Basel CH-4001, Switzerland
| | - Alison Krentel
- Bruyère Research Institute, Ottawa, ON, K1R 6M1, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | | | | | - Alexandre Pavluck
- Sightsavers, Haywards Heath; Sightsavers, 35 Perrymount Road, Haywards Heath RH16 3BW, UK
| |
Collapse
|
8
|
Amazigo UV, Leak SGA, Zoure HGM, Okoronkwo C, Diop Ly M, Isiyaku S, Crump A, Okeibunor JC, Boatin B. Community-directed distributors-The "foot soldiers" in the fight to control and eliminate neglected tropical diseases. PLoS Negl Trop Dis 2021; 15:e0009088. [PMID: 33661903 PMCID: PMC7932156 DOI: 10.1371/journal.pntd.0009088] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The neglected tropical diseases (NTDs) affect hundreds of millions of people, predominantly in rural, often difficult-to-access areas, poorly served by national health services. Here, we review the contributions of 4.8 million community-directed distributors (CDDs) of medicines over 2 decades in 146,000 communities in 27 sub-Saharan African countries to control or eliminate onchocerciasis and lymphatic filariasis (LF). We examine their role in the control of other NTDs, malaria, HIV/AIDS interventions, immunisation campaigns, and support to overstretched health service personnel. We are of the opinion that CDDs as community selected, trained, and experienced “foot soldiers,” some of whom were involved in the Ebola outbreak responses at the community level in Liberia, if retrained, can assist community leaders and support health workers (HWs) in the ongoing Coronavirus Disease 2019 (COVID-19) crisis. The review highlights the improved treatment coverage where there are women CDDs, the benefits and lessons from the work of CDDs, their long-term engagement, and the challenges they face in healthcare delivery. It underscores the value of utilising the CDD model for strong community engagement and recommends the model, with some review, to hasten the achievement of the NTD 2030 goal and assist the health system cope with evolving epidemics and other challenges. We propose that, based on the unprecedented progress made in the control of NTDs directly linked to community engagement and contributions of CDDs “foot soldiers,” they deserve regional and global recognition. We also suggest that the World Health Organization (WHO) and other international stakeholders promote policy and guidance for countries to adapt this model for the elimination of NTDs and to strengthen national health services. This will enhance the accomplishment of some Sustainable Development Goals (SDGs) by 2030 in sub-Saharan Africa. Community-directed distributors (CDDs), sometimes known as community health workers (CHWs), have proved to be critical in the delivery of medicines and other tools for the control of neglected tropical diseases (NTDs), prevention of malaria, and other beneficial health interventions. The distributors are the unsung heroes and heroines without whom the health of hundreds of thousands of communities in rural Africa would be worse than it is today. In this paper, we document more than 2 decades (1997–2019) of the contributions of 146,000 communities and 4.8 million CDDs of medicines for NTDs, unpaid or minimally compensated, some have provided 18 years of uninterrupted service. We report on the burden of work and their perspectives of the challenges involved in mass drug administration (MDA) across 27 countries in sub-Saharan Africa. We suggest that they have not been adequately recognised and that harnessing such community human resources could contribute to improving health system’s responses to the ongoing Coronavirus Disease 2019 (COVID-19) crisis. We recommend policy measures for a wider application of existing networks of CDDs by countries’ health systems to consolidate and accelerate the achievements made as well as for the attainment of the goals set forth in the newly developed World Health Organization (WHO) NTD Roadmap.
Collapse
Affiliation(s)
- Uche V. Amazigo
- African Programme for Onchocerciasis Control, World Health Organization, Enugu, Nigeria
- * E-mail:
| | - Stephen G. A. Leak
- African Programme for Onchocerciasis Control, World Health Organization, Macclesfield, Cheshire, United Kingdom
| | | | | | | | | | | | | | - Boakye Boatin
- Onchocerciasis Control Programme in West Africa, World Health Organization, Accra, Ghana
| |
Collapse
|
9
|
Lenk EJ, Moungui HC, Boussinesq M, Kamgno J, Nana-Djeunga HC, Fitzpatrick C, Peultier ACMM, Klion AD, Fletcher DA, Nutman TB, Pion SD, Niamsi-Emalio Y, Redekop WK, Severens JL, Stolk WA. A Test-and-Not-Treat Strategy for Onchocerciasis Elimination in Loa loa-coendemic Areas: Cost Analysis of a Pilot in the Soa Health District, Cameroon. Clin Infect Dis 2021; 70:1628-1635. [PMID: 31165855 PMCID: PMC7146010 DOI: 10.1093/cid/ciz461] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/03/2019] [Indexed: 11/24/2022] Open
Abstract
Background Severe adverse events after treatment with ivermectin in individuals with high levels of Loa loa microfilariae in the blood preclude onchocerciasis elimination through community-directed treatment with ivermectin (CDTI) in Central Africa. We measured the cost of a community-based pilot using a test-and-not-treat (TaNT) strategy in the Soa health district in Cameroon. Methods Based on actual expenditures, we empirically estimated the economic cost of the Soa TaNT campaign, including financial costs and opportunity costs that will likely be borne by control programs and stakeholders in the future. In addition to the empirical analyses, we estimated base-case, less intensive, and more intensive resource use scenarios to explore how costs might differ if TaNT were implemented programmatically. Results The total costs of US$283 938 divided by total population, people tested, and people treated with 42% coverage were US$4.0, US$9.2, and US$9.5, respectively. In programmatic implementation, these costs (base-case estimates with less and more intensive scenarios) could be US$2.2 ($1.9–$3.6), US$5.2 ($4.5–$8.3), and US$5.4 ($4.6–$8.6), respectively. Conclusions TaNT clearly provides a safe strategy for large-scale ivermectin treatment and overcomes a major obstacle to the elimination of onchocerciasis in areas coendemic for Loa loa. Although it is more expensive than standard CDTI, costs vary depending on the setting, the implementation choices made by the institutions involved, and the community participation rate. Research on the required duration of TaNT is needed to improve the affordability assessment, and more experience is needed to understand how to implement TaNT optimally.
Collapse
Affiliation(s)
- Edeltraud J Lenk
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam.,Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands
| | - Henri C Moungui
- Centre for Research on Filariasis and Other Tropical Diseases, Yaounde, Cameroon
| | - Michel Boussinesq
- Unité Mixte Internationale, TransVIHMI, Institut de Recherche pour le Développement, University of Montpellier, France
| | - Joseph Kamgno
- Centre for Research on Filariasis and Other Tropical Diseases, Yaounde, Cameroon
| | | | | | | | - Amy D Klion
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Thomas B Nutman
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sébastien D Pion
- Unité Mixte Internationale, TransVIHMI, Institut de Recherche pour le Développement, University of Montpellier, France
| | | | - William K Redekop
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam
| | - Johan L Severens
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam
| | - Wilma A Stolk
- Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands
| |
Collapse
|
10
|
Fanelli S, Salvatore FP, De Pascale G, Faccilongo N. Insights for the future of health system partnerships in low- and middle-income countries: a systematic literature review. BMC Health Serv Res 2020; 20:571. [PMID: 32571317 PMCID: PMC7310020 DOI: 10.1186/s12913-020-05435-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/15/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite growing support for the private sector involvement in the provision of public health services in Low- and Middle-Income Countries (LMICs), a lack of clear information on the future of the provision of such services restricts the ability of managers and policy-makers to assess how feasible integration between public and private actors may be in these countries. This paper presents a systematic literature review which traces the dynamics and boundaries of public-private partnerships for the healthcare sector in LMICs. METHODS A total of 723 articles indexed in Scopus were initially submitted to bibliometric analysis. Finally, 148 articles published in several academic journals were selected for independent full-text review by two researchers. Content analysis was made in order to minimise mistakes in interpreting the findings of studies in the sample. RESULTS Public-private partnerships identified through the content analysis were categorised into four research areas: 1) Transfer of resources; 2) Co-production of health goods and services; 3) Governance networks; 4) Criteria for successful partnership development. CONCLUSIONS The four main research areas supply suggestions for a future research agenda, and managerial and policy implications for partnerships in LMICs.
Collapse
Affiliation(s)
- Simone Fanelli
- Department of Economics and Management, University of Parma, Via J. F. Kennedy, 6, Parma, Italy.
| | | | | | | |
Collapse
|
11
|
Ayalew F, Atnafu DD, Bedimo M, Mulatu K. Determinants of community-led ivermectin treatment adherence for onchocerciasis control in Western Ethiopia: a case-control study. Trop Med Health 2020; 48:22. [PMID: 32336928 PMCID: PMC7168851 DOI: 10.1186/s41182-020-00210-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/08/2020] [Indexed: 11/30/2022] Open
Abstract
Background Onchocerciasis is an infection of a filarial worm which is endemic in Sub-Saharan Africa, including Ethiopia. Annual mass treatment with high coverage over for a long period of time should lead to a complete interruption of transmission and the ultimate elimination of the parasite. However, in Ethiopia, the required coverage levels were not achieved. Thus, the aim of this study was to identify the possible determinants of onchocerciasis treatment adherence in Assossa District. Methods A case-control study was conducted among 528 respondents (176 cases and 352 controls). Cases were respondents who took all five doses of treatments, and controls were those who took at most four does of ivermectin treatments (missed at least one or more doses). Structured questionnaire was used for data collection. Each possible factor for treatment adherence, with a P value < 0.2 obtained in the bi-variable logistic regression was entered into the multivariable logistic regression models to control the confounding factors. p value < 0.05 was used as cut-off-point for a variable to become a significant determinant of treatment adherence in multivariable logistic regression. Results Participation in selecting drug distributers [AOR = 2.7, 95%CI (1.7–4.1)], measuring height for dose determination [AOR = 3.6, 95%CI (1.9–6.7)], perceived risk of getting onchocerciasis [AOR = 2.1, 95%CI (1.6–2.7)], living near running water [AOR = 1.7, 95%CI (1.1–2.8)], and perceived needs of support for intake of ivermectin [AOR = 3.2, 95%CI(2.1–4.9)] were independent predictors for t treatment adherence. Conclusions Treatment adherence was influenced by participation in selecting drug distributers, measuring height for dose determination, perceived risk of getting onchocerciasis, living near running water and perceived needs of support for intake of ivermectin. To improve intake of the drug and its adherence, the community should be empowered to make decisions, and counseling family members and sensitizing those living far from river sides is commendable. Health information about onchocerciasis should be strengthening to increase risk perception.
Collapse
Affiliation(s)
- Fikadu Ayalew
- 1School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Desta Debalkie Atnafu
- 2Department of Health System and Health Economics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Melkamu Bedimo
- 3Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kebadnew Mulatu
- 3Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
12
|
Dissak-Delon FN, Kamga GR, Humblet PC, Robert A, Souopgui J, Kamgno J, Ghogomu SM, Godin I. Do Communities Really "Direct" in Community-Directed Interventions? A Qualitative Assessment of Beneficiaries' Perceptions at 20 Years of Community Directed Treatment with Ivermectin in Cameroon. Trop Med Infect Dis 2019; 4:E105. [PMID: 31311093 DOI: 10.3390/tropicalmed4030105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/11/2019] [Accepted: 07/13/2019] [Indexed: 11/21/2022] Open
Abstract
Recent studies in Cameroon after 20 years of implementation of the Community Directed Treatment with ivermectin (CDTI) strategy, revealed mixed results as regards community ownership. This brings into question the feasibility of Community Directed Interventions (CDI) in the country. We carried out qualitative surveys in 3 health districts of Cameroon, consisting of 11 individual interviews and 10 Focus Group Discussions (FGDs) with specific community members. The main topic discussed during individual interviews and FGDs was about community participation in health. We found an implementation gap in CDTI between the process theory in the 3 health districts. Despite this gap, community eagerness for health information and massive personal and financial adhesion to interventions that were perceived important, were indicators of CDI feasibility. The concept of CDI is culturally feasible in rural and semi-urban settlements, but many challenges hinder its actual implementation. In the view of community participation as a process rather than an intervention, these challenges include real dialogue with communities as partners, dialogue and advocacy with operational level health staff, and macroeconomic and political reforms in health, finance and other associated sectors.
Collapse
|
13
|
Dissak-Delon FN, Kamga GR, Humblet PC, Robert A, Souopgui J, Kamgno J, Ghogomu SM, Godin I. Barriers to the National Onchocerciasis Control Programme at operational level in Cameroon: a qualitative assessment of stakeholders' views. Parasit Vectors 2019; 12:246. [PMID: 31109348 PMCID: PMC6528230 DOI: 10.1186/s13071-019-3497-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 05/09/2019] [Indexed: 11/16/2022] Open
Abstract
Background The global burden of onchocerciasis is the heaviest in sub-Saharan Africa. Studies have shown the importance of the role of Community-Directed Distributors (CDDs) and nurses in onchocerciasis control, but little is known about their experience in implementing onchocerciasis control programmes. Our aim was to document the barriers that CDDs and local health administrators face in implementing onchocerciasis control activities. Methods We conducted a qualitative survey consisting of 16 in-depth interviews and 8 focus group discussions (FGDs) across three health districts of Cameroon. We interviewed a total of 9 local health officials at the district and Health Area levels, and 7 CDDs. Eight FGDs were conducted with CDDs and Health Committee members. Results The major barriers to the implementation of Community Directed Treatment with Ivermectin that we identified were linked and interrelated. Examples of these barriers included: contextual factors (geographical and cultural background), top-to-bottom planning, insufficient human and material resources, and lack of transparency in the management of the programme’s funds. Conclusions The CDTI at operational level still faces many obstacles which negatively affect therapeutic coverages. This can lead to the non-adhesion of the communities to the programme, consequently jeopardizing the sustainability of the onchocerciasis elimination programme. We recommend that the national programme planners put in place a transparent management and planning system for onchocerciasis elimination activities, with better communication with local programme stakeholders.
Collapse
Affiliation(s)
- Fanny Nadia Dissak-Delon
- Ministry of Public Health, N°8, Rue 3038 quartier du Lac, Yaounde, Cameroon. .,Ecole de Santé Publique - Campus Erasme, Université Libre de Bruxelles, Route de Lennik 808 CP591, 1070, Brussels, Belgium. .,Molecular and Cell Biology Laboratory, Department of Biochemistry and Molecular Biology, University of Buea, P.O. Box 63, Buea, Cameroon.
| | - Guy-Roger Kamga
- Ministry of Public Health, N°8, Rue 3038 quartier du Lac, Yaounde, Cameroon.,Molecular and Cell Biology Laboratory, Department of Biochemistry and Molecular Biology, University of Buea, P.O. Box 63, Buea, Cameroon.,Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Clos Chapelle-aux-champs 30 bte B1.30.13, 1200, Brussels, Belgium
| | - Perrine Claire Humblet
- Ecole de Santé Publique - Campus Erasme, Université Libre de Bruxelles, Route de Lennik 808 CP591, 1070, Brussels, Belgium
| | - Annie Robert
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Clos Chapelle-aux-champs 30 bte B1.30.13, 1200, Brussels, Belgium
| | - Jacob Souopgui
- Institute of Molecular Biology and Medicine, Université Libre de Bruxelles, Rue des professeurs Jeener et Brachet 12, Gosselies, 6041, Charleroi, Belgium
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases, P.O. Box 5797, Yaounde, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaounde, Cameroon
| | - Stephen Mbigha Ghogomu
- Molecular and Cell Biology Laboratory, Department of Biochemistry and Molecular Biology, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Isabelle Godin
- Ecole de Santé Publique - Campus Erasme, Université Libre de Bruxelles, Route de Lennik 808 CP591, 1070, Brussels, Belgium
| |
Collapse
|
14
|
Siewe JFN, Ngarka L, Tatah G, Mengnjo MK, Nfor LN, Chokote ES, Boullé C, Nkouonlack C, Dema F, Nkoro GA, Njamnshi WY, Tabah EN, Zoung-Kanyi Bissek AC, Colebunders R, Njamnshi AK. Clinical presentations of onchocerciasis-associated epilepsy (OAE) in Cameroon. Epilepsy Behav 2019; 90:70-78. [PMID: 30513438 DOI: 10.1016/j.yebeh.2018.11.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/16/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND A high prevalence of epilepsy has been observed in several onchocerciasis-endemic countries, including Cameroon. However, little is known on the clinical presentations of the affected persons with epilepsy (PWE). A community-based study was conducted with the aim of describing the spectrum of seizures in selected onchocerciasis-endemic villages in Cameroon and documenting relevant medical history in patients with onchocerciasis-associated epilepsy (OAE). METHODS We carried out door-to-door surveys in 5 onchocerciasis-endemic villages in Cameroon and recruited all consenting PWE. Epilepsy was diagnosed using a 2-step approach consisting of the administration of a standardized 5-item questionnaire followed by confirmation of the suspected cases by a neurologist. Onchocerciasis-associated epilepsy was defined as ≥2 seizures without an obvious cause, starting between the ages of 3-18 years in previously healthy persons having resided for at least 3 years in an onchocerciasis-endemic area. Ivermectin use by PWE was verified. Seizure history, relevant past medical, and family history, as well as neurological findings, were noted. RESULTS In all, 156 PWE were recruited in the 5 villages. The modal age group for epilepsy onset was 10-14 years. The diagnostic criteria for OAE were met by 93.2% of the PWE. Participants had one or more of the following seizure types: generalized tonic-clonic seizures (89.1%), absences (38.5%), nodding (21.8%), focal nonmotor (7.7%), and focal motor seizures (1.9%). One case (0.6%) with the "Nakalanga syndrome" was identified. More than half (56.4%) of PWE had at least one seizure per month. In one village, 56.2% of PWE had onchocercal skin lesions. CONCLUSION People with epilepsy in onchocerciasis-endemic villages in Cameroon present with a wide clinical spectrum including nodding seizures and Nakalanga features. A great majority of participants met the diagnostic criteria for OAE, suggesting that better onchocerciasis control could prevent new cases. Epilepsy management algorithms in these areas must be adjusted to reflect the varied seizure types.
Collapse
Affiliation(s)
| | - Leonard Ngarka
- Neurology Department, Yaoundé Central Hospital, Cameroon; Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Cameroon
| | - Godwin Tatah
- Neurology Department, Yaoundé Central Hospital, Cameroon; Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Cameroon; Neurology Department, CH Saint Nazaire, France
| | - Michel K Mengnjo
- Neurology Department, Yaoundé Central Hospital, Cameroon; Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Cameroon
| | - Leonard N Nfor
- Neurology Department, Yaoundé Central Hospital, Cameroon; Neurology Department, CHU Brugmann, Belgium
| | - Eric S Chokote
- Neurology Department, Yaoundé Central Hospital, Cameroon; Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Cameroon
| | - Charlotte Boullé
- Institut de Recherche pour le Développement, UMI 233-Inserm U1175-Montpellier University, France
| | | | | | - Grace A Nkoro
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Cameroon
| | - Wepnyu Y Njamnshi
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Cameroon; Faculty of Science and Medicine, University of Fribourg, Switzerland
| | | | | | | | - Alfred K Njamnshi
- Neurology Department, Yaoundé Central Hospital, Cameroon; Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon.
| |
Collapse
|
15
|
Siewe Fodjo JN, Tatah G, Tabah EN, Ngarka L, Nfor LN, Chokote SE, Mengnjo MK, Dema F, Sitouok AT, Nkoro G, Ntone FE, Bissek ACZK, Chesnais CB, Boussinesq M, Colebunders R, Njamnshi AK. Epidemiology of onchocerciasis-associated epilepsy in the Mbam and Sanaga river valleys of Cameroon: impact of more than 13 years of ivermectin. Infect Dis Poverty 2018; 7:114. [PMID: 30501640 DOI: 10.1186/s40249-018-0497-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A high epilepsy prevalence has been reported in several onchocerciasis-endemic villages along the Mbam and Sanaga river valleys in Cameroon, including Bilomo and Kelleng. We sought to determine the prevalence of epilepsy in these two villages following more than 13 years of community-directed treatment with ivermectin (CDTI). METHODS Door-to-door surveys were performed on the entire resident population in the villages in August 2017 and January 2018. Epilepsy was diagnosed using a 2-step approach: administration of a standardized 5-item questionnaire followed by confirmation by a neurologist. Previously published diagnostic criteria for onchocerciasis-associated epilepsy (OAE) were used. Ov16 serology was done for children aged 7-10 years to assess onchocerciasis transmission. Findings were compared with previous data from these two villages. RESULTS A total of 1525 individuals (1321 in Bilomo and 204 in Kelleng) in 233 households were surveyed in both villages. The crude prevalence of epilepsy was 4.6% in Bilomo (2017) and 7.8% in Kelleng (2018), including 12 (15.6% of cases) persons with epilepsy (PWE) with nodding seizures. The age and sex-standardized prevalence in Kelleng decreased from 13.5% in 2004 to 9.3% in 2018 (P < 0.001). The median age of PWE shifted from 17 (IQR: 12-22) years to 24 (IQR: 20-30) years in Bilomo (P < 0.001); and slightly from 24 (IQR: 14-34) years to 28 (IQR: 21.25-36.75) years in Kelleng (P = 0.112). Furthermore, 47.6% of all tested children between 7 and 10 years had Ov16 antibodies. CONCLUSIONS There is a decrease in epilepsy prevalence after 13 years and more of CDTI in both villages. The age-shift observed in PWE suggests that ivermectin may prevent OAE in younger residents. Ov16 seropositivity in children indicates ongoing onchocerciasis transmission possibly due to suboptimal control measures. Our findings support the existence of OAE in Cameroon and highlight the need to strengthen onchocerciasis elimination programs.
Collapse
Affiliation(s)
| | - Godwin Tatah
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neurology Department, CH Saint-Nazaire, Saint-Nazaire, France.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Earnest Njih Tabah
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Ministry of Public Health, Yaoundé, Cameroon
| | - Leonard Ngarka
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Leonard Njamnshi Nfor
- Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon.,Neurology Department, CHU Brugman, Brussels, Belgium
| | - Samuel Eric Chokote
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Michel K Mengnjo
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Fidèle Dema
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Yoko District Hospital, Yaoundé, Cameroon
| | - Aurélien Tele Sitouok
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Grace Nkoro
- Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Félicien E Ntone
- Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Anne-Cécile Zoung-Kanyi Bissek
- Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon.,Ministry of Public Health, Yaoundé, Cameroon
| | - Cédric B Chesnais
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.,Université Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | - Michel Boussinesq
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.,Université Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | | | - Alfred K Njamnshi
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon.,Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| |
Collapse
|
16
|
Kamga GR, Dissak-Delon FN, Nana-Djeunga HC, Biholong BD, Ghogomu SM, Souopgui J, Kamgno J, Robert A. Audit of the community-directed treatment with ivermectin (CDTI) for onchocerciasis and factors associated with adherence in three regions of Cameroon. Parasit Vectors 2018; 11:356. [PMID: 29921312 PMCID: PMC6009063 DOI: 10.1186/s13071-018-2944-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/07/2018] [Indexed: 11/23/2022] Open
Abstract
Background After more than 15 years of community-directed treatment with ivermectin (CDTI) in the Centre 1, Littoral 2 and West CDTI projects in Cameroon, the epidemiological evaluation conducted in 2011 revealed that onchocerciasis endemicity was still high in some communities. To investigate the potential reasons explaining this high endemicity, a cluster coverage survey was conducted in April-May 2015 in three health districts (HD), to assess the implementation of the CDTI, the 2014 therapeutic coverage and the five-year adherence to treatment. A two-stage cluster design was considered during analyses, with data weighted proportionally to age and gender distribution in the population. Results In the three HDs, 69 community leaders, 762 heads of households, 83 community drug distributors (CDD) and 2942 household members were interviewed. The CDTI organization and the involvement of heads of households were in average weak, with 84.0% (95% CI: 81.2–86.4%) of them who had not participated in activities during the 2014 mass drug administration (MDA). On average, six of ten community leaders declared that the period of treatment was decided by the health personnel while the CDDs selection was made during a community meeting for only 43.4% of them. The 2014 weighted therapeutic coverage was 64.1% (95% CI: 56.8–70.9%), with no significant difference in the three HDs. The survey coverages were lower than the reported coverages with a significant difference varying from 14.1% to 22.0%. Among those aged 10 years and above, 57.8% (95% CI: 50.2–65.1%) declared having taken the treatment each time during the last five MDAs with no significant difference among HDs, while 9.8% (95% CI: 7.5–12.8%) declared that they had never taken the drug. In multivariate analysis, the most important factors associated with the five-year adherence to treatment were high involvement in CDTI and age (40+ years). Conclusions Despite more than 15 years of CDTI, there was still weak community participation and ownership, a lower coverage than reported and an average five-year adherence in the surveyed HDs. The reinforcement of the community ownership by the Ministry of Public Health officials and the timely procurement of ivermectin as requested by the communities are some measures that should be implemented to improve the therapeutic coverage, adherence to treatment and hence achieve onchocerciasis elimination. Further anthropological and entomological studies would provide better insights into our understanding of the persistence of the disease in these three CDTI projects.
Collapse
Affiliation(s)
- Guy-Roger Kamga
- Ministry of Public Health, N°8, Rue 3038 quartier du Lac, Yaoundé, Cameroon. .,Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon. .,Institut de Recherche Expérimentale et Clinique, Faculté de santé publique, Université catholique de Louvain, Clos Chapelle-aux-champs 30 bte B1.30.13, BE-1200, Brussels, Belgium.
| | - Fanny N Dissak-Delon
- Ministry of Public Health, N°8, Rue 3038 quartier du Lac, Yaoundé, Cameroon.,Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon.,Institute of Biology of Molecular Medicine, Rue des professeurs Jeener et Brachet 12 BE-6041 Gosselies, Université Libre de Bruxelles, Brussels, Belgium
| | - Hugues C Nana-Djeunga
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon.,Parasitology and Ecology Laboratory, Faculty of Science, University of Yaoundé 1, PO, Box 812, Yaoundé, Cameroon
| | | | - Stephen Mbigha Ghogomu
- Molecular and Cell Biology Laboratory, Department of Biochemistry and Molecular Biology, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Jacob Souopgui
- Institute of Biology of Molecular Medicine, Rue des professeurs Jeener et Brachet 12 BE-6041 Gosselies, Université Libre de Bruxelles, Brussels, Belgium
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon
| | - Annie Robert
- Institut de Recherche Expérimentale et Clinique, Faculté de santé publique, Université catholique de Louvain, Clos Chapelle-aux-champs 30 bte B1.30.13, BE-1200, Brussels, Belgium
| |
Collapse
|
17
|
Elhassan E, Zhang Y, Bush S, Molyneux D, Kollmann MKH, Sodahlon Y, Richards F. The role of the NGDO Coordination Group for the Elimination of Onchocerciasis. Int Health 2018; 10:i97-i101. [PMID: 29471339 DOI: 10.1093/inthealth/ihx050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/30/2017] [Indexed: 11/14/2022] Open
Abstract
The NGDO Coordination Group for the Control of Onchocerciasis was launched in 1992, and with the paradigm shift from control of disease to elimination of onchocerciasis transmission, the Group shifted its orientation to that new paradigm in 2013. It also changed its name, replacing 'control' with 'elimination.' In doing so, the Group has repositioned itself to build on the successes of the past to finish the job it began over 25 years ago.
Collapse
Affiliation(s)
| | | | | | - David Molyneux
- Liverpool School of Tropical Medicine and Hygiene, Liverpool, UK
| | | | | | | |
Collapse
|
18
|
Boussinesq M, Fobi G, Kuesel AC. Alternative treatment strategies to accelerate the elimination of onchocerciasis. Int Health 2018; 10:i40-i48. [PMID: 29471342 PMCID: PMC5881258 DOI: 10.1093/inthealth/ihx054] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/30/2017] [Accepted: 11/14/2017] [Indexed: 02/06/2023] Open
Abstract
The use of alternative (or complementary) treatment strategies (ATSs) i.e. differing from annual community-directed treatment with ivermectin (CDTI) is required in some African foci to eliminate onchocerciasis by 2025. ATSs include vector control, biannual or pluriannual CDTI, better timing of CDTI, community-directed treatment with combinations of currently available anthelminthics or new drugs, and 'test-and-treat' (TNT) strategies requiring diagnosis of infection and/or contraindications to treatment for decisions on who to treat with what regimen. Two TNT strategies can be considered. Loa-first TNT, designed for loiasis-endemic areas and currently being evaluated using a rapid test (LoaScope), consists of identifying individuals with levels of Loa microfilaremia associated with a risk of post-ivermectin severe adverse events to exclude them from ivermectin treatment and in treating the rest (usually >97%) of the population safely. Oncho-first TNT consists of testing community members for onchocerciasis before giving treatment (currently ivermectin or doxycycline) to those who are infected. The choice of the ATS depends on the prevalences and intensities of infection with Onchocerca volvulus and Loa loa and on the relative cost-effectiveness of the strategies for the given epidemiological situation. Modelling can help select the optimal strategies, but field evaluations to determine the relative cost-effectiveness are urgently needed.
Collapse
Affiliation(s)
- Michel Boussinesq
- IRD UMI 233-INSERM U1175-Montpellier University, 34394 Montpellier, France
| | - Grace Fobi
- African Programme for Onchocerciasis Control, Ouagadougou, Burkina Faso
| | - Annette C Kuesel
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland
| |
Collapse
|
19
|
Dissak-Delon FN, Kamga GR, Humblet PC, Robert A, Souopgui J, Kamgno J, Essi MJ, Ghogomu SM, Godin I. Adherence to ivermectin is more associated with perceptions of community directed treatment with ivermectin organization than with onchocerciasis beliefs. PLoS Negl Trop Dis 2017; 11:e0005849. [PMID: 28806785 PMCID: PMC5570488 DOI: 10.1371/journal.pntd.0005849] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 08/24/2017] [Accepted: 08/03/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The fight against onchocerciasis in Africa has boomed thanks to the Community Directed Treatment with Ivermectin (CDTI) program. However, in Cameroon, after more than 15 years of mass treatment, onchocerciasis prevalence is still above the non-transmission threshold. This study aimed to explore a possible association between people's beliefs/perceptions of onchocerciasis and of CDTI program, and their adherence to ivermectin in three regions of Cameroon. METHODOLOGY/PRINCIPAL FINDINGS A cross sectional survey was carried out in three health districts with persistent high onchocerciasis prevalence. Participants were randomly selected in 30 clusters per district. Adherence to ivermectin was comparable between Bafang and Bafia (55.0% and 48.8%, respectively, p>0.05) and lower in Yabassi (40.7%). Among all factors related to program perceptions and disease representations that were studied, perceptions of the program are the ones that were most determinant in adherence to ivermectin. People who had a "not positive" opinion of ivermectin distribution campaigns were less compliant than those who had a positive opinion about the campaigns (40% vs 55% in Bafang, and 48% vs 62% in Bafia, p<0.01), as well as those who had a negative appreciation of community drug distributors' commitment (22% vs 53% in Bafang, 33% vs 59% in Bafia, 27% vs 47% in Yabassi; p<0.01). The most common misconception about onchocerciasis transmission was the lack of hygiene, especially in Bafia and Yabassi. In Bafang, high proportions of people believed that onchocerciasis was due to high consumption of sugar (31% vs less than 5% in Bafia and Yabassi, p<0.001). CONCLUSION/SIGNIFICANCE There are still frequent misconceptions about onchocerciasis transmission in Cameroon. Perceptions of ivermectin distribution campaigns are more strongly associated to adherence. In addition to education/sensitisation on onchocerciasis during the implementation of the CDTI program, local health authorities should strive to better involve communities and more encourage community distributors' work.
Collapse
Affiliation(s)
- Fanny Nadia Dissak-Delon
- Ministry of Public Health, Yaoundé, Cameroon
- Université Libre de Bruxelles, Brussels, Belgium
- University of Buea, Buea, Cameroon
| | - Guy-Roger Kamga
- Ministry of Public Health, Yaoundé, Cameroon
- University of Buea, Buea, Cameroon
- Epidemiology and Biostatistics Research Division, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels’ campus, Brussels, Belgium
| | | | - Annie Robert
- Epidemiology and Biostatistics Research Division, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels’ campus, Brussels, Belgium
| | | | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
- University of Yaoundé I, Yaoundé, Cameroon
| | | | | | | |
Collapse
|
20
|
Nana-Djeunga HC, Tchouakui M, Njitchouang GR, Tchatchueng-Mbougua JB, Nwane P, Domche A, Bopda J, Mbickmen-Tchana S, Akame J, Tarini A, Epée E, Biholong BD, Zhang Y, Tougoue JJ, Kabore A, Njiokou F, Kamgno J. First evidence of lymphatic filariasis transmission interruption in Cameroon: Progress towards elimination. PLoS Negl Trop Dis 2017; 11:e0005633. [PMID: 28662054 PMCID: PMC5490934 DOI: 10.1371/journal.pntd.0005633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 05/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is among the 10 neglected tropical diseases targeted for control or elimination by 2020. For LF elimination, the World Health Organization (WHO) has proposed a comprehensive strategy including (i) interruption of LF transmission through large-scale annual treatment (or mass drug administration (MDA)) of all eligible individuals in endemic areas, and (ii) alleviation of LF-associated suffering through morbidity management and disability prevention. In Cameroon, once-yearly mass administration of ivermectin and albendazole has been implemented since 2008. The aim of this study was to assess progress towards the elimination goal, looking specifically at the impact of six rounds of MDA on LF transmission in northern Cameroon. METHODOLOGY The study was conducted in the North and Far North Regions of Cameroon. Five health districts that successfully completed six rounds of MDA (defined as achieving a treatment coverage ≥ 65% each year) and reported no positive results for Wuchereria bancrofti microfilariaemia during routine surveys following the fifth MDA were grouped into three evaluation units (EU) according to WHO criteria. LF transmission was assessed through a community-based transmission assessment survey (TAS) using an immunochromatographic test (ICT) for the detection of circulating filarial antigen (CFA) in children aged 5-8 years old. PRINCIPAL FINDINGS A total of 5292 children (male/female ratio 1.04) aged 5-8 years old were examined in 97 communities. Positive CFA results were observed in 2, 8 and 11 cases, with a CFA prevalence of 0.13% (95% CI: 0.04-0.46) in EU#1, 0.57% (95% CI: 0.32-1.02) in EU#2, and 0.45% (95% CI: 0.23-0.89) in EU#3. CONCLUSION/SIGNIFICANCE The positive CFA cases were below WHO defined critical cut-off thresholds for stopping treatment and suggest that transmission can no longer be sustained. Post-MDA surveillance activities should be organized to evaluate whether recrudescence can occur.
Collapse
Affiliation(s)
- Hugues C. Nana-Djeunga
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Magellan Tchouakui
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Guy R. Njitchouang
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
| | | | - Philippe Nwane
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
| | - André Domche
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jean Bopda
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
| | | | - Julie Akame
- Helen Keller International, Yaoundé, Cameroon
| | - Ann Tarini
- Helen Keller International, Yaoundé, Cameroon
| | | | | | - Yaobi Zhang
- Helen Keller International, Regional Office for Africa, Dakar, Senegal
| | - Jean J. Tougoue
- RTI International, Washington, D.C., United States of America
| | - Achille Kabore
- RTI International, Washington, D.C., United States of America
| | - Flobert Njiokou
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- * E-mail:
| |
Collapse
|
21
|
Aerts C, Sunyoto T, Tediosi F, Sicuri E. Are public-private partnerships the solution to tackle neglected tropical diseases? A systematic review of the literature. Health Policy 2017; 121:745-754. [PMID: 28579276 DOI: 10.1016/j.healthpol.2017.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 05/12/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
Abstract
Pharmaceutical companies are reluctant to invest in research and development (R&D) of products for neglected tropical diseases (NTDs) mainly due to the low ability-to-pay of health insurance systems and of potential consumers. The available preventive and curative interventions for NTDs mostly rely on old technologies and products that are often not adequate. Moreover, NTDs mostly affect populations living in remote rural areas and conflict zones, thereby hampering access to healthcare. The challenges posed by NTDs have led to the proliferation of a variety of public-private partnerships (PPPs) in the last decades. We conducted a systematic review to assess the functioning and impact of these partnerships on the development of and access to better technologies for NTDs. Our systematic review revealed a clear lack of empirical assessment of PPPs: we could not find any impact evaluation analyses, while these are crucial to realize the full potential of PPPs and to progress further towards NTDs elimination.
Collapse
Affiliation(s)
- Céline Aerts
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
| | - Temmy Sunyoto
- The Institute of Tropical Medicine, Antwerpen, Belgium.
| | - Fabrizio Tediosi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Centre for Research on Health and Social Care Management (CERGAS), Università Bocconi, Milan, Italy.
| | - Elisa Sicuri
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
| |
Collapse
|
22
|
|
23
|
Tambo E, Khater EIM, Chen JH, Bergquist R, Zhou XN. Nobel prize for the artemisinin and ivermectin discoveries: a great boost towards elimination of the global infectious diseases of poverty. Infect Dis Poverty 2015; 4:58. [PMID: 26708575 PMCID: PMC4692067 DOI: 10.1186/s40249-015-0091-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/10/2015] [Indexed: 11/15/2022] Open
Abstract
The Millennium Development Goals (MDGs) made a marked transformation for neglected and vulnerable communities in the developing countries from the start, but infectious diseases of poverty (IDoPs) continue to inflict a disproportionate global public health burden with associated consequences, thereby contributing to the vicious cycle of poverty and inequity. However, the effectiveness and large-scale coverage of artemisinin combination therapy (ACT) have revolutionized malaria treatment just as the control of lymphatic filariasis (LF) and onchocerciasis have benefitted from harnessing the broad-spectrum effect of avermectin-based derivatives. The paradigm shift in therapeutic approach, effected by these two drugs and their impact on community-based interventions of parasitic diseases plaguing the endemic low- and middle-income countries (LIMCs), led to the Nobel Prize in Physiology or Medicine in 2015. However, the story would not be complete without mentioning praziquantel. The huge contribution of this drug in modernizing the control of schistosomiasis and also some intestinal helminth infections had already shifted the focus from control to potential elimination of this disease. Together, these new drugs have provided humankind with powerful new tools for the alleviation of infectious diseases that humans have lived with since time immemorial. These drugs all have broad-spectrum effects, yet they are very safe and can even be packaged together in various combinations. The strong effect on so many of the great infectious scourges in the developing countries has not only had a remarkable influence on many endemic diseases, but also contributed to improving the cost structure of healthcare. Significant benefits include improved quality of preventive and curative medicine, promotion of community-based interventions, universal health coverage and the fostering of global partnerships. The laudable progress and benefits achieved are indispensable in championing, strengthening and moving forward elimination of the IDoPs. However, there is an urgent need for further innovative, contextual and integrated approaches along with the advent of the Sustainable Development Goals (SDGs), replacing the MDGs in ensuring global health security, well-being and economic prosperity for all.
Collapse
Affiliation(s)
- Ernest Tambo
- Department of Biochemistry and Pharmaceutical Sciences, Higher Institute of Health Sciences, Université des Montagnes, Bangangté, Cameroon. .,Sydney Brenner Institute for Molecular Biosciences, University of the Witwatersrand, Johannesburg, South Africa. .,Africa Disease Intelligence and Surveillance, Communication and Response Foundation (Africa DISCoR), Yaoundé, Cameroon. .,Center for Sustainable Malaria Control, Department of Biochemistry, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa.
| | - Emad I M Khater
- Public Health Pests Laboratory, Jeddah Municipality, Jeddah, Saudi Arabia.,Department of Entomology, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Jun-Hu Chen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, P.R. China. .,Key Laboratory of Parasite and Vector Biology of the Chinese Ministry of Health, Shanghai, 200025, P.R. China. .,WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025, P.R. China.
| | | | - Xiao-Nong Zhou
- Public Health Pests Laboratory, Jeddah Municipality, Jeddah, Saudi Arabia. .,Department of Entomology, Faculty of Science, Ain Shams University, Cairo, Egypt. .,National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, P.R. China.
| |
Collapse
|
24
|
Macpherson EE, Adams ER, Bockarie MJ, Hollingsworth TD, Kelly-Hope LA, Lehane M, Kovacic V, Harrison RA, Paine MJ, Reimer LJ, Torr SJ. Mass Drug Administration and beyond: how can we strengthen health systems to deliver complex interventions to eliminate neglected tropical diseases? BMC Proc 2015; 9:S7. [PMID: 28281705 PMCID: PMC4699030 DOI: 10.1186/1753-6561-9-s10-s7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Achieving the 2020 goals for Neglected Tropical Diseases (NTDs) requires scale-up of Mass Drug Administration (MDA) which will require long-term commitment of national and global financing partners, strengthening national capacity and, at the community level, systems to monitor and evaluate activities and impact. For some settings and diseases, MDA is not appropriate and alternative interventions are required. Operational research is necessary to identify how existing MDA networks can deliver this more complex range of interventions equitably. The final stages of the different global programmes to eliminate NTDs require eliminating foci of transmission which are likely to persist in complex and remote rural settings. Operational research is required to identify how current tools and practices might be adapted to locate and eliminate these hard-to-reach foci. Chronic disabilities caused by NTDs will persist after transmission of pathogens ceases. Development and delivery of sustainable services to reduce the NTD-related disability is an urgent public health priority. LSTM and its partners are world leaders in developing and delivering interventions to control vector-borne NTDs and malaria, particularly in hard-to-reach settings in Africa. Our experience, partnerships and research capacity allows us to serve as a hub for developing, supporting, monitoring and evaluating global programmes to eliminate NTDs.
Collapse
Affiliation(s)
| | - Emily R Adams
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | | | - Mike Lehane
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Vanja Kovacic
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Mark Ji Paine
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lisa J Reimer
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | |
Collapse
|
25
|
Brooker SJ, Mwandawiro CS, Halliday KE, Njenga SM, Mcharo C, Gichuki PM, Wasunna B, Kihara JH, Njomo D, Alusala D, Chiguzo A, Turner HC, Teti C, Gwayi-Chore C, Nikolay B, Truscott JE, Hollingsworth TD, Balabanova D, Griffiths UK, Freeman MC, Allen E, Pullan RL, Anderson RM. Interrupting transmission of soil-transmitted helminths: a study protocol for cluster randomised trials evaluating alternative treatment strategies and delivery systems in Kenya. BMJ Open 2015; 5:e008950. [PMID: 26482774 PMCID: PMC4611208 DOI: 10.1136/bmjopen-2015-008950] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In recent years, an unprecedented emphasis has been given to the control of neglected tropical diseases, including soil-transmitted helminths (STHs). The mainstay of STH control is school-based deworming (SBD), but mathematical modelling has shown that in all but very low transmission settings, SBD is unlikely to interrupt transmission, and that new treatment strategies are required. This study seeks to answer the question: is it possible to interrupt the transmission of STH, and, if so, what is the most cost-effective treatment strategy and delivery system to achieve this goal? METHODS AND ANALYSIS Two cluster randomised trials are being implemented in contrasting settings in Kenya. The interventions are annual mass anthelmintic treatment delivered to preschool- and school-aged children, as part of a national SBD programme, or to entire communities, delivered by community health workers. Allocation to study group is by cluster, using predefined units used in public health provision-termed community units (CUs). CUs are randomised to one of three groups: receiving either (1) annual SBD; (2) annual community-based deworming (CBD); or (3) biannual CBD. The primary outcome measure is the prevalence of hookworm infection, assessed by four cross-sectional surveys. Secondary outcomes are prevalence of Ascaris lumbricoides and Trichuris trichiura, intensity of species infections and treatment coverage. Costs and cost-effectiveness will be evaluated. Among a random subsample of participants, worm burden and proportion of unfertilised eggs will be assessed longitudinally. A nested process evaluation, using semistructured interviews, focus group discussions and a stakeholder analysis, will investigate the community acceptability, feasibility and scale-up of each delivery system. ETHICS AND DISSEMINATION Study protocols have been reviewed and approved by the ethics committees of the Kenya Medical Research Institute and National Ethics Review Committee, and London School of Hygiene and Tropical Medicine. The study has a dedicated web site. TRIAL REGISTRATION NUMBER NCT02397772.
Collapse
Affiliation(s)
- Simon J Brooker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Charles S Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Katherine E Halliday
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Sammy M Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Paul M Gichuki
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Beatrice Wasunna
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jimmy H Kihara
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Doris Njomo
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Dorcas Alusala
- Neglected Tropical Diseases Unit, Division of Communicable Disease Prevention and Control, Ministry of Health, Nairobi, Kenya
| | - Athuman Chiguzo
- Office of the Executive Committee, Medical Services and Public Health, Kwale County Government, Kwale, Kenya
| | - Hugo C Turner
- Faculty of Medicine, Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research, School of Public Health, St Mary's Campus, Imperial College London, London, UK
| | | | | | - Birgit Nikolay
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - James E Truscott
- Faculty of Medicine, Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research, School of Public Health, St Mary's Campus, Imperial College London, London, UK
| | - T Déirdre Hollingsworth
- Warwick Mathematics Institute, University of Warwick, Coventry, UK School of Life Sciences, University of Warwick, Coventry, UK
| | - Dina Balabanova
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Ulla K Griffiths
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew C Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Elizabeth Allen
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel L Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Roy M Anderson
- Faculty of Medicine, Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research, School of Public Health, St Mary's Campus, Imperial College London, London, UK
| |
Collapse
|
26
|
Rao GN. The Barrie Jones Lecture-Eye care for the neglected population: challenges and solutions. Eye (Lond) 2015; 29:30-45. [PMID: 25567375 DOI: 10.1038/eye.2014.239] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/02/2014] [Indexed: 11/09/2022] Open
Abstract
Globally, pockets of 'neglected populations' do not have access to basic health-care services and carry a much greater risk of blindness and visual impairment. While large-scale public health approaches to control blindness due to vitamin A deficiency, onchocerciasis, and trachoma are successful, other causes of blindness still take a heavy toll in the population. High-quality comprehensive eye care that is equitable is the approach that needs wide-scale application to alleviate this inequity. L V Prasad Eye Institute of India developed a multi-tier pyramidal model of eye care delivery that encompasses all levels from primary to advanced tertiary (quaternary). This has demonstrated the feasibility of 'Universal Eye Health Coverage' covering promotive, preventive, corrective, and rehabilitative aspects of eye care. Using human resources with competency-based training, effective and cost-effective care could be provided to many disadvantaged people.
Collapse
|
27
|
Brieger WR, Sommerfeld JU, Amazigo UV. The Potential for Community-Directed Interventions: Reaching Underserved Populations in Africa. Int Q Community Health Educ 2015; 35:295-316. [PMID: 26470395 DOI: 10.1177/0272684x15592757] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Community-directed interventions (CDIs) have the potential for fulfilling the promise of primary health care by reaching underserved populations in various settings. CDI has been successfully tested by expanding access to additional health services like malaria case management through local effort in communities where ivermectin distribution is ongoing. The question remains whether the CDI approach has potential in communities that do not have a foundation of community-directed treatment with ivermectin. The UNICEF/UNDP/World Bank/WHO Special Program of Research and Training in Tropical Diseases commissioned three sets of formative studies to explore the potential for introducing CDI among nomads, urban poor, and rural areas with no community-directed treatment with ivermectin. This article reviews their findings. Community and health system respondents identified a set of mainly communicable diseases that could be adapted to CDI as well as participatory mechanisms like community-based organizations and leaders that could form a foundation for local organizing and participation. It is hoped that the results of these formative studies will spur further research on CDI among peoples with poor health-care access.
Collapse
Affiliation(s)
- William R Brieger
- Department of International Health, Health System Program, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Johannes U Sommerfeld
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Uche V Amazigo
- African Program for Onchocerciasis Control, World Health Organization, Ouagadougou, Burkina Faso
| | | |
Collapse
|
28
|
Cross C, Olamiju F, Richards F, Bush S, Hopkins A, Haddad D. From River Blindness to Neglected Tropical Diseases--Lessons Learned in Africa for Programme Implementation and Expansion by the Non-governmental Partners. PLoS Negl Trop Dis 2015; 9:e0003506. [PMID: 25974037 PMCID: PMC4431851 DOI: 10.1371/journal.pntd.0003506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | - Frank Richards
- The Carter Center, Atlanta, Georgia, United States of America
| | | | - Adrian Hopkins
- Mectizan Donation Programme, Atlanta, Georgia, United States of America
| | - Danny Haddad
- Emory Global Vision Initiative, Atlanta, Georgia, United States of America
| |
Collapse
|
29
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
30
|
Truscott JE, Hollingsworth TD, Brooker SJ, Anderson RM. Can chemotherapy alone eliminate the transmission of soil transmitted helminths? Parasit Vectors 2014; 7:266. [PMID: 24916278 DOI: 10.1186/1756-3305-7-266] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/03/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Amongst the world's poorest populations, availability of anthelmintic treatments for the control of soil transmitted helminths (STH) by mass or targeted chemotherapy has increased dramatically in recent years. However, the design of community based treatment programmes to achieve the greatest impact on transmission is still open to debate. Questions include: who should be treated, how often should they be treated, how long should treatment be continued for? METHODS Simulation and analysis of a dynamic transmission model and novel data analyses suggest refinements of the World Health Organization guidelines for the community based treatment of STH. RESULTS This analysis shows that treatment levels and frequency must be much higher, and the breadth of coverage across age classes broader than is typically the current practice, if transmission is to be interrupted by mass chemotherapy alone. CONCLUSIONS When planning interventions to reduce transmission, rather than purely to reduce morbidity, current school-based interventions are unlikely to be enough to achieve the desired results.
Collapse
|
31
|
Whittaker MA, Dean AJ, Chancellor A. Advocating for malaria elimination - learning from the successes of other infectious disease elimination programmes. Malar J 2014; 13:221. [PMID: 24902848 PMCID: PMC4057589 DOI: 10.1186/1475-2875-13-221] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/01/2014] [Indexed: 11/10/2022] Open
Abstract
Malaria elimination is back on the agenda, but it remains challenging for countries to make the transition from effective control to elimination. Many other infectious diseases have been targeted by globally-coordinated elimination advocacy campaigns, and advocacy has been considered an essential component of the success of other disease elimination programmes. What can the malaria community learn from these successes? A review of infectious disease elimination programmes to identify successful elements of advocacy for disease elimination was undertaken. Key elements are: (i) a global elimination plan, supported by international health bodies; (ii) thorough costings and tools to support the business case; (iii) an approach that is positioned within a development framework; (iv) core elimination advocacy messages; (v) provision of advocacy tools for partners (vi) extensive and effective community engagement; and (vii) strong partnerships. These features provide insights into 'what works' in global elimination advocacy. Advocacy is a powerful tool to support the long-term political and financial commitment necessary for malaria elimination. The global malaria community needs to work together, to ensure that the early steps towards the end goal of malaria elimination are taken.
Collapse
Affiliation(s)
- Maxine A Whittaker
- School of Population Health, The University of Queensland, Herston, Australia
| | - Angela J Dean
- School of Population Health, The University of Queensland, Herston, Australia
| | - Arna Chancellor
- School of Population Health, The University of Queensland, Herston, Australia
| |
Collapse
|
32
|
Mactaggart I, Ricard P. How to empower communities to take action on improving eye health. Community Eye Health 2014; 27:64-6. [PMID: 26113773 PMCID: PMC4477811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Islay Mactaggart
- Research Fellow in Disability and Global Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Paddy Ricard
- Editor, Community Ear and Hearing Health, London, UK
| |
Collapse
|
33
|
Koroma JB, Sesay S, Sonnie M, Hodges MH, Sahr F, Zhang Y, Bockarie MJ. Impact of three rounds of mass drug administration on lymphatic filariasis in areas previously treated for onchocerciasis in Sierra Leone. PLoS Negl Trop Dis 2013; 7:e2273. [PMID: 23785535 DOI: 10.1371/journal.pntd.0002273] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 05/06/2013] [Indexed: 11/19/2022] Open
Abstract
Background 1974–2005 studies across Sierra Leone showed onchocerciasis endemicity in 12 of 14 health districts (HDs) and baseline studies 2005–2008 showed lymphatic filariasis (LF) endemicity in all 14 HDs. Three integrated annual mass drug administration (MDA) were conducted in the 12 co-endemic districts 2008–2010 with good geographic, programme and drug coverage. Midterm assessment was conducted 2011 to determine impact of these MDAs on LF in these districts. Methodology/Principal Findings The mf prevalence and intensity in the 12 districts were determined using the thick blood film method and results compared with baseline data from 2007–2008. Overall mf prevalence fell from 2.6% (95% CI: 2.3%–3.0%) to 0.3% (95% CI: 0.19%–0.47%), a decrease of 88.5% (p = 0.000); prevalence was 0.0% (100.0% decrease) in four districts: Bo, Moyamba, Kenema and Kono (p = 0.001, 0.025, 0.085 and 0.000 respectively); and seven districts had reductions in mf prevalence of between 70.0% and 95.0% (p = 0.000, 0.060, 0.001, 0.014, 0.000, 0.000 and 0.002 for Bombali, Bonthe, Kailahun, Kambia, Koinadugu, Port Loko and Tonkolili districts respectively). Pujehun had baseline mf prevalence of 0.0%, which was maintained. Only Bombali still had an mf prevalence ≥1.0% (1.58%, 95% CI: 0.80%–3.09%)), and this is the district that had the highest baseline mf prevalence: 6.9% (95% CI: 5.3%–8.8%). Overall arithmetic mean mf density after three MDAs was 17.59 mf/ml (95% CI: 15.64 mf/ml–19.55 mf/ml) among mf positive individuals (65.4% decrease from baseline of 50.9 mf/ml (95% CI: 40.25 mf/ml–61.62 mf/ml; p = 0.001) and 0.05 mf/ml (95% CI: 0.03 mf/ml–0.08 mf/ml) for the entire population examined (96.2% decrease from baseline of 1.32 mf/ml (95% CI: 1.00 mf/ml–1.65 mf/ml; p = 0.000)). Conclusions/Significance The results show that mf prevalence decreased to <1.0% in all but one of the 12 districts after three MDAs. Overall mf density reduced by 65.0% among mf-positive individuals, and 95.8% for the entire population. Onchocerciasis studies across Sierra Leone between 1974 and 2005 showed that 12 of the 14 health districts (HDs) are endemic for onchocerciasis. Baseline lymphatic filariasis (LF) studies 2005–2008 showed that all 14 HDs of Sierra Leone are LF endemic. Three annual rounds of integrated mass drug administration (MDA) with ivermectin and albendazole 2008–2010 were conducted in the 12 HDs that are co-endemic for onchocerciasis and LF with good geographic, epidemiological drug (or programme) and drug coverage. A midterm evaluation study of mf prevalence and density was conducted in the 12 HDs in 2011. The hypothesis proposed for this study is that areas previously exposed to ivermectin treatment for onchocerciasis control may require less rounds of annual MDA to eliminate LF (i.e. reduce microfilaremia (mf) prevalence to <1%). Results of the midterm evaluation study showed very significant and rapid reduction of mf prevalence and density with 11 out of the 12 districts having mf prevalence <1%. Relatively low LF baseline prevalence and effective integrated MDA for onchocerciasis and LF have led to rapid reduction in LF prevalence.
Collapse
|