Fourteen Million People Treated in One Year for Debilitating Neglected Tropical Diseases
During 2007—its first year of operation—the Neglected Tropical Disease Control program distributed about 36 million treatments to 14 million people, signaling a real basis for hope that many will escape the ravages of neglected tropical diseases (NTDs).
 |
|
Children are especially vulnerable to infections from neglected tropical diseases. [Photo: Andrea Peterson] |
RTI is leading the NTD control program, which will treat more than 40 million people over five years. NTDs, although largely unknown in developed nations, cause severe disabilities, including blindness, reduced mobility, impaired childhood growth, and disfigurement. The economic toll of NTDs includes loss of productivity and poverty. Approximately one billion people—one-sixth of the world’s population—suffer from one or more NTDs, according to the World Health Organization (WHO), and the diseases annually cause 415,000 deaths worldwide.
The NTD Control program is the first global effort to support developing countries’ own programs to control selected NTDs by scaling up and integrating their existing approaches to include additional populations or diseases. The program is funded by the U.S. Agency for International Development.
Scaling Up of Country Programs Yields Impressive Results
The NTD program assists ministries of health in Africa, Asia, and Latin America that have a high prevalence of NTDs, have recognized them as a national priority, and are expanding and integrating their existing disease-specific programs. “We’re building on the success of these programs by integrating and scaling up treatment, and through monitoring and evaluation. In this way, the program makes a large, very cost-effective contribution to reduce and potentially eliminate these debilitating diseases,” said Jean Shaikh, RTI’s NTD program director.
Integration, organization, and dedication have produced stunning results. In 2007, safe and effective drugs for five of the most prevalent NTDs were distributed in Burkina Faso, Ghana, Mali, and Niger, and distribution in Uganda was recently completed. In Mali—in four months—workers mobilized to publicize, train, manage logistics, and administer treatments for five diseases in 24 districts to more than 4.5 million people. And in Ghana, more than 21,000 volunteers and health workers administered medications in 60 districts, treating more than five million people.
Mobilizing for Mass Drug Administration
Medicines valued at more than $400 million have been generously donated by Merck, GlaxoSmithKline, the Bill & Melinda Gates Foundation, Johnson & Johnson, and Pfizer through their ongoing donation programs. Health ministries obtain donated medications from pharmaceutical companies, or RTI assists them with purchases through the NTD program to reach more at-risk populations.
The program concentrates on mass drug administration (MDA) for the most prevalent NTDs:
• Trachoma—blinding eye infection
• Soil-transmitted helminths (STH)—hookworm, ascaris, trichuris
• Onchocerciasis—river blindness
• Schistosomiasis—snail fever
• Lymphatic filariasis—elephantiasis.
 |
| Residents of a community in Burkina Faso register for the administration of NTD drugs. Registration ensures compliance and safety. [Photo: Dr. Albis Gabrielli, Schistosomiasis Control Initiative] |
NTDs and their treatments share characteristics that support the integration of resources to maximize MDA coverage. In many developing countries, populations are affected by more than three NTDs. Some drugs can treat multiple NTDs and are administered annually over successive years, making integration and cost efficiencies critical in the far-reaching efforts needed to conduct MDA for additional populations and diseases. Participating countries expand and integrate their existing programs’ logistical structures for procurement, shipping, tracking, and distribution on a larger scale. They analyze funding needs and develop work plans and budgets to increase coverage. These mechanisms can be streamlined and reused for ongoing annual MDA campaigns.
Social mobilization prepares the countries’ populations for receiving the medicines. Communications through television and radio spots, printed materials, and door-to-door visits inform communities about MDA and the schedule for distributing the medicines. At the same time, a host of health workers and volunteers are trained to administer appropriate dosages of drugs, enter data into log books, and follow up to determine if any adverse effects occurred.
The countries are meeting the challenges to make scaling up work. In Burkina Faso, for instance, all at-risk districts were being treated through the country’s existing program for STH, onchocerciasis, and lymphatic filariasis. In 2007, with help from the NTD Control Program, people in 33 additional districts were treated for trachoma with Zithromax®, which was administered, for the first time, to one million people in three districts. More than 3,800 health workers and 28,800 volunteers conducted the MDA.
Overall, participating countries have achieved coverage rates of more than 80% of the population eligible for treatment according to drug dosing protocols.
Supporting Country Programs
 |
| A volunteer in Uganda uses a dosing pole to determine how much NTD medicine to administer. [Photo: Henrietta Allen, WHO] |
The NTD program supports governments that implement country-wide NTD control efforts through grants to nongovernmental organizations (NGOs). RTI administers the grants program, which is based on a transparent and competitive process, described on the program’s website.
This year, the program will reach Haiti, Southern Sudan, and Sierra Leone in addition to continuing its work with the original five countries participating in the program. Plans are under way to determine when more countries will be added.
Through its monitoring and evaluation responsibilities, RTI is measuring the NTD program’s effectiveness by comparing baseline data from countries’ original programs with data collected from post-MDA surveys. RTI is also analyzing participating countries’ scale-up processes and will disseminate guidelines for implementation and models for sustaining the integrated control of NTDs.
“The NTD program’s innovative approach to integrating the country disease control programs has produced dramatic results,” said Barbara Kennedy, RTI vice president of international health. “It’s exciting to collaborate with the ministries of health to scale up treatments and see that millions of people may be spared the afflictions of NTDs,” she said.
More information:
Jean Shaikh, e-mail jshaikh@rti.org;
NTD Control Program website: ntd.rti.org