Building links with polio surveillance in Ghana

By Lucas Cunningham

The COUNTDOWN team in Ghana completed a successful qPCR workshop and I stayed on in Accra and with Dr Mike Osei-Atweneboana to help consolidate research links with The Noguchi Memorial Institute for Medical Research (NMIMR).  During the week I started to implement the practical skills learnt and develop laboratory protocols for our qPCR diagnostic assays acquired during our workshop.

The NMIMR was founded in 1979 as a memorial to the Japanese scientist Hideyo Noguchi who died in Accra from yellow fever in 1928. The NMIMR is part of the University of Ghana and is a world leading biomedical research facility in West Africa. The NMIMR includes the Ghanaian national polio laboratory, which is part of the global polio laboratory network (GPLN). The Ghanaian polio laboratory receives over 1000 faecal samples from across the country of suspected polio cases. Typically the samples have come from individuals presenting with acute flaccid paralysis, a classic sign of acute polio.

COUNTDOWN will carry out a preliminary screening of the faecal collections to test the possibility of tapping into the vast resources of the global polio surveillance programme to co-screen for worm infections. Along with schistosomiasis, these diseases are collectively grouped within the soil-transmitted helminth and make up a considerable public health burden in Ghana and across the developing world, ranking that of other, more infamous diseases such as malaria and TB.

Using the TaqMan® qPCR assay, the team at NMIMR will screen for the six major helminth parasites associated with poor sanitation and hygiene, Ascaris lumbricoides, Trichuris trichuria, Strongyloides stercoralis plus the two hookworm species Necator americanus and Ancylostoma duodenale. In addition, faecal samples will be screened for Schistosoma spp.. Several of Mike’s staff from Council for Scientific and Industrial Research (CSIR) were part of the visit to NMIMR which provided another opportunity for crosstalk between two of the research centres focal to COUNTDOWN in Ghana.

In total seven collaborators from both institutes took part, including two members of NMIMR’s parasitological department. Dealing with a smaller group allowed for a more informal approach to the optimisation and testing of the compatibility of the reagents with the specific equipment in the polio lab. Our adapted assays were carried out efficiently, resulting in an effective triplex assay, where three species of parasite can be detected simultaneously in each tube. Armed with this new tool we were then able to screen 15 faecal DNA extracts obtained from a recent pilot survey undertaken at a Lake Weij. The test results were surprising. Although all 15 samples were negative for the five soil transmitted helminths (STH) they all tested highly positive for Schistosoma s.l., indicating a heavy egg load in the faecal samples.

Having carried out the work at NMIMR we were able to reinforce the methods developed in the workshop and also leave behind enough laboratory materials for our colleagues at both the CSIR and NMIMR to practice and perfect their qPCR assays and hone their TaqMan® skills. We have also shown the importance of the COUNTDOWN consortium in bringing together different silos within Neglected Tropical Disease work and helping with the capacity building and thereby control of some the most neglected of NTDs.

Our experiences and successes in Ghana were recently broadcast to a wider audience at the British Society for Parasitology’s Spring Meeting (@BSPparasitology, #BSP2016). There I provided an overview and account of our recent activities in Accra during a well-attended session dedicated to research on NTDs and I hoped to show how our interdisciplinary research links have been strengthened. In short I outlined how the second year of COUNTDOWN research is shaping up, so watch this space!

Photo credit: Our teams from CSIR and NMIMR by the Noguchi memorial plaque, from left to right: Buhari Hamid, Linda Boatemaa, Edward Tettevi, Deborah Pratt, Millicent Opoku, Nana Pels and Nana Asante-Ntim

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COUNTDOWN on diagnostics for soil-transmitted helminthiasis and schistosomiasis in Ghana

By Russell Stothard

Shortly before Christmas, I had the pleasure of visiting Accra and Dodowa to discuss with the COUNTDOWN teams our research on DNA diagnostics. Previously, the surveillance of soil-transmitted helminthiasis (STH) and schistosomiasis has relied upon traditional parasitological methods. This involves rather old-fashioned techniques to visualise worm eggs in stool or urine samples by light microscopy. Although pragmatic in field-based surveys, these parasitological methods are insensitive and do not precisely capture the true levels of infections.

Improving diagnostics by introduction of modern molecular methods is important for two reasons. First and at a population level, infected cases are better detected leading to more accurate reporting and subsequently better allocation of treatment. Second and at an individual level, the more cryptic associations between infection and disease are unveiled. For example, for the latter in better describing the relationship between growth stunting and STH in children or the gynaecological impact of female genital schistosomiasis in adolescent girls.

A major research theme in COUNTDOWN is to develop and strengthen the molecular diagnostic capacity within the laboratory of Dr Mike Osei-Atweneboana. Mike will also explore future synergies with the Ghanaian polio programme based in the Ngouchi Institute, Accra which regularly collects thousands of stool samples from children. Regular access to these samples and heightened scrutiny with molecular diagnostics could provide a wider platform to assess STH throughout the country.

Last September, Dr Emily Adams visited Mike’s laboratory to make a preliminary situation assessment of his equipment needs. I was there in December to assist him with further planning for a forthcoming training workshop in DNA diagnostics. This is to be held the week of 14th March in Accra and in liaison with colleagues from the Ngouchi Institute. I visited a primary school in New Abarim where ongoing deworming had just taken place. We also made a spot-check visit on the local health centre in Adausena. It is clear that future application of DNA diagnostics in these settings will shed new light on the true burden of disease.

Ahead of the workshop in March, Emily and I will be taking steps with Lucas Cunningham to develop a training manual and also assemble the necessary DNA reagents for transfer to Ghana. To make a success of the training course, I am delighted to report that Dr Jaco Verweij, the world’s expert on DNA diagnostics, will be visiting the LSTM in February to provide use with best technical advice and later also join us in Ghana to develop best clinical international standards.

 

The official launch of the COUNTDOWN programme in Ghana

By Adriana Opong

On Thursday, 15th October 2015, the Neglected Tropical Disease (NTD) Programme under the Public Health Division of the Ghana Health Service officially launched the COUNTDOWN Programme in Ghana. In attendance were key stakeholders and the NTD national Ambassador Dr. Joyce Aryee as the chair for the launch. The Director-General of the Ghana Health Service and a representative of the Minister of Health were also present.

In Sub-Saharan Africa, Ghana’s commitment to the elimination and management of NTDs is in an advance stage. The NTD Programme treats over 12 million people for onchocerciasis and lymphatic filariasis and over 4 million school – aged children for schistomiasis and soil helminthiasis annually. But there still remain cases and issues of hotspots areas of infection for both lymphatic filariasis and onchocerciasis, access to medication for some of the diseases is still limited and a more integrated approach to a single programme is required.

In the her acceptance speech, Dr. Joyce Aryee, the chair explained that NTDs are a class of diseases that can be eliminated, and that the launch of COUNTDOWN represents the last lap towards riding Ghana off the NTD burden of morbidity and mortality.

Within the COUNTDOWN Programme, the project activities in Ghana’s will include:

  • Filling the gap with Implementation Research
  • Integration at the different levels of health systems, NTDs programmes within and beyond the health sectors
  • Assessing and informing the equity, efficiency and sustainability of current NTD approaches
  • Looking for strategies on dealing with the issue of hotspots
  • Linking research to policy through dialogue and consultation

The implementing partners in the COUNTDOWN Project Ghana, are the NTD Programme of the Ghana Health Service, The Dodowa Health Research Centre (DHRC), and the Ghana Health Service and the Water Research Institute of the Council for Scientific and Industrial Research (CSIR). The Ghana management team is under the leadership of Dr Nana- Kwadwo Biritwum, the Programme Manager, Dr. Margaret Gyapong the Director of the Dodowa Health Research Centre and Dr. Mike Osei- Atweneboana.

Dr. Ebenezer Appiah-Denkyira in his welcome address said,  “We need not wait for Neglected Tropical Diseases to create epidemics before we take action on Neglected Tropical Diseases  this will no longer be neglected”. A representative of the Minister of Health delivered the keynote address for the launch. The overview of the COUNTDOWN programme and a message from the Director, COUNTDOWN was presented by Julie Irving.

Defining Lymphatic Filariasis hotspots in Ghana

By Lisa Reimer, Liverpool School of Tropical Medicine

We must appreciate the heterogeneities of NTDs across communities and understand the factors that have resulted in persistent disease, only then can we apply a sustainable strategy for elimination.

Lymphatic Filariasis in Ghana

Lymphatic Filariasis (LF) is a mosquito-borne infection caused by filarial worms that can result in significant illness, disability and disfigurement. The LF Elimination Programme in Ghana has achieved great success with annual, community-wide distribution of microfilaricides. It is recommended that the drugs are distributed to the entire community for 5-7 years which is the estimated life span of adult worms. Mass drug administration (MDA) has been underway for over ten years, but there are still communities endemic for LF. So what is unique about these communities? Why has the recommended strategy failed to eliminate LF? Will scaling up MDA provide the final push towards elimination?

Hotspots and heterogeneities

These communities are often referred to as ‘hotspots’ and they are likely a product of the heterogeneous nature of vector-borne diseases. For example, there is great diversity among the vectors of LF ranging from those that are highly competent to incompetent, those that bite indoors and those that bite outdoors, those that preferentially feed on humans and those that are generalist feeders. There may be differences in village characteristics that can support a larger population of the most capable vectors. There may be greater risks to certain individuals of a community depending on their habits, house structure, house location and their occupation. There will be individuals in a community who decline treatment, are unavailable during distributions or prefer not to use a bed net. There may be other barriers to delivery of services and interventions. There may be differences in insecticide resistance or drug resistance influencing the efficacy of MDA and vector control.

It may not be enough to scale up access to MDA, we need to understand the dynamics that have contributed to persistent transmission in these communities in order to inform the most appropriate delivery of interventions.

Planning for change

I recently met with COUNTDOWN colleagues Dr. Benjamin Marfo, Dr. Nana Kwadwo-Britwum and Dr. Margaret Gyapong from Ghana Health Service and Dr. Mike Osei-Atweneboana from the Council for Scientific and Industrial Research, to lay the groundwork for our investigation of lymphatic filariasis hotspots in Ghana. We are planning an in-depth investigation into the social, entomological and epidemiological factors that are driving transmission. We will evaluate current epidemiology in the context of baseline prevalence. We will explore adherence to MDA, bed net usage, transmission, vector behaviours, vector competence, insecticide and drug resistance, community beliefs and practices, experiences of the health workers and drug distributors. This understanding will then inform a new approach to integrated delivery of vector control and MDA. Our study will evaluate the costs, experiences and the impacts of integrated complementary strategies for LF.

We are now making plans for our first visits to study communities in January 2016. I am particularly looking forward to joining postdoctoral researcher, Dr. Kingsley Badu for our mosquito surveys to evaluate vector behaviours and current transmission dynamics.

The Neglected Tropical Disease hotspot puzzle requires multidisciplinary investigation

Sally Theobald, Margaret Gyapong, Mike Osei-Atweneboano, Sheila Addei, Alexander Adjei, Adriana Opong, Samantha Page and Kate Hawkins Dr Benjamin Kofi Marfo, Deputy Director of the Neglected Tropical Disease (NTD) programme in Ghana, is fizzing with energy as he explains the NTD hotspot conundrum in Ghana. Hotspots, or areas with persistent NTD prevalence above a threshold set by the World Health Organisation, present the final hurdle to elimination of certain NTDs. The COUNTDOWN team meeting in Accra brought together the Ghana Health Service (GHS) NTD team, colleagues from Dodowa Health Research Centre, the Council for Scientific and Industrial Research, Liverpool School of Tropical Medicine and Pamoja Communications. Together we discussed the map of hotspots for Lymphatic Filariasis (LF) in Ghana – bringing to mind a detective story – we debated different explanatory possibilities:

  • Border areas: All but four of the 22 hotspot areas are either on the border or next to a border district – with the Cote D’Ivoire (West of Ghana), and Burkina Faso (North of Ghana), but intriguingly not Togo (East of Ghana). These borders, carved up by colonial powers, separate families and communities and in reality are porous with regular movement and trade across them. Could it be that people here are missing Mass Drug Administration as they move from one country to the other? Dr Marfo and his team discussed the importance and challenge of cross border NTD collaboration and the possibility of synchronising approaches to MDA to minimise losing people from the process.
  • Genetic variation in human population: Why is it that in some families people get LF and others don’t although their exposure is arguably similar. Are there some genetic factors at play which predispose certain individuals or communities to LF?
  • Genetic variation in parasite or vector population that we don’t understand: Are there some genetic changes in some population of parasites and/or vectors and some geographically specific adaptation going on that needs further investigation?
  • Context specific socio-cultural beliefs or practices: Or is there something specific about the understanding, livelihoods and socio-cultural realities of these communities that lead to additional vulnerability or challenges in accessing and adhering to drugs (or in NTD language are there more persistent non-compliers in hotspots?)
  • Health system challenges: Or could it be that there are some health systems challenges and bottle necks within the hotspots? Challenges relating to distribution or possibly community based drug distributors feeling under motivated and undervalued?

Or does the explanation lie in a mixture of some or all of the factors above? Trachoma is on the road to elimination in Ghana. However, with the exception of the Upper East Region, it is more problematic in the Northern and Upper West Regions of Ghana. Why is the Upper East Region less affected? Dr Marfo explained how this district has benefitted from different Non-Governmental Organisations conducting water, sanitation and hygiene programmes, which have supported access to fresh water and the construction of latrines. There is also an eye hospital in the Region which has enabled earlier access to treatment. The trachoma story highlights the importance of understanding the context and historical evolution of the Regions when looking at NTDs. It also illustrates the positive legacy of interventions in water and sanitation and the importance of multisectoral partnership in efforts to address the debilitating and disabling effects of NTDs. The tricky conundrum presented by hotspots demands multidisciplinary investigation and multi-sectoral engagement to understand which factors play out in different contexts to shape hotspots. COUNTDOWN brings together social scientists, health systems researchers, health communication experts, health economists, parasitologists, molecular biologists and modellers to work in partnership with NTD programmes in Ghana, Cameroon and Liberia to support NTD programmes. Watch this space as we bring different disciplines to bear to understand and address hotspots.

COUNTDOWN launches in Liverpool with a special guest from Liberia by @sci_ntds

By Alan Fenwick, Imperial College

The presence of Dr Anthony Bettee at the COUNTDOWN launch was poignant because he had flown from Liberia. In two weeks, providing there are no new cases, Liberia will be declared Ebola free. However during the last 9 months almost 200 health workers have paid the price for their dedication and loyalty and lost their lives to Ebola infection. Despite this tragic result Liberia is ready to restart treatment of schistosomiasis and STH. We wish them well.

Other speakers included Nana Biritwum and Margaret Gyapong who were both brilliant. Louis Albert Tchuem Tchuente gave the Cameroon perspective.

The project will be directed by Professor Russell Stothard and I hope he thrives and grasps this exciting DFID funded research project.

How can learning from Lymphatic Filariasis help guide advocacy for Female Genital Schistosomiasis?

By Margaret Gyapong (Ghana Health Service)

It was really useful for me to attend the recent meeting in South Africa on Female Genital Schistosomiasis. I have never worked on Schistosomiasis before. Most of my work has been on Lymphatic Filariasis and Neglected Tropical Disease but I moved about a decade or so into malaria, Demographic Surveillance, maternal health and other areas of research. In recent times however, I find that I am being drawn back into Neglected Tropical Diseases. Hence my attendance at this all important meeting on Female Genital Schistosomiasis, and I find the emerging discussions intriguing. Clearly there are many research questions that still need to be answered on the relationship between schistosomiasis, reproductive health and HIV. Work needs to be done to get this issue on the radar of decision makers and scientists. To support this there is a lot that we can learn from the journey we took in Ghana to put Lymphatic Filariasis on the national and international health agenda.

Early days

There is evidence that more than a decade ago scientists were drawing attention to Female Genital Schistosomiasis so why is it not on the agenda? 25 years ago there was no Lymphatic Filariasis programme in Ghana and a lot of effort had to go into convincing the decision makers in the health sector that the disease was a problem and needed attention.

Work on Lymphatic Filariasis  started kind of by mistake when in the early 1990’s some of us were posted to the north of the country to work on a Vitamin A supplementation trial. During field work we noticed a lot of people walking around with big legs and baggy pants (that were clearly disguising scrotal swelling, technically known as hydrocele).  Coming from the South of Ghana, this was unusual and we decided to explore the issue in more depth.

Gathering the evidence

A survey we conducted  in 1995 with lay field workers using local terms for the disease showed  that over 12% of households reported at least one person with a big leg (lymphoedema (tissue swelling) or elephantiasis (skin/tissue thickening) of limbs). We spoke to the powers that be in the Ministry of Health at the time but the response was very much, “The disease doesn’t kill and there are many more burning issues such as malaria that needed urgent attention.”

Luckily for us the World Health Organisation’s TDR, the Special Programme for Research and Training in Tropical Diseases, was putting out calls for proposals at that time and we linked up with other countries and scientists to gather further evidence.  From 1996-2001 we aggressively collected evidence on the epidemiology of the disease in the entire country and showed the highest prevalence in the north of the country, the number of working days lost due to disability from the acute phase of the disease, and varying cultural beliefs and practices about Lymphatic Filariasis. This enabled us present a much more complete picture to national policy makers.

Advocacy

But evidence alone wasn’t enough to provoke change, and we also engaged in activities which could more accurately be classed as advocacy. We realised that at the international level there were many people doing disease modelling who had probably never met a person with the condition. So we showed photos of people from the field – and to be honest many of them were pretty gory. But they got people’s attention. We also thought it was important for people affected by the condition to tell their story. Photovoice methodologies enabled community members to describe their lives before and after becoming disabled by Lymphatic Filariasis. We took one woman with us to a meeting in Geneva. This had a personal impact on scientists and policy makers. The photovoice stories on Lymphatic Filariasis moved some of the female policy makers almost to tears because they could relate to the way that women described their relationships with their bodies and the impact of Lymphatic Filariasis on their family and intimate relationships.

Why hasn’t their been more action on Female Genital Schistosomiasis

In 2005 my colleague and I did a review on gender and Neglected Tropical Diseases and I realised from the document (when I was preparing for the Female Genital Schistosomiasis conference) that as far back as 1992 issues related to Female Genital Schistomiasis  had been documented. Scientists had indicated that sequelae from Female Genital Schistosomiasis such as infertility have an important social and pathological impact.  They had also indicated that conditions may be undiagnosed because women would be more likely to present to a gynaecologist than an infectious disease specialist probably because Female Genital Schistosomiasis is not well recognised. Another interesting observation at the time was that Female Genital Schistosomiasis increases the risk of HIV infection because the lesion provides easier access to deeper vaginal cell layers during intercourse with an infected partner.

Why are we still talking about it today rather than acting?

Like Lymphatic Filariasis, schistosomiasis is a disease of poverty. It effects people living around rivers – people earning a living through their interaction with water, their children playing in water bodies and households rely on this water in their domestic lives. I think that if schistosomiasis was a disease like Ebola which anyone could get then perhaps something would have been done about it.

We also have to think about the social-cultural context. The people suffering are marginalised and find it hard to speak about issues related to their sexuality. Who can they talk to? How does a child have the words to describe what is wrong? We need to start listening to their stories. They will be graphic, but they are necessary.

Blood in the urine in certain cultures means you are a strong man and mature. Women may just think that they are bleeding between periods and that it is not important. When women bleed after sex because they have schistosomiasis (that is if they know it is schistosomiasis related)  can they talk about it with their partners? What about when it causes infertility? In many cases the woman will be the one who is blamed and she will go through unnecessary tests. Then when she remains undiagnosed and unable to conceive she may well suffer stigma and possibly be abandoned. There are major gaps in our understanding of the genital manifestations of schistosomiasis including a lack of data on the possible psychological effects of dyspareunia and post coital bleeding in women with genital lesions.

Rolling out and scaling up

It is time to act on what we know and skill up health workers so that they can diagnose Female Genital Schistosomiasis either in the clinical context or during Mass Drug Administration. We need to think carefully about how and when integration into other services occurs. Integration at community level can only occur with joined up thinking at the top. Our task now is to ensure that an approach is taken that takes account of the health system as a whole rather than bombarding communities with a host of new vertical interventions.

And in all of this we need to remember that we are dealing not just with blood or urine samples, but with people who have names and faces and their suffering is unnecessary.

COUNTDOWN in South Africa – new friendships, thoughts and directions

By Russell Stothard, Liverpool School of Tropical Medicine

Returning from Magaliesburg in South Africa and sitting here early on a Saturday morning in Heathrow waiting for a flight to a snowy Manchester, I am really proud of what COUNTDOWN has achieved this past week. As both co-organiser and participant in the International Workshop on NTDs and importance of Female Genital Schistosomiasis (FGS) and its impact on HIV/AIDS, I represented both the Liverpool School of Tropical Medicine and our research consortium. Moreover, I was joined by Kate Hawkins our communications expert and by colleagues from Ghana, Benjamin Marfo who was representing Nana Biritwum, and Margaret Gyapong. We were also expecting Louis-Albert Tchuem-Tchuente from Cameroon to join us but he was called away last minute to Nigeria to represent WHO-AFRO in revision of their national Neglected Tropical Disease (NTD) plan but very fortunate given our future there.

Once in Magaliesburg and as co-organiser with Myra Taylor (The University of KwaZulu-Natal), Eryun Kejtland (The Oslo University Hospital), Jutta Reinhard-Rupp and Claudia Cecalupo (Merck-Serono), we finalised on-site arrangements. This included tailoring the agenda with the final list of participants who were set to arrive the next day, 75 in total and collectively coming from USA, Europe and Sub-Saharan Africa. We then performed a detailed cross-check and walk-through of all on-site logistics whilst being made aware of frequent power outages and their contingencies. Our Monday evening review meeting, for example, was held by candle-light owing to a particularly impressive electrical storm disrupting local supplies that night. Of course, there were surprises and for me it was being nominated by my co-organisers to give the Tuesday evening welcome dinner speech, a well set ambush perhaps despite our prior weekly teleconference calls from November!

So with microphone in hand and overcoming my nerves in front of such a very distinguished audience inclusive of WHO-Geneva and international donors, I gave my personal expectations for the following days. This was to be a very good thing for I find the most important beginning point of any small conference is to develop a friendly and social dialogue with its participants. This is crucial if you want to see the fruits of frank and open discussions evolve as often first undertaken by people who have never before met and also come to the agenda with very divergent experiences. Thus to do so from the onset people must be made to feel comfortable within such a larger group, and that their own opinion and contribution was to be valued and considered evenly with our own expectations.

Indeed the fruits of informed conversation grew and at the end of the workshop, it was evident that this was a key achievement of this meeting for all became increasingly animated and excited by this new cross-talk between NTDs and HIV. We discovered shared ground and addressed several issues ranging from access to diagnostics and treatment, gender and age-related inequities, primary health care services and better clinical management to future steps and studies to be taken and turned into best policies and optimal practices.

Kate, Margaret, Benjamin and I felt very motivated with the outcomes from this meeting and how it will be turned into tangible research and future policy repositioning within Ghana, starting this coming week (so my thanks to Margaret and Benjamin for being so quick to take action)! Indeed, we look forward to supporting this research uptake with targeted studies to be undertaken on the ground when deemed appropriate. This will be further discussed and developed across our partners within our inception workshop during the second week of March in the Liverpool School of Tropical Medicine, so you will hear more in due course.

So key highlights for me this past week? I had the good fortune to arrive at the airport with Barbara Mukasa from Mildmay and with it the opportunity to chat about our experiences in Uganda while waiting for transportation. As I have conducted many field surveys in the remoter areas of her country for NTDs, I have always been impressed by the community outreach that Mildmay has had in facilitating access to health services for HIV and AIDS. I have only met Barbara a couple of times before and only discussed with her intestinal schistosomiasis which is more prevalent in Uganda but in this conference with the focus on urogenital schistosomiasis she really grasped the importance of FGS in the context of her own work both in children and in adults.

Moreover, Barbara gave a really touching presentation highlighting the holistic view Mildmay has in supporting children as well as their carers, with real honesty by appreciating the often shortcomings of human behaviour which can range from the darker side of deception and violence to the lighter side of compassion and love. In the context of safe childhood, with a gynaecological disease such as FGS we should also remain vigilant to often cryptic signs of sexual abuse and coercion as well as the unfortunate stigmatisation and low self-esteem that this disease can induce with its signs and symptoms. This made me think more deeply about the pressing need for social science studies and assessment of burden of disease at the psycho-social level.

Other personal highlights included: seeing Kate very busy blogging and Tweeting about the issues being raised and helping me to get to grips with the newer side of social media; reading Alan Fenwick’s blog about our workshop after the first day from his perspective as Director of the Schistosomiasis Control Initiative; meeting with Refilwe Sello a HIV/reproductive health specialist from the FHI360 South African office and seeing her become enthused about NTDs; meeting again Peter Leutcher who I had last seen in 1997 in Madagascar while working with the Institut Pasteur Antananarivo and listening to his really authoritative keynote address on Male Genital Schistosomiasis and its implications; and finally helping my colleagues Myra, Eryun and Jutta draw attention to the need and use of donated praziquantel in South Africa by supporting direct engagement with stakeholders from the local Ministry and local HIV-action groups.

But what did I learn? In line with my own research on techniques and tools for diagnosis of schistosomiasis, there is an unmet need for new diagnostics for female genital schistosomiasis, especially in girls younger that their first sexual debut where a gynaecological examination cannot be performed for obvious reasons. Better access to praziquantel treatment in both pre-school-age and school-age is crucial if we are to prevent the later occurrence of FGS where it can be measured albeit with rather cumbersome invasive methods, i.e. by colposcopy. To that end, my colleague Amaya Bustinduy drew attention to the common plight of pre-school-aged children and that we must consider higher praziquantel dosing than the present 40 mg/kg and at shorter intervals, biannual or more for example, rather than the annual treatment regime. All this to be also set within access to Anti Retroviral Therapies in children with schistosomiasis-HIV co-infections, and we will revise our syllabus within our joint Diploma of Tropical Medicine and Hygiene teaching at Liverpool and London.

Arriving now in Manchester and taken as a whole, COUNTDOWN is well set to address these issues by fostering the scale-up of NTD control by focused implementation research tapping into newly formed research networks, which is something I am very privileged to lead and will promote this coming week in WHO-Geneva at a technical advisory group on diagnostics for schistosomiasis.

COUNTDOWN Research Consortium calls ‘time’ on Neglected Tropical Diseases (NTDs)

The COUNTDOWN research consortium has been launched today following a £7 million grant allocation from the UK Department for International Development (DFID) earlier in the year.

As part of the push towards universal access to health services, there is international consensus that NTDs such as onchocerciasis, lymphatic filariasis, soil-transmitted helminthiasis, schistosomiasis and trachoma, must be tackled more effectively and NTD control programmes need more assistance.

Where some of these diseases can be treated with a combination of antihelminthics and antibiotics they continue to cause ill-health and disability on a massive scale.

Pharmaceutical companies provide much of the needed medicines for free and Mass Drug Administration (MDA) programmes have managed to deliver these drugs to millions of people living in need.

COUNTDOWN will trial and evaluate new approaches to drug distribution, which target those who are currently overlooked and excluded. It will also examine how NTD programmes can be better integrated into broader health system responses.

COUNTDOWN Director, Professor Russell Stothard, said: “I would like to thank the UK Department for International Development for financing COUNTDOWN. Through a multi-disciplinary partnership which brings together researchers from Cameroon, Ghana, Liberia and Nigeria, the UK, and USA, we hope to create new knowledge which will kick-start other countries’ responses to NTDs and provide practical health systems guidance on how to speed-up and scale-up action.”

The partners in the COUNTDOWN consortium bring a substantive network of contacts in the NTD community including funders, academic and research institutions, drug companies, Ministries of Health, non-governmental organisations (NGOs) and policy stakeholders such as the World Health Organisation. This will ensure that COUNTDOWN benefits from the best research intelligence from within the NTD community and stays well informed.

NTD Programme Manager Nana-Kwadwo Biritwum said: “Ghana’s NTD Programme has made good progress over many years of programme implementation with its control and elimination strategies. The challenge now is to ensure elimination of lymphatic filariasis, onchocerciasis and trachoma. This end game stage poses technical challenges and can best be addressed by projects or initiatives such as COUNTDOWN 2020”

COUNTDOWN is working to support the achievement of the 2020 targets set out in the London Declaration on NTDs.

Partners in the COUNTDOWN Consortium include: the Cameroon Ministry of Public Health; the Centre for Schistosomiasis and Parasitology in Cameroon; Ghana Health Service; FHI 360; Liberia Ministry of Health and Social Welfare; Pamoja Communications and Liverpool School of Tropical Medicine (LSTM) which also acts as host and administrative hub of the Consortium.

The consortium’s Twitter handle is @NTDCOUNTDOWN and its website will go live early 2015.