Making An Impact: Treating & Preventing NTDs In Niger
If you haven’t heard of schistosomiasis, lymphatic filariasis, onchocerciasis, soil-transmitted helminths (STH), and trachoma, you aren’t alone. Most of these diseases have little recognition because they have a low case mortality rate but nevertheless they cause severe disability in the world’s poorest countries. In addition, their impact is often under- estimated as many of the effects, such as anaemia or diarrhoea, are attributed to other causes.
The entire population of Niger, some 15 million, are at risk of contracting one of these chronic and debil- itating diseases. The Niger government launched its schistosomiasis and STH control program in 2004 with support from the Schistosomiasis Control Initiative (SCI). Between 2004 and 2010 over 13 million people have been treated against NTDs in Niger – with treatments distributed by local volunteers in what has been described as a ‘people’s public health revolution’.
Without treatment, neglected tropical diseases (NTDs) such as schistosomiasis, lymphatic filariasis, onchocer- ciasis, soil-transmitted helminths (STH), and trachoma erode the general health of a population. They cause im- paired physical and cognitive development in children, hindering their ability to develop and learn. However, regular annual treatment with anti-parasitic drugs can help cure infections and alleviate these health risks.
These diseases have earned the name ‘neglected’ because although they weaken impoverished populations, they receive a disproportionately meagre amount of funding, with respect to the burden of disease caused. Nevertheless, more recently their significance to public health and economies has convinced governments, donors, and the pharmaceutical industry, to invest in preventing and controlling this diverse group of diseases.
These diseases have
earned the name
they receive a
meagre amount of
In Niger alone the entire population is at risk of contracting one of these debilitating diseases. The Niger government launched its schistosomiasis and STH control program in 2004 with the financial and technical support from the Schistosomiasis Control Initiative (SCI) at Imperial College, through the Bill and Melinda Gates Foundation (BMGF). By 2007 over 6.2 million treatments had been delivered across the 8 targeted regions. In 2007 the programme expanded to include trachoma, onchocerciasis and lymphatic filariasis, becoming an Integrated NTD Control Programme funded by the Niger Ministry of Health and USAID. Efforts to control Niger’s high NTD burden are well underway.
People’s Public Health Revolution
Assisted by external organisations such as the SCI and USAID, and with generous donations of drugs from international pharmaceutical companies, Niger has established a program to simultaneously combat a range of NTDs and empower it’s people to both educate the population about sanitation and primary health-care and distribute life-saving treatments on a scale never- before seen in the region. To date, nearly 40 million people have been treated for NTDs across Niger, with treatments distributed by local volunteers in what has been described as a ‘people’s public health revolution’.
Community Drug Distributors (CDDs) are selected by their respective village leaders to take on the responsibility of administering medications in the mass drug distribution in Niger. Training workshops are organised prior to the distribution after which, armed with dose-poles, the volunteers return to their villages to treat the local population en mass. The drugs are allocated based on the height of each patient.
To date, nearly
40 million people
treated for NTDs
A similar programme has been rolled out in neighbouring Burkina Faso, supported by the SCI. In both countries, the most heavily infected regions have been identified, local health staff and teachers have been trained, and health education has been provided to the people in those regions. As the programmes expanded, their effects were monitored in each country to demonstrate the impact of the treatments on health and well-being, and the success of the volunteer distribution model. Local and international partnerships have been forged to improve training and treatment delivery, and to assist other African nations in the development of similar national control plans and research programmes.
Just 50 Cents
There are long term crippling consequences, including high school drop-out rates and physical impairment, of such diseases yet they are easily and cheaply treatable. For only $0.50 per year, a person can be treated with four drugs that fight all five NTDs that are responsible for more than 90% of the disease burden. The cost of treatment at $0.50 per person, per year includes all costs associated with drug delivery, equipment, educational materials, personnel training and monitoring and evaluation.
The secret to the country’s success is not only the excellent commitment from the Niger Ministry of Health and the hard work of the NTD control program, but increased funding from the U.S Agency for International Development (USAID) as well as donations from pharmaceutical companies Merck and GSK. Indeed the NTDs are now much less neglected. The US Government recently expanded its existing NTD program, com- mitting $350 million to combat the five “able to treat” conditions over the next five years. The G8, the EC and the Director General of WHO have also made strongly supportive statements. Furthermore, the UK’s department for international development (DFID) is putting £25 million over five years. The money will pay for 75 million treatments against intestinal worms and schistosomiasis to help ensure that the serious consequences of schistosomiasis will be eliminated from countries such as Niger.
For only $0.50 per
year, a person can
be treated for all
five NTDs that are
over 90% of the
With continued lobbying for contribution of donors such as USAID and DFID; drug donations from pharmaceutical companies such as Merck and Pfizer; and input from smaller scale private donors we can move towards elimination of such diseases. According to the WHO, five rounds of yearly treatment against LF and three rounds against Trachoma are sufficient to potentially eliminate these respective diseases in endemic areas. In the fifth year of the integrated NTD control program Niger such elimination goals are in sight.
Contributions from individuals also make a big difference. In 2007 a private donor from Arizona, Allan Lewis, donated $200,000 to organize surgical camps for those affected by Lymphatic filariasis. In addition, Elly Varvarina, a UK school student, raised £1,000 to pay for washing kits to reduce swelling and infection in elephantiasis sufferers.
End the Neglect
Recrudescence of infection is possible. It is important therefore to compliment chemotherapy with sustainable control measures such as management of vectors (molluscide treatment of rivers to kills the schistosomiasis snail host or mosquito control for LF control) as well as water and sanitation efforts. Currently few NTD control programs have the financial and logistical sup- port to implement such complementary activities. The reason for this is because chemotherapy, thanks to the contribution from the pharmaceutical companies, is the currently the cheapest means of NTD control. Although treatment with drugs is excellent for morbidity control and maintaining low transmission rates of disease, it is not a sustainable means to eliminate such parasites forever.
Although NTDs threaten the lives of millions in the developing world, their burden on global health remains under-resourced. Continuing action is needed to facilitate the dissemination of information about NTDs, to identify funding opportunities and the most cost-effective ways to fight NTDs. If elimination is to be achieved it is important to also explore possibilities for promoting and implementing projects beyond chemotherapy, such as water and sanitation strategies, that will support sustainable alleviation of the NTD burden. By highlighting important implementation challenges, the SCI calls on the global community for continued support as well as innovative efforts in tackling the global burden of NTDs.
Anna Phillips is the West Africa Programme Manager at the Schistosomiasis Control Initiative (SCI), Imperial College London.