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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Learning from the Neglected Tropical Disease NGDO Network

By Suzy Campbell,

Over the past few years it has been exciting to see momentum building to address integration and health systems strengthening beyond the traditional vertical approaches of funding and delivery of single disease strategies. A recent supplementary issue of International Health, a journal of the Royal Society of Tropical Medicine and Hygiene has a strong focus on health systems strengthening, and should be essential reading for anyone with interest in addressing NTDs.

The supplement has been largely coordinated by the Neglected Tropical Disease (NTD) Non-governmental Development Organisations Network (NNN), and is refreshingly dedicated to partnering across the entire sector to continue addressing the challenging issues pertaining to prevention, treatment and management of NTDs.

Intersectoral and transdisciplinary cooperation and learning

Of particular note is the article by Hopkins who describes the new project framework developed by the World Health Organization (WHO) Africa Region to replace the African Programme for Onchocerciasis Control (APOC). APOC ceased in 2015 yet has been widely recognised for its contributions towards health systems strengthening, as it has enabled infrastructure development and mobilisation via community health workers, thereby facilitating access to chemotherapeutic drugs by people who have otherwise been truly unable to reach them. The new framework, the Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN), will be introduced throughout 2016 and will extend beyond onchocerciasis to coordinate all NTD activities in the African region. Together with the current focus on intersectoral, transdisciplinary cooperation and learning, ESPEN will provide an unprecedented opportunity to drive impetus for integrated health system strengthening activities. This does set a new support structure for integrated NTD control and elimination, and we look forward to its further development with great interest.

NTD morbidity

Much valuable work has been done over the last 15 years to map various NTDs and enable resource prioritisation via chemotherapy. Yet the sheer scale, and varying morbidity, of NTDs means that, in addition to the important prevalence and treatment coverage statistics, it is equally important to capture data on additional morbidity measures. Having sound knowledge of the disease burden from these diseases does facilitate advocacy for their control. There are several articles in the supplement that highlight the importance of capturing data on NTD morbidity, including the importance and measurement of coverage statistics, and a research agenda for the NNN to identify common indicators that can be shared across NTDs.

Integration

Integration, as it is directly influenced by NTD control and elimination strategies, needs to be strengthened with inclusion of structural system enhancements delivered as part of the universal health coverage agenda. For many NTDs, this does require consideration beyond chemotherapy to include “multi-component integration”. However, it is clearly acknowledged that more evidence is required, that it is expensive and logistically challenging, and that it requires strong cross-sectoral collaboration. In the supplement, Waite et al. provide a comprehensive review of the progress that has been achieved in, and opportunities to prioritise, integrating water, sanitation and hygiene (WASH) with NTD programmes. Integrated WASH and NTD control contributes simultaneously to several Sustainable Development Goals and every opportunity needs to be taken to further promulgate this.

What’s next?

The international health community does need to determine what a truly integrated universal health coverage agenda should encompass. The NNN has contributed heavily to driving this agenda, as have other organisations. Looking beyond NTDs, this is in direct alignment with macro-political strategies as set by the World Bank, the WHO and other parties. By necessity, a universal health coverage agenda must be broader than NTDs, however NTDs are a major part of this (having been referred to by the WHO as a “litmus test”). As NTD practitioners and researchers we therefore have a major opportunity to collectively share knowledge and in so doing propose critical requirements of integrated health care.

We at COUNTDOWN are delighted to see this supplement published and are wholehearted in our support of its messages.

 

Launch of the Ross Fund at LSTM

By Russell Stothard
This Monday LSTM hosted The UK Chancellor of the Exchequer, the Rt Hon George Osborne MP and the philanthropist Bill Gates who came to announce the launch of the Ross Fund.

Named in Honour of Sir Ronald Ross, The Ross Fund is a new international initiative to stem the spread of antimicrobial resistance, move towards elimination of malaria and control several Neglected Tropical Diseases. The Fund is a portfolio of programmes led by the Department for International Development (DFID) or the UK Department of Health.

At the launch, they both gave their opinions about the importance of the Ross Fund and discussed key challenges in global health. They also drew attention to the importance of existing international research networks and how these are set to expand and respond. The discussions were captured on video and illustrate how interventions against malaria and Neglected Tropical Diseases (NTDs) are top priorities.

The Rt Hon Justine Greening, the Secretary of State for Department for DFID, who joined George Osborne and Bill Gates on a tour of the LSTM laboratories, discussing NTD research with Professor Mark Taylor and Dr Joe Turner, from the COUNTDOWN team.
In short, the 25th January was an excellent opportunity to demonstrate to the world the importance of translating the best laboratory findings into the most appropriate public health policies, to transform the lives of those with NTDs by supporting better health for all.

Interested in how to build capacity in research programmes?

By Kate Hawkins

Part of the theory of change that underpins COUNTDOWN is that we will use our platform to strengthen the pre-existing capacity of participating organisations and the stakeholders that we interact with. This area of the work is still under development, but we are lucky to be working with the Capacity Research Unit at Liverpool School of Tropical Medicine who have a great deal of experience in this area. If it is a topic that you are interested in we recommend that you read this paper from the Unit, “Indicators for tracking programmes to strengthen health research capacity in lower- and middle-income countries: A qualitative synthesis.”

As part of this work our colleague Laura Dean will be presenting at this week’s European Congress on Tropical Medicine and International Health. Her poster is on laboratory capacity to support the control of Neglected Tropical Diseases. Here is a sneak peek…

If you would like to learn more, or have a chat with Laura, you will find her in Poster Session 2, Hall 4.1, PS2.309 Abstract 394, 12:15-13:45, Wednesday 9th September.

Go and say hello.

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.

Co-Infections: Impact on Neglected Tropical Diseases

By Kate Hawkins

Next week the 9th European Congress on Tropical Medicine and International Health will meet in Basel, Switzerland. We are delighted that our team member Margaret Gyapong will be there representing COUNTDOWN.

Margaret will speak in a satellite session on co-infections and their impact on Neglected Tropical Diseases. Panellists in this session will talk about female genital schistosomiasis and health systems, the association of the schistosome infection with inflammatory response profiles and the challenges of co-infections, in particular Visceral Leishmaniasis (VL) and HIV.

If you are going to the conference do pop along and give Margaret your support. The satellite is on Monday 7 September from 12:15 to 13:15 in the Sydney Meeting Room.

We look forward to reading your tweets!

Intestinal schistosomiasis in Uganda: Taking advanced diagnostics to the lakeshore

By Hajri Al-Shehri

Neglected Tropical Diseases (NTDs) are often a symptom of poverty and challenging living conditions. Those who are most affected are the poorest people living in remote rural areas, urban slums or in conflict zones. Schistosomiasis, for example, is often found in populations with very limited access to safe water and in environments poorly served by primary health outposts as typified by out-of-stock drugs and inadequate diagnostic testing. The lack of reliable statistics reporting on treatment and disease has kept the true burden of schistosomiasis in the shadows and failed to identify the inefficiencies of control programmes that are committed to reach those most in need of treatment.

I have just returned from a three-week epidemiological study on the shores of Lake Albert, Uganda. Working with Vector Control Division (VCD), Ministry of Health, Uganda we visited five rural primary schools in Hoima and Buliisa Districts, examining just over 50 children per school with a combination of diagnostic methods.

Performance of diagnostic tools in a high prevalence settings

urine antogen testsOur basic analysis revealed that in three schools on the immediate lakeshore, prevalence of active intestinal schistosomiasis was just over 85%. With such high levels detected, it is taken for granted that these children are in regular contact with contaminated water, remaining a daily way of life and mitigates the impact of the national control programme (NCP). The Uganda NCP started in 2003 and has been providing annual treatment of school children with praziquantel (PZQ) for over several years. But despite best intentions, it is clear that annual treatment is failing on the lakeshore and needs to be strengthened. Our clinical assessments showed substantial amounts of morbidity in these unfortunate children with swollen livers, numerous schistosome eggs and blood in stool as well as enlarged tummies.

My thoughts on successful fieldwork

Fieldwork is not just an important, stimulating and often challenging part of the research process I undertake; it also offers a wonderful way of seeing the world, and a chance for personal development. The key points are to understand theory, develop skills, integrate and build tacit knowledge, develop alternative solutions for the problems in certain places, and work cooperatively with a team. Despite our best efforts in preparations, fieldwork constantly offers surprises and ad hoc solutions that may fail miserably for many reasons: a sudden rainstorm reduces time at the study site, your way back to camp is blocked by a flood and you endure water-logged muddy roads that drain your energy, as does our intermittent camp electrical supply as our portable generator fails then you are hounded by irritating lake flies that dance around your head torch while you concentrate at the microscope. Conditions in the field are often unpredictable and can affect your aims in different ways sometimes being left frustrated but when you overcome these obstacles you have good reason to be proud and satisfied.

car in UgandaSo what are the ingredients for successful fieldwork? I now realise that fieldwork should have clear vision of what you want to accomplish but be flexible within a set of integrated goals and contingency plans that can be brought rapidly into action when needed. For example, assessing each day everyone’s workload, checking in-field logistics and sampling techniques is essential to adapt to local conditions, as well as having enough in reserve to put in extra effort when required. Before leaving to Uganda, my supervisor and I had many discussions during the planning process who explained the theory but I have now the practice. The key ingredient is that there is a small window of opportunity to get the survey right where all the necessary equipment, reagents and team’s skills are brought together at the right place and at the right time, ensuring that these remote communities can be well-attended. Only by doing so can the true burden of NTDs be brought out of the shadows and highlight today’s treatment needs. I am proud to have made an important contribution to the Uganda NCP with our colleagues from VCD.  

About the author

I was born in Asser, Saudi Arabia, and have worked there for several years as a specialist in molecular diagnosis of infectious diseases in Asser Central Hospital. Being based in this busy clinical laboratory, I have developed interests in Neglected Tropical Diseases, especially schistosomiasis, and completed an MSc degree in the UK in Biomolecular and Biomedical Sciences, Faculty of Life Sciences & Medicine, at Glasgow Caledonian University. To further extend my qualifications and broaden my experience, I started my PhD in June 2014 at the Liverpool School of Tropical Medicine with Professor Russell Stothard and decided to focus on the epidemiology and control of intestinal parasites. My project hopes to compare the performance of state-of-the-art diagnostic tools in high prevalence versus low prevalence settings and understand how these tools can be applied in my own country where schistosomiasis and soil-transmitted helminthiasis are nearing elimination. Writing a science blog helps me stay motivated and by sharing my recent fieldwork in Uganda, and highlights what I have learned.

 

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.

The history of innovation in Neglected Tropical Diseases: Some useful points from Jürg Utzinger

By Rossely Paulo

Jürg Utzinger (Swiss Tropical and Public Health Institute) was one of the key note speakers at the recent meeting of the British Society for Parasitology. He gave a great overview of some of the history of Neglected Tropical Diseases (NTDs) and areas where innovation is needed.

NTDs: Where did the term come from?

Three of the eight Millennium Development Goals are health-related. Although NTDs were not specifically mentioned, Goal 6 is focussed on combating HIV, malaria, TB and other diseases. Jürg explained that the conceptual framework of the Neglected Tropical Diseases was formulated in the years following the 2000 launch of the Millenium Declaration. NTDs, as a concept, went on to be popularised in seminal papers written by David Molyneux, Peter Hotez, Alan Fenwick and David Rollinson. Many at this time were arguing that it is important to look across the spectrum of the diseases that particularly affect poorer people in low-income settings rather than singling out a few priority illnesses. An initial list of NTDs was drawn up that clustered together 15 complaints.

Innovation in work on NTDs

Jürg explained that large–scale, longitudinal, community-based surveys have provided a great opportunity to drive innovation in NTDs by allowing us to assess population risk and guiding interventions for control and elimination.

But challenges remain

For example the current anthelminthic drug – albendazol and mebendazole – have a low kill rate against Trichuris which lead us to the conclusion that there is an urgent need to develop new drugs. One alternative could be multiple dosing of existing drugs which decreases the Trichuris parasitemia rate, the hardest parasite to cure. Diagnosis of various NTDs such as S. mansoni are still largely dependent on stool examination based on the Kato-Katz thick smears technique. But this has become a big concern due to its low sensitivity particularly in low-endemicity areas. Therefore, more sophisticated diagnostic techniques are required such as the Point-of-Care urine assay for the detection of Circulating Cathodic Antigen (POC-CCA) and the multivalent faecal egg count (FLOTAC) methods which are three times more sensitive than Kato-Katz. There is a need for more integrated control programming which brings together different sectors. Jürg pointed to efforts in China and Zanzibar where work on schistosomasis control and elimination is based on working with stool samples, agricultural factors, Mass Drug Administration, snail control and vector behaviour as examples of interesting practice.

The future

NTDs are finally on the radar screen of policy makers but how do we sustain these positive developments. We have some tools for control and elimination but they are insufficient! We need constant innovation and validation of the tools and strategies. Jürg ended by stressing that innovation is crucial to prepare and be ready for the future and that collaboration, communication and partnership are the absolute keys to success.

Looking back and looking forward: What we learnt from the NTD Day

By Sally Theobald, Liverpool School of Tropical Medicine

“If you do not know where you came from you will not know where you are going” Akan proverb cited by Daniel Boakyo, APOC

Looking backwards and learning from history in order to inform and improve current and future partnerships to address Neglected Tropical Diseases (NTDs) was a key theme that emerged from LSTM’s NTD day. David Molyneux kicked off the day with an overview of the great (white, male) scientists of the past – Prof Ronald Ross who made the links between malaria and mosquitoes and Prof Dutton who identified the cause of sleeping sickness. This historical overview is interesting and important and the resulting records, photos and artefacts reflect the scientific breakthroughs of the time. Fast forward a hundred plus years to today’s meeting and key learning as we move forward to address NTDs is as follows:

Strategic collaborative partnerships are critical:

The critical importance of strategic collaborative partnerships to address NTDs within and beyond countries in the global south was clearly illustrated. Many of the presentations showcased partnerships between researchers, practitioners, pharmaceutical companies and policy makers. The importance of building relationships within and beyond the health system was clearly stressed, including multi-sectoral approaches and joint working with ministries and organisations working on agriculture, education and gender. Missing from the discussions (with the exception of a video from GSK) were the views, perspectives and experiences of people living with NTDs from endemic communities and front line health workers such as community health workers and community based drug distributors. This is not unusual in the world of NTDs or health per se but we need to rise to the challenge of developing meaningful relationships, methods and communication channels to ensure these voices and priorities have a seat at the table and inform ongoing NTD priorities and strategies.

The whole is bigger than the sum of the parts – we need multidisciplinary research:

The importance of multidisciplinary research going beyond the classic scientific and laboratory based approaches was also clearly illustrated – for example Steve Torr discussed the importance of health economics in assessing the costs of different approaches to stop tsetse flies in spreading sleeping sickness; while Imelda Bates outlined strategic and evidence informed steps for capacity building; and Russell Stothard discussed how social science research will inform and underpin the new COUNTDOWN programme of research. Social science methods also have much to offer in collating and analysing the views and experiences of affected communities who are all too often not at the policy table or the research debate. Photovoice, life histories and participatory approaches including workshops and seasonal calendars are all powerful methods which can capture, analyse and present the experiences of different stakeholders including women, men, girls and boys affected by disabling NTDs. The need for strategic and context embedded approaches to research uptake were also stressed – research that responds to country and community priorities and doesn’t simply “gather dust” on library shelves or in cyberspace.

Context is key:

There is a lot of exciting innovation and good practice in NTDs being rolled out in different contexts. But what works in one place may not work in another – we need to understand the physical, geographical, social, cultural and NTD contexts. Also contexts are not static: David Molyneux highlighted how unpredictable events such as extreme climate events, war and conflict bring additional challenges to NTD elimination. Alvaro Acosta Serrano showed how conflict in Syria is exacerbating the spread of cutaneous leishmaniasis – with war reducing the focus on disease control and how diseases can be spread as individuals and communities are forced to leave their homes to seek safety.

In COUNTDOWN we will generate evidence and also want to learn from the field as a whole and the NTD day provided a fantastic opportunity to learn from others and build new networks, particularly with NGO partners such as LEPRA and Sightsavers. It was heartening that there was a clear demand for social scientists to work in partnership with COR-NTDs, parasitologists, Ministries of Health and others, and great to meet other social scientists taking forward work on NTDs, such as Dr. Mary Amuyunzu-Nyamongo from the African Institute of Health and Development. As we move forward in COUNTDOWN we will rise to the challenge of further strengthening our strategic partnerships to deploy multidisciplinary research within different contexts to ensure our research feeds into policy and practice and meets the needs of different constituencies.